["Medication, Order": "Medications for Below Normal BMI"]
Data Element Scope: This value set may use a model element related to Medication.
Inclusion Criteria: Includes concepts that represent a medication for weight gain in patients with a below normal body mass index (BMI) measurement.
Exclusion Criteria: No exclusions.
Constrained to codes in the Medication, Order: Medications for Below Normal BMI value set (2.16.840.1.113883.3.526.3.1562)
"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) 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.
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.
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.
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.