QRDA I STU R5 Updates Since pre-ballot content Review July 28th , 2017 CQI WG Meeting QRDA I STU R5 Updates Since pre-ballot content Review

QRDA I STU R5 Updates – Vol 2 Added latest QDM 5.3 updates (QDM Version 5.3 Annotated) Added Related To attribute to: Communication: from provider to patient Communication: from patient to provider Communication: from provider to provider Assessment Performed Modeled Related To as sdtc:isFulfillmentOf1 to allow reference to another QDM element instance Changed Related To contained in Care Goal to this new Related To Retired the Fulfills template This operator was removed from QDM

QRDA I STU R5 Updates – Vol 2 Diagnostic Study Performed/Procedure Performed Result – change from 0..* to 0..1 to match QDM spec Laboratory Test Performed No longer conforms to Result Observation, but instead contains Result Observation to support the Result and Result dateTime QDM attributes Added SHALL NOT use observation/value, to ensure the consistency of using the Result Observation Template in Laboratory Test Performed Now similar to Diagnostic Study Performed Added Facility Location attribute to Encounter Order and Encounter Recommended (it was missed previously) Corrected a few issues to the templates and example figures identified in the QA

QRDA I STU R5 Updates – Vol 2 Diagnostic Study Performed/Procedure Performed Result – change from 0..* to 0..1 to match QDM spec Laboratory Test Performed No longer conforms to Result Observation, but instead contains Result Observation to support the Result and Result dateTime QDM attributes Added SHALL NOT use observation/value, to ensure the consistency of using the Result Observation Template in Laboratory Test Performed Now similar to Diagnostic Study Performed Added Facility Location attribute to Encounter Order and Encounter Recommended (it was missed previously)

QRDA I STU R5 Updates – Vol 1 Updated the HQMF QDM Datatype to CDA Mapping Tables to align with the QDM-based HQMF Templates for CQL, R1, STU R2.1 The HQMF Templates STU R2.1 will be posted for CQI WG internal review, which includes changes made based on QDM 5.3

Ballot Package QRDA-I_CDAR2_QRDA_1_R1_S5_2017AUG.zip Which contains the following materials

QDM-based HQMF Templates R1 STU 2.1, Volume 3 for member only review

Scope of Changes Updated to align with the QDM Version 5.3 Annotated specification Based on the Volume 3 of CQL-based HQMF IG R1, STU R2 (STU R2 was based on QDM Version 5.02) See Chapter 8 Change Log for detailed changes

July 14th , 2017 CQI WG Meeting HL7 QRDA I R1 STU R5 updates

Scope Update to support QDM v5.3 QRDA I STU R4 supports QDM v4.3 Remove the requirement of sdtc:valueSet Support Direct Referenced Code Duplicate data

Main QDM 5.3 Changes Including changes in QDM 5.02 DRAFT, QDM 5.01 DRAFT, QDM 5.0 DRAFT Added QDM data types: Allergy/Intolerance Adverse Event Participation new attribute to support: Participation Period. Added QDM attributes: Author Datetime Diagnosis, Allergy/Intolerance, and Adverse Event Device, Applied; Diagnostic Study, Performed; Intervention, Performed; Encounter, Performed; Laboratory Test, Performed; Medication, Administered; Physical Exam, Performed; Procedure, Performed; Substance, Administered. (V5.02) Component Assessment, Performed; Diagnostic, Performed; Laboratory Test, Performed. (V5.01) Code all data types Timing: prevalence period, relevant period, Author Datetime Admission Source and Discharge Disposition (replaces Discharge status) attributes for Encounter, Performed

Main QDM 5.3 Changes Other removal: Cardinality Removed QDM data types: Encounter, Active all previous datatypes referencing Allergy, Intolerance and Adverse Reaction (V5.0) Transfer to (V5.0) Transfer from (V5.0) Other removal: Radiation Dose and Radiation Duration attributes Reason attribute from Encounter, Performed Cumulative Medication Duration has been removed as the concept can be expressed directly using existing QDM datatypes and attributes with CQL logic expressions (V5.0) Cardinality

Timing author/time (Author Participation) effectiveTime (low and high) Author Datetime Active Datetime (Immunication Order, Medication Order) effectiveTime (low and high) Prevalence period Relevant period Expiration Datetime (Patient Characteristic Expired) Incision Datetime Location Period Participation Period Result Datetime Cardinality

July 21st, 2017 CQI WG Meeting HL7 QRDA I R1 STU R5 updates

Retired QDM Data Types Templates Diagnostic Study Adverse Event Diagnostic Study Intolerance Device Intolerance Device Allergy Device Adverse Event Intervention Adverse Event Intervention Intolerance Laboratory Test Adverse Event Laboratory Test Intolerance Procedure Adverse Event Procedure Intolerance Medication Adverse Effect Medication Intolerance Medication Allergy Act Intolerance or Adverse Event Observation Encounter Active Transfer From Act/Transfer From Transfer To Act/Transfer To

Retired Templates Due to QDM 5.3 updates Radiation Dosage and Duration Reaction Due to removal of sdtc:valueSet Result

Added Templates QDM data type templates QDM attributes templates Adverse Event Allergy Intolerance Patient Characteristic Coverage Type Participation QDM attributes templates Component Related to (this was not new, but created a new template rather embedding)

legalAuthenticator Removed the SHALL requirement in the QRDA Category I Framework template to align with the SHOULD requirement in US Realm Header

Not Done Removed the SHALL requirement of sdtc:valueSet However, when report “not done”, If it is a value set sdtc:valueSet will still be required If it is direct referenced code No sdtc:valueSet <manufacturedMaterial> <code nullFlavor="NA" sdtc:valueSet="2.16.840.1.113883.3.464.1003.196.12.1001"> <originalText>None of value set: Antibiotic Medications for Pharyngitis </originalText> </code> </manufacturedMaterial>

Author dateTime Should QRDA use Author Participation C-CDA template? <!-- C-CDA R2.1 Author Participation --> <templateId root="2.16.840.1.113883.10.20.22.4.119"/> <time value="201504081130"/> <assignedAuthor> <id root="2.16.840.1.113883.4.6" extension="111111111"/> </assignedAuthor> </author>

Medication Administered Immunization Administered Removed the outside act wrapper Directly conform to Medication Activity/Immunization Activity