QRDA-I R1 D3 Medication Administered template is constrained to (0..1) entryRelationship to a Reason observation (CONF:1140-27022). The Reason template value element requires a single (1..1) sdtc:valueSet attribute (CONF:1140-27657). This constraint is a problem when the value code for the Reason template belongs to more than one value-set. Only one or the other value-set can be specified in the Reason template.

An example of where this causes a conflict is when supply negation rationale for "Low Dose Unfractionated Heparin for VTE Prophylaxis" (2.16.840.1.113762.1.4.1045.39). In both CMS108v4 and CMS190v4 the Medical Reason value-set (2.16.840.1.113883.3.117.1.7.1.473) is used for "Medication, Administered not done: Medical Reason" for "Low Dose Unfractionated Heparin for VTE Prophylaxis" but in CMS114v4 the Medical Contraindication value-set (2.16.840.1.113883.3.117.1.7.1.412) is used for "Medication, Administered not done: Medical Contraindication" for "Low Dose Unfractionated Heparin for VTE Prophylaxis". Two different negation value-sets used to negate the same medication value-set. The Medical Contraindication value-set appears to be a subset of the Medical Reason value-set making it highly probable that this condition will occur.

This problem appears to exist when negating any of the VTE Prophylaxis Medications or Devices contained in CMS114v4 (VTE-6).

Please advise.

Unclear how to create EH QRDA-I Documents for measures containing negation rationale for EH VTE measures