Back to top
Top
U.S. flag

An official website of the United States government

Dot gov

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Https

Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

CMS Measure ID: CMS72v12    Performance/Reporting Period: 2024    NQF Number: Not Applicable
Description:

Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2

Data Elements and coded QDM Attributes contained within the eCQM

+ Expand all

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 Hemorrhagic Stroke value set (2.16.840.1.113883.3.117.1.7.1.212)

QDM Attribute and Definition

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" diagnoses 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" diagnoses was present at the time of admission (an indicator used to evaluate patient safety and adverse events). See presentOnAdmissionIndicator attribute definition and Section A.1.4 for information about using the "Encounter, Performed" diagnoses attribute.

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

With an "Encounter, Performed" diagnoses, 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 procedures of intravenous or intra-arterial thrombolytic (t-PA) therapy.
Data Element Scope: This value set may use a model element related to Procedure.
Inclusion Criteria: Includes concepts that identify a procedure for intravenous or intra-arterial thrombolytic (t-PA) therapy.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intravenous or Intra arterial Thrombolytic tPA Therapy Prior to Arrival value set (2.16.840.1.113762.1.4.1110.21)

QDM Attribute and Definition

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" diagnoses 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" diagnoses was present at the time of admission (an indicator used to evaluate patient safety and adverse events). See presentOnAdmissionIndicator attribute definition and Section A.1.4 for information about using the "Encounter, Performed" diagnoses attribute.

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

With an "Encounter, Performed" diagnoses, 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 Ischemic Stroke value set (2.16.840.1.113883.3.117.1.7.1.247)

QDM Attribute and Definition

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" diagnoses 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" diagnoses was present at the time of admission (an indicator used to evaluate patient safety and adverse events). See presentOnAdmissionIndicator attribute definition and Section A.1.4 for information about using the "Encounter, Performed" diagnoses attribute.

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

With an "Encounter, Performed" diagnoses, 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 procedures of intravenous or intra-arterial thrombolytic (t-PA) therapy.
Data Element Scope: This value set may use a model element related to Procedure.
Inclusion Criteria: Includes concepts that identify a procedure for intravenous or intra-arterial thrombolytic (t-PA) therapy.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intravenous or Intra arterial Thrombolytic tPA Therapy Prior to Arrival value set (2.16.840.1.113762.1.4.1110.21)

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.

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 Emergency Department Visit value set (2.16.840.1.113883.3.117.1.7.1.292)

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 of encounters for non-elective inpatient admission.
Data Element Scope: This value set may use a model element related to Encounter.
Inclusion Criteria: Includes concepts that represent an encounter for a non-elective inpatient admission.
Exclusion Criteria: Excludes concepts that represent an encounter for an elective inpatient admission.

Constrained to codes in the Nonelective Inpatient Encounter value set (2.16.840.1.113883.3.117.1.7.1.424)

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

Constrained to codes in the Observation Services value set (2.16.840.1.113762.1.4.1111.143)

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 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 Comfort Measures value set (1.3.6.1.4.1.33895.1.3.0.45)

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 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 Comfort Measures value set (1.3.6.1.4.1.33895.1.3.0.45)

QDM Datatype and Definition

"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 INR value set (2.16.840.1.113883.3.117.1.7.1.213)

QDM Datatype and Definition

"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 of medications that are anticoagulant and antiplatelet medications used to reduce stroke mortality and morbidity.
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 antithrombotic medication, including oral, rectal, and injectable dose forms.
Exclusion Criteria: Excludes concepts that represent enoxaparin and heparin generally given for VTE prophylaxis.

Constrained to codes in the Antithrombotic Therapy for Ischemic Stroke value set (2.16.840.1.113762.1.4.1110.62)

QDM Datatype and Definition

"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 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 indicating pharmacological contraindications for antithrombotic therapy.
Data Element Scope: This value set may use a model element related to Medication.
Inclusion Criteria: Includes concepts that represent a medication for pharmacological contraindications for antithrombotic therapy.
Exclusion Criteria: Excludes concepts that are not for human use and that are not prescribable in the US.

Constrained to codes in the Pharmacological Contraindications For Antithrombotic Therapy value set (2.16.840.1.113762.1.4.1110.52)

QDM Datatype and Definition

"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 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 prescribed for thrombolytic (t-PA) therapy for treatment of ischemic stroke.
Data Element Scope: This value set may use a model element related to Medication.
Inclusion Criteria: Includes concepts that represent a medication for stroke treatment consistent with administration by intravenous (IV) route.
Exclusion Criteria: No exclusions.

Constrained to codes in the Thrombolytic tPA Therapy value set (2.16.840.1.113883.3.117.1.7.1.226)

QDM Datatype and Definition

"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 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 medications that are anticoagulant and antiplatelet medications used to reduce stroke mortality and morbidity.
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 antithrombotic medication, including oral, rectal, and injectable dose forms.
Exclusion Criteria: Excludes concepts that represent enoxaparin and heparin generally given for VTE prophylaxis.

Constrained to codes in the Antithrombotic Therapy for Ischemic Stroke value set (2.16.840.1.113762.1.4.1110.62)

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 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 Medical Reason For Not Providing Treatment value set (2.16.840.1.113883.3.117.1.7.1.473)

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 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 Patient Refusal value set (2.16.840.1.113883.3.117.1.7.1.93)

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 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 payer 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 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 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 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.

Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to represent concepts for procedures of intravenous or intra-arterial thrombolytic (t-PA) therapy.
Data Element Scope: This value set may use a model element related to Procedure.
Inclusion Criteria: Includes concepts that identify a procedure for intravenous or intra-arterial thrombolytic (t-PA) therapy.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intravenous or Intraarterial Thrombolytic tPA Therapy value set (2.16.840.1.113762.1.4.1045.21)

QDM Datatype and Definition

"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.
  • See section 6.4 for guidance about differentiating between successful and unsuccessful procedures.