eCQMs use the Quality Data Model (QDM) to define the EMR elements needed in a patient record. The QDM (as well as many other HIT standards) defines a physical examination of the patient as a "Procedure". In this measure (CMS 131) the examination of the retina is considered a type of physical examination therefore the concepts expected to be recorded in a patient record will be procedures. In essence this means all the many examinations that a clinician may make during the course of a standard or extended physical examination, can each be individually identified as a particular procedure. An electronic patient record will then have a record of those examination procedures that were completed for the patient during a particular visit, either by just noting that the "procedure" was done (and no result - not a preferred approach), or by noting the result (or something like "not done"). It is worth noting that changes to the data model could potentially change how the physical exam is captured; however, at the current time, no such changes are anticipated. In CMS 131, the value set has multiple procedures codes because the quality measure assumes if any of those specific retinal exam procedures was done, then the patient has had an acceptable exam.