Data elements that meet criteria using this datatype should document that the device indicated by the QDM category and its corresponding value set is in use, or impacts or alters the treatment, care plan, or encounter (e.g., an antithrombotic device has been placed on the patient's legs to prevent thromboembolism or a cardiac pacemaker is in place).

Timing:

• relevantPeriod addresses:
  • startTime - when the device is inserted or first used.
  • stopTime - when the device is removed or last used.
  • relevantPeriod references a start and stop time for a device if the application occurred over a time interval.
• relevant dateTime addresses the time the device is applied if it was used at a single point in time.
• author dateTime references the time the action was recorded.
• Refer to the eCQM expression to determine allowable timings to meet measure criteria.

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.

See Appendix 6.1 for updated guidance regarding how to use Device, Applied

Data elements that meet criteria using this datatype should document an order for the device indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; author dateTime.

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.

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" diagnosis 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" diagnosis was present at the time of admission (an indicator used to evaluate patient safety and adverse events). See presentOnAdmissionIndicator attribute definition for information about using the "Encounter, Performed" diagnosis attribute.

The "Encounter, Performed" diagnosis (rank) replaces the principal diagnosis attribute. To reference a principal diagnosis, eCQM developers should express the "Encounter, Performed" diagnosis with a diagnosis (code) and a rank of 1. See definition of rank attribute.

With an "Encounter, Performed" diagnosis, 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"

Data elements that meet criteria using this datatype should document the Condition/Diagnosis/Problem and its corresponding value set. The onset dateTime corresponds to the implicit start dateTime of the datatype and the abatement dateTime corresponds to the implicit stop dateTime of the datatype. If the abatement dateTime is not present, then the diagnosis is considered to still be active. When this datatype is used with timing relationships, the criterion is looking for an active diagnosis for the time frame indicated by the timing relationships.

Timing: The prevalencePeriod references the time from the onset date to the abatement date.

Data elements that meet criteria using this datatype should document the Condition/Diagnosis/Problem and its corresponding value set. The onset dateTime corresponds to the implicit start dateTime of the datatype and the abatement dateTime corresponds to the implicit stop dateTime of the datatype. If the abatement dateTime is not present, then the diagnosis is considered to still be active. When this datatype is used with timing relationships, the criterion is looking for an active diagnosis for the time frame indicated by the timing relationships.

Timing: The prevalencePeriod references the time from the onset date to the abatement date.

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 5.5 addresses that concept using the diagnosis rank=1.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here. 

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.

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 5.5 addresses that concept using the diagnosis rank=1.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here. 

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.

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 5.5 addresses that concept using the diagnosis rank=1.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here. 

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.

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 5.5 addresses that concept using the diagnosis rank=1.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here. 

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.

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 5.5 addresses that concept using the diagnosis rank=1.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here. 

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.

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 5.5 addresses that concept using the diagnosis rank=1.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here. 

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.

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 5.5 addresses that concept using the diagnosis rank=1.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here. 

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.

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 5.5 addresses that concept using the diagnosis rank=1.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here. 

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.

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 5.5 addresses that concept using the diagnosis rank=1.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here. 

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.

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 5.5 addresses that concept using the diagnosis rank=1.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here. 

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.

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 5.5 addresses that concept using the diagnosis rank=1.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here. 

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.

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 5.5 addresses that concept using the diagnosis rank=1.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here. 

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.

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 5.5 addresses that concept using the diagnosis rank=1.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here. 

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.

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 5.5 addresses that concept using the diagnosis rank=1.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here. 

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.

Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; author dateTime.

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.

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

Timing:

• relevant dateTime references the time the intervention is performed when the intervention occurs at a single point in time.
• relevantPeriod references a start and stop time for an intervention that occurs over a time interval. relevantPeriod addresses:
  • startTime - The time the intervention begins.
  • stopTime - The time the intervention ends.
• author dateTime references the time the action was recorded.
• Refer to the eCQM expression to determine allowable timings to meet measure criterion.

Notes:

• Timing refers to a single instance of an intervention. If a measure seeks to evaluate multiple interventions over a period of time, the measure developer should use CQL logic to represent the query request.
• 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.
   

Data elements that meet criteria using this datatype should document the laboratory test indicated by the QDM category and its corresponding value set was performed.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.    

Timing:

• relevant dateTime references the time the laboratory test is performed when the laboratory test occurs at a single point in time.
• relevantPeriod references a start and stop time for a laboratory test that occurs over a time interval. relevantPeriod addresses:
  • startTime - The time the laboratory test begins.
  • stopTime - The time the laboratory test ends.
• author dateTime references the time the action was recorded.
• Refer to the eCQM expression to determine allowable timings to meet measure criterion.

Examples:

• Initiation of a venipuncture for a fasting blood glucose to the time venipuncture for the fasting blood glucose is completed – use relevant dateTime to reference this single point in time for many specimen collections
• Initiation of a 24-hour urine collection for measured creatinine clearance until completion of the 24-hour urine collection – use relevantPeriod to reference the start to stop time for this event.

Notes:

• The time that the result report is available is a separate attribute than the time of the study (specimen collection).
• 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.

Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set is being taken by the patient. Keep in mind that when this datatype is used with timing relationships, the criterion is looking for a medication being taken for the time frame indicated by the timing relationships.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.  

Timing:

• relevant dateTime references the time the medication is active on the medication record if it was given or taken at a single point in time.
• relevantPeriod references a start and stop time for an active medication on the medication record that is given or taken over a time interval:
• The relevantPeriod addresses:
  • startTime - when the medication is first known to be used (generally the time of entry on the medication list).
  • stopTime - when the medication is no longer active.

In the original QDM 5.5 publication, stopTime stated: when the medication is discontinued (generally, the time discontinuation is recorded on the medication list). See Appendix 6.3 for clarification regarding definition of "Medication, Active" relevantPeriod stopTime.

The "Patient Characteristic Birthdate" should document the patient’s date of birth.

Timing: The "Patient Characteristic, Birthdate" is a single point in time representing the date and time of birth. It does not have a start and stop time.

Note: "Patient Characteristic Birthdate" is fixed to LOINC code 21112-8 (Birth date) and therefore cannot be further qualified with a value set.

Data elements that meet criteria using this datatype should document that the patient has one or more of the ethnicities indicated by the QDM category and its corresponding value set.

Timing: Ethnicity does not have a specific timing. Measures using "Patient Characteristic, Ethnicity" should address the most recent entry in the clinical record.

Data elements that meet criteria using this datatype should document that the patient has one or more of the payers indicated by the QDM category and its corresponding value set.

Timing:

The relevantPeriod addresses:

• startTime – the first day of insurance coverage with the referenced payer.
• stopTime – the last day of insurance coverage with the referenced payer.

Data elements that meet criteria using this datatype should document the patient’s race.

Timing: Race does not have a specific timing. Measures using "Patient Characteristic, Race" should address the most recent entry in the clinical record.

Data elements that meet criteria using this datatype should document that the patient's sex matches the QDM category and its corresponding value set.

Timing: Birth (administrative) sex does not have a specific timing.

Data elements that meet criteria using this datatype should document the symptom and its corresponding value set.

Timing:

• The prevalencePeriod references the time from the onset date to the abatement date.
• The onset dateTime corresponds to the implicit start dateTime of the datatype and the abatement dateTime corresponds to the implicit stop dateTime of the datatype. If the abatement dateTime is null, then the symptom is considered to still be active. When this datatype is used with timing relationships, the criterion is looking for whether the symptom was active for the time frame indicated by the timing relationships.