CLONE - SEVT errors for values with nullFlavor="OTH" and a translation

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    • Type: Implementation Guidance
    • Resolution: Answered
    • Priority: Major
    • Component/s: None
    • This is preventing us from generating valid QRDA documents for our customers to submit to CMS using the SEVT tool.
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      When the HL7 QRDA-I standard was developed, it reused C-CDA templates when applicable. QDM-based QRDA-I is tightly coupled with the QDM and was designed specifically for quality reporting purpose, but C-CDA is not. Effort has been made and is still on going to harmonize the value set mismatch issue between eCQMs, QRDA-I, and C-CDA. eCQMs have value set defined for each quality data element to suit very specific measure logic need, which almost guarantees that value sets from C-CDA such as problem type are always a mismatch. CMS QRDA I is taking a consistent approach to handle all entry templates the same way, which always use the eCQM specified value sets as the primary code. We understand that this means a few discrepancies. Certification and CMS reporting are working together to align validations as much as possible.
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      When the HL7 QRDA-I standard was developed, it reused C-CDA templates when applicable. QDM-based QRDA-I is tightly coupled with the QDM and was designed specifically for quality reporting purpose, but C-CDA is not. Effort has been made and is still on going to harmonize the value set mismatch issue between eCQMs, QRDA-I, and C-CDA. eCQMs have value set defined for each quality data element to suit very specific measure logic need, which almost guarantees that value sets from C-CDA such as problem type are always a mismatch. CMS QRDA I is taking a consistent approach to handle all entry templates the same way, which always use the eCQM specified value sets as the primary code. We understand that this means a few discrepancies. Certification and CMS reporting are working together to align validations as much as possible.

      We are validating QRDA-I files with the SEVT tool at QualityNet, and we are receiving errors when trying to submit files that use nullFlavor="OTH" for the value element.

      For the QRDA-I, we have been receiving this error for the measure CMS75, and possibly for others as well. When sending the active diagnosis, we have an ICD10 code to send, but since the coded value is required to be SNOMED, we send nullFlavor="OTH for the main value, and send the data as a translation. This is an example of what we send:
      <value codeSystem="2.16.840.1.113883.6.96" xsi:type="CD" nullFlavor="OTH" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
      <translation code="K02.3" codeSystem="2.16.840.1.113883.6.90" codeSystemName="ICD10CM" displayName="Arrested dental caries" sdtc:valueSet="2.16.840.1.113883.3.464.1003.125.12.1004" xmlns:sdtc="urn:hl7-org:sdtc"/>
      </value>

      This works when validating data against the latest version of Cypress, but the SEVT tool throws the following 2 errors.

      • SHALL contain exactly one [1..1] value with @xsi:type="CD" (CONF:12008).
        and
        *SHALL contain exactly one [1..1] value with @xsi:type="CD", where the @code SHOULD be selected from ValueSet Problem Value Set 2.16.840.1.113883.3.88.12.3221.7.4 DYNAMIC (CONF:9058).

            Assignee:
            Matthew Tiller
            Reporter:
            David Sundaram-Stukel (Inactive)
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              Created:
              Updated:
              Resolved: