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CMS Measure ID: CMS108v10    Performance/Reporting Period: 2022    Version: 10    NQF Number: Not Applicable
Description:

This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given between the day of arrival to the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission

Data Elements and coded QDM Attributes contained within the eCQM

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Direct Reference Code

Constrained to 'Risk for venous thromboembolism' 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 for a device of graduated compression stocking devices used to prevent venous thromboembolism (VTE) in patients.
Data Element Scope: This value set may use a model element related to Device.
Inclusion Criteria: Includes concepts that represent a device for graduated compression stockings.
Exclusion Criteria: No exclusions.

Constrained to codes in the Device, Applied: Graduated compression stockings (GCS) value set (2.16.840.1.113883.3.117.1.7.1.256)

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 using intermittent pneumatic compression devices for venous thromboembolism (VTE) prophylaxis.
Data Element Scope: This value set may use a model element related to Device.
Inclusion Criteria: Includes concepts that represent a device for intermittent pneumatic compression.
Exclusion Criteria: No exclusions.

Constrained to codes in the Device, Applied: Intermittent pneumatic compression devices (IPC) value set (2.16.840.1.113883.3.117.1.7.1.214)

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 identify concepts for a device for a venous pump applied for venous thromboembolism (VTE) prophylaxis.
Data Element Scope: This value set may use a model element related to Device.
Inclusion Criteria: Includes concepts that represent a device used for venous thromboembolism (VTE) prophylaxis.
Exclusion Criteria: No exclusions.

Constrained to codes in the Device, Applied: Venous foot pumps (VFP) value set (2.16.840.1.113883.3.117.1.7.1.230)

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 for a device of graduated compression stocking devices used to prevent venous thromboembolism (VTE) in patients.
Data Element Scope: This value set may use a model element related to Device.
Inclusion Criteria: Includes concepts that represent a device for graduated compression stockings.
Exclusion Criteria: No exclusions.

Constrained to codes in the Device, Order: Graduated compression stockings (GCS) value set (2.16.840.1.113883.3.117.1.7.1.256)

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 of devices using intermittent pneumatic compression devices for venous thromboembolism (VTE) prophylaxis.
Data Element Scope: This value set may use a model element related to Device.
Inclusion Criteria: Includes concepts that represent a device for intermittent pneumatic compression.
Exclusion Criteria: No exclusions.

Constrained to codes in the Device, Order: Intermittent pneumatic compression devices (IPC) value set (2.16.840.1.113883.3.117.1.7.1.214)

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 identify concepts for a device for a venous pump applied for venous thromboembolism (VTE) prophylaxis.
Data Element Scope: This value set may use a model element related to Device.
Inclusion Criteria: Includes concepts that represent a device used for venous thromboembolism (VTE) prophylaxis.
Exclusion Criteria: No exclusions.

Constrained to codes in the Device, Order: Venous foot pumps (VFP) value set (2.16.840.1.113883.3.117.1.7.1.230)

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 of diagnoses to identify patients with a history of atrial fibrillation/flutter or a current finding of atrial fibrillation/flutter.
Data Element Scope: This value set may use a model element related to Diagnosis.
Inclusion Criteria: Includes concepts that identify a diagnosis of a history of atrial fibrillation/flutter or a current finding of atrial fibrillation/flutter.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnoses: Atrial Fibrillation/Flutter value set (2.16.840.1.113883.3.117.1.7.1.202)

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 identify concepts for diagnoses of hemorrhagic stroke.
    Data Element Scope: This value set may use a model element related to Diagnosis.
    Inclusion Criteria: Includes concepts that represent a diagnosis of hemorrhagic stroke.
    Exclusion Criteria: No exclusions.

    Constrained to codes in the Diagnoses: Hemorrhagic Stroke value set (2.16.840.1.113883.3.117.1.7.1.212)

    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 ischemic strokes.
      Data Element Scope: This value set may use a model element related to Diagnosis.
      Inclusion Criteria: Includes concepts that represent a diagnosis of ischemic stroke.
      Exclusion Criteria: No exclusions.

      Constrained to codes in the Diagnoses: Ischemic Stroke value set (2.16.840.1.113883.3.117.1.7.1.247)

      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 a diagnosis of mental health disorders.
        Data Element Scope: This value set may use a model element related to Diagnosis.
        Inclusion Criteria: Includes concepts that represent a diagnosis for mental health disorders.
        Exclusion Criteria: No exclusions.

        Constrained to codes in the Diagnoses: Mental Health Diagnoses value set (2.16.840.1.113883.3.464.1003.105.12.1004)

        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 of diagnoses to identify patients who have venous thromboembolism (VTE) related to pregnancy or obstetrics.
          Data Element Scope: This value set may use a model element related to Diagnosis.
          Inclusion Criteria: Includes concepts that represent a diagnosis for venous thromboembolism related to pregnancy or obstetrics.
          Exclusion Criteria: No exclusions.

          Constrained to codes in the Diagnoses: Obstetrics VTE value set (2.16.840.1.113883.3.117.1.7.1.264)

          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 identify concepts of diagnoses of a condition related to pregnancy or obstetrics.
            Data Element Scope: This value set may use a model element related to Diagnosis.
            Inclusion Criteria: Includes concepts that describe a diagnosis related to pregnancy or obstetrics.
            Exclusion Criteria: No exclusions.

            Constrained to codes in the Diagnoses: Obstetrics value set (2.16.840.1.113883.3.117.1.7.1.263)

            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 venous thromboembolism (VTE), including a pulmonary embolism.
              Data Element Scope: This value set may use a model element related to Diagnosis. .
              Inclusion Criteria: Includes concepts that represent a diagnosis of proximal venous thromboembolism (VTE) and pulmonary embolism of popliteal veins, femoral/superficial femoral veins, deep femoral veins, ileofemoral veins, iliac veins and inferior vena cava.
              Exclusion Criteria: No exclusions.

              Constrained to codes in the Diagnoses: Venous Thromboembolism value set (2.16.840.1.113883.3.117.1.7.1.279)

              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 of diagnoses to identify patients with a history of atrial fibrillation/flutter or a current finding of atrial fibrillation/flutter.
                Data Element Scope: This value set may use a model element related to Diagnosis.
                Inclusion Criteria: Includes concepts that identify a diagnosis of a history of atrial fibrillation/flutter or a current finding of atrial fibrillation/flutter.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Diagnosis: Atrial Fibrillation/Flutter value set (2.16.840.1.113883.3.117.1.7.1.202)

                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 venous thromboembolism (VTE), including a pulmonary embolism.
                Data Element Scope: This value set may use a model element related to Diagnosis. .
                Inclusion Criteria: Includes concepts that represent a diagnosis of proximal venous thromboembolism (VTE) and pulmonary embolism of popliteal veins, femoral/superficial femoral veins, deep femoral veins, ileofemoral veins, iliac veins and inferior vena cava.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Diagnosis: Venous Thromboembolism value set (2.16.840.1.113883.3.117.1.7.1.279)

                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 in the emergency department (ED).
                Data Element Scope: This value set may use a model element related to Encounter.
                Inclusion Criteria: Includes concepts that represent an encounter ocurring in the emergency department (ED).
                Exclusion Criteria: Excludes concepts that represent services not performed in the emergency department, including critical care and observation services.

                Constrained to codes in the Encounter, Performed: Emergency Department Visit value set (2.16.840.1.113883.3.117.1.7.1.292)

                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 observation in the inpatient setting.
                Data Element Scope: This value set may use a model element related to Encounter.
                Inclusion Criteria: Includes concepts that represent an encounter for inpatient observation.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Encounter, Performed: Observation Services value set (2.16.840.1.113762.1.4.1111.143)

                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 locations of adult or pediatric intensive care units (ICUs).
                Data Element Scope: This value set may use a model element related to Encounter.
                Inclusion Criteria: Includes concepts that represent a location for an adult or pediatric intensive care unit (ICU).
                Exclusion Criteria: Excludes concepts that represent neonatal intensive care units (NICU).

                Constrained to codes in the Facility Locations: Intensive Care Unit value set (2.16.840.1.113762.1.4.1029.206)

                QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

                facilityLocations

                The particular locations in a facility in which the diagnostic study or encounter occurs or occurred. Examples include intensive care units (ICUs), nonICUs, burn critical care unit, neonatal ICU, and respiratory care unit. Each "Encounter, Performed" may have one or more locations. For example, a patient treated in multiple locations during an individual encounter might be expressed as:
                • "Encounter, Performed": Inpatient Admission, facility locations
                  • ICU (locationPeriod)
                  • Non-ICU Admission (locationPeriod)
                  • Rehab (locationPeriod)
                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to define concepts for interventions of comfort measures care.
                Data Element Scope: This value set may use a model element related to Intervention.
                Inclusion Criteria: Includes concepts that identify an intervention for comfort measures, terminal care, dying care and hospice care.
                Exclusion Criteria: Excludes concepts that identify palliative care.

                Constrained to codes in the Intervention, Order: Comfort Measures value set (1.3.6.1.4.1.33895.1.3.0.45)

                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 define concepts for interventions of comfort measures care.
                Data Element Scope: This value set may use a model element related to Intervention.
                Inclusion Criteria: Includes concepts that identify an intervention for comfort measures, terminal care, dying care and hospice care.
                Exclusion Criteria: Excludes concepts that identify palliative care.

                Constrained to codes in the Intervention, Performed: Comfort Measures value set (1.3.6.1.4.1.33895.1.3.0.45)

                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 laboratory test for international normalized ratio (INR).
                Data Element Scope: This value set may use a model element related to Laboratory Test.
                Inclusion Criteria: Includes concepts that represent a laboratory test of INR (International Normalized Ratio).
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Laboratory Test, Performed: INR value set (2.16.840.1.113883.3.117.1.7.1.213)

                QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

                "Laboratory Test, Performed"

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

                Timing:

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

                Examples:

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

                Notes:

                • The time that the result report is available is a separate attribute than the time of the study (specimen collection).
                • negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.
                   
                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts for medications that are direct thrombin inhibitors.
                Data Element Scope: This value set may use a model element related to Medication.
                Inclusion Criteria: Includes concepts that represent a medication that is a direct thrombin inhibitors.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Medication, Administered: Direct Thrombin Inhibitor value set (2.16.840.1.113883.3.117.1.7.1.205)

                QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

                "Medication, Administered"

                Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient.

                Timing:

                • relevant dateTime references the time the medication is administered if it was given or taken at a single point in time.
                • relevantPeriod references a start and stop time for medication administration if the administration event occurred over a time interval (e.g., an intravenous infusion). The relevantPeriod addresses:
                  • startTime - when a single medication administration event starts (e.g., the initiation of an intravenous infusion).
                  • stopTime - when a single medication administration event ends (e.g., the end time of the intravenous infusion).
                • author dateTime references the time the action was recorded.
                • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

                Notes:

                • Measure developers should address multiple administrations over a period of time using CQL logic.
                • 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.
                 

                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts for medications to identify glycoprotein Iib/IIIa inhibitors.
                Data Element Scope: This value set may use a model element related to Medication.
                Inclusion Criteria: Includes concepts that represent a medication that is a glycoprotein Iib/IIIa inhibitor.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Medication, Administered: Glycoprotein IIb/IIIa Inhibitors value set (2.16.840.1.113762.1.4.1045.41)

                QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

                "Medication, Administered"

                Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient.

                Timing:

                • relevant dateTime references the time the medication is administered if it was given or taken at a single point in time.
                • relevantPeriod references a start and stop time for medication administration if the administration event occurred over a time interval (e.g., an intravenous infusion). The relevantPeriod addresses:
                  • startTime - when a single medication administration event starts (e.g., the initiation of an intravenous infusion).
                  • stopTime - when a single medication administration event ends (e.g., the end time of the intravenous infusion).
                • author dateTime references the time the action was recorded.
                • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

                Notes:

                • Measure developers should address multiple administrations over a period of time using CQL logic.
                • 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.
                 

                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts for medications of injectable factor Xa inhibitors used for venous thromboembolism (VTE) prophylaxis.
                Data Element Scope: This value set may use a model element related to Medication.
                Inclusion Criteria: Includes concepts that represent a medication that is an injectable factor Xa inhibitor.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Medication, Administered: Injectable Factor Xa Inhibitor for VTE Prophylaxis value set (2.16.840.1.113883.3.117.1.7.1.211)

                QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

                "Medication, Administered"

                Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient.

                Timing:

                • relevant dateTime references the time the medication is administered if it was given or taken at a single point in time.
                • relevantPeriod references a start and stop time for medication administration if the administration event occurred over a time interval (e.g., an intravenous infusion). The relevantPeriod addresses:
                  • startTime - when a single medication administration event starts (e.g., the initiation of an intravenous infusion).
                  • stopTime - when a single medication administration event ends (e.g., the end time of the intravenous infusion).
                • author dateTime references the time the action was recorded.
                • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

                Notes:

                • Measure developers should address multiple administrations over a period of time using CQL logic.
                • 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.
                 

                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts for medications of unfractionated heparin with strengths that could be used for venous thromboembolism (VTE) prophylaxis.
                Data Element Scope: This value set may use a model element related to Medication.
                Inclusion Criteria: Includes concepts that represent a medication that could reasonably be used to achieve a dose of at least 5000 units when administered subcutaneously.
                Exclusion Criteria: Excludes concepts that represent concentrations less than 250 units/mL.

                Constrained to codes in the Medication, Administered: Low Dose Unfractionated Heparin for VTE Prophylaxis value set (2.16.840.1.113762.1.4.1045.39)

                QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

                "Medication, Administered"

                Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient.

                Timing:

                • relevant dateTime references the time the medication is administered if it was given or taken at a single point in time.
                • relevantPeriod references a start and stop time for medication administration if the administration event occurred over a time interval (e.g., an intravenous infusion). The relevantPeriod addresses:
                  • startTime - when a single medication administration event starts (e.g., the initiation of an intravenous infusion).
                  • stopTime - when a single medication administration event ends (e.g., the end time of the intravenous infusion).
                • author dateTime references the time the action was recorded.
                • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

                Notes:

                • Measure developers should address multiple administrations over a period of time using CQL logic.
                • 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.
                 

                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts of medication for parenteral administration of low molecular weight heparin medications used for venous thromboembolism (VTE) prophylaxis.
                Data Element Scope: This value set may use a model element related to Medication.
                Inclusion Criteria: Includes concepts that represent a medication for parenteral administration of low molecular weight heparin.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Medication, Administered: Low Molecular Weight Heparin for VTE Prophylaxis value set (2.16.840.1.113883.3.117.1.7.1.219)

                QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

                "Medication, Administered"

                Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient.

                Timing:

                • relevant dateTime references the time the medication is administered if it was given or taken at a single point in time.
                • relevantPeriod references a start and stop time for medication administration if the administration event occurred over a time interval (e.g., an intravenous infusion). The relevantPeriod addresses:
                  • startTime - when a single medication administration event starts (e.g., the initiation of an intravenous infusion).
                  • stopTime - when a single medication administration event ends (e.g., the end time of the intravenous infusion).
                • author dateTime references the time the action was recorded.
                • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

                Notes:

                • Measure developers should address multiple administrations over a period of time using CQL logic.
                • 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.
                 

                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts for medications of oral factor Xa inhibitors indicated for venous thromboembolism (VTE) prophylaxis and treatment.
                Data Element Scope: This value set may use a model element related to Medication.
                Inclusion Criteria: Includes concepts that represent a medication for oral forms of factor Xa inhibitors.
                Exclusion Criteria: Excludes concepts that represent dose forms of factor Xa inhibitors other than oral.

                Constrained to codes in the Medication, Administered: Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment value set (2.16.840.1.113883.3.117.1.7.1.134)

                QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

                "Medication, Administered"

                Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient.

                Timing:

                • relevant dateTime references the time the medication is administered if it was given or taken at a single point in time.
                • relevantPeriod references a start and stop time for medication administration if the administration event occurred over a time interval (e.g., an intravenous infusion). The relevantPeriod addresses:
                  • startTime - when a single medication administration event starts (e.g., the initiation of an intravenous infusion).
                  • stopTime - when a single medication administration event ends (e.g., the end time of the intravenous infusion).
                • author dateTime references the time the action was recorded.
                • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

                Notes:

                • Measure developers should address multiple administrations over a period of time using CQL logic.
                • 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.
                 

                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts for medications of rivaroxaban and betrixaban indicated for venous thromboembolism (VTE) prophylaxis and treatment.
                Data Element Scope: This value set may use a model element related to Medication.
                Inclusion Criteria: Includes concepts that represent a medication for oral forms of rivaroxaban and betrixaban.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Medication, Administered: Rivaroxaban and Betrixaban for VTE Prophylaxis value set (2.16.840.1.113762.1.4.1110.50)

                QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

                "Medication, Administered"

                Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient.

                Timing:

                • relevant dateTime references the time the medication is administered if it was given or taken at a single point in time.
                • relevantPeriod references a start and stop time for medication administration if the administration event occurred over a time interval (e.g., an intravenous infusion). The relevantPeriod addresses:
                  • startTime - when a single medication administration event starts (e.g., the initiation of an intravenous infusion).
                  • stopTime - when a single medication administration event ends (e.g., the end time of the intravenous infusion).
                • author dateTime references the time the action was recorded.
                • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

                Notes:

                • Measure developers should address multiple administrations over a period of time using CQL logic.
                • 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.
                 

                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts of medication for continuous infusion of heparin formulations to treat venous thromboembolism (VTE).
                Data Element Scope: This value set may use a model element related to Medication.
                Inclusion Criteria: Includes concepts that represent a medication that could be used for continuous infusion of heparin and achieve therapeutic levels.
                Exclusion Criteria: Excludes concepts that describe concentrations < 250 UNT/ML (except those representing premixed heparin infusion bags, per inclusion criteria).

                Constrained to codes in the Medication, Administered: Unfractionated Heparin value set (2.16.840.1.113883.3.117.1.7.1.218)

                QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

                "Medication, Administered"

                Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient.

                Timing:

                • relevant dateTime references the time the medication is administered if it was given or taken at a single point in time.
                • relevantPeriod references a start and stop time for medication administration if the administration event occurred over a time interval (e.g., an intravenous infusion). The relevantPeriod addresses:
                  • startTime - when a single medication administration event starts (e.g., the initiation of an intravenous infusion).
                  • stopTime - when a single medication administration event ends (e.g., the end time of the intravenous infusion).
                • author dateTime references the time the action was recorded.
                • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

                Notes:

                • Measure developers should address multiple administrations over a period of time using CQL logic.
                • 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.
                 

                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts for medications of warfarin administered to patients to reduce the risk of blood clot formation.
                Data Element Scope: This value set may use a model element related to Medication.
                Inclusion Criteria: Includes concepts that represent a medication for single ingredient drug forms consistent with oral administration.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Medication, Administered: Warfarin value set (2.16.840.1.113883.3.117.1.7.1.232)

                QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

                "Medication, Administered"

                Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient.

                Timing:

                • relevant dateTime references the time the medication is administered if it was given or taken at a single point in time.
                • relevantPeriod references a start and stop time for medication administration if the administration event occurred over a time interval (e.g., an intravenous infusion). The relevantPeriod addresses:
                  • startTime - when a single medication administration event starts (e.g., the initiation of an intravenous infusion).
                  • stopTime - when a single medication administration event ends (e.g., the end time of the intravenous infusion).
                • author dateTime references the time the action was recorded.
                • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

                Notes:

                • Measure developers should address multiple administrations over a period of time using CQL logic.
                • 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.
                 

                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts for medications of injectable factor Xa inhibitors used for venous thromboembolism (VTE) prophylaxis.
                Data Element Scope: This value set may use a model element related to Medication.
                Inclusion Criteria: Includes concepts that represent a medication that is an injectable factor Xa inhibitor.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Medication, Order: Injectable Factor Xa Inhibitor for VTE Prophylaxis value set (2.16.840.1.113883.3.117.1.7.1.211)

                QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

                "Medication, Order"

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

                Timing:

                • 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 medication order (prescription) is authored.

                Notes:

                • When calculating cumulative medication duration, the stopTime may be present directly in the medication order. If the stopTime is not available, the duration in days is the difference between the relevantPeriod start and stop times multiplied by (1 + the number of refills).
                • 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.

                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts for medications of unfractionated heparin with strengths that could be used for venous thromboembolism (VTE) prophylaxis.
                Data Element Scope: This value set may use a model element related to Medication.
                Inclusion Criteria: Includes concepts that represent a medication that could reasonably be used to achieve a dose of at least 5000 units when administered subcutaneously.
                Exclusion Criteria: Excludes concepts that represent concentrations less than 250 units/mL.

                Constrained to codes in the Medication, Order: Low Dose Unfractionated Heparin for VTE Prophylaxis value set (2.16.840.1.113762.1.4.1045.39)

                QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

                "Medication, Order"

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

                Timing:

                • 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 medication order (prescription) is authored.

                Notes:

                • When calculating cumulative medication duration, the stopTime may be present directly in the medication order. If the stopTime is not available, the duration in days is the difference between the relevantPeriod start and stop times multiplied by (1 + the number of refills).
                • 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.

                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts of medication for parenteral administration of low molecular weight heparin medications used for venous thromboembolism (VTE) prophylaxis.
                Data Element Scope: This value set may use a model element related to Medication.
                Inclusion Criteria: Includes concepts that represent a medication for parenteral administration of low molecular weight heparin.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Medication, Order: Low Molecular Weight Heparin for VTE Prophylaxis value set (2.16.840.1.113883.3.117.1.7.1.219)

                QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

                "Medication, Order"

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

                Timing:

                • 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 medication order (prescription) is authored.

                Notes:

                • When calculating cumulative medication duration, the stopTime may be present directly in the medication order. If the stopTime is not available, the duration in days is the difference between the relevantPeriod start and stop times multiplied by (1 + the number of refills).
                • 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.

                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts for medications of rivaroxaban and betrixaban indicated for venous thromboembolism (VTE) prophylaxis and treatment.
                Data Element Scope: This value set may use a model element related to Medication.
                Inclusion Criteria: Includes concepts that represent a medication for oral forms of rivaroxaban and betrixaban.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Medication, Order: Rivaroxaban and Betrixaban for VTE Prophylaxis value set (2.16.840.1.113762.1.4.1110.50)

                QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

                "Medication, Order"

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

                Timing:

                • 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 medication order (prescription) is authored.

                Notes:

                • When calculating cumulative medication duration, the stopTime may be present directly in the medication order. If the stopTime is not available, the duration in days is the difference between the relevantPeriod start and stop times multiplied by (1 + the number of refills).
                • 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.

                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts for medications of warfarin administered to patients to reduce the risk of blood clot formation.
                Data Element Scope: This value set may use a model element related to Medication.
                Inclusion Criteria: Includes concepts that represent a medication for single ingredient drug forms consistent with oral administration.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Medication, Order: Warfarin value set (2.16.840.1.113883.3.117.1.7.1.232)

                QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

                "Medication, Order"

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

                Timing:

                • 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 medication order (prescription) is authored.

                Notes:

                • When calculating cumulative medication duration, the stopTime may be present directly in the medication order. If the stopTime is not available, the duration in days is the difference between the relevantPeriod start and stop times multiplied by (1 + the number of refills).
                • 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.

                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts of negation rationale for medical reasons for not providing treatment.
                Data Element Scope: This value set may use a model element related to Negation Rationale.
                Inclusion Criteria: Includes concepts that represent a negation rationale or reason for not providing treatment.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Negation Rationale: Medical Reason value set (2.16.840.1.113883.3.117.1.7.1.473)

                QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

                negationRationale

                Indicates the reason that an action was not performed. Only QDM datatypes that represent actions (e.g., performed, recommended, communication, order, dispensed) allow the negation rationale attribute. The intent is to indicate a justification that such action did not happen as expected. This attribute specifically does not address the presence or absence of information in a clinical record (e.g., documented absence of allergies versus lack of documentation about allergies). QDM assumes a world view that absence of evidence indicates information does not exist or an action did not happen. To express such lack of evidence, an eCQM author should use the CQL expression not exists with reference to the data element rather than the QDM data model. negation rationale in QDM signifies only a reason for such absence, i.e., the reason must be present to qualify for negation rationale. The syntax in the human readable HQMF is addressed in CQL examples and in the MAT User Guide. Prior versions of QDM used the syntax, "Procedure, Performed not done." QDM versions starting with 5.3 use the syntax, "Procedure, not Performed." Section A-5 provides examples for expressing negation rationale in CQL.

                Note: negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.

                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts of negation rationale for a patient's refusal of treatment.
                Data Element Scope: This value set may use a model element related to Negation Rationale.
                Inclusion Criteria: Includes concepts that identify a negation rationale for refusal of any intervention.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Negation Rationale: Patient Refusal value set (2.16.840.1.113883.3.117.1.7.1.93)

                QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

                negationRationale

                Indicates the reason that an action was not performed. Only QDM datatypes that represent actions (e.g., performed, recommended, communication, order, dispensed) allow the negation rationale attribute. The intent is to indicate a justification that such action did not happen as expected. This attribute specifically does not address the presence or absence of information in a clinical record (e.g., documented absence of allergies versus lack of documentation about allergies). QDM assumes a world view that absence of evidence indicates information does not exist or an action did not happen. To express such lack of evidence, an eCQM author should use the CQL expression not exists with reference to the data element rather than the QDM data model. negation rationale in QDM signifies only a reason for such absence, i.e., the reason must be present to qualify for negation rationale. The syntax in the human readable HQMF is addressed in CQL examples and in the MAT User Guide. Prior versions of QDM used the syntax, "Procedure, Performed not done." QDM versions starting with 5.3 use the syntax, "Procedure, not Performed." Section A-5 provides examples for expressing negation rationale in CQL.

                Note: negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.

                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.

                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts of a procedure for surgery where a general and/or neuraxial anesthesia is used.
                Data Element Scope: This value set may use a model element related to Procedure.
                Inclusion Criteria: Includes concepts that represent a procedure for general and/or neuraxial anesthesia.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Procedure, Performed: General or Neuraxial Anesthesia value set (2.16.840.1.113883.3.666.5.1743)

                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 of procedures for thoracic and abdominal general surgery procedures, except for cardiac procedures.
                Data Element Scope: This value set may use a model element related to Procedure.
                Inclusion Criteria: Includes concepts that represent a procedure for thoracic and abdominal general surgery, except for cardiac procedures.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Procedure, Performed: General Surgery value set (2.16.840.1.113883.3.117.1.7.1.255)

                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 of procedures of gynecologic surgery.
                Data Element Scope: This value set may use a model element related to Procedure.
                Inclusion Criteria: Includes concepts that represent a procedure for gynecologic surgery.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Procedure, Performed: Gynecological Surgery value set (2.16.840.1.113883.3.117.1.7.1.257)

                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 procedures of hip fracture surgery.
                Data Element Scope: This value set may use a model element related to Procedure.
                Inclusion Criteria: Includes concepts that represent a procedure for hip fracture surgery.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Procedure, Performed: Hip Fracture Surgery value set (2.16.840.1.113883.3.117.1.7.1.258)

                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 of procedures for total hip replacement procedures.
                Data Element Scope: This value set may use a model element related to Procedure.
                Inclusion Criteria: Includes concepts that represent a procedure for a total hip replacement.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Procedure, Performed: Hip Replacement Surgery value set (2.16.840.1.113883.3.117.1.7.1.259)

                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 procedures of intracranial neurosurgery.
                Data Element Scope: This value set may use a model element related to Procedure.
                Inclusion Criteria: Includes concepts that represent a procedure for intracranial neurosurgery.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Procedure, Performed: Intracranial Neurosurgery value set (2.16.840.1.113883.3.117.1.7.1.260)

                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 the procedure of a total knee replacement.
                Data Element Scope: This value set may use a model element related to Procedure.
                Inclusion Criteria: Includes concepts that represent a procedure for total knee replacement.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Procedure, Performed: Knee Replacement Surgery value set (2.16.840.1.113883.3.117.1.7.1.261)

                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 procedures of urological surgery.
                Data Element Scope: This value set may use a model element related to Procedure.
                Inclusion Criteria: Includes concepts that represent a procedure for urologic surgery.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Procedure, Performed: Urological Surgery value set (2.16.840.1.113883.3.117.1.7.1.272)

                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 describe concepts for an assessment with a measurement containing results of 'low.'
                Data Element Scope: This value set may use a model element related to Assessment.
                Inclusion Criteria: Includes concepts that represent an assessment with results of 'low'.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Result: Low Risk value set (2.16.840.1.113883.3.117.1.7.1.400)

                QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

                result

                The final consequences or data collected from the datatype. results can be used in four ways to express:

                • That a result is present in the electronic record but any entry is acceptable
                • A numerical result is reported directly as a value. Values may be integers or decimal numbers without units, or as a quantity with a value and units - examples:
                  • 100mg/dL for a lab test
                  • 140 mmHg for blood pressure
                  • as a percentage (actually as a quantity with % as units)
                  • as a titer or ratio (e.g., 1:4, 1:80)
                • A result that matches one of a specific set of coded concepts in a value set or a code that matches a direct reference code
                • A result as a dateTime ("Assessment, Performed" and components)
                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to identify concepts of a procedure of medication administered intravenously.
                Data Element Scope: This value set may use a model element related to Procedure.
                Inclusion Criteria: Includes concepts that identify a procedure of a medication given intravenously.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Route: Intravenous Route value set (2.16.840.1.113883.3.117.1.7.1.222)

                QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

                route

                Refers to the path by which the medication or substance should be taken into the body system, such as intradermally, intrathecally, intramuscularly, intranasally, intravenously, orally, rectally, subcutaneously, sublingually, topically, or vaginally.
                Value Set Description from VSAC
                Clinical Focus: The purpose of this value set is to represent concepts for a medication administered by subcutaneous route.
                Data Element Scope: This value set may use a model element related to Medication.
                Inclusion Criteria: Includes concepts that identify a medication given subcutaneously.
                Exclusion Criteria: No exclusions.

                Constrained to codes in the Route: Subcutaneous Route value set (2.16.840.1.113883.3.117.1.7.1.223)

                QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

                route

                Refers to the path by which the medication or substance should be taken into the body system, such as intradermally, intrathecally, intramuscularly, intranasally, intravenously, orally, rectally, subcutaneously, sublingually, topically, or vaginally.