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"Diagnostic Study, Performed"

QDM Datatype

Performance/Reporting Period
2023
QDM Datatype (QDM Version 5.6):

Data elements that meet criteria using this datatype should document the completion of the diagnostic study indicated by the QDM category and its corresponding value set.

Timing:

  • relevant dateTime references the time the diagnostic study is performed if it occurs at a single point in time.
  • relevantPeriod references a start and stop time for an assessment that occurs over a time interval:
    • startTime - when the diagnostic study is initiated.
    • stopTime - when the diagnostic study is completed.
  • author dateTime references the time the action was recorded.
  • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

Examples using relevantPeriod:

  • Initiation of a treadmill stress test to the time the treadmill stress test has completed
  • Initiation of the ultrasound study until completion of the ultrasound study

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

Diagnostic Study

Diagnostic Study represents any kind of medical test performed as a specific test or series of steps to aid in diagnosing or detecting disease (e.g., to establish a diagnosis, measure the progress or recovery from disease, confirm that a person is free from disease). The QDM defines diagnostic studies as those that are not performed in organizations that perform testing on samples of human blood, tissue, or other substance from the body (such as clinical laboratories). Diagnostic studies may make use of digital images and textual reports. Such studies include, but are not limited to, imaging studies, cardiology studies (electrocardiogram, treadmill stress testing), pulmonary function testing, and vascular laboratory testing.
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.

components

Elements included or documented as part of evaluations or test panels.
  • Examples include: specific questions included in assessments, tests included in a laboratory test panel, observations included in a cardiac exam during a physical examination. Each assessment, diagnostic study, laboratory test, physical exam, or procedure may have one or more components.
  • components also reference specific details about encounter diagnoses such as those that are presentOnAdmission and those with a rank=1 (i.e., those representing the principal diagnosis.

facilityLocation

The particular locations in a facility in which the diagnostic study or encounter occurs or occurred. Examples include intensive care units (ICUs), non-ICUs, 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)

interpretation

A categorical assessment of an observation value. For example, high, low, normal, critical high, critical low.

This attribute is consistent with the FHIR observation.interpretation element and should be routinely available for laboratory tests that include critical flags. However, measure developers should carefully evaluate and test feasibility for interpretation of findings related to imaging studies ("Diagnostic Study, Performed") or evaluation instruments ("Assessment, Performed"). Some specialty societies have determined that natural language processing at sites provide structured data about interpretation and, therefore, it is included in QDM version 5.6 for "Diagnostic Study, Performed" and "Assessment, Performed" to enable testing especially since FHIR-based measures will have similar capabilities.

method

Indicates the procedure or technique used in its performance.

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.

For updated guidance and implementer feedback regarding use of the QDM negation rationale attribute see Section 6.6.

performer

The performer is the person or organization that is responsible for the action (e.g., the individual or organization carrying out the activity). The performer references a QDM entity and any or all of the attributes of the selected QDM entity. For example, to reference that a physician who performed a procedure is the same person who was the primary participant in an Encounter and assure the physician’s specialty meets the measure’s requirements, the eCQM can reference 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.

[See Sections 2.6 and 4.2 for description of Entities]

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.

relatedTo

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

See Section 5.8 for examples for using relatedTo.

Note: QDM 5.6 relatedTo attribute is consistent with the FHIR element basedOn which is available for many FHIR resources addressed by the QDM datatypes added in the QDM 5.6 version. These QDM additions allow evaluation and testing during a period of FHIR transition specifically to relate actions with orders that generate them. However, measure developers should carefully determine feasibility for each use case when using the relatedTo attribute.

relevantDateTime

relevant dateTime addresses the time an activity occurs as a single point in time. If the activity occurs over a period of time, use relevantPeriod.

relevantPeriod

relevantPeriod addresses the time between the start of an action to the end of an action. Each QDM datatype using relevantPeriod 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 datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod

result

The final consequences or data collected from the datatype. results can be used in four ways to express:

  • That a result is present in the electronic record but any entry is acceptable
  • A numerical result is reported directly as a value. Values may be integers or decimal numbers without units, or as a quantity with a value and units - examples:
    • 100mg/dL for a lab test
    • 140 mmHg for blood pressure
    • as a percentage (actually as a quantity with % as units)
    • as a titer or ratio (e.g., 1:4, 1:80)
  • A result that matches one of a specific set of coded concepts in a value set or a code that matches a direct reference code
  • A result as a dateTime ("Assessment, Performed" and components)

resultDateTime

The date and time an individual observation was made available to providers, typically after the results have been reviewed and verified.

status

Indicates the particular stage of the action represented by the datatype.
Last Updated: Jul 15, 2022