Rob/Jon,

I see what you are saying. After a bit of additional digging this appears to be an issue related to 2.3 and before. Prior to 2.4 the Risk assessment template did not properly deal with coded values and as a result the nullFlavors where produced. Upon looking at the template however the resolution in 2.4 is not correct either as it is rendering the overall depression screening code and not the value code. I believe that we can fix this is a point release within the next few weeks.

What I would suggest as guidance for the ATLs is that they understand it is a necessity for anyone consuming the Cat I documents for the Depression Screening measures or any other measure that contains a Risk Category Assessment data criteria to be allowed to alter the documents to include the correct coded values. Or that they will need to be modified in the system after the import for the calculation results to match.

Per the Master Patient List, the GP Peds B patient from the 2.3 bundle should meet the IPP, Denominator, and Numerator for CMS2v3. To accomplish that, based on the patient data in the HTML and the measure criteria, it needs to meet the following criteria from the Numerator:

• AND: MOST RECENT:"Occurrence A of Risk Category Assessment: Adolescent Depression Screening (result: 'Depression Screening Result')" during "Measurement Period"
• AND: "Patient Characteristic Birthdate: birth date" < 18 year(s) starts before start of "Occurrence A of Risk Category Assessment: Adolescent Depression Screening (result: 'Depression Screening Result')"
• AND:
  • OR: "Occurrence A of Risk Category Assessment: Adolescent Depression Screening (result: 'Negative Depression Screening')" during "Measurement Period

As you can see, the Risk Category Assessment result is definitely needed, yet the necessary information, while present in the HTML, is missing from the QRDA.

Likewise, Heart Adult C should meet the IPP, Denominator, and Denominator Exclusions for the measure. It should meet the following criteria from the Denominator Exclusions:

• AND: MOST RECENT:"Occurrence A of Risk Category Assessment: Adult Depression Screening (result: 'Depression Screening Result')" during "Measurement Period"
• AND NOT: "Occurrence A of Diagnosis, Active: Depression diagnosis" ends before start of "Occurrence A of Risk Category Assessment: Adult Depression Screening (result: 'Depression Screening Result')"
• AND: "Occurrence A of Diagnosis, Active: Depression diagnosis" starts before start of "Occurrence A of Risk Category Assessment: Adult Depression Screening (result: 'Depression Screening Result')"

As with the other patient, the necessary information is in the HTML but not in the QRDA thus these patients cannot meet their expected populations when processed from QRDA.

Rob,

I believe when entries like this are encountered it is because the entries where added to meet the criteria that something was done but the value itself for the data criteria that was being targeted did not matter. For example a situation where a measure simply needs to know that a Depression Screening was performed but there was no constraint on the results value. Do you feel that these are being used in a situation where they are matching a result such as positive or negative?