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.

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.

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.

Data elements that meet criteria using this datatype should document that the patient has one or more of the ethnicities indicated by the QDM category and its corresponding value set.

Timing: Ethnicity does not have a specific timing. Measures using "Patient Characteristic, Ethnicity" should address the most recent entry in the clinical record.

Data elements that meet criteria using this datatype should document that the patient has one or more of the payers indicated by the QDM category and its corresponding value set.

Timing:

The relevantPeriod addresses:

• startTime – the first day of insurance coverage with the referenced payer.
• stopTime – the last day of insurance coverage with the referenced payer.

Data elements that meet criteria using this datatype should document the patient’s race.

Timing: Race does not have a specific timing. Measures using "Patient Characteristic, Race" should address the most recent entry in the clinical record.

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

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

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.