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  2. CQM-1681

Clarification on CMS60v4 Multiple Results for ECG

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      ​Thank you for your inquiry. It is true QRDA-1 does not currently allow multiple result values for the same diagnostic test, but the EHR itself (the source of data) will most likely allow multiple values for the same test stored in the datebase. To submit data in QRDA-I, “AND NOT” will not be submitted, the absence of diagnostic study ECG STEMI Exclusions in QRDA-I means that it is a “NOT”.

      We will discuss this further with the measure steward to determine if it is true whether a result of Acute or Evolving MI means NOT STEMI Exclusions is always true. If so, then we will plan to remove the AND NOT clause (AND NOT: "Occurrence A of Diagnostic Study, Performed: Electrocardiogram (ECG) (result: STEMI Exclusions).
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      ​Thank you for your inquiry. It is true QRDA-1 does not currently allow multiple result values for the same diagnostic test, but the EHR itself (the source of data) will most likely allow multiple values for the same test stored in the datebase. To submit data in QRDA-I, “AND NOT” will not be submitted, the absence of diagnostic study ECG STEMI Exclusions in QRDA-I means that it is a “NOT”. We will discuss this further with the measure steward to determine if it is true whether a result of Acute or Evolving MI means NOT STEMI Exclusions is always true. If so, then we will plan to remove the AND NOT clause (AND NOT: "Occurrence A of Diagnostic Study, Performed: Electrocardiogram (ECG) (result: STEMI Exclusions).

      In the Denominator block of CMS60v4, the ANDed lines referencing "Occurrence A of Diagnostic Study, Performed: Electrocardiogram (ECG)" specify "result: Acute or Evolving MI" AND NOT "result: STEMI Exclusions".

      • AND: "Occurrence A of Diagnostic Study, Performed: Electrocardiogram (ECG) (result: Acute or Evolving MI)"
      • AND NOT: "Occurrence A of Diagnostic Study, Performed: Electrocardiogram (ECG) (result: STEMI Exclusions)"

      Given that a single Diagnostic Study template in QRDA can only have one result (SHOULD contain zero or one (0..1) @value) and there are no codes that are shared between the referenced value sets, how should we interpret the logic for implementation?

      For clarification, here are the possible interpretations I see:

      • The Occurrence A scope definition is intended to include the result value so that the 2 statements are treated as separate occurrences (e.g. Any occurrence of ECG (result: Acute or Evolving MI) AND NOT any occurrence of ECG (result: STEMI Exclusion).
      • The QRDA entries are intended to be linked via a common <id/@root> identifier to provide for multiple result values for a single ECG test
      • The AND NOT statement is superfluous since QRDA only allows for a single result per <entry> and consequently an ECG with result: Acute or Evolving MI cannot also have a result: STEMI Exclusion

      This question was previously asked and unanswered in CQM-1243

            JLeflore Joelencia Leflore
            bthiessen Brian Thiessen (Inactive)
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