["Medication, Order": "List of Single RxNorm Code Concepts for High Risk Drugs for the Elderly"]

Performance/Reporting Period

2021

Value Set Description from VSAC

Clinical Focus: This value set contains concepts that represent medication concepts considered as high risk for the elderly.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Medication, Ordered.
Inclusion Criteria: Includes only relevant concepts associated with semantic clinical drugs (concepts associated with component, form and strength); generic; human use only; prescribable; medications considered high risk for the elderly.
Exclusion Criteria: Excludes branded drugs; components or ingredient only; non-prescribable medications.

Constrained to codes in the Medication, Order: List of Single RxNorm Code Concepts for High Risk Drugs for the Elderly value set (2.16.840.1.113883.3.464.1003.196.12.1272)

QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

"Medication, Order"

Data elements that meet criteria using this datatype should document a request to a pharmacy to provide the medication indicated by the QDM category and its corresponding value set.

Timing:

relevantPeriod addresses the time referenced in the dosage instruction indicating when the medication administration should start and end.
In the initial publication of QDM 5.5, relevantPeriod referenced the validity period, i.e., the time period for which the ordered supply is authorized by the prescription authorizing the dispensing event.
For clarification, see Appendix 6.4 with additional guidance for referencing relevantPeriod updating the definition for Medication, Order, "Medication Dispensed", and "Substance, Order".
author dateTime references the date and time the medication order (prescription) or the reason for not ordering the medication (i.e., negationRationale) is authored.

Notes:

When calculating cumulative medication duration, the stopTime may be present directly in the medication order. If the stopTime is not available, the duration in days is the difference between the relevantPeriod start and stop times multiplied by (1 + the number of refills).
negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.

Refer to Special Cases in Appendix A (Section 5.7) for scenarios to consider in calculating cumulative medication duration.

eCQMs using this data element:

CMS156v9 - Use of High-Risk Medications in Older Adults

QDM Attributes

authorDateTime

The time the data element was entered into the clinical software. Note, some datatypes include both relevant dateTime and author dateTime attributes. When both are present, author dateTime is included to accommodate negation rationale.

The author dateTime addresses when an activity is documented. Documentation can occur at the beginning, during, at the end, or subsequent to the end of the activity. The author dateTime should be used only if the relevantPeriod cannot be obtained or to represent the time negation rationale is documented.

Note: negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.