"Medication, Dispensed"

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.

The individual performing the dispense.

The dispenser attribute references the new QDM entities (Patient, Care Partner, Practitioner, Organization, or Location) 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.

• 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).

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.

The person who ordered the prescription.

The prescriber attribute references the 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.

[See Section 2.6 for description of Entities].

The CQL can specify which identifier the measure expects to be used (e.g., NPI or Tax Identifier Number) or it can avoid referencing an identifier to allow the implementing organization or practice to use its own identifier.

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 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

The quantity (amount) of therapeutic agent provided to a patient per dispensing event (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: "Medication, Discharge" includes medications the provider has indicated the patient should take after discharge 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).