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CMS Measure ID: CMS22v11    Performance/Reporting Period: 2023    NQF Number: Not Applicable
Description:

Percentage of patient visits for patients aged 18 years and older seen during the measurement period who were screened for high blood pressure AND a recommended follow-up plan is documented, as indicated, if blood pressure is elevated or hypertensive

Data Elements and coded QDM Attributes contained within the eCQM

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

Constrained to codes in the Diagnosis: Diagnosis of Hypertension value set (2.16.840.1.113883.3.600.263)

QDM Datatype and Definition

"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.

Direct Reference Code

Constrained to 'EKG 12 channel panel' LOINC code

QDM Datatype and Definition

"Diagnostic Study, Order"

Data elements that meet criteria using this datatype should document a request by a clinician or appropriately licensed care provider to an appropriate provider or organization to perform the diagnostic study indicated by the QDM category and its corresponding value set. The request may be in the form of a consultation or a direct order to the organization that performs the diagnostic study. Diagnostic studies are those that are not performed in the clinical laboratory. Such studies include, but are not limited to, imaging studies, cardiology studies (electrocardiogram, treadmill stress testing), pulmonary function testing, and vascular laboratory testing.

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.

Direct Reference Code

Constrained to 'EKG study' LOINC code

QDM Datatype and Definition

"Diagnostic Study, Order"

Data elements that meet criteria using this datatype should document a request by a clinician or appropriately licensed care provider to an appropriate provider or organization to perform the diagnostic study indicated by the QDM category and its corresponding value set. The request may be in the form of a consultation or a direct order to the organization that performs the diagnostic study. Diagnostic studies are those that are not performed in the clinical laboratory. Such studies include, but are not limited to, imaging studies, cardiology studies (electrocardiogram, treadmill stress testing), pulmonary function testing, and vascular laboratory testing.

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

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

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

Constrained to codes in the Encounter, Performed: Encounter to Screen for Blood Pressure value set (2.16.840.1.113883.3.600.1920)

QDM Datatype and Definition

"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 5.6 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 recommendations and education for diet and nutrition.
Data Element Scope: This value set may use a model element related to Intervention or Procedure.
Inclusion Criteria: This value set may use a model element related to Intervention or Procedure.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Dietary Recommendations value set (2.16.840.1.113883.3.600.1515)

QDM Datatype and Definition

"Intervention, Order"

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

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

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

Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to represent concepts for follow-up timing.
Data Element Scope: This value set may use a model element related to Intervention.
Inclusion Criteria: Includes concepts that represent follow-up timing from one day to one month.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Follow Up Within 4 Weeks value set (2.16.840.1.113883.3.526.3.1578)

QDM Datatype and Definition

"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.

Direct Reference Code

Constrained to 'Follow-up 2-3 months (finding)' SNOMEDCT code

QDM Datatype and Definition

"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.

Direct Reference Code

Constrained to 'Follow-up 4-6 months (finding)' SNOMEDCT code

QDM Datatype and Definition

"Intervention, Order"

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

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

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

Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to represent concepts for lifestyle needs and education related to hypertension.
Data Element Scope: This value set may use a model element related to Procedure or Intervention.
Inclusion Criteria: Includes concepts that represent a procedure or intervention for lifestyle education focused on hypertension.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Lifestyle Recommendation value set (2.16.840.1.113883.3.526.3.1581)

QDM Datatype and Definition

"Intervention, Order"

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

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

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

Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to represent concepts for recommendations for exercise and nutrition education.
Data Element Scope: This value set may use a model element related to Intervention or Procedure.
Inclusion Criteria: Includes concepts that represent an intervention or procedure for promoting exercise and nutrition regimens.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Recommendation to Increase Physical Activity value set (2.16.840.1.113883.3.600.1518)

QDM Datatype and Definition

"Intervention, Order"

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

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

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

Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to represent concepts for interventions relevant to alcohol use.
Data Element Scope: This value set may use a model element related to Procedure or Intervention.
Inclusion Criteria: Includes concepts that indicate an intervention for the type of education provided, referral to community service, or rehabilitation center for alcohol use.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Referral or Counseling for Alcohol Consumption value set (2.16.840.1.113883.3.526.3.1583)

QDM Datatype and Definition

"Intervention, Order"

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

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

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

Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to represent concepts for referrals to an alternate or primary care provider.
Data Element Scope: This value set may use a model element related to Intervention.
Inclusion Criteria: Includes concepts that describe an intervention of a referral to an alternate or primary care provider.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Referral to Primary Care or Alternate Provider value set (2.16.840.1.113883.3.526.3.1580)

QDM Datatype and Definition

"Intervention, Order"

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

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

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

Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to represent concepts for discussion, education and management of weight reduction.
Data Element Scope: This value set may use a model element related to Intervention or Procedure.
Inclusion Criteria: Includes concepts that represent discussion, education and management of weight reduction.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Weight Reduction Recommended value set (2.16.840.1.113883.3.600.1510)

QDM Datatype and Definition

"Intervention, Order"

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

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

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

Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to represent concepts for lab tests that are commonly performed on patients with hypertension.
Data Element Scope: This value set may use a model element related to Laboratory Test.
Inclusion Criteria: Includes concepts that represent concepts for lab tests that are commonly performed on patients with hypertension.
Exclusion Criteria: No exclusions.

Constrained to codes in the Laboratory Test, Order: Laboratory Tests for Hypertension value set (2.16.840.1.113883.3.600.1482)

QDM Datatype and Definition

"Laboratory Test, Order"

Data elements that meet criteria using this datatype should document a request for the laboratory test 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 medications prescribed for the treatment of hypertension.
Data Element Scope: This value set may use a model element related to Medication.
Inclusion Criteria: Includes concepts that describe a medication for treatment of hypertension.
Exclusion Criteria: Excludes concepts that represent branded and non-prescribable drugs.

Constrained to codes in the Medication, Order: Pharmacologic Therapy for Hypertension value set (2.16.840.1.113883.3.526.1577)

QDM Datatype and Definition

"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.
  • author dateTime references the date and time the medication order (prescription) is authored.

Notes:

  • The medication order (prescription) is unlikely to indicate a relevantPeriod, the time period for which the ordered supply is to be administered/taken including all refills. Therefore, to determine the number of days covered by a single dispensing event, use the daysSupplied attribute and the relevant dateTime of the event to determine when the ordered medication will run out. If daysSupplied is not available, derive it from the supply (quantity of medication ordered) divided by the dosage (amount of medication to be taken at a single administration) times the frequency (number of units per time period – e.g., per day):
    daysSupplied = supply / (dosage x frequency)
    And multiply the daysSupplied per dispensing event multiplied by one plus the number of refills to determine the total daysSupplied ordered.
    daysSupplied x (1 + #refills)
    Starting with the relevant dateTime add the total daysSupplied (including refills) to determine when the ordered medication quantity will run out.
  • 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 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 medical reasons for not receiving a therapy or service.
Data Element Scope: This value set may use a model element related to Negation Rationale.
Inclusion Criteria: Includes concepts that describe a medical reason for not receiving a therapy or service.
Exclusion Criteria: No exclusions.

Constrained to codes in the Negation Rationale: Medical Reason value set (2.16.840.1.113883.3.526.3.1007)

QDM Attribute and Definition

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.

For updated guidance and implementer feedback regarding use of the QDM negation rationale attribute see Section 6.6.

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

Constrained to codes in the Negation Rationale: Patient Declined value set (2.16.840.1.113883.3.526.3.1582)

QDM Attribute and Definition

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.

For updated guidance and implementer feedback regarding use of the QDM negation rationale attribute see Section 6.6.

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

"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

"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

"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

"Patient Characteristic, Sex"

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

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

Direct Reference Code

Constrained to 'Diastolic blood pressure' LOINC code

QDM Datatype and Definition

"Physical Exam, Performed"

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

Timing:

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

Notes:

  • Timing refers to a single instance of a physical examination activity. If a measure seeks to evaluate multiple physical examination activities over a period of time, the measure developer should use CQL logic to represent the query request.
  • negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.
Direct Reference Code

Constrained to 'Systolic blood pressure' LOINC code

QDM Datatype and Definition

"Physical Exam, Performed"

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

Timing:

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

Notes:

  • Timing refers to a single instance of a physical examination activity. If a measure seeks to evaluate multiple physical examination activities over a period of time, the measure developer should use CQL logic to represent the query request.
  • negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod.
Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to represent concepts for diagnoses of elevated blood pressure or hypertension.
Data Element Scope: This value set may use a model element related to Diagnosis.
Inclusion Criteria: Includes concepts that represent a diagnosis of elevated blood pressure or hypertension.
Exclusion Criteria: No exclusions.

Constrained to codes in the Reason: Finding Of Elevated Blood Pressure Or Hypertension value set (2.16.840.1.113762.1.4.1047.514)

QDM Attribute and Definition

reason

The thought process or justification for the datatype. In some measures, specific treatments are acceptable inclusion criteria only if a justified reason is present. Each of these measures uses a value set (often, but not exclusively, using SNOMED CT) to express acceptable justification reasons. Other measures specify reasons as justification for exclusions.

Examples include patient, system, or medical-related reasons for declining to perform specific actions. Each of these measures also uses a value set to express acceptable justification reasons for declining to perform expected actions.