"Immunization, Order"

Performance/Reporting Period

2021

QDM Datatype (QDM Version 5.5 Guidance Update):

Data elements that meet criteria using this datatype should document a request for the immunization indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; author dateTime.

Notes: 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 Datatype and Definition

Immunization

Immunization represents vaccines administered to patients in healthcare settings, but does not include non-vaccine agents.

QDM Attributes

activeDateTime

When the order indicates the first immunization administration should occur. active dateTime is most often used to specify immunizations for which administration is intended at a specific time in the future. If active dateTime is not specified, it defaults to the author dateTime (when signed).

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.

dosage

Details of how much medication is taken or is to be taken, i.e., the quantity (mg, cc, tablets) to be taken at a single administration.

negationRationale

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.

reason

The thought process or justification for the datatype. In some measures, specific treatments are acceptable inclusion criteria only if a justified reason is present. Each of these measures uses a value set (often, but not exclusively, using SNOMED CT) to express acceptable justification reasons. Other measures specify reasons as justification for exclusions. Examples include patient, system, or medical-related reasons for declining to perform specific actions. Each of these measures also uses a value set to express acceptable justification reasons for declining to perform expected actions.

route

Refers to the path by which the medication or substance should be taken into the body system, such as intradermally, intrathecally, intramuscularly, intranasally, intravenously, orally, rectally, subcutaneously, sublingually, topically, or vaginally.

supply

The quantity (amount) of therapeutic agent that was provided to a patient (i.e., number of doses, number of tablets or pills, volume of medication) indicated to be given during a procedure, diagnostic test, or medication, or substance administration.

Note: Prior versions of the QDM (4.3 and earlier) addressed dose with two potential interpretations - (1) the quantity to be taken or administered with each administration and (2) the quantity of medication supplied (i.e., number of doses). QDM 5.0 and subsequent versions clarify the difference by defining dosage and supply, respectively.

"Medication, Discharge" includes medications the provider has indicated the patient should take after dischange from the hospital. This medication list is part of the discharge instructions provided to a patient. The list may include medication supply if it incorporates medication orders written at discharge even though the supply will not be present for medications the patient already has at home or purchases over-the-counter (without a prescription).

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