Clause Workspace. Measure Authoring Tool Beta User Guide

Transcription

1 The tab contains the Code Lists box in the upper left corner, the Clause Library Measure Phrases box in the lower left corner, the system clause blinds (Population, Numerator, Denominator, etc.) in the right two thirds of the tab, and the Property Editor box on the bottom of the right side of the screen. 1

2 Code Lists Box The code lists you have created display in the box in the upper left corner of the tab. Any of the code lists that have a Category other than Attribute are available for creating a Quality Data Set (QDS) element for use in building your measure. NOTE: If you are in a measure that you did not create but which was shared with you, only the code lists associated to that measure are visible in this box, in addition to the Measurement Period, Measurement End Date, and Measurement Start Date options. Additional code lists that you created while in this measure s workspace will also appear in this list. The Code System abbreviation displays next to the code list name (e.g., SNM, GRP, etc.) and the code list Category abbreviation displays next to the Code System abbreviation (e.g., PRC, CDP, ATT, etc.). The Code System and Category abbreviations are as follows: Code System Code System Category Category Abbreviation Abbreviation CPT CPT ATT Attribute CVX CVX CDP Condition/Diagnosis/Problem HCP HCPCS COM Communication HL7 HL7 DEV Device I10 ICD 10 CM DXS Diagnostic Study I9 ICD 9 CM ENC Encounter LNC LOINC EXP Care Experience RxN RxNorm FXS Functional Status SNM SNOMED IND Individual Characteristic INT Intervention LAB Laboratory Test MED Medication PE Physical Exam PLN Care Plan PRC Procedure 2

3 RSK Risk Category/Assessment SUB Substance SX Symptom SYS System Characteristic TRN Transfer of Care To create a QDS element for the measure: 1. Click the radio box next to the desired code list (e.g., Asthma). 2. Click Apply to Measure. 3. The data types associated with the category of the code list are available in the Select Data Type dropdown. Select the desired (e.g., diagnosis active). 3

4 4. Click Apply to Measure. 5. The QDS element will be available for selection in the Phrase Element field drop down when creating a measure phrase. To select an attribute code list to be available for use in the measure: 1. Click the radio box next to the desired code list (e.g., Persistent). 2. Click Apply to Measure. The attribute code list will be available for selection when applying an attribute to a QDS element. Example For our mock Asthma Drug Therapy measure, we will need to create the following QDS elements and Attributes from the code lists that were created previously: Asthma: Diagnosis, Active Asthma Persistent: Diagnosis, Active Office and Outpatient Consult: Encounter, Performed Asthma Med: Medication, Active Asthma Med: Medication, Adverse Effects Asthma Med: Medication, Allergy 4

5 Asthma Med: Medication, Intolerance Asthma Med: Medication, Order Birthdate: Patient Characteristic Persistent: Attribute Patient reason for no asthma medication: Attribute Measurement Period Measure Clauses/Measure Phrases Box Clause Library Tab The Clause Library tab contains all of the Population, Denominator, Numerator, Exception, and Exclusion clauses for measures that you created, as well as those that have been shared with you. It also contains all of the user defined clauses that you ve created and saved. These clauses are available for use in any measure through cloning (e.g., a single population clause can be built once for a diabetes measure, and then cloned and applied to other applicable diabetes measures that have the same population requirements). Measure Phrases Tab The Measure Phrases tab contains all of the phrases that have been built for the measure. The measure phrase name that you entered for each phrase displays in this list. To view or edit a phrase: 5

6 1. Click the phrase in the Measure Phrases tab. 2. A protected textual view of the phrase displays directly below the Measure Phrase blind. In addition, the Property Editor at the bottom of the screen displays the input area for the phrase. The phrase may be edited in the Property Editor box if desired. **Note: Users are not able to delete Measure Phrases at this time. Please rename your Measure Phrase indicating it is no longer applicable for reference. For example, append the letter Z to the name of the Measure Phrase so it is placed at the bottom of the list. System Clause Blinds Expandable blinds are available for creating each system clause (Population, Numerator, Denominator, Exclusion, Exception), as well as a blind for creating User defined clauses for a measure. Although a measure can contain multiple Populations, Numerators, and Denominators, at a minimum a measure must contain at least one Population, Numerator, and Denominator clause. A measure could also contain multiple Exception and Exclusion clauses; however, they are not required. If the Denominator for a measure is simply All patients in the initial population without any other requirements, the Denominator blind can be left blank. At the time of export, the Denominator will be handled accordingly. Clicking on the blind header bar (e.g., Population) will expand or collapse the blind. The Canvas View of the blind displays. This will contain a tree diagram view of the system clause once it is built. 6

7 System clauses consist of QDS elements and smaller measure phrases that are joined together by operators (And, Or), relativities (During, Starts Before Start of, etc.) and comparators (Less Than, Greater Than or Equal To, etc.). There are two main options for building a system clause: bottom up or top down. We will walk through each option while building the Asthma Drug Measure Population system clause. A hybrid of the two approaches could also be used. Bottom Up System Clause Building To build a system clause from the bottom up, you will build the smallest of measure phrases, build larger measure phrases consisting of the smaller measure phrases if needed, then finally connect the measure phrases together with the appropriate operators. First you will identify the smallest measure phrases that you ll be able to build in the Measure Authoring Tool. Although the tool cannot protect you from making clinically illogical phrases, it will assist you in building correctly formatted phrases. It does this by filtering the options based on your selections as you build a phrase. For example, if you start a phrase with a QDS element then select AND as your operator, you will be limited to only adding additional QDS elements or phrases connected with ANDs in that phrase. You will not be able to add a timing comparator onto the end of the phrase. To build a measure phrase: 1. Click the Measure Phrase blind, and click New Phrase. 2. The Property Editor fields display. Enter a Name for your phrase. As you may be building several phrases for your measure, it is important to provide a meaningful name for your phrase to easily refer to it later when building other phrases and clauses. 3. Enter a Description for your phrase, if desired, to further explain the purpose of your clause. 4. The Status field defaults to In Progress. You may change this to Complete if desired. This designation is not used in the beta release of MAT, however, may be used in future releases. 5. The remainder of the fields should be entered as appropriate, depending on the contents of the phrase you are building. These will be discussed in the examples, however, the following is a brief description of functionality: a. Function field: See the Functions_Operators_Relative Timings_BetaUserGuide.xlsx document for a description of each function. When some functions are selected, it may also be appropriate to complete the Operator and Quantity fields (e.g., Function: COUNT, Operator: Greater Than or Equal To Quantity: 2). b. Phrase Element field: This drop down list consists of all the QDS elements and attributes added to the measure. As phrases are added, the phrase names will also display at the top of the drop down. The phrase names and QDS elements will be separated by dashes in the drop down list. The smallest of phrases could consist of only one QDS element. 7

8 c. Use Comparison button: When clicked, this allows you to add a timing comparison to a QDS element. If Use Comparison is clicked, the Condition and second Phrase Element fields are replaced by Operator, Quantity, and Unit fields. (e.g., Encounter days would be built as Phrase Element: Encounter, Operator: Added To, Quantity: 165, Unit: Days ). d. Condition field: This drop down list contains the AND and OR operators, separated from Relativities (e.g., Starts Before or During), separated from Comparators (e.g., Less Than, Equal To). You will select the appropriate option based on the phrase you are building. e. Phrase Element field: As mentioned above, this list consists of all the QDS elements and attributes added to the measure. The phrase names will also display at the top of the drop down. The phrase names and QDS elements will be separated by dashes in the drop down list. If selecting an option from the second Phrase Element field, your phrase must also contain a selection from the first Phrase Element field, as well as a Condition. f. To add an attribute to a QDS element, click the 0 attributes; add or edit option below the Phrase Element field. This option is available for either Phrase Element field. An Add/Edit Attributes box displays. 1. The options in the Add/Edit Attributes drop down are filtered to show only those data type specific attributes that apply to the category and data type of the element selected. The top of the list displays the data type specific attribute options, while the bottom of the list displays the dataflow attribute options (e.g., Source Device, Source Informant, Recorder Informant, etc.). Select the appropriate option from the drop down list. 2. Click Add Attribute. A second drop down displays. 3. Three options are provided. Select Check if Present if you only need to verify if the attribute (e.g., route) is present. Select Comparison if you need to compare your attribute value to a certain threshold (e.g., equal to 150 mg). Select Code List to check for the presence of a code to indicate your attribute (e.g., severity attribute with a code list to indicate mild ). 4. Click Update Attribute. Your next options are dependent on the option you chose in the second drop down. If Check if Present was selected, then you re returned to the box to add additional attributes if desired. If Comparison was selected, three additional fields display for you to add the comparison values (e.g., duration attribute with less than 120 days comparator). If Code List was selected, an additional field displays for you to select the desired code list for your attribute (severity attribute with mild code list). 5. Click Update Attribute. The attribute will display in the Add/Edit Attributes box. 6. Click Save to add the attribute to the element. You re returned to the Property Editor box. 1 attribute; add or edit now displays below the Phrase Element field. 7. You must click Save again to save the entire Phrase. 8

9 **Note regarding DURATION: Users should not combine the duration type attribute with any other attribute for a given instance of a QDM element. Instead users should use an AND to connect the same QDM element and add the duration attribute to one QDM element and the other attribute to the second QDM element. For example: If for a Medication QDM element, both the duration and route needed to be defined, it might look like this. Medication Active.route AND Medication Active.duration **Note regarding COUNTDISTINCT : If you use the COUNTDISTINCT function, you must assign an attribute to the QDM element that you are counting in order for the EHR which implements the measure to understand what specifically you are counting. For example, if your measure wants to know if a patient had more than 4 distinct encounters during the measurement period, you could assign the start datetime attribute to the encounter element, to count the distinct number of encounter start datetimes. g. When Add is clicked at the end of the second Phrase Element field, three additional fields display for adding a timing comparison onto your phrase. Select the desired options from the Operator, Quantity, and Unit fields. Clicking Remove will delete the Operator, Quantity, and Unit fields. 6. Additional system clauses, such as a second population, can be added by clicking the appropriate button, e.g., Add Population, in the Property Editor box. Example The Population for our Asthma Drug Therapy measure example is as follows: Patients aged 5 60 years at the beginning of the measurement period, who had at least two face to face office visits during the measurement period, and who have a documented diagnosis of asthma. We can break the Population down into three main concepts: >= 2 office visits during the measurement period Patient age >= 5 and <=60 years prior to the measurement period Active asthma diagnosis before or during the measurement period In the MAT, we will first need to build the smallest of phrases for the above: COUNT >= 2 Office and Outpatient Consult: Encounter, Performed During Measurement Period Birthdate: Patient Characteristic >= 5 years Starts before start of Measurement Period Birthdate: Patient Characteristic <= 60 years Starts before start of Measurement Period 9

10 Asthma persistent: Diagnosis, Active Or Asthma: Diagnosis, Active (severity = persistent) Note that the fourth phrase does not contain the comparison During Measurement Period. Since we connected the two asthma QDS elements together with an Or, the MAT prevents us from adding the timing comparison in the same phrase. We must first build the smaller phrase, and then build a larger phrase containing the smaller nested phrase. The final fifth phrase will be: (Asthma persistent: Diagnosis, Active Or Asthma: Diagnosis, Active (severity = persistent)) Starts Before or During Measurement Period To build the first phrase, COUNT >= 2 Office and Outpatient Consult: Encounter, Performed During Measurement Period: 1. Click the Measure Phrase blind, and click New Phrase. The Property Editor fields display. 2. In the Name field enter >=2 encounters during meas period. 3. In the Description field enter >=2 office visits during measurement period. 4. The Status field defaults to In Progress. We will change this to Complete. 10

11 5. In the Function field, select COUNT. 7. In the Operator field to the right of the Function field, select Greater Than or Equal To. 8. In the Quantity field, enter In the Phrase Element field, note this list consists of all the QDS elements and attributes added to the measure. As phrases are added, the phrase names will also display at the top of the dropdown. The phrase names and QDS elements are separated by dashes in the drop down list. Select Office and Outpatient Consult: Encounter, Performed. 10. Select During in the Condition field. 11. In the second Phrase Element field, select Measurement Period: start of timing window. **Note when nesting phrases: Due to HQMF emeasure constraints, the use of Relative Timings should be limited to the right hand side of a clause. When nesting phrases, the first phrase element should always be either a QDM element or a measure phrase that does not use relative timing. 12. Click Save. The first measure phrase is complete. The phrase name now displays on the Measure Phrases tab in the lower left corner, and will also display at the top of the drop down list in the Phrase Element fields. 11

12 To build the second phrase, Birthdate: Patient Characteristic >= 5 years Starts before start of Measurement Period: 1. Click New Phrase. 2. Name: Age >=5 before start of meas period. 3. Description: Patient >=5 before the start of the measurement period. 4. Status: Complete. 5. In the first Phrase Element field, select Birthdate: Patient Characteristic. 6. Select Starts Before Start Of in the Condition field. 7. In the second Phrase Element field, select Measurement Period: start of timing window. 8. Click Add to the right of the second Phrase Element field. 12

13 9. An additional Operator, Quantity, and Unit field display below the second Phrase Element field. 10. Select Greater Than or Equal To in the Operator field. 11. Enter 5 in the Quantity field. 12. Select years in the Unit field. 13. Click Save. The second measure phrase is complete, and it added to the Measure Phrases tab in the lower left corner, as well as the top of the Phrase Element field drop down. 13

14 The third phrase is built exactly like the second phrase, however, you will enter Less Than or Equal To in the Operator field and 60 in the Quantity field. To build the fourth phrase, Asthma persistent: Diagnosis, Active Or Asthma: Diagnosis, Active (severity = persistent): 1. Click New Phrase. 2. Name: Asthma persistent dx or Asthma dx, severity persistent. 3. Description: Diagnosis of asthma persistent, or asthma with persistent severity. 4. Status: Complete. 5. First Phrase Element field: Asthma persistent: Diagnosis, Active. 6. Condition: OR. 7. Second Phrase Element field: Asthma: Diagnosis, Active. 8. Right below the second Phrase Element field, click 0 attributes: add or edit. 14

15 9. An Add/Edit Attributes box displays. The options in the Add/Edit Attributes drop down are filtered to show only those data type specific attributes that apply to the category and data type of the element selected. The top of the list displays the data type specific attribute options, while the bottom of the list displays the dataflow attribute options (e.g., Source Device, Source Informant, Recorder Informant, etc.). Select severity from the drop down list. 10. Click Add Attribute. A second drop down displays. 11. Select Code List, and click Update Attribute. 12. A third drop down displays. Select Persistent: Attribute. 13. Click Update Attribute. The attribute displayed in the Add/Edit Attributes box. 15

16 14. Click Save. 15. You must click Save again to save the entire phrase. The fourth measure phrase is complete. Now that the fourth phrase has been built, we can use it to build the fifth phrase, (Asthma persistent: Diagnosis, Active Or Asthma: Diagnosis, Active (severity = persistent)) Starts Before or During Measurement Period: 1. Click New Phrase. 2. Name: Asthma starts before or during meas period. 3. Description: Persistent asthma diagnosis starts before or during measurement period. 4. Status: Complete. 5. In the first Phrase Element field, select the name of the fourth phrase that you built, Asthma persistent dx or Asthma dx, severity persistent. 6. Condition: Starts Before or During. 7. Second Phrase Element: Measurement Period. 16

17 8. Click Save. The fifth measure phrase (containing the nested fourth measure phrase) is complete. As mentioned previously, the MAT assists you in building correctly formatted, unambiguous phrases. The following are examples of phrase formats that are acceptable in the MAT, each with an example: QDS o Asthma: Diagnosis, Active Function QDS o FIRST Asthma: Diagnosis, Active QDS AND/OR QDS o Asthma: Diagnosis, Active OR Asthma Persistent: Diagnosis, Active QDS AND/OR QDS AND/OR QDS o Asthma: Diagnosis, Active AND Asthma Persistent: Diagnosis, Active AND Office and Outpatient Consult: Encounter, Performed Function QDS AND/OR QDS... 17

18 o COUNT Total Cholesterol: Laboratory Test, Performed AND LDL c: Laboratory Test, Performed QDS Timing Relativity QDS o Asthma Persistent: Diagnosis, Active Starts Before or During Office and Outpatient Consult: Encounter, Performed QDS Timing Relativity QDS Operator Quantity Unit o Birthdate: Patient Characteristic Starts Before Start Of Office and Outpatient Consult: Encounter, Performed Greater Than or Equal To 18 years Function QDS Timing Relativity QDS o COUNT Greater Than or Equal To 2 Office and Outpatient Consult: Encounter, Performed During Measurement Period: start of timing window Function QDS Timing Relativity QDS Operator Quantity Unit o COUNT Greater Than or Equal To 2 Office and Outpatient Consult: Encounter, Performed Starts After Start Of Measurement Period: start of timing window Greater Than or Equal To 6 months Function Phrase o COUNT Greater Than or Equal to 2 (Office and Outpatient Consult: Encounter, Performed Starts After Start Of Measurement Period: start of timing window Greater Than or Equal To 6 months ) Phrase AND/OR Phrase o (Birthdate: Patient Characteristic Starts Before Start Of Office and Outpatient Consult: Encounter, Performed Greater Than or Equal To 5 years) AND (Birthdate: Patient Characteristic Starts Before Start Of Office and Outpatient Consult: Encounter, Performed Less Than or Equal To 18 years) Phrase AND/OR Phrase AND/OR Phrase o (Asthma: Diagnosis, Active During Measurement Period: start of timing window) AND (Birthdate: Patient Characteristic Starts Before Start Of Office and Outpatient Consult: Encounter, Performed Greater Than or Equal To 5 years) AND (Birthdate: Patient Characteristic Starts Before Start Of Office and Outpatient Consult: Encounter, Performed Less Than or Equal To 18 years) Function Phrase AND/OR Phrase o COUNT (LDL c: Laboratory Test, Performed During Measurement Period: start of timing window) AND (LDL c: Laboratory Test, Performed Starts Before Start of Measurement Period: start of timing window <= 12 months Phrase not containing timing relativity Timing Relativity QDS o (Asthma: Diagnosis, Active OR Asthma Persistent: Diagnosis, Active) Starts Before Start of Measurement Period: start of timing window Phrase not containing timing relativity Timing Relativity QDS Operator Quantity Unit o (Asthma: Diagnosis, Active OR Asthma Persistent: Diagnosis, Active) Starts Before Start of Measurement Period: start of timing window Greater Than or Equal To 12 months 18

19 Phrase not containing timing relativity Timing Relativity Phrase o (Asthma: Diagnosis, Active OR Asthma Persistent: Diagnosis, Active) Starts Before Start of (Office or Outpatient Visit: Encounter, Performed During Measurement Period: start of timing window) Phrase not containing timing relativity Timing Relativity Phrase Operator Quantity Unit o (Asthma: Diagnosis, Active OR Asthma Persistent: Diagnosis, Active) Starts Before Start of (Office or Outpatient Visit: Encounter, Performed During Measurement Period: start of timing window) Greater Than or Equal To 12 months Function Phrase not containing timing relativity Timing Relativity QDS o COUNT (Inpatient: Encounter, Performed OR Outpatient Visit: Encounter, Performed) During Measurement Period: start of timing window Function Phrase not containing timing relativity Timing Relativity QDS Operator Quantity Unit o COUNT (Inpatient: Encounter, Performed OR Outpatient Visit: Encounter, Performed) Starts After Start Of Measurement Period: start of timing window Less Than or Equal To 6 months QDS Timing Relativity Phrase o Asthma: Diagnosis, Active Starts Before or During (Outpatient Visit: Encounter, Performed During Measurement Period: start of timing window) QDS Timing Relativity Phrase Operator Quantity Unit o Asthma: Diagnosis, Active Starts Before Start Of (Outpatient Visit: Encounter, Performed During Measurement Period: start of timing window) Greater Than or Equal To 12 months Function QDS Timing Relativity Phrase o FIRST Asthma: Diagnosis, Active Starts Before Start Of (Outpatient Visit: Encounter, Performed During Measurement Period: start of timing window) Function QDS Timing Relativity Phrase Operator Quantity Unit o FIRST Asthma: Diagnosis, Active Starts Before Start Of (Outpatient Visit: Encounter, Performed During Measurement Period: start of timing window) Greater Than or Equal To 12 months Building a System Clause via the Canvas Area, Bottom Up The Canvas Area is used for connecting your system clauses together. System clauses (Population, Denominator, Numerator, Exclusions, Exceptions) are made up of several phrases connected with ANDs and/or ORs. To build your system clause in the canvas area: 19

20 1. Click the desired blind (e.g., Population, Numerator, etc.) to open the canvas area for the selected system clause. By default, a placeholder rectangle for the first system clause displays (e.g., measure name_population1). 2. Click the rectangle containing the measure name (e.g., measure name_population1) so that it is highlighted yellow. A Property Editor box appears at the bottom of the screen. 3. Click And or Or to add the first connector. The selection will appear attached to the highlighted rectangle in the Canvas area. 4. Click the AND or OR rectangle so that it is highlighted yellow. In the Property Editor box at the bottom of the screen, click Existing Phrase. A Phrase drop down, containing the list of phrases that have been created for the measure, displays at the bottom of the screen. 5. Select the desired phrase and click Ok. A rectangle containing the phrase name displays attached to the AND or OR in the canvas area. 6. To view the contents of a phrase, click the arrow above the phrase rectangle. The rectangle will expand, and hovering the tooltip over the box displays the entire contents of the phrase. 7. To connect another phrase to the initial AND or OR, click the AND or OR rectangle so that it is highlighted. 8. Click Existing Phrase at the bottom of the screen. 9. Select the desired phrase in the Phrase drop down and click Ok. A rectangle containing the phrase name displays attached to the AND or OR, below the first phrase that you added. 10. You can continue adding phrases to the initial AND or OR rectangle, or if you need to nest phrases deeper than the top level of the tree on the canvas, you can add additional ANDs or ORs to the top level AND or OR rectangle. The following is an example of this type of tree nesting: Phrase1 AND: Phrase2 Phrase3 Phrase4 OR: Phrase5 Phrase6 If we were to read the intent of the above, it would interpret as Phrase1 AND Phrase2 AND Phrase3 AND (Phrase4 OR Phrase5 OR Phrase6). Note that phrases 4, 5 and 6 are nested under phrases 1, 2, and Phrases can be nested at any level in the tree on the canvas. Another example of this: Phrase1 AND: Phrase2 Phrase3 Phrase4 OR: Phrase5 Phrase 6 Phrase7 AND: Phrase8 20

21 Phrase9 The above would interpret as Phrase1 AND Phrase2 AND Phrase3 AND (Phrase4 OR Phrase5 OR (Phrase6 AND Phrase7)). Note that phrases 4, 5, and 6 are nested under phrases 1, 2, and 3, and phrases 7, 8, and 9 are nested under phrases 4, 5, and 6. We have built five phrases which will make up the Population for the Asthma Drug Therapy measure. Now we must apply them to the canvas to put our Population together: 1. Click the Population blind. The Population canvas is displayed. 2. Click the Asthma Drug Tx_Population1 rectangle so that it is highlighted. 3. All of the clauses in our Population should be connected with an AND. Click And in the Property Editor box at the bottom of the screen. An AND rectangle displays in the canvas. 21

22 4. Click the AND rectangle so that it is highlighted. 5. Click Existing Phrase in the Property Editor box. 22

23 6. In the Phrase drop down below the Property Editor box, select the phrase titled >=2 encounters during meas period. Click Ok. 7. The phrase is added to the end of the AND rectangle. 8. While the AND rectangle is still highlighted, click Existing Phrase again in the Property Editor box. 9. In the Phrase drop down, select the phrase titled Age >=5 before start of meas period and click Ok. The second phrase displays connected to the AND rectangle, below the first phrase, in the Population canvas area. 23

24 10. Click Existing Phrase again in the Property Editor box. 11. In the Phrase drop down, select the phrase titled Age <=60 before start of meas period and click Ok. The third phrase displays connected to the AND rectangle, below the second phrase, in the Population canvas area. 12. Click Existing Phrase in the Property Editor box again to add the last phrase to the Population. 13. In the Phrase drop down, select the phrase titled Asthma starts before or during meas period and click Ok. The final phrase displays connected to the AND rectangle, below the third phrase, in the Population canvas area. This completes the building of the Asthma Drug Therapy Population system clause. Top Down System Clause Building Another option for building your system clause is to build from the top down. This allows you to build your measure phrases in the system clause canvas from the start. Building a system clause through this approach may require a little more forethought on how the phrases will need to be connected on the system clause tree as you build them. To build a system clause from the top down: 24

25 1. Click the desired system clause blind. The canvas area is displayed. 2. Click the rectangle containing the measure name (e.g., measure name_population1) so that it is highlighted yellow. A Property Editor box appears at the bottom of the screen. 3. Click And or Or to add the first connector. The selection displays attached to the highlighted rectangle in the Canvas area. 4. Click the AND or OR rectangle so that it is highlighted yellow. 5. Click New Phrase in the Property Editor. The phrase building workspace displays at the bottom of the page. 6. Follow the previous instructions for creating a measure phrase, then click Save. The measure phrase displays in the canvas area following the AND or OR rectangle. 7. If you need to build a phrase that contains a smaller nested phrase, you will first need to build the smaller phrase that will be nested. To do this: a. Open the Measure Phrase blind and click New Phrase. The measure phrase building workspace displays. b. Build the desired phrase, then click Save. The phrase displays in the Measure Phrases box in the lower left corner. It will also be available for selection in the Property Editor in the Phrase Element drop down when building new phrases. c. Open the desired system clause blind and click the appropriate AND or OR rectangle so that it is highlighted yellow. d. Click New Phrase in the Property Editor. The phrase building workspace displays at the bottom of the page. e. Build the phrase as desired. Note that when building the new phrase, the smaller nested phrase will display in both of the Phrase Element drop down fields. If the nested phrase that you built above contains any type of timing relativity (e.g., Starts Before or During, Starts after Start Of, etc.), it should only be used in the second Phrase Element field on the right side of the phrase. It should not be selected in the first Phrase Element field. f. When done building the phrase, click Save. 8. As with bottom up system clause building, you can continue adding phrases to the initial AND or OR, or if you need to nest phrases deeper than the top level of the tree, you can add ANDs or ORs to the top level AND or OR. The following is an example of this type of tree nesting: Phrase1 AND: Phrase2 Phrase3 Phrase4 OR: Phrase5 Phrase6 If we were to read the intent of the above, it would interpret as Phrase1 AND Phrase2 AND Phrase3 AND (Phrase4 OR Phrase5 OR Phrase6). Note that phrases 4, 5 and 6 are nested under phrases 1, 2, and Phrases can be nested at any level in the tree. Another example of this: 25

26 Phrase1 AND: Phrase2 Phrase3 Phrase4 OR: Phrase5 Phrase 6 Phrase7 AND: Phrase8 Phrase9 The above would interpret as Phrase1 AND Phrase2 AND Phrase3 AND (Phrase4 OR Phrase5 OR (Phrase6 AND Phrase7)). Note that phrases 4, 5, and 6 are nested under phrases 1, 2, and 3, and phrases 7, 8, and 9 are nested under phrases 4, 5, and 6. Cloning of Clauses Clauses can be cloned and used in the same or other measures as needed. When a clause is cloned, a new copy, or version, of the clause is made. You will be able to modify the new cloned copy of the clause without affecting the original copy. Cloning can be very useful, particularly if you are authoring a set of measures that utilize the same population criteria, or if you have a clause that is re used throughout one or more measures. To clone a clause: 1. On the Clause Library tab, click the desired clause that you want to clone. The clause name will appear highlighted. 2. Click Clone. 26

27 3. Open the system clause blind where you would like to paste the cloned phrase. 4. Click the rectangle containing the measure name (e.g., Asthma Drug Tx_Denominator1) so that it is highlighted. 5. In the Property Editor box click Paste Clone. 27

28 6. The cloned clause displays as a new system clause in the blind. 7. Changes may be made to the cloned clause if needed, or the cloned clause may be deleted. User Defined Clauses The User defined blind provides an area where you can paste and edit portions of other clauses to save as a user defined clause. User defined clauses display in the Clause Library tab in the lower left corner of the screen, and can be cloned to be re used in other measures. To create a user defined clause: 1. In the desired system clause blind, click the rectangle representing the spot from which you want to copy. 28

29 2. Click Copy. 3. Click the User defined blind to expand the canvas, and click the rectangle containing the measure name (e.g., Asthma Drug Tx_User Defined1) so that it is highlighted. 29

30 4. Click Paste. The copied measure information is pasted onto the rectangle. 30

31 5. If changes are needed, click the desired spot and click Edit in the Property Editor box. 6. The clause will be saved and available for cloning in the Clause Library tab in the lower left corner of the screen. Shortcut Keys for Cut, Copy and Paste are as follows: o o o CUT : ctrl alt x COPY: ctrl alt c PASTE: ctrl alt v 31