NDF-RT classes missing from CQM allergy value sets

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    • Type: Value Sets
    • Resolution: Answered
    • Priority: Major
    • Component/s: ValueSet
    • None
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      Sending a representative ingredient-level concept identifier (an RXCUI) is an acceptable work-around when communicating allergen reactants that have been recorded in the patient record at the "class level" and there is no patient data directly representative of a current member of the associated value set. We support additionally including the actual class-level concept as a translation in the CD datatype to help characterize the information - although this is not a part of MU validation or certification. We stress that caution should be maintained with this data as it is, in essence, a reporting construct, and not actual clinically-specific patient data.

      We anticipate that in the future class-level drug representation concepts will be included in appropriate value sets.
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      Sending a representative ingredient-level concept identifier (an RXCUI) is an acceptable work-around when communicating allergen reactants that have been recorded in the patient record at the "class level" and there is no patient data directly representative of a current member of the associated value set. We support additionally including the actual class-level concept as a translation in the CD datatype to help characterize the information - although this is not a part of MU validation or certification. We stress that caution should be maintained with this data as it is, in essence, a reporting construct, and not actual clinically-specific patient data. We anticipate that in the future class-level drug representation concepts will be included in appropriate value sets.

      ONC/CMS is not yet modeling NDF-RT classes within the CQM allergy value sets. As a result of this, patients with allergies to classes of medications (e.g. penicillin’s) cannot be excluded from various measures.

      When a patient presents and states they have an allergy to a class of drugs, the clinician will record that as such, not a specific drug. For data mapping we use the NDF-RT class code for the class of drugs rather than the individual RxNorm code for a specific drug, because the actual drug is unknown. Unfortunately ONC/CMS is not yet modeling NDF-RT classes within their CQM value sets. As a results we have no endorsed mechanism to establish correct exclusions.

      For example, a patient with a “Penicillin’s” allergy should be excluded from CMS-188 (NQF 0147) – Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients. “Penicillin’s” maps to a NDF-RT class which we expected to find in the Beta Lactam allergy value set, but it is not there. So if the patient is allergic to “all penicillin’s” there is no ability to exclude the class since the NDF-RT is not in the CQM value set.

      We recommend that the NDF-RT codes are incorporated into the allergy value sets as soon as possible. In the mean time we would like to confirm that temporary solution is acceptable. Attached please find a temporary solution suggested by FDB for consideration and approval.

        1. FDB example.pdf
          251 kB

            Assignee:
            Rob McClure
            Reporter:
            Siemens (Inactive)
            Abt Associate (Inactive), Minet Javellana (Inactive), Steve Emrick (Inactive)
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              Created:
              Updated:
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