Most discharge measures like NQF0435, NQF 0436, NQF0439, NQF0142 have exceptions that read like:
◾OR: "Medication, Order not done: Medical Reason" for "Antithrombotic Therapy RxNorm Value Set"
◾OR: "Medication, Order not done: Patient Refusal" for "Antithrombotic Therapy RxNorm Value Set"

With each different type of medication at discharge the value set with RXNorm will be different... but its the same idea and have same problem...

In real world, Physician when write discharge orders / prescriptions they do pick individual medication they are ordering and so RXNorm codes are fine but... when documenting contraindication they do not pick each individual possible med and give reasons for each of them... for example there are possible 144 RXNorm codes Physicians do not and will not pick each 144 and give why not reason... instead they just give medical reason for category - say Antithrombotic in this case and give reason why not to discharge on... medical or patient reason.
the spec expects reason to be attached to each RX which is not practical.
How can we proceed? Help...