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  1. eCQM Issue Tracker
  2. CQM-471

Clarification on Discharge Status Required by CQM Algorithms

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      There are several cases where a QRDA template, having been derived from a C-CDA template, has vocabulary constraints that conflict with the value sets used in eMeasures: gender, discharge disposition, route code, etc. Below are the resolutions for resolving this issue of conflicting vocabulary constraints:

      1) Short-term: relax the validation to allow for SNOMED route codes; provide guidance to implementers that SNOMED route codes will be accepted.

      2) Intermediate-term: work with NLM/VSAC to support measure developers creating value sets that align with approved vocabulary recommendations.

      3) Longer-term: QRDA templates inherit from C-CDA templates, and therefore adhere to C-CDA vocabulary recommendations. eCQMs adhere to HITSC vocabulary recommendations. In a few cases, the recommendations haven’t aligned. The longer-term suggestion was to invite HL7 into the LEAN process to help identify the reason for these mismatches and to collaborate on a “single source of truth” solution.
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      There are several cases where a QRDA template, having been derived from a C-CDA template, has vocabulary constraints that conflict with the value sets used in eMeasures: gender, discharge disposition, route code, etc. Below are the resolutions for resolving this issue of conflicting vocabulary constraints: 1) Short-term: relax the validation to allow for SNOMED route codes; provide guidance to implementers that SNOMED route codes will be accepted. 2) Intermediate-term: work with NLM/VSAC to support measure developers creating value sets that align with approved vocabulary recommendations. 3) Longer-term: QRDA templates inherit from C-CDA templates, and therefore adhere to C-CDA vocabulary recommendations. eCQMs adhere to HITSC vocabulary recommendations. In a few cases, the recommendations haven’t aligned. The longer-term suggestion was to invite HL7 into the LEAN process to help identify the reason for these mismatches and to collaborate on a “single source of truth” solution.

      Please provide clarification in regards to determining Discharge Status from a QRDA Cat I document. This element is required by numerous CQM algorithms (e.g. Stroke Education). Listed below are some conflicting considerations we are trying to work through:

      • The HL7 Implementation Guide refers to an element within the Encounter Activities entry for sdtc:dischargeDisposition which calls for a code of type “NUBC UB-04 FL17-Patient Status DYNAMIC or, if access to NUBC is unavailable, from CodeSystem 2.16.840.1.113883.12.112 HL7 Discharge Disposition”. There are no implementation examples in the guide.

      • The CQM algorithms are expecting a value set which uses only SNOMED codes. The Cypress samples are also using SNOMED codes for the sdtc:dischargeDisposition element. Example: <sdtc:dischargeDispositionCode code="10161009" codeSystem="2.16.840.1.113883.6.96"/>

      • Other documentation seems to indicate that Transfer To and Transfer From templates in the QRDA Cat I document might also be used as a discharge code, but the value sets referenced by the algorithms don’t seem to apply to the Transfer templates. The Transfer value sets don’t contain the necessary discharge status values (e.g. Discharged Home or Discharged to Police Custody)

      The Cypress approach of using sdtc:dischargeDisposition with a SNOMED code works fine for us, but we want to make sure that is the appropriate method both to obtain the value when consuming a QRDA document, and to submit the value to CMS.

      Can you please provide further clarification in this matter?

      Thank you

            yanheras Yan Heras
            bthiessen Brian Thiessen (Inactive)
            Abt Associate (Inactive), Deborah Krauss (Inactive), Saul Kravitz (Inactive)
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