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Communication, Performed

Performance/Reporting Period
2021
QDM Datatype (QDM Version 5.5 Guidance Update):

Data elements that meet criteria using this datatype reference conveyance of information from one entity (e.g., person, organization, or device) to another.

The "Communication, Performed" code attribute represents the reason for the communication (i.e., the subject). The category attribute allows reference to the type, or category, of communication (e.g., notification, request). In many cases, the eCQM developer may not know the local workflow to address the type of communication; hence, it is listed as an attribute to be used as feasibility allows.

Timing:

  • sent dateTime - when the communication was sent.
  • received dateTime - when the communication was received.

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.

QDM Category (QDM Version 5.5 Guidance Update)

Communication

Communication represents the transmission, receipt, or acknowledgement of information sent from a source to a recipient, such as from one clinician to another regarding findings, assessments, plans of care, consultative advice, instructions, and educational resources. The HL7 FHIR 3.0 resource Communication defines communication as a conveyance of information from one entity, a sender, to another entity, a receiver. The senders and receivers may be patients, practitioners, care partners, organizations, or devices. Established FHIR resources include:
  • A reminder or alert delivered to a responsible provider
  • A recorded notification from the nurse that a patient's temperature exceeds a value
  • A notification to a public health agency of a patient presenting with a communicable disease reportable to the public health agency
  • Patient educational material sent by a provider to a patient
  • Non-patient specific communication use cases may include:
    • A nurse call from a hall bathroom
    • Advisory for battery service from a pump
Generally, direct patient counseling, training or education represents an intervention or procedure. A time and a date stamp are required.
QDM through version 5.3 included three communication QDM datatypes:
  • "Communication, Provider to Patient"
  • "Communication, Patient to Provider"
  • "Communication, Provider to Provider"
These three datatypes restricted the measure developer to communication between patients and providers and among providers. The structure of the datatypes also provided implicit guidance to implementers to define what type of provider based on the intent of the measure.
QDM 5.4 merged the three communication QDM datatypes into one, "Communication, Performed" to allow greater expressivity and more explicit definition of the sender and receiver and to indicate the anticipated communication medium. This new QDM modeling is more consistent with other QDM datatypes and it is also modeled more consistently with existing communication interoperability resources (e.g., HL7 FHIR). Note that measure developers need to test measures that use "Communication, Performed" to determine if the sender and recipient attribute information is available. Confirmation regarding receipt of communications requires interoperability.
QDM Attributes

Author dateTime

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.

Category

The type of message conveyed by a communication (e.g., notification, alert, reminder, instruction).

Medium

A channel used for a communication (e.g., fax, email, etc.)

Negation Rationale

Indicates the reason that an action was not performed. Only QDM datatypes that represent actions (e.g., performed, recommended, communication, order, dispensed) allow the negation rationale attribute. The intent is to indicate a justification that such action did not happen as expected. This attribute specifically does not address the presence or absence of information in a clinical record (e.g., documented absence of allergies versus lack of documentation about allergies). QDM assumes a world view that absence of evidence indicates information does not exist or an action did not happen. To express such lack of evidence, an eCQM author should use the CQL expression not exists with reference to the data element rather than the QDM data model. negation rationale in QDM signifies only a reason for such absence, i.e., the reason must be present to qualify for negation rationale. The syntax in the human readable HQMF is addressed in CQL examples and in the MAT User Guide. Prior versions of QDM used the syntax, "Procedure, Performed not done." QDM versions starting with 5.3 use the syntax, "Procedure, not Performed." Section A-5 provides examples for expressing negation rationale in CQL.

A QDM Known Issue has been identified related to this attribute. To see this QDM known Issue, please click here.

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.

Recipient

The entity (e.g., person, organization, clinical information system, or device) which is the target of a communication.

The recipient attribute references the new QDM entities (Patient, Care Partner, Practitioner, or Organization) and any or all of the attributes of the respective QDM entity.

relatedTo

An attribute that indicates one QDM data element fulfills the expecations of another QDM data element.

Relevant Period

Relevant Period addresses the time between the start of an action to the end of an action. Each datatype using relevant period defines specific definitions for the start and stop time for the action listed.

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

Sender

The entity (e.g., person, organization, clinical information system, or device) that is the source of a communication.

The sender attribute references the new QDM entities (Patient, Care Partner, Practitioner, or Organization) and any or all of the attributes of the respective QDM entity.

Last Updated: Jun 08, 2020