"Communication, Performed"

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 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.

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.

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 thing (e.g., person, organization, clinical information system, or device) which is the target of a communication.

The recipient attribute references the QDM entities (Patient, Care Partner, Practitioner, Organization, or Location) and any or all of the attributes of the respective QDM entity.

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.

The thing (e.g., person, organization, clinical information system, or device) that is the source of a communication.

The sender 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.