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CMS Measure ID: CMS165v10    Performance/Reporting Period: 2022    Version: 10    NQF Number: Not Applicable
Description:

Percentage of patients 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (<140/90mmHg) during the measurement period

Data Elements and coded QDM Attributes contained within the eCQM

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Direct Reference Code

Constrained to 'Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)' LOINC code

QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

"Assessment, Performed"

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

Timing:

  • relevant dateTime references timing for an assessment that occurs at a single point in time.
  • relevant Period references a start and stop time for an assessment that occurs over a time interval
  • author dateTime references the time the action was recorded.
  • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

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.

Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to represent concepts of devices for durable medical equipment (DME) used by frail patients.
Data Element Scope: This value set may use a model element related to Device.
Inclusion Criteria: Includes concepts that represent durable medical equipment (DME) or devices for frailty.
Exclusion Criteria: No exclusions.

Constrained to codes in the Device, Applied: Frailty Device value set (2.16.840.1.113883.3.464.1003.118.12.1300)

QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

"Device, Applied"

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

 

Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to represent concepts of devices for durable medical equipment (DME) used by frail patients.
Data Element Scope: This value set may use a model element related to Device.
Inclusion Criteria: Includes concepts that represent durable medical equipment (DME) or devices for frailty.
Exclusion Criteria: No exclusions.

Constrained to codes in the Device, Order: Frailty Device value set (2.16.840.1.113883.3.464.1003.118.12.1300)

QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

"Device, Order"

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.

Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to represent concepts for a diagnosis of advanced illnesses.
Data Element Scope: This value set may use a model element related to Diagnosis.
Inclusion Criteria: Includes concepts that represent a diagnosis of advanced illness when combined with older age and indications of frailty. Codes cover a wide range of conditions: heart failure, end stage renal disease, liver disease, emphysema, dementia and neurodegenerative disorders, metastatic and sever cancers, respiratory failure, and pulmonary fibrosis.
Exclusion Criteria: Exclude concepts that indicate pregnancy, fetal, juvenile, childhood or neonatal conditions, concepts that indicate acute, temporary, or procedure-related conditions.

Constrained to codes in the Diagnoses: Advanced Illness value set (2.16.840.1.113883.3.464.1003.110.12.1082)

QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

diagnoses

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"
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for diagnoses of Stage 5 chronic kidney disease.
    Data Element Scope: This value set may use a model element related to Diagnosis.
    Inclusion Criteria: Includes concepts that represent a diagnosis of Stage 5 of chronic kidney disease.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Diagnosis: Chronic Kidney Disease, Stage 5 value set (2.16.840.1.113883.3.526.3.1002)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Diagnosis"

    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.

    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for diagnoses of end stage renal disease (ESRD).
    Data Element Scope: This value set may use a model element related to Diagnosis.
    Inclusion Criteria: Includes concepts that represent a diagnosis of end stage renal disease (ESRD).
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Diagnosis: End Stage Renal Disease value set (2.16.840.1.113883.3.526.3.353)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Diagnosis"

    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.

    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for a diagnosis of essential hypertension.
    Data Element Scope: This value set may use a model element related to Diagnosis.
    Inclusion Criteria: Includes concepts that represent a diagnosis of essential hypertension.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Diagnosis: Essential Hypertension value set (2.16.840.1.113883.3.464.1003.104.12.1011)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Diagnosis"

    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.

    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for a diagnosis of potential indicators of frailty.
    Data Element Scope: This value set may use a model element related to Diagnosis.
    Inclusion Criteria: Includes concepts that represent that a diagnosis of potential frailty when coupled with older age: dependence on durable medical equipment for long-term use, limitation of activities of daily living due to disability, need for assistance with care, pressure ulcers, and falls.
    Exclusion Criteria: Exclude concepts that indicate potential frailty when associated with pregnancy, fetal, juvenile, childhood or neonatal conditions; codes that indicate temporary need of durable medical equipment; codes that indicate accidental falls caused by another person, being pushed/shoved/collided into, falls on ice due to ice skates, falls due to impact against a baby buggy/shopping cart/wheelbarrow.

    Constrained to codes in the Diagnosis: Frailty Diagnosis value set (2.16.840.1.113883.3.464.1003.113.12.1074)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Diagnosis"

    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.

    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for a diagnosis of a history of kidney transplant.
    Data Element Scope: This value set may use a model element related to Diagnosis.
    Inclusion Criteria: Includes concepts that represent a diagnosis of a history of kidney transplant.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Diagnosis: Kidney Transplant Recipient value set (2.16.840.1.113883.3.464.1003.109.12.1029)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Diagnosis"

    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.

    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for diagnoses of pregnancy.
    Data Element Scope: This value set may use a model element related to Diagnosis.
    Inclusion Criteria: Includes concepts that represent a diagnosis of pregnancy.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Diagnosis: Pregnancy value set (2.16.840.1.113883.3.526.3.378)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Diagnosis"

    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.

    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for acute inpatient visits.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for comprehensive history, evaluation, and management of a patient in an acute inpatient setting.
    Exclusion Criteria: Excludes concepts that represent encounters other than an acute inpatient visit.

    Constrained to codes in the Encounter, Performed: Acute Inpatient value set (2.16.840.1.113883.3.464.1003.101.12.1083)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for annual wellness visits.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for a Medicare annual wellness visit.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Annual Wellness Visit value set (2.16.840.1.113883.3.526.3.1240)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for patients living in assisted living, domiciliary care or rest homes.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for services provided to new and established patients living in assisted living, domiciliary care or rest home who have had an interaction with a member of their medical team.
    Exclusion Criteria: Excludes concepts that represent an encounter for settings other than assisted living, domiciliary care, or rest homes.

    Constrained to codes in the Encounter, Performed: Care Services in Long-Term Residential Facility value set (2.16.840.1.113883.3.464.1003.101.12.1014)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters in the emergency department.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for care provided to new and established patients in the emergency department.
    Exclusion Criteria: Excludes concepts that represent an encounter not representative of ED visits, including critical care and observation services.

    Constrained to codes in the Encounter, Performed: Emergency Department Visit 1 value set (2.16.840.1.113883.3.464.1003.101.12.1010)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts of inpatient hospitalization encounters.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for inpatient hospitalizations.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Encounter Inpatient value set (2.16.840.1.113883.3.666.5.307)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for end-stage renal disease (ESRD) outpatient services.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for ESRD outpatients services.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: ESRD Monthly Outpatient Services value set (2.16.840.1.113883.3.464.1003.109.12.1014)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for nursing care services provided to frail patients.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for nursing care and home care services provided to frail patients.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Frailty Encounter value set (2.16.840.1.113883.3.464.1003.101.12.1088)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for home health visits.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for a home health visit for the evaluation and management of a new or established patient.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Home Healthcare Services value set (2.16.840.1.113883.3.464.1003.101.12.1016)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for nonacute inpatient visits.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for comprehensive history, evaluation, and management of a patient in a nonacute inpatient setting.
    Exclusion Criteria: Excludes concepts that represent an encounter other than nonacute inpatient visits.

    Constrained to codes in the Encounter, Performed: Nonacute Inpatient value set (2.16.840.1.113883.3.464.1003.101.12.1084)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters in a nursing facility.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter specific to a nursing facility, including skilled, intermediate and long term care facilities.
    Exclusion Criteria: Excludes concepts that represent an encounter other than a nursing facility visits.

    Constrained to codes in the Encounter, Performed: Nursing Facility Visit value set (2.16.840.1.113883.3.464.1003.101.12.1012)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for observation stays.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for comprehensive history, evaluation, and management of a patient in an observation care setting.
    Exclusion Criteria: Excludes concepts that represent an encounter not representative of observation care, including critical care and ED visits.

    Constrained to codes in the Encounter, Performed: Observation value set (2.16.840.1.113883.3.464.1003.101.12.1086)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for an outpatient visit.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for the comprehensive history, evaluation, and management of a patient presenting with minor to high severity problems.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Office Visit value set (2.16.840.1.113883.3.464.1003.101.12.1001)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: Includes concepts that represent an encounter using online modalities.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter using online modalities.
    Exclusion Criteria: Excludes concepts that represent encounters other than online.

    Constrained to codes in the Encounter, Performed: Online Assessments value set (2.16.840.1.113883.3.464.1003.101.12.1089)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for outpatient visits.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for comprehensive history, evaluation, and management of a patient in an outpatient setting.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Outpatient value set (2.16.840.1.113883.3.464.1003.101.12.1087)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for palliative care services.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for admission and management for palliative care services.
    Exclusion Criteria: Excludes concepts that represent encounters for hospice and a referral to palliative care.

    Constrained to codes in the Encounter, Performed: Palliative Care Encounter 1 value set (2.16.840.1.113883.3.464.1003.101.12.1090)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for preventive care.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for comprehensive preventive medicine reevaluation and management of an individual 18 years of age or over.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up value set (2.16.840.1.113883.3.464.1003.101.12.1025)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for preventive care.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for comprehensive preventive medicine reevaluation and management of a patient 18 years or over.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up value set (2.16.840.1.113883.3.464.1003.101.12.1023)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for encounters for telephone visits.
    Data Element Scope: This value set may use a model element related to Encounter.
    Inclusion Criteria: Includes concepts that represent an encounter for assessment, evaluation and management services to a patient by telephone.
    Exclusion Criteria: Excludes concepts that represent an encounter for telephone assessment, evaluation and management services that last for less than five minutes.

    Constrained to codes in the Encounter, Performed: Telephone Visits value set (2.16.840.1.113883.3.464.1003.101.12.1080)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Encounter, Performed"

    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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts of interventions to identify patients receiving hospice care outside of a hospital or long term care facility.
    Data Element Scope: This value set may use a model element related to Procedure or Intervention.
    Inclusion Criteria: Includes concepts that represent a procedure or intervention for hospice care.
    Exclusion Criteria: Excludes concepts that represent palliative care or comfort measures.

    Constrained to codes in the Intervention, Order: Hospice care ambulatory value set (2.16.840.1.113762.1.4.1108.15)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Intervention, Order"

    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.

    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts of interventions to identify patients receiving hospice care outside of a hospital or long term care facility.
    Data Element Scope: This value set may use a model element related to Procedure or Intervention.
    Inclusion Criteria: Includes concepts that represent a procedure or intervention for hospice care.
    Exclusion Criteria: Excludes concepts that represent palliative care or comfort measures.

    Constrained to codes in the Intervention, Performed: Hospice care ambulatory value set (2.16.840.1.113762.1.4.1108.15)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Intervention, Performed"

    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.
       
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for palliative care interventions.
    Data Element Scope: This value set may use a model element related to Intervention.
    Inclusion Criteria: Includes concepts that represent palliative care interventions, including procedures and regime/therapy provided as part of palliative care services.
    Exclusion Criteria: Excludes concepts that represent an intervention for hospice.

    Constrained to codes in the Intervention, Performed: Palliative Care Intervention value set (2.16.840.1.113883.3.464.1003.198.12.1135)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Intervention, Performed"

    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.
       
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for dementia medications.
    Data Element Scope: This value set may use a model element related to Medication.
    Inclusion Criteria: Includes concepts that represent generic, human use and prescribable dementia medications.
    Exclusion Criteria: Excludes concepts that represent non-prescribable or branded drugs and excludes concepts that represent components or ingredients.

    Constrained to codes in the Medication, Active: Dementia Medications value set (2.16.840.1.113883.3.464.1003.196.12.1510)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Medication, Active"

    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.

    Direct Reference Code

    Constrained to 'Birth date' LOINC code

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Patient Characteristic, Birthdate"

    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.

    Value Set Description from VSAC
    Clinical Focus: n/a Data Element Scope: n/a Inclusion Criteria: n/a Exclusion Criteria: n/a

    Constrained to codes in the Patient Characteristic, Ethnicity: Ethnicity value set (2.16.840.1.114222.4.11.837)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Patient Characteristic, Ethnicity"

    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.

    Value Set Description from VSAC
    Clinical Focus: Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system
    Data Element Scope: @code in CCDA r2.1 template Planned Coverage [act: identifier urn:oid:2.16.840.1.113883.10.20.22.4.129 (open)] DYNAMIC
    Inclusion Criteria: All codes in the code system
    Exclusion Criteria: none

    Constrained to codes in the Patient Characteristic, Payer: Payer value set (2.16.840.1.114222.4.11.3591)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Patient Characteristic, Payer"

    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.
    Value Set Description from VSAC
    Clinical Focus: n/a Data Element Scope: n/a Inclusion Criteria: n/a Exclusion Criteria: n/a

    Constrained to codes in the Patient Characteristic, Race: Race value set (2.16.840.1.114222.4.11.836)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Patient Characteristic, Race"

    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.

    Value Set Description from VSAC
    Clinical Focus: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.
    Data Element Scope: Gender
    Inclusion Criteria: Male and Female only.
    Exclusion Criteria: Any gender identity that is not male or female.

    Constrained to codes in the Patient Characteristic, Sex: ONC Administrative Sex value set (2.16.840.1.113762.1.4.1)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Patient Characteristic, Sex"

    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.

    Direct Reference Code

    Constrained to 'Diastolic blood pressure' LOINC code

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Physical Exam, Performed"

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

    Timing:

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

    Notes:

    • Timing refers to a single instance of a physical examination activity. If a measure seeks to evaluate multiple physical examination activities 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.
    Direct Reference Code

    Constrained to 'Systolic blood pressure' LOINC code

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Physical Exam, Performed"

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

    Timing:

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

    Notes:

    • Timing refers to a single instance of a physical examination activity. If a measure seeks to evaluate multiple physical examination activities 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.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for dialysis services.
    Data Element Scope: This value set may use a model element related to Procedure.
    Inclusion Criteria: Includes concepts that represent dialysis services.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Procedure, Performed: Dialysis Services value set (2.16.840.1.113883.3.464.1003.109.12.1013)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Procedure, Performed"

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

    Timing:

    • relevant dateTime references the time the procedure is performed when the procedure occurs at a single point in time.
    • relevantPeriod references a start and stop time for a procedure that occurs over a time interval. relevantPeriod addresses:
      • startTime - The time the procedure begins.
      • stopTime - The time the procedure 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 a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request.
    • The incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.
    • 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 clarification, see Appendix 6.6 with 2020 guidance about differentiating between successful and unsuccessful procedures.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for a kidney transplant.
    Data Element Scope: This value set may use a model element related to Procedure.
    Inclusion Criteria: Includes concepts that represent kidney transplants.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Procedure, Performed: Kidney Transplant value set (2.16.840.1.113883.3.464.1003.109.12.1012)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Procedure, Performed"

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

    Timing:

    • relevant dateTime references the time the procedure is performed when the procedure occurs at a single point in time.
    • relevantPeriod references a start and stop time for a procedure that occurs over a time interval. relevantPeriod addresses:
      • startTime - The time the procedure begins.
      • stopTime - The time the procedure 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 a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request.
    • The incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.
    • 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 clarification, see Appendix 6.6 with 2020 guidance about differentiating between successful and unsuccessful procedures.
    Value Set Description from VSAC
    Clinical Focus: The purpose of this value set is to represent concepts for symptoms of frailty.
    Data Element Scope: This value set may use a model element related to Symptom.
    Inclusion Criteria: Includes concepts that represent a symptom of frailty.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Symptom: Frailty Symptom value set (2.16.840.1.113883.3.464.1003.113.12.1075)

    QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

    "Symptom"

    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.