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"Encounter, Performed"
Performance/Reporting Period
2025
QDM Datatype (QDM Version 5.6):
Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.
The "Encounter, Performed" participant references the primary participant.
Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.6 addresses that concept using the diagnosis rank=1.
Timing:
- The relevantPeriod addresses:
- startTime - The time the encounter began (admission time).
- stopTime - The time the encounter ended (discharge time).
- author dateTime references the time the action was recorded.
- Refer to the eCQM expression to determine allowable timings to meet measure criteria.
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.
- The locationPeriod is an attribute of the attribute facility location that addresses:
- startTime - the time the patient arrived at the location. The time the encounter began (admission time).
- stopTime - the time the patient departed from the location.
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 DRC or value set value associated with the element.
Data Elements defined by this QDM Datatype:
QDM Attributes
admissionSource
The location from which the patient was admitted (e.g., physician referral, facility from which the patient was transferred).
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.
class
Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health, virtual visits (telehealth), etc.
diagnoses
Coded diagnoses/problems addressed during the encounter. The diagnoses attribute has three components:
- diagnosis (code)
- presentOnAdmissionIndicator (code)
- rank (positive integer)
To reference an encounter diagnosis, the expression must include the diagnosis code component. The other components are optional. The expression should only include the presentOnAdmissionIndicator if it is necessary to reference present on admission and should only include the rank if it is necessary to reference principal diagnosis.
The "Encounter, Performed" diagnoses attribute is intended to capture ALL diagnoses, including the principal diagnosis, i.e., all diagnoses addressed during the encounter represented by the diagnosis (code) used in the expression.The presentOnAdmissionIndicator (code) allows the eCQM developer to include criteria about whether each specific "Encounter, Performed" diagnoses was present at the time of admission (an indicator used to evaluate patient safety and adverse events). See presentOnAdmissionIndicator attribute definition and Section A.1.4 for information about using the "Encounter, Performed" diagnoses attribute.
The "Encounter, Performed" diagnoses (rank) replaces the principal diagnosis attribute. To reference a principal diagnosis, eCQM developers should express the "Encounter, Performed" diagnoses with a diagnosis (code) and a rank of 1. See definition of rank in this attribute table.
With an "Encounter, Performed" diagnoses, there is no dependency on the timing of the diagnosis in relation to the encounter.
Use of the "Encounter, Performed": diagnoses attribute component and the "Diagnosis" datatype is redundant for relating the diagnosis to the "Encounter, Performed". The "Encounter, Performed": diagnoses component syntax is preferred.
- Referencing the same diagnosis using "Encounter, Performed" (diagnoses attribute) and "Diagnosis" (datatype) should only occur if the measure must define a specified length of a prevalencePeriod, e.g.,
- The measure must assure that the diagnoses:
- have been present for at least some defined time period before the encounter, and
- were addressed during the "Encounter, Performed"
- The measure must assure that the diagnoses:
dischargeDisposition
The disposition, or location to which the patient is transferred at the time of hospital discharge.
facilityLocations
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)
lengthOfStay
The difference between the admission date/time and the discharge date/time for the encounter. This attribute should not be used for outpatient encounters.
participant
participant references a practitioner or the organization taking part in an encounter. For the purpose of QDM, participant references the primary performer, i.e., restricted to the principal or primary participant in the encounter.
The participant attribute references the QDM entities (Patient, Care Partner, Practitioner, Organization, or Location) and any or all the attributes of the respective QDM entity. For example, to reference that the physician who was the primary participant (performer) of an encounter, was also the requester of a "Medication, Order", and assure the physician’s specialty meets the measures requirements the eCQM can use the Practitioner entity and its attributes. The eCQM could also reference a physician practice or a hospital as the participant and reference the Organization entity and indicate the identifier and/or the organization type. [See Section 2.6 for description
[See Section 2.6 for description of QDM Entities]
priority
priority indicates the urgency of the procedure or the encounter referenced. In eCQMs the priority attribute will help distinguish elective from urgent encounters (e.g., hospital admissions) or procedures. priority is a codable concept (i.e., may use a DRC or a value set). For example, priority is used to express an elective procedure or encounter from an emergency procedure or encounter.)
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.
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
Last Updated: Jun 26, 2024