​Thank you for your question. The ingredient-specific value sets were created to mitigate an implementation issue with documentation of negation. Specifically, implementers indicated it was difficult to attach the negation to a particular form of a medication (e.g. Aspirin oral table 500mg). The expectation for medication orders and medication administration is that implementers would be able to capture sufficient information to map to the more granular medication term type used in the value sets, which include the ingredient, strength and dose form. Therefore, there are no plans to add ingredients for measure logic other than where currently used (ie, negation).

 In the current measure specifications (CMS135, 140, 141, 144, and 145), “Medication, Order not done” and “Medication, Allergy” QDM datatypes are linked to ingredient specific value sets. However, feedback from the field suggests that we should be linking the “Medication, Order not done” to the RxNorm SCD value set that represents the prescribable medications, as the approach to reporting “not done” in QRDA has been changed. We were informed that when the expected medications are “not done”, measure implementers simply send “N/A” and link to the OID of the RxNorm SCD (prescribable medications) value set. We also received feedback for ingredient specific value sets to only contain term type IN to be consistent with EH ingredient specific value sets. Currently, the ingredient specific value sets include term types IN, BN, PIN, and MIN.   In order to align the practices across the EP and EH programs, we propose to revise the included term types used within the RxNorm ingredient specific value sets with those used in the EH program. We also propose to link the ingredient specific value sets to the QDM datatype “Medication, Allergy” only, and establish a new link for the QDM datatype “Medication, Order not done” with the RxNorm value set for prescribable medications.   eCQI Resource Center Specs: https://ecqi.healthit.gov/ep/ecqms-2017-performance-period/heart-failure-hf-angiotensin-converting-enzyme-ace-inhibitor-or https://ecqi.healthit.gov/ep/ecqms-2017-performance-period/heart-failure-hf-beta-blocker-therapy-left-ventricular-systolic https://ecqi.healthit.gov/ep/ecqms-2017-performance-period/coronary-artery-disease-cad-beta-blocker-therapy-prior-myocardial We seek feedback on the following proposed changes: 1. Revise logic for QDM datatype “Medication, Order not done” to be linked to the RxNorm SCD (prescribable medications) value set, rather than the relevant ingredient specific value sets. 2. Remove term types BN, PIN, and MIN from ingredient specific value sets, only retain term type IN to be consistent with EH ingredient specific value sets. 3. “Medication, Allergy” datatype will remain to be linked to ingredient specific value sets.

 - Revise logic for QDM datatype “Medication, Order not done” to be linked to the RxNorm SCD (prescribable medications) value set, rather than the relevant ingredient specific value sets.  CMS135: ACE Inhibitor or ARB (OID 2.16.840.1.113883.3.526.3.1139) is replacing ACE Inhibitor or ARB Ingredient (OID (2.16.840.1.113883.3.526.3.1489) CMS144 and 145: Beta Blocker Therapy for LVSD (OID 2.16.840.1.113883.3.526.3.1184) is replacing Beta Blocker Therapy Ingredient (OID 2.16.840.1.113883.3.526.3.1493​) - Remove term types BN, PIN, and MIN from ingredient specific value sets, only retain term type IN to be consistent with EH ingredient specific value sets.