We seek comment on which of the two methods below is appropriate, and when, based on your experience. For the evaluateMeasure operation, you can manage what data to evaluate the measure in one of two ways: 1) Define the CQL rules to only look at a resource that has certain elements or elements of a certain value. This scenario puts the burden on the measure developer to add the specific needs into the CQL statements 2) Specify that a specific profile of a Resource should be used to calculate the measure. This would require the generator of the FHIR data to insure that a Resource meets the conditions of the profile Most of the examples and profiles in the DEQM assume the first (1) approach above. However DEQM MedicationAdministration profile is created here to represent how measure requirements could be handled by profiling a resource, (2) above.

Mandatory Data Elements and Terminology

The following data-elements are mandatory (i.e data MUST be present).

Each MedicationAdministration must have:

1. A medication code that identifies the medication that was administered
2. The period of time during which the administration took place

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from QICoreMedicationAdministration

Name	Flags	Card.	Type	Description & Constraints
MedicationAdministration		0..*	QICoreMedicationAdministration	Administration of medication to a patient
medication[x]	S	1..1	CodeableConcept	What was administered
effective[x]	S	1..1	Period	Start and end time of administration
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
MedicationAdministration		0..*	QICoreMedicationAdministration	Administration of medication to a patient
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown Binding: MedicationAdministration Status Codes (required): A set of codes indicating the current status of a MedicationAdministration.
statusReason	S	0..*	CodeableConcept	Reason administration not performed Binding: SNOMEDCTReasonMedicationNotGivenCodes (example): A set of codes indicating the reason why the MedicationAdministration is negated.
medication[x]	SΣ	1..1	CodeableConcept	What was administered Binding: US Core Medication Codes (RxNorm) (preferred): The set of RxNorm codes to represent medications
subject	SΣ	1..1	Reference(QICorePatient)	Who received medication
context	S	0..1	Reference(QICoreEncounter | EpisodeOfCare)	Encounter or Episode of Care administered as part of
effective[x]	SΣ	1..1	Period	Start and end time of administration
reasonCode	S	0..*	CodeableConcept	Reason administration performed Binding: ReasonMedicationGivenCodes (example): A set of codes indicating the reason why the MedicationAdministration was made.
dosage	C	0..1	BackboneElement	Details of how medication was taken
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
route	S	0..1	CodeableConcept	Path of substance into body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
dose	S	0..1	SimpleQuantity	Amount of medication per dose
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
MedicationAdministration.status	required	MedicationAdministration Status Codes
MedicationAdministration.statusReason	example	SNOMEDCTReasonMedicationNotGivenCodes
MedicationAdministration.medication[x]	preferred	USCoreMedicationCodes
MedicationAdministration.reasonCode	example	ReasonMedicationGivenCodes
MedicationAdministration.dosage.route	example	SNOMEDCTRouteCodes

Name	Flags	Card.	Type	Description & Constraints
MedicationAdministration		0..*	QICoreMedicationAdministration	Administration of medication to a patient
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	External identifier
instantiates	Σ	0..*	uri	Instantiates protocol or definition
partOf	Σ	0..*	Reference(MedicationAdministration | Procedure)	Part of referenced event
status	?!SΣ	1..1	code	in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown Binding: MedicationAdministration Status Codes (required): A set of codes indicating the current status of a MedicationAdministration.
statusReason	S	0..*	CodeableConcept	Reason administration not performed Binding: SNOMEDCTReasonMedicationNotGivenCodes (example): A set of codes indicating the reason why the MedicationAdministration is negated.
category		0..1	CodeableConcept	Type of medication usage Binding: MedicationAdministration Category Codes (preferred): A coded concept describing where the medication administered is expected to occur.
medication[x]	SΣ	1..1	CodeableConcept	What was administered Binding: US Core Medication Codes (RxNorm) (preferred): The set of RxNorm codes to represent medications
subject	SΣ	1..1	Reference(QICorePatient)	Who received medication
context	S	0..1	Reference(QICoreEncounter | EpisodeOfCare)	Encounter or Episode of Care administered as part of
supportingInformation		0..*	Reference(Resource)	Additional information to support administration
effective[x]	SΣ	1..1	Period	Start and end time of administration
performer	Σ	0..*	BackboneElement	Who performed the medication administration and what they did
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function		0..1	CodeableConcept	Type of performance Binding: MedicationAdministration Performer Function Codes (example): A code describing the role an individual played in administering the medication.
actor	Σ	1..1	Reference(QICorePractitioner | QICorePatient | QICoreRelatedPerson | QICoreDevice)	Who performed the medication administration
reasonCode	S	0..*	CodeableConcept	Reason administration performed Binding: ReasonMedicationGivenCodes (example): A set of codes indicating the reason why the MedicationAdministration was made.
reasonReference		0..*	Reference(Condition | Observation | DiagnosticReport)	Condition or observation that supports why the medication was administered
request		0..1	Reference(QICoreMedicationRequest)	Request administration performed against
device		0..*	Reference(QICoreDevice)	Device used to administer
note		0..*	Annotation	Information about the administration
dosage	C	0..1	BackboneElement	Details of how medication was taken
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
text		0..1	string	Free text dosage instructions e.g. SIG
site		0..1	CodeableConcept	Body site administered to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route	S	0..1	CodeableConcept	Path of substance into body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
method		0..1	CodeableConcept	How drug was administered Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
dose	S	0..1	SimpleQuantity	Amount of medication per dose
rate[x]		0..1		Dose quantity per unit of time
rateRatio			Ratio
rateQuantity			Quantity(SimpleQuantity)
eventHistory		0..*	Reference(Provenance)	A list of events of interest in the lifecycle
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
MedicationAdministration.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
MedicationAdministration.status	required	MedicationAdministration Status Codes
MedicationAdministration.statusReason	example	SNOMEDCTReasonMedicationNotGivenCodes
MedicationAdministration.category	preferred	MedicationAdministration Category Codes
MedicationAdministration.medication[x]	preferred	USCoreMedicationCodes
MedicationAdministration.performer.function	example	MedicationAdministration Performer Function Codes
MedicationAdministration.reasonCode	example	ReasonMedicationGivenCodes
MedicationAdministration.dosage.site	example	SNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationAdministration.dosage.route	example	SNOMEDCTRouteCodes
MedicationAdministration.dosage.method	example	SNOMEDCTAdministrationMethodCodes

Differential View

This structure is derived from QICoreMedicationAdministration

Name	Flags	Card.	Type	Description & Constraints
MedicationAdministration		0..*	QICoreMedicationAdministration	Administration of medication to a patient
medication[x]	S	1..1	CodeableConcept	What was administered
effective[x]	S	1..1	Period	Start and end time of administration
Documentation for this format

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
MedicationAdministration		0..*	QICoreMedicationAdministration	Administration of medication to a patient
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown Binding: MedicationAdministration Status Codes (required): A set of codes indicating the current status of a MedicationAdministration.
statusReason	S	0..*	CodeableConcept	Reason administration not performed Binding: SNOMEDCTReasonMedicationNotGivenCodes (example): A set of codes indicating the reason why the MedicationAdministration is negated.
medication[x]	SΣ	1..1	CodeableConcept	What was administered Binding: US Core Medication Codes (RxNorm) (preferred): The set of RxNorm codes to represent medications
subject	SΣ	1..1	Reference(QICorePatient)	Who received medication
context	S	0..1	Reference(QICoreEncounter | EpisodeOfCare)	Encounter or Episode of Care administered as part of
effective[x]	SΣ	1..1	Period	Start and end time of administration
reasonCode	S	0..*	CodeableConcept	Reason administration performed Binding: ReasonMedicationGivenCodes (example): A set of codes indicating the reason why the MedicationAdministration was made.
dosage	C	0..1	BackboneElement	Details of how medication was taken
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
route	S	0..1	CodeableConcept	Path of substance into body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
dose	S	0..1	SimpleQuantity	Amount of medication per dose
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
MedicationAdministration.status	required	MedicationAdministration Status Codes
MedicationAdministration.statusReason	example	SNOMEDCTReasonMedicationNotGivenCodes
MedicationAdministration.medication[x]	preferred	USCoreMedicationCodes
MedicationAdministration.reasonCode	example	ReasonMedicationGivenCodes
MedicationAdministration.dosage.route	example	SNOMEDCTRouteCodes

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
MedicationAdministration		0..*	QICoreMedicationAdministration	Administration of medication to a patient
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	External identifier
instantiates	Σ	0..*	uri	Instantiates protocol or definition
partOf	Σ	0..*	Reference(MedicationAdministration | Procedure)	Part of referenced event
status	?!SΣ	1..1	code	in-progress | not-done | on-hold | completed | entered-in-error | stopped | unknown Binding: MedicationAdministration Status Codes (required): A set of codes indicating the current status of a MedicationAdministration.
statusReason	S	0..*	CodeableConcept	Reason administration not performed Binding: SNOMEDCTReasonMedicationNotGivenCodes (example): A set of codes indicating the reason why the MedicationAdministration is negated.
category		0..1	CodeableConcept	Type of medication usage Binding: MedicationAdministration Category Codes (preferred): A coded concept describing where the medication administered is expected to occur.
medication[x]	SΣ	1..1	CodeableConcept	What was administered Binding: US Core Medication Codes (RxNorm) (preferred): The set of RxNorm codes to represent medications
subject	SΣ	1..1	Reference(QICorePatient)	Who received medication
context	S	0..1	Reference(QICoreEncounter | EpisodeOfCare)	Encounter or Episode of Care administered as part of
supportingInformation		0..*	Reference(Resource)	Additional information to support administration
effective[x]	SΣ	1..1	Period	Start and end time of administration
performer	Σ	0..*	BackboneElement	Who performed the medication administration and what they did
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function		0..1	CodeableConcept	Type of performance Binding: MedicationAdministration Performer Function Codes (example): A code describing the role an individual played in administering the medication.
actor	Σ	1..1	Reference(QICorePractitioner | QICorePatient | QICoreRelatedPerson | QICoreDevice)	Who performed the medication administration
reasonCode	S	0..*	CodeableConcept	Reason administration performed Binding: ReasonMedicationGivenCodes (example): A set of codes indicating the reason why the MedicationAdministration was made.
reasonReference		0..*	Reference(Condition | Observation | DiagnosticReport)	Condition or observation that supports why the medication was administered
request		0..1	Reference(QICoreMedicationRequest)	Request administration performed against
device		0..*	Reference(QICoreDevice)	Device used to administer
note		0..*	Annotation	Information about the administration
dosage	C	0..1	BackboneElement	Details of how medication was taken
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
text		0..1	string	Free text dosage instructions e.g. SIG
site		0..1	CodeableConcept	Body site administered to Binding: SNOMEDCTAnatomicalStructureForAdministrationSiteCodes (example): A coded concept describing the site location the medicine enters into or onto the body.
route	S	0..1	CodeableConcept	Path of substance into body Binding: SNOMEDCTRouteCodes (example): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
method		0..1	CodeableConcept	How drug was administered Binding: SNOMEDCTAdministrationMethodCodes (example): A coded concept describing the technique by which the medicine is administered.
dose	S	0..1	SimpleQuantity	Amount of medication per dose
rate[x]		0..1		Dose quantity per unit of time
rateRatio			Ratio
rateQuantity			Quantity(SimpleQuantity)
eventHistory		0..*	Reference(Provenance)	A list of events of interest in the lifecycle
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
MedicationAdministration.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
MedicationAdministration.status	required	MedicationAdministration Status Codes
MedicationAdministration.statusReason	example	SNOMEDCTReasonMedicationNotGivenCodes
MedicationAdministration.category	preferred	MedicationAdministration Category Codes
MedicationAdministration.medication[x]	preferred	USCoreMedicationCodes
MedicationAdministration.performer.function	example	MedicationAdministration Performer Function Codes
MedicationAdministration.reasonCode	example	ReasonMedicationGivenCodes
MedicationAdministration.dosage.site	example	SNOMEDCTAnatomicalStructureForAdministrationSiteCodes
MedicationAdministration.dosage.route	example	SNOMEDCTRouteCodes
MedicationAdministration.dosage.method	example	SNOMEDCTAdministrationMethodCodes

This structure is derived from QICoreMedicationAdministration

Summary

Must-Support: 2 elements

This profile is used in the following transactions:

• Venous Thromboembolism Prophylaxis (VTE-1)