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 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

• "Encounter, Performed": Inpatient Admission, facility locations
  • ICU (locationPeriod)
  • Non-ICU Admission (locationPeriod)
  • Rehab (locationPeriod)

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 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.

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.

Data elements that meet criteria using this datatype should document that a prescription for the medication indicated by the QDM category and its corresponding value set has been dispensed and provided to the patient or patient proxy. In the ambulatory setting, medications are primarily taken directly by patients and not directly observed. Hence, dispensed or fulfillment information is the closest health provider documentation of medication compliance. In settings where patients attest to taking medications in electronic format (perhaps a Personal Health Record), patient attestation of medication taken may be available. The QDM datatype, "Medication, Administered" addresses medication taken; to address the source of the information, a measure addressing such patient attestation would require use of the entity fulfilling the role of the performer attribute for the administration event.

Timing:

• relevant dateTime references the dateTime the prescription dispensing event occurred, i.e., the time the prescription was handed over to the patient or patient’s representative.
• relevantPeriod addresses the time referenced in the dosage instruction indicating when the medication administration should start and end.
• In the initial publication of QDM 5.5, relevantPeriod referenced the validity period, i.e., the time period for which the ordered supply is authorized by the prescription authorizing the dispensing event.
• For clarification, see Appendix 6.4 with additional guidance for referencing relevantPeriod updating the definition for "Medication, Order", "Medication Dispensed", and "Substance, Order".
• author dateTime references the date and time the dispensing event is recorded.

Notes:

• When calculating cumulative medication duration, the medication dispensed stopTime may be present directly in the fulfillment record. If the stopTime is not available, the duration in days is the difference between the relevantPeriod start and stop times. The record may indicate which of the available refills the fulfillment represents but each dispensing event is unique. Therefore, the measure developer should use CQL logic to address multiple dispensing events over a period of time.
• 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.

Refer to Special Cases in Appendix A (Section 5.7) for scenarios to consider in calculating cumulative medication duration.

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.