"Encounter, Recommended"

Performance/Reporting Period

2022

QDM Datatype (QDM Version 5.5 Guidance Update):

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set has been recommended.

Timing: The time the recommendation is authored (i.e., provided to the patient).

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.
Recommendations address the time that the recommendation occurs, a single point in time. Vendors have expressed concerns that recommendations are not necessarily captured or managed in a standard manner as part of structured data capture in clinical workflow; many are documented as part of assessments in narrative text. Measure developers should address the feasibility of clinical workflow to capture recommendations when evaluating measures.

QDM Datatype and Definition

Encounter

Encounter represents an identifiable grouping of healthcare-related activities characterized by the entity relationship between the subject of care and a healthcare provider; such a grouping is determined by the healthcare provider. A patient encounter represents interaction between a healthcare provider and a patient with a face-to-face patient visit to a clinician's office, or any electronically remote interaction with a clinician for any form of diagnostic treatment or therapeutic event. Encounters can be billable events but are not limited to billable interactions. Each encounter has an associated location or modality within which it occurred (such as an office, home, electronic methods, phone encounter, or telemedicine methods). The encounter location attribute defines the patient's location at the time of measurement. Different levels and modes of interaction can be specified in the direct reference code or value set value associated with the element.

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.

facilityLocation

The particular locations in a facility in which the diagnostic study or encounter occurs or occurred. Examples include intensive care units (ICUs), nonICUs, burn critical care unit, neonatal ICU, and respiratory care unit. Each "Encounter, Performed" may have one or more locations. For example, a patient treated in multiple locations during an individual encounter might be expressed as:

"Encounter, Performed": Inpatient Admission, facility locations
- ICU (locationPeriod)
- Non-ICU Admission (locationPeriod)
- Rehab (locationPeriod)

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.

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.

requester

The requester is who or what is requesting service (e.g., the individual or organization asking for the service to be carried out). The requester attribute references the new QDM entities (Patient, Care Partner, Practitioner, or Organization) and any or all of the attributes of the respective QDM entity. For example, to reference that a physician who requested a procedure is the same person who was the primary participant in an "Encounter, Performed" and assure the physician's specialty meets the measures requirements, the eCQM can use the Practitioner Entity and its attributes. Should the eCQM choose to reference a physician practice or a hospital, the performer can reference the Organization Entity and indicate the identifier and/or the organization type.