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Type: QRDA-I Standard
Resolution: Delivered
Priority: Minor
Component/s: None
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Generally, negation rationales on Medications in their various states are handled just like negations on everything else. That being said, the QRDA-I document is inconsistent in this regard.

"Section 1.11.8 discusses how negationInd and Reason can be used to describe how and why and act was not performed. What can be confusing to implementers is that while these can be used in several different templates, they are mentioned in some, but not others. For example, negationInd is mentioned explicitly in Problem Observation, but not for something like Medication Administration. Along the same lines, the Reason template is listed as optional for several templates, but not all templates where it can be used (like Medication Administration).

An errata request was filed to the QRDA DSTU. However, the HL7 SDWG doesn't think that the omission of documentation for how to express a negation rationale for a medication is an erratum in the QRDA-I spec. In fact, there is nothing in the spec that forbids using the negation on medication. Nevertheless, one could consider this is an error of omission.

There are planned updates to the documentation so that negationInd and

For the time being, one can follow the QRDA standards to determine when these suggestions are officially part of QRDA use. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=35

We plan to update the QRDA-I spec to incorporate expanded guidance on the use of negation rationales wherever appropriate in the next QRDA-I ballot cycle (tentatively planned for Sept 2013 or Jan 2014).

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Generally, negation rationales on Medications in their various states are handled just like negations on everything else. That being said, the QRDA-I document is inconsistent in this regard. "Section 1.11.8 discusses how negationInd and Reason can be used to describe how and why and act was not performed. What can be confusing to implementers is that while these can be used in several different templates, they are mentioned in some, but not others. For example, negationInd is mentioned explicitly in Problem Observation, but not for something like Medication Administration. Along the same lines, the Reason template is listed as optional for several templates, but not all templates where it can be used (like Medication Administration). An errata request was filed to the QRDA DSTU. However, the HL7 SDWG doesn't think that the omission of documentation for how to express a negation rationale for a medication is an erratum in the QRDA-I spec. In fact, there is nothing in the spec that forbids using the negation on medication. Nevertheless, one could consider this is an error of omission. There are planned updates to the documentation so that negationInd and For the time being, one can follow the QRDA standards to determine when these suggestions are officially part of QRDA use. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=35 We plan to update the QRDA-I spec to incorporate expanded guidance on the use of negation rationales wherever appropriate in the next QRDA-I ballot cycle (tentatively planned for Sept 2013 or Jan 2014).

Regarding the QRDA Category I spec (July 2012), which we understand to be the current and official version for MU Stage 2 (as listed on the HealthIT Standards Hub)...

Section 1.11.8 discusses the use of the negationInd attribute and the Reason template to indicate an act that was observed not to have occurred, corresponding to "not done" criteria in the eMeasures.

The spec specifically supports the use of the Reason template (section 7.55) for Encounter Performed (section 7.13.2) and various other templates, but the Reason template is not listed as an option for any of the Medication templates, among others. Moreover the Reason template itself does not list any Medication templates in the "Used By" column of its Reason Contexts table (Table 267).

The templates for several datatypes, including Medication Active, Medication Administered, and Medication Order, clearly need to support a reason code since the datatypes are used with reason value sets, in "not done" criteria in the measures.

We have planned to include the Reason template for these datatypes when necessary, following the example of the Encounter Performed template. But since the document does not indicate that the Reason template is a valid child for these other templates, we would like to know whether this is the correct, supported approach. If so, perhaps the QRDA Category I specification could be updated to reflect such support for all applicable datatypes.

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