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  1. eCQM Issue Tracker
  2. CQM-709

Incorrect code system for route in QRDA generated by Cypress 2.2.0

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      Cypress v2.3 and its associated measure bundles will output the SNOMED code system OID.

      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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      Cypress v2.3 and its associated measure bundles will output the SNOMED code system OID. 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.
    • CMS108v1/NQF371, CMS109v1/NQF0374, CMS114v1/NQF0376, CMS171v1/NQF0527, CMS172v1/NQF0528, CMS188v1/NQF0147, CMS190v1/NQF0372

      In the generated HTML for the 19 EH test patients, route is always specified as a SNOMED-CT code. But in the QRDA output generated by Cypress 2.2.0 for the Medication Administered template, the routeCode element specifies the correct SNOMED-CT code, yet reports the code system as 2.16.840.1.113883.3.26.1.1 (NCI Thesaurus).

      Example from HTML:

      Route: code_system: SNOMED-CT code: 418114005 title: Intravenous route

      Corresponding QRDA:

      <routeCode code="418114005" codeSystem="2.16.840.1.113883.3.26.1.1"/>

      The code system should be 2.16.840.1.113883.6.96 (SNOMED-CT).

      When consuming these QRDA files, calculation engines that include the code system when matching codes against value sets (as they reasonably should) will fail to match these routes against the value sets in the affected measures, thus failing the measures.

      This issue is related to CQM-634 but is, I believe, sufficiently different to warrant this separate submission. CQM-634 drives at possible changes to the QRDA specification and/or the Medication Route FDA value set. This issue is specifically about the QRDA output that Cypress generates with the nonsensical statement that a SNOMED-CT code is actually an NCI Thesaurus code. Regardless of the possible changes to the spec or value set, the current QRDA output is wrong. It should either be changed to specify the SNOMED-CT OID or be removed altogether since the code is not in the value set.

      But the latter approach would further break certification testing since the route code is needed to satisfy various measures. Further in favor of the first approach (specifying the correct code system), the QRDA requirements for the routeCode element (CONF:7514 and CONF:12600) are "MAY" and there are no Schematron rules for them, thus none to be violated, so the approach is compatible with the existing QRDA validation rules. It also provides the correct output for either solution proposed in CQM-634: removing/relaxing the value set requirement or adding the SNOMED-CT codes to the value set.

      Affected measures:

      • CMS108v2 (VTE-1)
      • CMS109v2 (VTE-4)
      • CMS114v2 (VTE-6)
      • CMS171v3 (SCIP-INF-1)
      • CMS172v3 (SCIP-INF-2)
      • CMS188v3 (PN-6)
      • CMS190v2 (VTE-2)

            renee.rookwood Renee Rookwood (Inactive)
            jon.salmon Jon Salmon (Inactive)
            Deborah Krauss (Inactive), Kevin Larsen (Inactive), Robert Dingwell (Inactive), Rob McClure, Saul Kravitz (Inactive), Yan Heras
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