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  1. eCQM Issue Tracker
  2. CQM-636

Incompatibility in reporting HQMF Substance Administered in QRDA Category I documents

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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.

      This issue has been filed as an errata item against the QRDA CAt I DSTU as comment #272.

      The HQMF template "Substance Administered" is mapped to the QRDA template "Medication Administered - 2.16.840.1.113883.10.20.24.3.42 " . The Medication Administered template is then required to contain a Medication Activity entry via (CONF:12456). The Medication Activity template is then required to contain a consumable (CONF:7520). which is required to contain a Medication Information through (CONF:16085). The Medication Information template is required to use data coded in RxNorm via (CONF: 7412).

      This last requirement to enforce codes from RxNorm presents issues when translating from HQMF Substance Administered items as they do not all fall within the RxNorm category.

      Example: e Measure NQF 480 declares a Substance Administered of Breast Milk - translating this to Medication Administered in QRDA would require there to be an RxNorm code that represents Breast Milk, but one does not exist.

      The general issue here being that not all Substance Administered are going to be representable via Medication Administered because not everything that is administrable is going to be a medication. The Medication Information template constraint on requiring the use of RXNORM as the code system should be relaxed to allow other code systems.

            yanheras Yan Heras
            rdrr Robert Dingwell (Inactive)
            Bob Dolin (Inactive), Kevin Larsen (Inactive), Saul Kravitz (Inactive)
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