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  1. eCQM Issue Tracker
  2. CQM-913

Discharge medications with Negation but no RxNorm Code

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    • Icon: EH/CAH eCQMs EH/CAH eCQMs
    • Resolution: Delivered
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      This issue is framed in a number of tickets, which are linked below. Currently there is a proposed solution which is under review at HL7 for the QRDA standard to use a null value for the specific code to indicate that all of the items in the value set were not done. There is additional consideration being given to adding modifier terms to note when at least one code is appropriate versus when none or all of the codes are appropriate. We will update this ticket when there is definitive resolution of the approach.

      4/Mar/15 UPDATE: As previously noted, this topic was discussed by the HL7 CQI and StructuredDoc Work Groups. The next publication of QRDA Cat I will specify that the code should contain a nullFlavor of "NA" and the sdtc:valueSet attribute should be set to the valueset OID. See below for an example:

      <manufacturedMaterial>
        <code nullFlavor="NA" sdtc:valueSet="2.16.840.1.113883.3.600.470">
          <originalText>None of value set: [valueSet name]</originalText>
        </code>
      </manufacturedMaterial>

      UPDATE 2016: This issue was formally corrected in QRDA Release 3.
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      This issue is framed in a number of tickets, which are linked below. Currently there is a proposed solution which is under review at HL7 for the QRDA standard to use a null value for the specific code to indicate that all of the items in the value set were not done. There is additional consideration being given to adding modifier terms to note when at least one code is appropriate versus when none or all of the codes are appropriate. We will update this ticket when there is definitive resolution of the approach. 4/Mar/15 UPDATE: As previously noted, this topic was discussed by the HL7 CQI and StructuredDoc Work Groups. The next publication of QRDA Cat I will specify that the code should contain a nullFlavor of "NA" and the sdtc:valueSet attribute should be set to the valueset OID. See below for an example: <manufacturedMaterial>   <code nullFlavor="NA" sdtc:valueSet="2.16.840.1.113883.3.600.470">     <originalText>None of value set: [valueSet name]</originalText>   </code> </manufacturedMaterial> UPDATE 2016: This issue was formally corrected in QRDA Release 3.

      I have a question about specifying negations for discharge medications. Here is how a medication activity is represented:

      <!-- Irrelevant elements removed -->
      <entryRelationship typeCode="COMP">
      <substanceAdministration classCode="SBADM" moodCode="EVN">

      <!-- REMOVED -->

      <consumable>
      <manufacturedProduct classCode="MANU">

      <!-- REMOVED -->
      <manufacturedMaterial>
      <code code="1361568" codeSystem="2.16.840.1.113883.6.88" sdtc:valueSet="2.16.840.1.113883.3.117.1.7.1.218"><originalText>Unfractionated Heparin</originalText></code>
      </manufacturedMaterial>

      </manufacturedProduct>
      </consumable>
      </substanceAdministration>
      </entryRelationship>

      The above section indicates that a medication with RxNorm code 1361568 under 2.16.840.1.113883.3.117.1.7.1.218 was given to this patient. If the medication was negated, my understanding is there will be a corresponding entryRelationship with typeCode "RSON", with the corresponding SNOMED code for being negated.

      But, if a medication was not done (negated), is it still required to specify the "code" (1361568) attribute? Can we specify a nullFlavor for the code attribute alone and just specify the medication's corresponding "valueSet" (2.16.840.1.113883.3.117.1.7.1.218) ?

            chris.moesel Chris Moesel (Inactive)
            kanant Karthik Ananthapadmanaban (Inactive)
            Rob McClure
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