source: qrda/CCR/PQRI-101026/M1-PAT_100839_QRDA_V1_0_0Ver2.xml@ 1153

Last change on this file since 1153 was 990, checked in by George Lilly, 14 years ago

submissions to PQRI testing
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A CCR/PQRI-101026
A CCR/PQRI-101026/M1-PAT_100146_QRDA_V1_0_0Ver2-gpl.xml
A CCR/PQRI-101026/M1-PAT_100146_QRDA_V1_0_0Ver2.xml
A CCR/PQRI-101026/M1-PAT_100850_QRDA_V1_0_0Ver2.xml
A CCR/PQRI-101026/M1-PAT_100852_QRDA_V1_0_0Ver2.xml
A CCR/PQRI-101026/M1-PAT_100846_QRDA_V1_0_0Ver2.xml
A CCR/PQRI-101026/M1-PAT_100855_QRDA_V1_0_0Ver2.xml
A CCR/PQRI-101026/M1-PAT_100847_QRDA_V1_0_0Ver2.xml
A CCR/PQRI-101026/cda.xsl
A CCR/PQRI-101026/M1-PAT_100839_QRDA_V1_0_0Ver2.xml
A CCR/PQRI-101026/M1-PAT_100848_QRDA_V1_0_0Ver2.xml
A CCR/PQRI-101026/M1-PAT_100858_QRDA_V1_0_0Ver2.xml
A CCR/PQRI-101026/M1-PAT_100849_QRDA_V1_0_0Ver2.xml
File size: 27.3 KB
Line 
1<?xml version="1.0" encoding="utf-8"?>
2<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:voc="urn:hl7-org:v3/voc" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:hl7-org:v3 CDA.xsd">
3<realmCode code="US"/>
4<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
5<templateId root="2.16.840.1.113883.10.20.12"/>
6<templateId root="2.16.840.1.113883.3.249.11.100.1"/>
7<id root="90112294-b6cc-4a31-a81d-8130b8c882e1"/>
8<code code="55182-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Quality Measure Report"/>
9<title>QRDA Incidence Report</title>
10<effectiveTime value="20100703"/>
11<confidentialityCode codeSystem="2.16.840.1.113883.5.25" code="N"/>
12<languageCode code="en-US"/>
13<setId root="2.16.840.1.113883.3.543" extension="01.01.01.100000001"/>
14<versionNumber value="1"/>
15<recordTarget>
16<patientRole>
17<id extension="002030004" root="2.16.840.1.113883.4.1"/>
18<addr use="H">
19<streetAddressLine/>
20<city/>
21<state/>
22<postalCode/>
23</addr>
24<telecom/>
25<patient>
26<name>
27<given>JODY</given>
28<given>JEAN</given>
29<family>JONES</family>
30</name>
31<administrativeGenderCode displayName="FEMALE" code="F" codeSystemName="HL7 AdministrativeGender" codeSystem="2.16.840.1.113883.5.1"/>
32<birthTime value="1945111200"/>
33<raceCode code="2076-8" codeSystem="2.16.840.1.113883.5.104"/>
34<ethnicGroupCode code="2186-5" codeSystem="2.16.840.1.113883.5.50"/>
35</patient>
36 <providerOrganization>
37<!-- NPI for the provider-->
38 <id root="2.16.840.1.113883.4.6" extension="1558574525" />
39 <name>WorldVistA Test Clinic</name>
40 <!--WVV Address of organization is optional except for the STATE-->
41 <addr>
42 <state>MD</state>
43 <postalCode>20877</postalCode>
44
45 </addr>
46 <!--WVP required asOrganizationPartOf added to sample-->
47 <asOrganizationPartOf>
48 <wholeOrganization>
49 <!-- Tax ID is the extension-->
50 <id root="2.16.840.1.113883.4.2" extension="226864459"/>
51 </wholeOrganization>
52 </asOrganizationPartOf>
53 </providerOrganization>
54
55</patientRole>
56</recordTarget>
57<author>
58<time value="20100703"/>
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60<id root="2.16.840.1.113883.3.249.6" extension="100001"/>
61<assignedPerson>
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63<given>Nancy</given>
64<family>Anthracite</family>
65<suffix>MD</suffix>
66</name>
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68<representedOrganization>
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70<name>WorldVistA Test Clinic</name>
71</representedOrganization>
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79<name>World VistA Test Clinic</name>
80</representedOrganization>
81</assignedEntity>
82</informant>
83<custodian>
84<assignedCustodian>
85<representedCustodianOrganization>
86<id root="2.16.840.1.113883.3.543" extension="1558574526"/>
87<name>WorldVistA Test Clinic</name>
88</representedCustodianOrganization>
89</assignedCustodian>
90</custodian>
91<legalAuthenticator>
92<time value="20100703"/>
93<signatureCode code="S"/>
94<assignedEntity>
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96<assignedPerson>
97<name>
98<given>Nancy</given>
99<family>Anthracite</family>
100<suffix>MD</suffix>
101</name>
102</assignedPerson>
103<representedOrganization>
104<id root="2.16.840.1.113883.3.543" extension="1558574526"/>
105<name>WorldVistA Test Clinic</name>
106</representedOrganization>
107</assignedEntity>
108</legalAuthenticator>
109<participant typeCode="PRF">
110<functionCode code="PCP" codeSystem="2.16.840.1.113883.5.88"/>
111<associatedEntity classCode="PROV">
112<id root="2.16.840.1.113883.3.249.6" extension="111111"/>
113<associatedPerson>
114<name>
115<prefix>Dr.</prefix>
116<given>Nancy</given>
117<family>Anthracite</family>
118</name>
119</associatedPerson>
120</associatedEntity>
121</participant>
122<documentationOf>
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132 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
133 <addr>
134 <streetAddressLine>123 Maple Ave</streetAddressLine>
135 <city>Gaithersburg</city>
136 <state>MD</state>
137 <postalCode>20877</postalCode>
138 </addr>
139 <assignedPerson>
140 <name>
141 <given>Nancy</given>
142 <family>Anthracite</family>
143 <suffix>MD</suffix>
144 </name>
145 </assignedPerson>
146 </assignedEntity>
147 </performer>
148 </serviceEvent>
149 </documentationOf>
150<documentationOf>
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152<code displayName="INTERMEDIATE (15min)" code="99213" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
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157<performer typeCode="PRF">
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159 <id root="2.16.840.1.113883.4.6" extension="1558574525"/>
160 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
161 <addr>
162 <streetAddressLine>123 Maple Ave</streetAddressLine>
163 <city>Gaithersburg</city>
164 <state>MD</state>
165 <postalCode>20877</postalCode>
166 </addr>
167 <assignedPerson>
168 <name>
169 <given>Nancy</given>
170 <family>Anthracite</family>
171 <suffix>MD</suffix>
172 </name>
173 </assignedPerson>
174 </assignedEntity>
175 </performer>
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177 </documentationOf>
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188 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
189 <addr>
190 <streetAddressLine>123 Maple Ave</streetAddressLine>
191 <city>Gaithersburg</city>
192 <state>MD</state>
193 <postalCode>20877</postalCode>
194 </addr>
195 <assignedPerson>
196 <name>
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198 <family>Anthracite</family>
199 <suffix>MD</suffix>
200 </name>
201 </assignedPerson>
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216 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
217 <addr>
218 <streetAddressLine>123 Maple Ave</streetAddressLine>
219 <city>Gaithersburg</city>
220 <state>MD</state>
221 <postalCode>20877</postalCode>
222 </addr>
223 <assignedPerson>
224 <name>
225 <given>Nancy</given>
226 <family>Anthracite</family>
227 <suffix>MD</suffix>
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230 </assignedEntity>
231 </performer>
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244 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
245 <addr>
246 <streetAddressLine>123 Maple Ave</streetAddressLine>
247 <city>Gaithersburg</city>
248 <state>MD</state>
249 <postalCode>20877</postalCode>
250 </addr>
251 <assignedPerson>
252 <name>
253 <given>Nancy</given>
254 <family>Anthracite</family>
255 <suffix>MD</suffix>
256 </name>
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272 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
273 <addr>
274 <streetAddressLine>123 Maple Ave</streetAddressLine>
275 <city>Gaithersburg</city>
276 <state>MD</state>
277 <postalCode>20877</postalCode>
278 </addr>
279 <assignedPerson>
280 <name>
281 <given>Nancy</given>
282 <family>Anthracite</family>
283 <suffix>MD</suffix>
284 </name>
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286 </assignedEntity>
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301 <addr>
302 <streetAddressLine>123 Maple Ave</streetAddressLine>
303 <city>Gaithersburg</city>
304 <state>MD</state>
305 <postalCode>20877</postalCode>
306 </addr>
307 <assignedPerson>
308 <name>
309 <given>Nancy</given>
310 <family>Anthracite</family>
311 <suffix>MD</suffix>
312 </name>
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329 <addr>
330 <streetAddressLine>123 Maple Ave</streetAddressLine>
331 <city>Gaithersburg</city>
332 <state>MD</state>
333 <postalCode>20877</postalCode>
334 </addr>
335 <assignedPerson>
336 <name>
337 <given>Nancy</given>
338 <family>Anthracite</family>
339 <suffix>MD</suffix>
340 </name>
341 </assignedPerson>
342 </assignedEntity>
343 </performer>
344 </serviceEvent>
345 </documentationOf>
346<documentationOf>
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348<code displayName="Office/Outpatient Visit of an Established Patient requiring (2 of 3) a Detailed History, an Exam and Medical Decision Making of Moderate Complexity (CPT-4 99214)" code="99214" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
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356 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
357 <addr>
358 <streetAddressLine>123 Maple Ave</streetAddressLine>
359 <city>Gaithersburg</city>
360 <state>MD</state>
361 <postalCode>20877</postalCode>
362 </addr>
363 <assignedPerson>
364 <name>
365 <given>Nancy</given>
366 <family>Anthracite</family>
367 <suffix>MD</suffix>
368 </name>
369 </assignedPerson>
370 </assignedEntity>
371 </performer>
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373 </documentationOf>
374<component>
375<structuredBody>
376<component>
377<section>
378<templateId root="2.16.840.1.113883.3.249.11.50"/>
379<code code="55185-3" codeSystem="2.16.840.1.113883.6.1"/>
380<title>Measure set: CMS EHR Measure Set</title>
381<text>2010 Measures Set Measures</text>
382<component>
383<section>
384<templateId root="2.16.840.1.113883.3.249.11.2"/>
385<templateId root="2.16.840.1.113883.3.249.11.3"/>
386<templateId root="2.16.840.1.113883.3.249.11.4"/>
387<templateId root="2.16.840.1.113883.3.249.11.5"/>
388<templateId root="2.16.840.1.113883.3.249.11.6"/>
389<templateId root="2.16.840.1.113883.3.249.11.7"/>
390<templateId root="2.16.840.1.113883.3.249.11.8"/>
391<templateId root="2.16.840.1.113883.3.249.11.9"/>
392<templateId root="2.16.840.1.113883.3.249.11.10"/>
393<templateId root="2.16.840.1.113883.3.249.11.11"/>
394<templateId root="2.16.840.1.113883.3.249.11.15"/>
395<templateId root="2.16.840.1.113883.3.249.11.51"/>
396<templateId root="2.16.840.1.113883.3.249.11.52"/>
397<templateId root="2.16.840.1.113883.3.249.11.53"/>
398<templateId root="2.16.840.1.113883.3.249.11.54"/>
399<templateId root="2.16.840.1.113883.3.249.11.55"/>
400<templateId root="2.16.840.1.113883.3.249.11.56"/>
401<templateId root="2.16.840.1.113883.3.249.11.57"/>
402<templateId root="2.16.840.1.113883.3.249.11.58"/>
403<templateId root="2.16.840.1.113883.3.249.11.59"/>
404<templateId root="2.16.840.1.113883.3.249.11.60"/>
405<code code="55186-1" codeSystem="2.16.840.1.113883.6.1"/>
406<title>Measure Section</title>
407<text>
408<list>
409<item>CMS Measure #1: Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus</item>
410<item>CMS Measure #2: Diabetes Mellitus: Low Density Lipoprotein (LDL-C) Control in Diabetes Mellitus</item>
411<item>CMS Measure #3: Diabetes Mellitus: High Blood Pressure Control in Diabetes Mellitus</item>
412<item>CMS Measure #5: Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)</item>
413<item>CMS Measure #7: Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)</item>
414<item>CMS Measure #110: Preventive Care and Screening: Influenza Immunization for Patients &gt;= 50 Years</item>
415<item>CMS Measure #111: Preventive Care and Screening: Pneumonia Vaccination for Patients 65 Years and Older</item>
416<item>CMS Measure #112: Preventive Care and Screening: Screening Mammography</item>
417<item>CMS Measure #113: Preventive Care and Screening: Colorectal Cancer Screening</item>
418<item>CMS Measure #124: Health Information Technology (HIT): Adoption/Use of Electronic Health Records (EHR)</item>
419<item>CMS Measure eRx:Adoption/Use of Medication Electronic Prescribing Measure</item>
420<item>CMS Measure #39: Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older</item>
421<item>CMS Measure #47: Advance Care Plan </item>
422<item>CMS Measure #48: Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older</item>
423<item>CMS Measure #128: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up </item>
424<item>CMS Measure #173: Preventive Care and Screening: Unhealthy Alcohol Use - Screening</item>
425<item>CMS Measure #0013: Hypertension (HTN): Blood Pressure Measurement - QRDA Cat I template </item>
426<item>CMS Measure #0022: Drugs to be avoided in the Elderly </item>
427<item>CMS Measure #0024: Body Mass Index (BMI) 2 through 18 years of age </item>
428<item>CMS Measure #0028: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention</item>
429<item>CMS Measure #0038: Childhood Immunization Status - QRDA Cat I template</item>
430</list>
431</text>
432<entry typeCode="DRIV">
433<act classCode="ACT" moodCode="DEF">
434<code code="PQRI-1" codeSystem="2.16.840.1.113883.3.249.12" displayName="Hemoglobin A1c Poor Control in Diabetes Mellitus"/>
435<text>Percentage of patients 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1C greater than 9.0%</text>
436<statusCode code="completed"/>
437</act>
438</entry>
439<component>
440<section>
441<code code="55187-9" codeSystem="2.16.840.1.113883.6.1"/>
442<title>Reporting Parameters</title>
443<text>
444<list>
445<item>Reporting Period Jan 1, 2010 to Dec 31, 2010</item>
446</list>
447</text>
448<entry>
449<act classCode="ACT" moodCode="EVN">
450<code code="252116004" codeSystem="2.16.840.1.113883.6.96" displayName="Observation Parameters"/>
451<effectiveTime>
452<low value="20100101"/>
453<high value="20101231"/>
454</effectiveTime>
455</act>
456</entry>
457</section>
458</component>
459<component>
460<section>
461<code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
462<title>Patient Data</title>
463</section>
464</component>
465<component>
466<section>
467<templateId root="2.16.840.1.113883.3.88.11.83.103" assigningAuthorityName="HITSP/C83"/>
468<templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.6" assigningAuthorityName="IHE PCC"/>
469<templateId root="2.16.840.1.113883.10.20.1.11" assigningAuthorityName="HL7 CCD"/>
470<code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem list"/>
471<title>Problems</title>
472<text/>
473<entry typeCode="DRIV">
474<act classCode="ACT" moodCode="EVN">
475<templateId root="2.16.840.1.113883.10.20.1.27"/>
476<id root="PROBLEM1" extension="CCRObjectID"/>
477<code nullFlavor="NA"/>
478<performer typeCode="PRF">
479<assignedEntity>
480<id extension="ACTORPROVIDER_10000000183" root="CCRActorID"/>
481<addr use="WP">
482<streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
483<city>ALBANY</city>
484<state>NY</state>
485<postalCode>12180</postalCode>
486</addr>
487<telecom/>
488<assignedPerson>
489<name>
490<given>MATTHEW</given>
491<given>M</given>
492<family>KING</family>
493</name>
494</assignedPerson>
495</assignedEntity>
496</performer>
497<entryRelationship typeCode="SUBJ">
498<observation classCode="OBS" moodCode="EVN">
499<templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
500<id root="PROBLEM1" extension="CCRObjectID"/>
501<code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNM"/>
502<text>
503<reference value="#PROBLEM1"/>
504</text>
505<statusCode code="completed"/>
506<effectiveTime>
507<low value="20101016"/>
508<high value="20101016"/>
509</effectiveTime>
510<value xsi:type="CD" displayName="HTN (ICD-9-CM 401.9)" code="401.9" codeSystemName="I9" codeSystem="2.16.840.1.113883.6.103"/>
511<entryRelationship typeCode="REFR">
512<observation classCode="OBS" moodCode="EVN">
513<templateId root="2.16.840.1.113883.10.20.1.50"/>
514<code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
515<statusCode code="completed"/>
516<value xsi:type="CD" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM">
517<originalText>Active</originalText>
518</value>
519</observation>
520</entryRelationship>
521</observation>
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