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  1. eCQM Issue Tracker
  2. CQM-634

Conflict between QRDA Cat I specification and HQMF Measure definitions WRT routeCode

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      As a tactical fix, the routeCode constraints have been removed from the schematron rules, as suggested by Bob Dolin. This will be noted in CMS implementation guidance.

      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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      As a tactical fix, the routeCode constraints have been removed from the schematron rules, as suggested by Bob Dolin. This will be noted in CMS implementation guidance. 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.

      The QRDA Cat I specification states the following wrt to routeCodes:

      routeCode, which SHALL be selected from ValueSet Medication Route FDA Value Set 2.16.840.1.113883.3.88.12.3221.8.7

      This effectively causes all routeCodes to be coded in NCI Thesaurus as that is the only code system in the FDA valueset 2.16.840.1.113883.3.88.12.3221.8.7.

      All of the e-measures specify routeCode using SNOMED-CT so this creates a bit of an impedance mismatch between what the measures state is required and what is capable of being transmitted in a CAT I document.

            saul.kravitz Saul Kravitz (Inactive)
            rdrr Robert Dingwell (Inactive)
            Kevin Larsen (Inactive), Rob McClure, Saul Kravitz (Inactive)
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