The current QDM-based HQMF Implementation Guide maps start datetime and stop datetime to effectiveTime low/high for all data types. In the case of Order datatypes, however, the intent of measure authors is to refer to the time the order was created / signed. For example:

"Procedure, Order: ABC" starts during "Encounter, Performed: XYZ"

In the above case, the intent is that the physician ordered the procedure during the encounter. Based on the current mapping to effectiveTime, however, this would actually mean that ordered procedure was scheduled to occur during the encounter.

The intent of the measure author was confirmed in a decision made in QRDA-44 (and recorded in the last comment):

"On further investigation, we have confirmed that in all cases (EH and EP), when an order-type pattern is used in a criterion, the intent of the measure developer when asserting a temporal comparison was to compare against the author/time and not the effectiveTime."

This decision has already been reflected in the 2014 CMS QRDA I Implementation Guides for Eligible Professionals Clinical Quality Measures and the HL7 Implementation Guide for CDA® Release 2: Quality Reporting Document Architecture - Category I, DSTU Release 2 (US Realm) .

In order to align with the intent of measure developers, the QDM-based HQMF IG must be updated to reflect that the start datetime, stop datetime, and default datetimes (for temporal relationships) are mapped to the author/time of the Order.

The QDM Specification will be updated to clarify that the start datetime and stop datetime for Order datatypes reflects the author time of the order. In terms of the QDM specification, this is considered a clarification since it reflects what has been the intent of the datatypes all along.