"Medication, Dispensed"
Data elements that meet criteria using this datatype should document that a prescription for the medication indicated by the QDM category and its corresponding value set has been dispensed and provided to the patient or patient proxy. In the ambulatory setting, medications are primarily taken directly by patients and not directly observed. Hence, dispensed or fulfillment information is the closest health provider documentation of medication compliance. In settings where patients attest to taking medications in electronic format (perhaps a Personal Health Record), patient attestation of medication taken may be available. The QDM datatype, "Medication, Administered" addresses medication taken; to address the source of the information, a measure addressing such patient attestation would require use of the entity fulfilling the role of the performer attribute for the administration event.
Timing:
- relevant dateTime references the dateTime the prescription dispensing event occurred, i.e., the time the prescription was handed over to the patient or patient’s representative.
- 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 dispensing event is recorded.
Notes:
- When calculating cumulative medication duration, the medication dispensed stopTime may be present directly in the fulfillment record. If the stopTime is not available, the duration in days is the difference between the relevantPeriod start and stop times. The record may indicate which of the available refills the fulfillment represents but each dispensing event is unique. Therefore, the measure developer should use CQL logic to address multiple dispensing events over a period of time.
- 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.
Medication
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.
daysSupplied
dispenser
The individual performing the dispense.
The dispenser 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, a measure developer seeking to assure the dispensing pharmacy is part of the same organization as the prescribing physician can specify that both the "Medication, Order" prescriber and dispenser and specify the same QDM entity = organization identifer for each.
dosage
frequency
- Is administered to a patient for an active medication (a).
- Was administered to the patient (b).
- Should be taken by the patient or administered to the patient (c).
- Is recommended to be given to the patient (d).
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.
prescriber
The person who ordered the prescription.
The prescriber 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 prescribed a medication is the same person who was the primary participant in an Encounter 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.
The CQL can specify which identifier the measure expects to be used (e.g., National Provider Identifier or Tax Identifier Number) or it can avoid referencing an identifier to allow the implementing organization or practice to use its own identifier.
refills
relevantDateTime
relevantPeriod
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
route
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).