"Device, Recommended"

Performance/Reporting Period

2027

QDM Datatype (QDM Version 5.6):

Data elements that meet criteria using this datatype should document a recommendation to use the device indicated by the QDM category and its corresponding value set.

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 feasibility of clinical workflow to capture recommendations when evaluating measures

QDM Datatype and Definition

Device

Device represents an instrument, apparatus, implement, machine, contrivance, implant, in-vitro reagent, or other similar or related article, including a component part or accessory, intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease and not dependent on being metabolized to achieve any of its primary intended purposes.

Documented evidence of a device may exist in a clinical record in various ways:

A provider may document placement of a device as an intervention or procedure (e.g., the QDM datatypes "Intervention, Performed", or "Procedure, Performed"). Example: ["Procedure, Performed": "Pacemaker insertion"].
The provider may document presence of the device as a finding, perhaps including the finding on the problem list. Example: ["Diagnosis": "Pacemaker present"], or ["Assessment, Performed": "Pacemaker present"].
A provider may also document the device as an observation or "Assessment, Performed".
- Example: ["Device, Applied": "Transtelephonic monitoring of pacemaker assessment"].

Given the variation in determining evidence of device usage, a measure developer may need to include multiple queries (or retrieves) to assure capture of all devices present in the measure population. The QDM 5.6 retires datatype "Device, Applied" with recommendation to use "Procedure, Performed", "Intervention, Performed", "Diagnosis", or "Assessment, Performed" as noted above.

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.

code

The single code or a member of the value set used to represent the quality data element. The code attribute explicitly specifies the value set (or DRC) filter such that the query will retrieve only values defined by the QDM data element value or value set. Previous versions of QDM datatypes implicitly refer to attributes about a set of items that are included in a value set.

All QDM data elements require a QDM datatype with either a value set or DRC to specify the data element and a code is required.
If the QDM data element’s attribute specifies a value set or DRC, the code attribute is required.
If the QDM data element’s attribute does not specify a value set or DRC, the code attribute is not required.

Earlier versions did not explicitly state that the datatype attributes only refer to a specific item that is a member of the defined value set. The code is applied in the CQL Model Info16 used to translate the CQL into the Expression Logical Model (ELM) to enhance computer readability. Measure developers do not need to specify any additional code.

iD

The identifier of a specific instance of any QDM data element. CQL logic uses the id reference to specify that a query expects a specific instance of an element to be retrieved.

See Section 5.8 for examples for using id to indicate specific instances of QDM data elements in CQL statements with the relatedTo attribute.

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.

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, Organization, or Location) 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. [See Section 2.6 for description of QDM Entities.]