Upon reviewing the QRDA 1 data element sections, I noticed that for the Intervention Order section, we are using the same Hospice Care procedure Snomed code for the Reason section as for the Planned act itself. But logically, the procedure cannot be the reason for the planned act itself. Thus, we are now wondering whether we could remove the Reason section.

Background:

We do not actually have a way to link one Snomed code to another in Raintree, so creating a clear link for a procedure to a reason for ordering this procedure is not really possible. We could do it in the backend for import if needed, but we should first make sure whether a reason is actually needed or not, or whether we can just remove this section.

• According to the HL7 implementation guide, this entryRelationship section is not required (keyword used: MAY), so based on this, I would assume that we can just leave it out and not have a reason for the Intervention Order.

On the Proctor Sheet, section 170.315(c)(1)-(c)(4), in the “Important Notes and Information” section on page 103, it says that “Data required for CQM exclusions or exceptions must be codified entries, which may include specific terms as defined by each CQM, or may include codified expressions of “patient reason,” “system reason,” or “medical reason.”

In section c.1.2 on page 105, point 3 for Developer/Proctor Action it says that “Developer demonstrates codified entries are recorded for CQM exclusions/exceptions including, but not limited to, patient reason, system reason, and medical reason. If codified entries are not displayed in user interface, verification of the codified entries in the data store (back-end database) is permitted.”

Question:

We discussed this with the Peds team, and think we can interpret this as if the Reason section is optional, but as the developer is supposed to be able to demonstrate that exclusions (in our case hospice care) have codified entries recorded and that these include the reasons, then we need your help to determine whether this is a requirement for hospice exclusion or not.

The entryRelationship > Reason section is not present in the test deck files.

This would affect both the Intervention Order and Intervention Performed sections.

This would affect both the Intervention Order and Intervention Performed sections.