ecqm.measure

CMS147v8 - Preventive Care and Screening: Influenza Immunization

Rationale:

Preventive Care and Screening: Influenza Immunization. Influenza vaccination is the most effective protection against influenza virus infection (CDC, 2016). Influenza may lead to serious complications including hospitalization or death (CDC, 2016). Influenza vaccine is recommended for all persons aged >=6 months who do not have contraindications to vaccination. However, data indicate that less than half of all eligible individuals receive an influenza vaccination (CDC, 2015). This measure promotes annual influenza vaccination for all persons aged >= 6 months.

Data Elements

InfluenzaVaccineAllergyIntolerance

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

ResultValue constrained to codes in the Influenza Vaccine valueset (2.16.840.1.113883.3.526.3.1254)

AllergyIntolerance: Allergy is used to address immune-mediated reactions to a substance such as type 1 hypersensitivity reactions, other allergy-like reactions, including pseudo-allergy. Intolerance is a record of a clinical assessment of a propensity, or a potential risk to an individual, to have a non-immune mediated adverse reaction on future exposure to the specified substance, or class of substance.

DataType

Cardinality

InfluenzaVaccineAllergyIntolerance

0..*

InfluenzaVaccineAdministered

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

ObservableCode constrained to codes in the Influenza Vaccine Administered valueset (2.16.840.1.113883.3.464.1003.110.12.1044).

Procedure: Procedure is derived directly from HL7 and Canada Health Infoway: “An Act whose immediate and primary outcome (post-condition) is the alteration of the physical condition of the subject. ... Procedure is but one among several types of clinical activities such as observation, substance- administrations, and communicative interactions ... Procedure does not comprise all acts of [sic] whose intent is intervention or treatment.”17 A procedure may be a surgery or other type of physical manipulation of a person’s body in whole or in part for purposes of making observations and diagnoses or providing treatment

DataType

Cardinality

InfluenzaVaccineAdministered

0..*

InfluenzaVaccinationAllergyIntolerance

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

ResultValue constrained to codes in the Influenza Vaccination valueset (2.16.840.1.113883.3.526.3.402)

AllergyIntolerance: Allergy is used to address immune-mediated reactions to a substance such as type 1 hypersensitivity reactions, other allergy-like reactions, including pseudo-allergy. Intolerance is a record of a clinical assessment of a propensity, or a potential risk to an individual, to have a non-immune mediated adverse reaction on future exposure to the specified substance, or class of substance.

DataType

Cardinality

InfluenzaVaccinationAllergyIntolerance

0..*

InfluenzaVaccinationPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Influenza Vaccination

ProcedurePerformed: 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: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) 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. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

InfluenzaVaccinationPerformed

0..*

EggSubstanceAllergyIntolerance

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

ResultValue constrained to codes in the Egg Substance valueset (2.16.840.1.113883.3.526.3.1537)

AllergyIntolerance: Allergy is used to address immune-mediated reactions to a substance such as type 1 hypersensitivity reactions, other allergy-like reactions, including pseudo-allergy. Intolerance is a record of a clinical assessment of a propensity, or a potential risk to an individual, to have a non-immune mediated adverse reaction on future exposure to the specified substance, or class of substance.

DataType

Cardinality

EggSubstanceAllergyIntolerance

0..*

PreviousReceiptOfInfluenzaVaccineCommunicationFromPatientToProvider

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

ObservableCode constrained to codes in the Previous Receipt of Influenza Vaccine valueset (2.16.840.1.113883.3.526.3.1185)

CommunicationFromPatientToProvider: To meet criteria using this datatype, the communication indicated by the Communication QDM category and its corresponding value set must be communicated from a patient to a provider. Timing: The time the communication occurs, or is sent; Author dateTime.

DataType

Cardinality

PreviousReceiptOfInfluenzaVaccineCommunicationFromPatientToProvider

0..*

InfluenzaVaccinationDeclinedCommunicationFromPatientToProvider

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

ObservableCode constrained to codes in the Influenza Vaccination Declined valueset (2.16.840.1.113883.3.526.3.1255)

CommunicationFromPatientToProvider: To meet criteria using this datatype, the communication indicated by the Communication QDM category and its corresponding value set must be communicated from a patient to a provider. Timing: The time the communication occurs, or is sent; Author dateTime.

DataType

Cardinality

InfluenzaVaccinationDeclinedCommunicationFromPatientToProvider

0..*

AllergyToEggsDiagnosis

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

ResultValue constrained to codes in the Allergy to Eggs valueset (2.16.840.1.113883.3.526.3.1253)

Diagnosis: Condition/Diagnosis/Problem represents a practitioner’s identification of a patient’s disease, illness, injury, or condition. This category contains a single datatype to represent all of these concepts: Diagnosis. A practitioner determines the diagnosis by means of examination, diagnostic test results, patient history, and/or family history. Diagnoses are usually considered unfavorable, but may also represent neutral or favorable conditions that affect a patient’s plan of care (e.g., pregnancy). The QDM does not prescribe the source of diagnosis data in the EHR. Diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. The preferred terminology for diagnoses is SNOMED-CT, but diagnoses may also be encoded using ICD-9/10. The Diagnosis datatype should not be used for differential diagnoses or rule-out diagnoses (neither of which are currently supported by the QDM).

DataType

Cardinality

AllergyToEggsDiagnosis

0..*

AllergyToInfluenzaVaccineDiagnosis

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

ResultValue constrained to codes in the Allergy to Influenza Vaccine valueset (2.16.840.1.113883.3.526.3.1256)

Diagnosis: Condition/Diagnosis/Problem represents a practitioner’s identification of a patient’s disease, illness, injury, or condition. This category contains a single datatype to represent all of these concepts: Diagnosis. A practitioner determines the diagnosis by means of examination, diagnostic test results, patient history, and/or family history. Diagnoses are usually considered unfavorable, but may also represent neutral or favorable conditions that affect a patient’s plan of care (e.g., pregnancy). The QDM does not prescribe the source of diagnosis data in the EHR. Diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. The preferred terminology for diagnoses is SNOMED-CT, but diagnoses may also be encoded using ICD-9/10. The Diagnosis datatype should not be used for differential diagnoses or rule-out diagnoses (neither of which are currently supported by the QDM).

DataType

Cardinality

AllergyToInfluenzaVaccineDiagnosis

0..*

IntoleranceToInfluenzaVaccineDiagnosis

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

ResultValue constrained to codes in the Intolerance to Influenza Vaccine valueset (2.16.840.1.113883.3.526.3.1257)

Diagnosis: Condition/Diagnosis/Problem represents a practitioner’s identification of a patient’s disease, illness, injury, or condition. This category contains a single datatype to represent all of these concepts: Diagnosis. A practitioner determines the diagnosis by means of examination, diagnostic test results, patient history, and/or family history. Diagnoses are usually considered unfavorable, but may also represent neutral or favorable conditions that affect a patient’s plan of care (e.g., pregnancy). The QDM does not prescribe the source of diagnosis data in the EHR. Diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. The preferred terminology for diagnoses is SNOMED-CT, but diagnoses may also be encoded using ICD-9/10. The Diagnosis datatype should not be used for differential diagnoses or rule-out diagnoses (neither of which are currently supported by the QDM).

DataType

Cardinality

IntoleranceToInfluenzaVaccineDiagnosis

0..*

OfficeVisit1Performed

Clinical Focus: This value set identifies patients who have had an office or other outpatient visit.

Data Element Scope: This value set was intended to map to the QDM data type of encounter.

Inclusion Criteria: Includes comprehensive history, evaluation, and management of a patient in an office or outpatient facility. Patient can be presenting with problems that are minor to high severity.

Exclusion Criteria: Excludes non-office visits, including telehealth services.

Subject constrained to the Office Visit1

EncounterPerformed: 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. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

OfficeVisit1Performed

0..*

OutpatientConsultationPerformed

Clinical Focus: This value set indentifies patients who have had an outpatient interaction at an office with a member of their medical care team.

Data Element Scope: This value set was intended to map to the QDM data type of encounter.

Inclusion Criteria: Includes comprehensive history, evaluation, and management of a patient in an office or outpatient facility. Patient can be presenting with problems that are minor to high severity.

Exclusion Criteria: Excludes non-office visits, including telehealth services.

Subject constrained to the Outpatient Consultation

EncounterPerformed: 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. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

OutpatientConsultationPerformed

0..*

NursingFacilityVisitPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Nursing Facility Visit

EncounterPerformed: 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. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

NursingFacilityVisitPerformed

0..*

DischargeServicesNursingFacilityPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Discharge Services - Nursing Facility

EncounterPerformed: 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. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

DischargeServicesNursingFacilityPerformed

0..*

CareServicesInLongTermResidentialFacilityPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Care Services in Long-Term Residential Facility

EncounterPerformed: 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. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

CareServicesInLongTermResidentialFacilityPerformed

0..*

HomeHealthcareServicesPerformed

Clinical Focus: This value set identifies patients who have had a home health visit by a provider for the evaluation or management of a new or existing patient.

Data Element Scope: This value set was intended to map to the QDM data type of encounter.

Inclusion Criteria: Include all home visits for the evaluation and management of a new or established patient.

Exclusion Criteria: None

Subject constrained to the Home Healthcare Services

EncounterPerformed: 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. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

HomeHealthcareServicesPerformed

0..*

PreventiveCareServicesInitialOfficeVisit0To17Performed

Clinical Focus: Initial comprehensive preventive medical evaluation, including regular preventive care or care of small problem or preexisting condition that requires no extra work, for a patient that has no prior outpatient professional services from the physician practice in the last 3 years.

Data Element Scope: This value set was intended to map to the QDM data type of encounter.

Inclusion Criteria: Include only codes that indicate initial comprehensive preventive medical evaluation, including regular preventive care or care of small problem or preexisting condition that requires no extra work, for a patient that has no prior outpatient professional services from the physician practice in the last 3 years.

Exclusion Criteria: Exclude codes that are not for comprehensive preventive medical evaluations and codes that are for patients who have been seen in the last 3 years.

Subject constrained to the Preventive Care Services, Initial Office Visit, 0 to 17

EncounterPerformed: 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. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

PreventiveCareServicesInitialOfficeVisit0To17Performed

0..*

PreventiveCareServicesInitialOfficeVisit18AndUp1Performed

Clinical Focus: This value set identifies patients over the age of 18 who have had an initial preventive care office visit.

Data Element Scope: This value set was intended to map to the QDM data type of encounter.

Inclusion Criteria: Includes comprehensive preventive medicine reevaluation and management of an individual over the age of 18.

Exclusion Criteria: Excludes non-office visits, including telehealth services.

Subject constrained to the Preventive Care Services-Initial Office Visit, 18 and Up1

EncounterPerformed: 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. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

PreventiveCareServicesInitialOfficeVisit18AndUp1Performed

0..*

PreventiveCareEstablishedOfficeVisit0To17Performed

Clinical Focus: Initial comprehensive preventive medical evaluation, including regular preventive care or care of small problem or preexisting condition that requires no extra work, for a patient that received prior outpatient professional services from the physician practice in the last 3 years.

Data Element Scope: This value set was intended to map to the QDM data type of encounter.

Inclusion Criteria: Include only codes that indicate initial comprehensive preventive medical evaluation, including regular preventive care or care of small problem or preexisting condition that requires no extra work, for a patient that received prior outpatient professional services from the physician practice in the last 3 years.

Exclusion Criteria: Exclude codes that are not for comprehensive preventive medical evaluations and codes that are for patients who have not been seen in the last 3 years.

Subject constrained to the Preventive Care, Established Office Visit, 0 to 17

EncounterPerformed: 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. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

PreventiveCareEstablishedOfficeVisit0To17Performed

0..*

PreventiveCareServicesEstablishedOfficeVisit18AndUp1Performed

Clinical Focus: This value set identifies patients over the age of 18 who have had an established preventive care office visit.

Data Element Scope: This value set was intended to map to the QDM data type of encounter.

Inclusion Criteria: Includes comprehensive preventive medicine reevaluation and management of an individual over the age of 18.

Exclusion Criteria: Excludes non-office visits, including telehealth services.

Subject constrained to the Preventive Care Services - Established Office Visit, 18 and Up1

EncounterPerformed: 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. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

PreventiveCareServicesEstablishedOfficeVisit18AndUp1Performed

0..*

PreventiveCareServicesIndividualCounselingPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Preventive Care Services-Individual Counseling

EncounterPerformed: 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. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

PreventiveCareServicesIndividualCounselingPerformed

0..*

PreventiveCareServicesGroupCounselingPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Preventive Care Services - Group Counseling

EncounterPerformed: 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. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

PreventiveCareServicesGroupCounselingPerformed

0..*

PreventiveCareServicesOtherPerformed

Clinical Focus: This value set identifies patients who patients who had an unlisted preventive medicine service. Inclusion: Includes unlisted preventive medicine services

Data Element Scope: This value set was intended to map to the QDM data type of encounter.

Inclusion Criteria: Includes unlisted preventive medicine services.

Exclusion Criteria: Excludes visits that are not performed in-person, including telehealth services.

Subject constrained to the Preventive Care Services - Other

EncounterPerformed: 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. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

PreventiveCareServicesOtherPerformed

0..*

PatientProviderInteractionPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Patient Provider Interaction

EncounterPerformed: 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. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

PatientProviderInteractionPerformed

0..*

AnnualWellnessVisit1Performed

Clinical Focus: This value set contains concepts related to annual wellness visits.

Data Element Scope: The intent of this data element is to identify patients who have had an annual wellness visit. Using the Quality Data Model, this particular data element would be classified under the 'Encounter' category.

Inclusion Criteria: Includes encounters specific to annual wellness visits.

Exclusion Criteria: None

Subject constrained to the Annual Wellness Visit1

EncounterPerformed: 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. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

AnnualWellnessVisit1Performed

0..*

EncounterInfluenzaPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Encounter-Influenza

EncounterPerformed: 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. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

EncounterInfluenzaPerformed

0..*

MedicalReason1NegationRationale

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

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 Vs lack of documentation about allergies). The syntax in the human readable HQMF is address in CQL examples and in the MAT User Guide. Prior versions of QDM used the syntax, “Procedure, Performed not done.” QDM 5.0 DRAFT uses the syntax, “Procedure, not Performed.” Note: Some datatypes include both Relevant Time and Author dateTime attributes. The purpose is to accommodate Author dateTime if the actual start and stop times are not available when evaluating for feasibility, and also to allow specification of a time for Negation Rationale.

DataType

Cardinality

MedicalReason1NegationRationale

0..*

PatientReasonNegationRationale

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

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 Vs lack of documentation about allergies). The syntax in the human readable HQMF is address in CQL examples and in the MAT User Guide. Prior versions of QDM used the syntax, “Procedure, Performed not done.” QDM 5.0 DRAFT uses the syntax, “Procedure, not Performed.” Note: Some datatypes include both Relevant Time and Author dateTime attributes. The purpose is to accommodate Author dateTime if the actual start and stop times are not available when evaluating for feasibility, and also to allow specification of a time for Negation Rationale.

DataType

Cardinality

PatientReasonNegationRationale

0..*

SystemReasonNegationRationale

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

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 Vs lack of documentation about allergies). The syntax in the human readable HQMF is address in CQL examples and in the MAT User Guide. Prior versions of QDM used the syntax, “Procedure, Performed not done.” QDM 5.0 DRAFT uses the syntax, “Procedure, not Performed.” Note: Some datatypes include both Relevant Time and Author dateTime attributes. The purpose is to accommodate Author dateTime if the actual start and stop times are not available when evaluating for feasibility, and also to allow specification of a time for Negation Rationale.

DataType

Cardinality

SystemReasonNegationRationale

0..*

EthnicityPatientCharacteristicEthnicity

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

ResultValue constrained to codes in the Ethnicity valueset (2.16.840.1.114222.4.11.837)

PatientCharacteristicEthnicity: 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.

DataType

Cardinality

EthnicityPatientCharacteristicEthnicity

0..*

OncAdministrativeSexPatientCharacteristicGender

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.

ResultValue constrained to codes in the ONC Administrative Sex valueset (2.16.840.1.113762.1.4.1)

PatientCharacteristicGender: 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.

DataType

Cardinality

OncAdministrativeSexPatientCharacteristicGender

0..*

PayerPatientCharacteristicPayer

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

ResultValue constrained to codes in the Payer valueset (2.16.840.1.114222.4.11.3591)

PatientCharacteristicPayer: 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 Relevant Period addresses: startTime – The first day of insurance coverage with the referenced payer stopTime – The last day of insurance coverage with the referenced payer

DataType

Cardinality

PayerPatientCharacteristicPayer

0..*

RacePatientCharacteristicRace

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

ResultValue constrained to codes in the Race valueset (2.16.840.1.114222.4.11.836)

PatientCharacteristicRace: 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.

DataType

Cardinality

RacePatientCharacteristicRace

0..*

HemodialysisPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Hemodialysis

ProcedurePerformed: 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: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) 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. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

HemodialysisPerformed

0..*

PeritonealDialysisPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Peritoneal Dialysis

ProcedurePerformed: 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: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) 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. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

PeritonealDialysisPerformed

0..*