[990] | 1 | <?xml version="1.0" encoding="utf-8"?>
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| 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">
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| 3 | <realmCode code="US"/>
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| 6 | <templateId root="2.16.840.1.113883.3.249.11.100.1"/>
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| 7 | <id root="eb60a84e-ae24-4f77-a649-ccfeb10a373f"/>
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| 8 | <code code="55182-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Quality Measure Report"/>
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| 9 | <title>QRDA Incidence Report</title>
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| 10 | <effectiveTime value="20100703"/>
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| 11 | <confidentialityCode codeSystem="2.16.840.1.113883.5.25" code="N"/>
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| 12 | <languageCode code="en-US"/>
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| 14 | <versionNumber value="1"/>
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| 15 | <recordTarget>
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| 20 | <city/>
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| 21 | <state/>
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| 22 | <postalCode/>
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| 23 | </addr>
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| 24 | <telecom/>
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| 25 | <patient>
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| 26 | <name>
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| 27 | <given>MALE-A</given>
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| 28 | <family>MEASURE-ONE</family>
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| 30 | <administrativeGenderCode displayName="MALE" code="M" codeSystemName="HL7 AdministrativeGender" codeSystem="2.16.840.1.113883.5.1"/>
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| 34 | </patient>
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| 35 | <providerOrganization>
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| 36 | <!-- NPI for the provider-->
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| 37 | <id root="2.16.840.1.113883.4.6" extension="1558574525" />
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| 38 | <name>WorldVistA Test Clinic</name>
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| 39 | <!--WVV Address of organization is optional except for the STATE-->
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| 40 | <addr>
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| 41 | <state>MD</state>
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| 42 | <postalCode>20877</postalCode>
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| 43 |
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| 44 | </addr>
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| 45 | <!--WVP required asOrganizationPartOf added to sample-->
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| 46 | <asOrganizationPartOf>
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| 47 | <wholeOrganization>
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| 48 | <!-- Tax ID is the extension-->
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| 49 | <id root="2.16.840.1.113883.4.2" extension="226864459"/>
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| 50 | </wholeOrganization>
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| 51 | </asOrganizationPartOf>
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| 52 | </providerOrganization>
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| 53 |
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| 54 | </patientRole>
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| 55 | </recordTarget>
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| 57 | <time value="20100703"/>
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| 63 | <family>Anthracite</family>
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| 64 | <suffix>MD</suffix>
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| 68 | <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
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| 69 | <name>WorldVistA Test Clinic</name>
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| 70 | </representedOrganization>
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| 71 | </assignedAuthor>
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| 72 | </author>
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| 73 | <informant>
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| 76 | <representedOrganization>
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| 77 | <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
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| 78 | <name>World VistA Test Clinic</name>
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| 79 | </representedOrganization>
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| 80 | </assignedEntity>
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| 81 | </informant>
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| 82 | <custodian>
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| 84 | <representedCustodianOrganization>
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| 85 | <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
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| 86 | <name>WorldVistA Test Clinic</name>
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| 87 | </representedCustodianOrganization>
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| 88 | </assignedCustodian>
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| 89 | </custodian>
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| 90 | <legalAuthenticator>
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| 91 | <time value="20100703"/>
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| 96 | <name>
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| 97 | <given>Nancy</given>
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| 98 | <family>Anthracite</family>
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| 99 | <suffix>MD</suffix>
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| 100 | </name>
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| 101 | </assignedPerson>
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| 102 | <representedOrganization>
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| 103 | <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
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| 104 | <name>WorldVistA Test Clinic</name>
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| 105 | </representedOrganization>
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| 106 | </assignedEntity>
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| 107 | </legalAuthenticator>
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| 109 | <functionCode code="PCP" codeSystem="2.16.840.1.113883.5.88"/>
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| 110 | <associatedEntity classCode="PROV">
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| 112 | <associatedPerson>
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| 113 | <name>
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| 114 | <prefix>Dr.</prefix>
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| 115 | <given>Nancy</given>
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| 116 | <family>Anthracite</family>
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| 117 | </name>
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| 118 | </associatedPerson>
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| 119 | </associatedEntity>
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| 120 | </participant>
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| 121 | <documentationOf>
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| 122 | <serviceEvent>
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| 123 | <code displayName="COMPREHENSIVE (45min)" code="99204" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
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| 124 | <effectiveTime>
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| 125 | <low value="20101013"/>
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| 126 | <high value="20101013"/>
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| 127 | </effectiveTime>
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| 128 | <performer typeCode="PRF">
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| 129 | <assignedEntity>
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| 130 | <id root="2.16.840.1.113883.4.6" extension="1558574525"/>
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| 131 | <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
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| 132 | <addr>
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| 133 | <streetAddressLine>123 Maple Ave</streetAddressLine>
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| 134 | <city>Gaithersburg</city>
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| 135 | <state>MD</state>
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| 136 | <postalCode>20877</postalCode>
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| 137 | </addr>
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| 138 | <assignedPerson>
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| 139 | <name>
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| 140 | <given>Nancy</given>
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| 141 | <family>Anthracite</family>
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| 142 | <suffix>MD</suffix>
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| 143 | </name>
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| 144 | </assignedPerson>
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| 147 | </serviceEvent>
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| 148 | </documentationOf>
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| 149 | <documentationOf>
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| 152 | <effectiveTime>
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| 153 | <low value="20101014"/>
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| 159 | <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
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| 160 | <addr>
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| 161 | <streetAddressLine>123 Maple Ave</streetAddressLine>
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| 162 | <city>Gaithersburg</city>
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| 163 | <state>MD</state>
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| 164 | <postalCode>20877</postalCode>
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| 165 | </addr>
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| 166 | <assignedPerson>
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| 167 | <name>
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| 168 | <given>Nancy</given>
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| 169 | <family>Anthracite</family>
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| 170 | <suffix>MD</suffix>
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| 171 | </name>
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| 172 | </assignedPerson>
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| 173 | </assignedEntity>
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| 174 | </performer>
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| 175 | </serviceEvent>
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| 176 | </documentationOf>
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| 177 | <component>
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| 178 | <structuredBody>
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| 179 | <component>
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| 180 | <section>
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| 181 | <templateId root="2.16.840.1.113883.3.249.11.50"/>
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| 182 | <code code="55185-3" codeSystem="2.16.840.1.113883.6.1"/>
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| 183 | <title>Measure set: CMS EHR Measure Set</title>
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| 184 | <text>2010 Measures Set Measures</text>
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| 185 | <component>
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| 186 | <section>
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| 187 | <templateId root="2.16.840.1.113883.3.249.11.2"/>
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| 188 | <templateId root="2.16.840.1.113883.3.249.11.3"/>
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| 189 | <templateId root="2.16.840.1.113883.3.249.11.4"/>
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| 190 | <templateId root="2.16.840.1.113883.3.249.11.5"/>
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| 191 | <templateId root="2.16.840.1.113883.3.249.11.6"/>
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| 192 | <templateId root="2.16.840.1.113883.3.249.11.7"/>
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| 193 | <templateId root="2.16.840.1.113883.3.249.11.8"/>
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| 194 | <templateId root="2.16.840.1.113883.3.249.11.9"/>
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| 195 | <templateId root="2.16.840.1.113883.3.249.11.10"/>
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| 196 | <templateId root="2.16.840.1.113883.3.249.11.11"/>
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| 197 | <templateId root="2.16.840.1.113883.3.249.11.15"/>
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| 198 | <templateId root="2.16.840.1.113883.3.249.11.51"/>
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| 199 | <templateId root="2.16.840.1.113883.3.249.11.52"/>
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| 200 | <templateId root="2.16.840.1.113883.3.249.11.53"/>
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| 201 | <templateId root="2.16.840.1.113883.3.249.11.54"/>
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| 202 | <templateId root="2.16.840.1.113883.3.249.11.55"/>
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| 203 | <templateId root="2.16.840.1.113883.3.249.11.56"/>
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| 204 | <templateId root="2.16.840.1.113883.3.249.11.57"/>
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| 205 | <templateId root="2.16.840.1.113883.3.249.11.58"/>
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| 206 | <templateId root="2.16.840.1.113883.3.249.11.59"/>
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| 207 | <templateId root="2.16.840.1.113883.3.249.11.60"/>
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| 208 | <code code="55186-1" codeSystem="2.16.840.1.113883.6.1"/>
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| 209 | <title>Measure Section</title>
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| 210 | <text>
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| 211 | <list>
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| 212 | <item>CMS Measure #1: Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus</item>
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| 213 | <item>CMS Measure #2: Diabetes Mellitus: Low Density Lipoprotein (LDL-C) Control in Diabetes Mellitus</item>
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| 214 | <item>CMS Measure #3: Diabetes Mellitus: High Blood Pressure Control in Diabetes Mellitus</item>
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| 215 | <item>CMS Measure #5: Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)</item>
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| 216 | <item>CMS Measure #7: Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)</item>
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| 217 | <item>CMS Measure #110: Preventive Care and Screening: Influenza Immunization for Patients >= 50 Years</item>
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| 218 | <item>CMS Measure #111: Preventive Care and Screening: Pneumonia Vaccination for Patients 65 Years and Older</item>
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| 219 | <item>CMS Measure #112: Preventive Care and Screening: Screening Mammography</item>
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| 220 | <item>CMS Measure #113: Preventive Care and Screening: Colorectal Cancer Screening</item>
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| 221 | <item>CMS Measure #124: Health Information Technology (HIT): Adoption/Use of Electronic Health Records (EHR)</item>
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| 222 | <item>CMS Measure eRx:Adoption/Use of Medication Electronic Prescribing Measure</item>
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| 223 | <item>CMS Measure #39: Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older</item>
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| 224 | <item>CMS Measure #47: Advance Care Plan </item>
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| 225 | <item>CMS Measure #48: Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older</item>
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| 226 | <item>CMS Measure #128: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up </item>
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| 227 | <item>CMS Measure #173: Preventive Care and Screening: Unhealthy Alcohol Use - Screening</item>
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| 228 | <item>CMS Measure #0013: Hypertension (HTN): Blood Pressure Measurement - QRDA Cat I template </item>
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| 229 | <item>CMS Measure #0022: Drugs to be avoided in the Elderly </item>
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| 230 | <item>CMS Measure #0024: Body Mass Index (BMI) 2 through 18 years of age </item>
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| 231 | <item>CMS Measure #0028: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention</item>
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| 232 | <item>CMS Measure #0038: Childhood Immunization Status - QRDA Cat I template</item>
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| 233 | </list>
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| 234 | </text>
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| 235 | <entry typeCode="DRIV">
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| 236 | <act classCode="ACT" moodCode="DEF">
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| 237 | <code code="PQRI-1" codeSystem="2.16.840.1.113883.3.249.12" displayName="Hemoglobin A1c Poor Control in Diabetes Mellitus"/>
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| 238 | <text>Percentage of patients 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1C greater than 9.0%</text>
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| 239 | <statusCode code="completed"/>
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| 240 | </act>
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| 241 | </entry>
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| 242 | <component>
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| 243 | <section>
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| 244 | <code code="55187-9" codeSystem="2.16.840.1.113883.6.1"/>
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| 245 | <title>Reporting Parameters</title>
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| 246 | <text>
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| 247 | <list>
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| 248 | <item>Reporting Period Jan 1, 2010 to Dec 31, 2010</item>
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| 249 | </list>
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| 250 | </text>
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| 251 | <entry>
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| 252 | <act classCode="ACT" moodCode="EVN">
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| 253 | <code code="252116004" codeSystem="2.16.840.1.113883.6.96" displayName="Observation Parameters"/>
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| 254 | <effectiveTime>
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| 255 | <low value="20100101"/>
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| 256 | <high value="20101231"/>
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| 257 | </effectiveTime>
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| 258 | </act>
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| 259 | </entry>
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| 260 | </section>
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| 261 | </component>
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| 262 | <component>
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| 263 | <section>
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| 264 | <code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
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| 265 | <title>Patient Data</title>
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| 266 | </section>
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| 267 | </component>
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| 268 | <component>
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| 269 | <section>
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| 270 | <templateId root="2.16.840.1.113883.3.88.11.83.103" assigningAuthorityName="HITSP/C83"/>
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| 271 | <templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.6" assigningAuthorityName="IHE PCC"/>
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| 272 | <templateId root="2.16.840.1.113883.10.20.1.11" assigningAuthorityName="HL7 CCD"/>
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| 273 | <code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem list"/>
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| 274 | <title>Problems</title>
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| 275 | <text/>
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| 276 | <entry typeCode="DRIV">
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| 277 | <act classCode="ACT" moodCode="EVN">
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| 280 | <code nullFlavor="NA"/>
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| 281 | <performer typeCode="PRF">
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| 282 | <assignedEntity>
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| 283 | <id extension="ACTORPROVIDER_10000000020" root="CCRActorID"/>
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| 284 | <addr use="WP">
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| 285 | <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
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| 286 | <city>ALBANY</city>
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| 287 | <state>NY</state>
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| 288 | <postalCode>12180</postalCode>
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| 289 | </addr>
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| 290 | <telecom/>
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| 291 | <assignedPerson>
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| 292 | <name>
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| 293 | <given>NANCY</given>
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| 294 | <family>ANTHRACITE</family>
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| 295 | </name>
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| 296 | </assignedPerson>
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| 297 | </assignedEntity>
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| 298 | </performer>
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| 299 | <entryRelationship typeCode="SUBJ">
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| 300 | <observation classCode="OBS" moodCode="EVN">
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| 301 | <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
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| 302 | <id root="PROBLEM1" extension="CCRObjectID"/>
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| 303 | <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNM"/>
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| 304 | <text>
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| 305 | <reference value="#PROBLEM1"/>
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| 306 | </text>
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| 307 | <statusCode code="completed"/>
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| 308 | <effectiveTime>
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| 309 | <low value="20101014"/>
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| 310 | <high value="20101014"/>
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| 311 | </effectiveTime>
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| 312 | <value xsi:type="CD" displayName="Diabetes (ICD-9-CM 250.00)" code="250.00" codeSystemName="I9" codeSystem="2.16.840.1.113883.6.103"/>
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| 313 | <entryRelationship typeCode="REFR">
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| 314 | <observation classCode="OBS" moodCode="EVN">
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| 315 | <templateId root="2.16.840.1.113883.10.20.1.50"/>
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| 316 | <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
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| 317 | <statusCode code="completed"/>
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| 318 | <value xsi:type="CD" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM">
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| 319 | <originalText>Active</originalText>
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| 320 | </value>
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| 321 | </observation>
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| 322 | </entryRelationship>
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| 323 | </observation>
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| 324 | </entryRelationship>
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| 325 | </act>
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| 326 | </entry>
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| 327 | <entry typeCode="DRIV">
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| 328 | <act classCode="ACT" moodCode="EVN">
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| 333 | <assignedEntity>
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| 334 | <id extension="ACTORPROVIDER_10000000020" root="CCRActorID"/>
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| 335 | <addr use="WP">
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| 336 | <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
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| 337 | <city>ALBANY</city>
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| 338 | <state>NY</state>
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| 339 | <postalCode>12180</postalCode>
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| 340 | </addr>
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| 341 | <telecom/>
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| 342 | <assignedPerson>
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| 343 | <name>
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| 344 | <given>NANCY</given>
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| 345 | <family>ANTHRACITE</family>
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| 346 | </name>
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| 347 | </assignedPerson>
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| 348 | </assignedEntity>
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| 349 | </performer>
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| 355 | <text>
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| 358 | <statusCode code="completed"/>
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| 360 | <low value="20101013"/>
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| 361 | <high value="20101013"/>
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| 362 | </effectiveTime>
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| 363 | <value xsi:type="CD" displayName="Nonproliferative Diabetic retinopathy NOS (ICD-9-CM 362.03)" code="362.03" codeSystemName="I9" codeSystem="2.16.840.1.113883.6.103"/>
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| 364 | <entryRelationship typeCode="REFR">
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| 368 | <statusCode code="completed"/>
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| 369 | <value xsi:type="CD" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM">
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| 370 | <originalText>Active</originalText>
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| 371 | </value>
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| 372 | </observation>
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| 373 | </entryRelationship>
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| 374 | </observation>
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| 375 | </entryRelationship>
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| 376 | </act>
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| 380 | <component>
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| 381 | <section>
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| 383 | <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
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| 384 | <title>Payers</title>
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| 385 | <entry typeCode="DRIV">
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| 386 | <act classCode="ACT" moodCode="DEF">
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| 387 | <templateId root="2.16.840.1.113883.10.20.1.20"/>
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| 390 | <statusCode code="completed"/>
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| 391 | <entryRelationship typeCode="COMP">
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| 392 | <act classCode="ACT" moodCode="EVN">
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| 394 | <id root="dbbb6311-8a4d-11df-a4ee-0800200c9c66"/>
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| 395 | <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>
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| 396 | <statusCode code="completed"/>
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| 397 | <performer typeCode="PRF">
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| 398 | <assignedEntity>
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| 399 | <id root="2.16.840.1.113883.12.86" extension="MC"/>
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| 400 | </assignedEntity>
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| 401 | </performer>
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| 402 | <participant typeCode="COV">
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| 403 | <participantRole>
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| 404 | <id root="2.16.840.1.113883.4.1" extension="345982321"/>
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| 405 | <code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
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| 406 | </participantRole>
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| 407 | </participant>
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| 408 | </act>
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| 409 | </entryRelationship>
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| 410 | </act>
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| 411 | </entry>
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| 412 | </section>
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| 413 | </component>
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| 414 | </section>
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| 415 | </component>
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| 416 | </section>
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| 417 | </component>
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| 418 | </structuredBody>
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| 419 | </component>
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| 420 | </ClinicalDocument>
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