Medication Active - Can you clarify the description and also provide us some examples?

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    • Type: Value Sets
    • Resolution: Fixed
    • Priority: Major
    • Component/s: Measure
    • None
    • Manish Parekhji
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      Discharge and Active medications are both described in the QRDA-I Implementation guide.
      Active Meds use CDA Template 2.16.840.1.113883.10.20.24.3.41.
      Discharge Meds use CDA Template 2.16.840.1.113883.10.20.24.3.105
      Active medications are those on the "active list" of the patients admission, as maintained by the provider. For discharge meds, see http://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_eCQM_Measure_Logic_Guidancev13_April2013.pdf.
      Table 323 doesn't include "Medication, Discharge" because it was added during late 2012 to the measures, and mapped to the existing template that had been allocated to support "Discharge MEdication (Health Record Field Flow Attribute)" that was not used in the measures.
      The STK6 Logic:
      AND NOT: "Occurrence A of Medication, Active: Lipid-lowering Agent" ends before start of "Occurrence A of Encounter, Performed: Non-Elective Inpatient Encounter"
      AND: "Occurrence A of Medication, Active: Lipid-lowering Agent" starts before start of "Occurrence A of Encounter, Performed: Non-Elective Inpatient Encounter"
      Means that the Lipid-Lowering agent starts PRIOR to admission, and continues past the start of the admission. In other words that there is temporal overlap between the medication active and the admission.
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      Discharge and Active medications are both described in the QRDA-I Implementation guide. Active Meds use CDA Template 2.16.840.1.113883.10.20.24.3.41. Discharge Meds use CDA Template 2.16.840.1.113883.10.20.24.3.105 Active medications are those on the "active list" of the patients admission, as maintained by the provider. For discharge meds, see http://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_eCQM_Measure_Logic_Guidancev13_April2013.pdf . Table 323 doesn't include "Medication, Discharge" because it was added during late 2012 to the measures, and mapped to the existing template that had been allocated to support "Discharge MEdication (Health Record Field Flow Attribute)" that was not used in the measures. The STK6 Logic: AND NOT: "Occurrence A of Medication, Active: Lipid-lowering Agent" ends before start of "Occurrence A of Encounter, Performed: Non-Elective Inpatient Encounter" AND: "Occurrence A of Medication, Active: Lipid-lowering Agent" starts before start of "Occurrence A of Encounter, Performed: Non-Elective Inpatient Encounter" Means that the Lipid-Lowering agent starts PRIOR to admission, and continues past the start of the admission. In other words that there is temporal overlap between the medication active and the admission.

      Several EH measures use the data element - Medication Active - but I have not seen a detailed description of how to use this concept in the QRDA and in the measures.

      In the Cypress QRDA test data files, there are examples where Active Medications are ALWAYS included under the DISCHARGE MEDICATION entry.

      My question is - can hospitals report an ACTIVE MEDICATION which is not a discharge medication? If so, can you provide us with an example QRDA entry of this situation? I think the answer is yes, because some measures check for Active medications prior to admission.

      It would be helpful to understand your interpretation of the concept of Medication Active.

      STK-6 has the following logic -
      â– AND NOT: "Occurrence A of Medication, Active: Lipid-lowering Agent" ends before start of "Occurrence A of Encounter, Performed: Inpatient Encounter"

      I would think what this is saying is that the Lipid Lowering agent should continue to be active after Admission Date (i.e. end date cannot be before admission date). In this example if the lipid lowering agent was active on admission but discontinued before discharge, meaning, not a discharge medication, what would that entry look like in the QRDA CAT 1 file? Would you still consider this an active medication? It is not active at discharge, but it was active when the patient was admitted.

      Also refer to CQM-433 where the submitter is asking a similar question. It seems there is need to clarify the description and expected implementation of the concept of Medication Active. An example of Medication Active, that is not a Discharge Medication in the test QRDA files would be very helpful and a first step.

      Thanks for your review and the opportunity to provide this feedback.

            Assignee:
            Julia Skapik (Inactive)
            Reporter:
            Manish Parekhji
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