Topic Mismatch issue between the value sets provided in MU Stage 2 CQM NQF 0469 and the QRDA Patient Characteristic Gestational Age template. Consensus was reached between representatives from MITRE, OFMQ, ONC, Telligen, CA Maternity, TJC (should be Governance group) effective February 3, 2014. Key Terms Value Sets, MU Stage 2, NQF 0469, QRDA, QRDA Patient Characteristic Gestational Age template Short-term solution for April annual update (see language below):  Use “physical exam finding” QDM element for Gestational Age calculation.  Change the logic to remove the SNOMED code(s) and replace them with a scalar value in weeks. Long-term plans (post-2014 Annual Update):  Standard to be updated with new template for QRDA that codes for “estimated date of confinement”  All 3 measures to be re-specified using new concept  Investigate related clinical data elements in eSpecifications used by The National Institute of Statistics supporting Public Health (working with Dr. Elliot Main).  Include the right attributes in QDM, create the templates that match the new attributes in HQMF and modify the MAT to allow for use of the new attribute as a long term solution. ______________________________________________________________________________ Updated Solution as of March 25, 2014 (language from the Logic and Implementation Guidance Document v1.6) : Three of the 2014 measures are designed to be used in the encounter including delivery, birth, or immediately after birth. In the 2014 specifications, a newborn at term indicates the gestational age is ≥ 37 weeks. For the Eligible Hospital update published in 2013, systems were asked to capture gestational age using the gestational age codes from SNOMED CT; however, this created a QRDA standard violation. This problem has been corrected for the 2014 annual update such that vendors/ providers generating QRDA-1 must now use the “physical exam finding” QDM element with a scalar value in weeks to codify the gestational age. The measures using this content has been updated in the EH measure update published on April 1, 2014. ________________________________________________________________________________ Original Solution from May 14 2013: QRDA spec requires the value to be in PQ format (value, units). This is a real problem. This has been submitted as a candidate erratum to the specification (see http://www.hl7.org/dstucomments/showdetail.cfm?dstuid=80) issue #195 dated 2/21/13. Here is the text: There is a bit of a mismatch between the value sets provided in MS Stage 2 CQM NQF 0469 and the Patient Characteristic Gestational Age template. NQF 0469 have value sets that provides codes used to represent gestational age. For example SNOMED-CT 57907009 for 36 week gestation period. Patient Characteristic Gestational Age locks down the code to SNOMED-CT 57036006 (length of gestation) and then requires the length of gestation to be placed in the value element. This creates two problems. It is not possible to properly use the stdc:valueSet attribute on the code element to list a value set from measure NQF 0469. Additionally, it is not possible to use the SNOMED-CT codes provided by the measure in this template. Somewhat analogous to issues 634 and 471 which highlight vocabulary discrepancies, this issue shows a discrepancy between a QRDA template that was derived from an existing CDA template (in the Neonatal Care Report) and the way that eMeasure implemented the Patient Characteristic Gestational Age template. A short term solution for now would be to allow the QRDA instance to contain an observation value that is either a Physical Quality or a Concept. Longer term, I'd suggest the eMeasures be updated, to remove the value sets, and instead use physical quantity based criteria. ______________________________________________________ Solution Update 08/21/14: This issue will be taken for further review to an obstetrics informatics group to determine whether updates are needed to both HL7 standards and the QDM to capture gestational age using an estimated date of confinement and then back or forward calculating the gestational age. We continue to welcome ongoing commentary from stakeholders and will forward to the relevant working groups.