cqm-reports 3.1.2 → 3.1.6

checksums.yaml

@@ -1,7 +1,7 @@
 ---
 SHA256:
-  metadata.gz: 9d999a13b64a6a37c2ad61c53c5325162a31eb948e95556a421474eb22cca735
-  data.tar.gz: f4d69a6e256859b77ea3da62a332f48e358ca4a3589d1d08bbf57889b6977f20
+  metadata.gz: 440f42a620879552f2e979057f0ed822da436b56f5d89a12f9005789d93cc0fd
+  data.tar.gz: a89b92c7368674e8876d228e37f72c06fda05b4c09be469a39cf4b7c654edfa5
 SHA512:
-  metadata.gz: 99e4bb97fe1ecbcb0a4f336b0e2e6d0f5d6d85dd05f539a4ea71ad28fbb091b9cf78c2c23605f0e1344c736b4fdc38e0cda8bc12efb2ca52f4f393f158f979c6
-  data.tar.gz: 5c0b2e94fa51e623b071aecfc34537bc16efed7069d1bac433b178491462679fde863b24b6ee7cce9191b27e320d24fdfa004b0077f6e5be8492524f23cc89e5
+  metadata.gz: eca1d234de6ebd75e5ab88e1c19deb4422b08b589fb3e7ea5708fc1a166f3df692a9c530a5ffc7536ffe0e4d8d7585f67ce43dbcad2de2c7b8468a0eaf50a4b1
+  data.tar.gz: e69941a67e3345f3c907ce86422607a28778063ddcbdabae63325fa0b4dba0ff00d33bd076a7bc5afcbd66fd3ca9bcd0a672be16dce1e848b21766931140d272

data/Gemfile

@@ -17,7 +17,7 @@ group :development do
 end
 
 group :test do
-  gem 'cqm-models', '~> 3.0.3'
+  gem 'cqm-models', '~> 3.0'
   gem 'factory_girl', '~> 4.1.0'
   gem 'tailor', '~> 1.1.2'
   gem 'cane', '~> 2.3.0'

data/lib/html-export/qdm-patient/data_element/_data_element_codes.mustache

@@ -2,7 +2,7 @@
 <div class="div-table-body">
 {{#dataElementCodes}}
 <div class="div-head-row">
-	<div class="div-table-head--no-border"><span class="criteria-heading">{{{code_system_name}}}:</span>  {{code}}</div>
+	<div class="div-table-head--no-border"><span class="criteria-heading">{{{code_system_name}}}:</span>  {{code}}{{{code_description}}}</div>
 </div>
 {{/dataElementCodes}}
 </div>

data/lib/html-export/qdm-patient/data_element/_data_element_other_fields.mustache

@@ -44,7 +44,7 @@
 {{/daysSupplied}}
 {{#diagnoses}}
 	<div class="div-head-row">
-		<div class="div-table-head--no-border"><span class="criteria-heading">Diagnosis:</span>  {{{nested_code_string}}}</div>
+		<div class="div-table-head--no-border"><span class="criteria-heading">Diagnosis{{{diagnosis_rank_string}}}:</span>  {{{nested_code_string}}}</div>
 	</div>
 {{/diagnoses}}
 {{#dischargeDisposition}}

data/lib/html-export/qdm-patient/qdm_patient.mustache

@@ -18,7 +18,7 @@
           <div class="div-table-head patient_narr_th panel-heading"><span class="td_label">Patient</span></div>
           <div class="div-table-head">{{given_name}} {{familyName}}</div>
           <div class="div-table-head patient_narr_th panel-heading"><span class="td_label">Sex</span></div>
-          <div class="div-table-head">{{{gender}}}</div>
+          <div class="div-table-head">{{{gender}}}{{#demographic_code_description}}gender{{/demographic_code_description}}</div>
         </div>
         <div class="div-head-row patient_narr_tr panel panel-default patient-details">
           <div class="div-table-head patient_narr_th panel-heading"><span class="td_label">Date of birth</span></div>
@@ -28,13 +28,13 @@
         </div>
         <div class="div-head-row patient_narr_tr panel panel-default patient-details">
           <div class="div-table-head patient_narr_th panel-heading"><span class="td_label">Race</span></div>
-          <div class="div-table-head">{{{race}}}</div>
+          <div class="div-table-head">{{{race}}}{{#demographic_code_description}}race{{/demographic_code_description}}</div>
           <div class="div-table-head patient_narr_th panel-heading"><span class="td_label">Ethnicity</span></div>
-          <div class="div-table-head">{{{ethnic_group}}}</div>
+          <div class="div-table-head">{{{ethnic_group}}}{{#demographic_code_description}}ethnic_group{{/demographic_code_description}}</div>
         </div>
         <div class="div-head-row patient_narr_tr panel panel-default patient-details">
           <div class="div-table-head patient_narr_th panel-heading"><span class="td_label">Insurance Providers</span></div>
-          <div class="div-table-head">{{{payer}}}</div>
+          <div class="div-table-head">{{{payer}}}{{#demographic_code_description}}payer{{/demographic_code_description}}</div>
           <div class="div-table-head patient_narr_th panel-heading"><span class="td_label">Patient IDs</span></div>
           <div class="div-table-head">{{{mrn}}} Cypress</div>
         </div>

data/lib/html-export/qdm-patient/qdm_patient.rb

@@ -91,13 +91,31 @@ class QdmPatient < Mustache
   end
 
   def code_for_element(element)
-    "#{element['code']} (#{HQMF::Util::CodeSystemHelper.code_system_for(element['system'])})"
+    "#{element['code']} (#{HQMF::Util::CodeSystemHelper.code_system_for(element['system'])})#{code_description(element)}"
   end
 
   def code_system_name
     HQMF::Util::CodeSystemHelper.code_system_for(self['system'])
   end
 
+  def code_description(element = self)
+    has_descriptions = @patient.respond_to?(:code_description_hash) && !@patient.code_description_hash.empty?
+    # mongo keys cannot contain '.', so replace all '.', key example: '21112-8:2_16_840_1_113883_6_1'
+    return " - #{@patient.code_description_hash["#{element['code']}:#{element['system']}".tr('.', '_')]}" if has_descriptions
+    # no code description available
+    ""
+  end
+
+  def demographic_code_description(code)
+    # only have code, don't need code system
+    has_descriptions = code && @patient.respond_to?(:code_description_hash) && !@patient.code_description_hash.empty?
+    if has_descriptions
+      key = @patient.code_description_hash.keys.detect { |k| k.starts_with?("#{send(code)}:") }
+      return " - #{@patient.code_description_hash[key]}"
+    end
+    ""
+  end
+
   def result_string
     return unit_string if self['value']
     return code_code_system_string if self['code']
@@ -109,6 +127,10 @@ class QdmPatient < Mustache
     code_for_element(self['code'])
   end
 
+  def diagnosis_rank_string
+    " (rank: #{self['rank']})" if self['rank']
+  end
+
   def end_time?
     self['high'] && DateTime.parse(self['high']).year < 3000
   end

data/lib/qrda-export/catI-r5/qrda_templates/communication_performed.mustache

@@ -48,7 +48,6 @@
         <entryRelationship typeCode="REFR">
           <observation classCode="OBS" moodCode="EVN">
             <templateId root="2.16.840.1.113883.10.20.24.3.88" extension="2017-08-01"/>
-            <id root="1.3.6.1.4.1.115" extension="{{object_id}}" />
             <code code="77301-0" codeSystem="2.16.840.1.113883.6.1" displayName="reason" codeSystemName="LOINC"/>
             <statusCode code="completed"/>
             <!-- QDM Attribute: Code -->

data/lib/qrda-export/catI-r5/qrda_templates/laboratory_test_performed.mustache

@@ -41,5 +41,9 @@
       <!-- QDM Attribute: Components -->
       {{> qrda_templates/template_partials/_component}}
     {{/components}}
+    {{#encounter_id}}
+      <!-- QDM Attribute: relatedTo -->
+      {{> qrda_templates/template_partials/_related_to}}
+    {{/encounter_id}}
     </observation>
 </entry>

data/lib/qrda-export/catI-r5/qrda_templates/physical_exam_performed.mustache

@@ -48,5 +48,9 @@
       <!-- QDM Attribute: Components -->
       {{> qrda_templates/template_partials/_component}}
     {{/components}}
+    {{#encounter_id}}
+      <!-- QDM Attribute: relatedTo -->
+      {{> qrda_templates/template_partials/_related_to}}
+    {{/encounter_id}}
   </observation>
 </entry>

data/lib/qrda-export/catI-r5/qrda_templates/template_partials/_reaction_observation.mustache

@@ -4,6 +4,6 @@
       <id root="4adc1020-7b14-11db-9fe1-0800200c9a64" />
       <code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4" />
       <statusCode code="completed" />
-      {{> qrda_templates/template_partials/_data_element_codes_as_values}}
+      <value xsi:type="CD" {{> _code}}/>
     </observation>
   </entryRelationship>

data/lib/qrda-export/catI-r5/qrda_templates/template_partials/_reason.mustache

@@ -1,7 +1,6 @@
 <entryRelationship typeCode="RSON">
   <observation classCode="OBS" moodCode="EVN">
     <templateId root="2.16.840.1.113883.10.20.24.3.88" extension="2017-08-01"/>
-    <id root="1.3.6.1.4.1.115" extension="{{random_id}}" />
     <code code="77301-0" codeSystem="2.16.840.1.113883.6.1" displayName="reason" codeSystemName="LOINC"/>
     {{#relevantPeriod}}
     {{{relevant_period}}}

data/lib/qrda-export/catIII-r2-1/_continuous_variable_value.mustache

@@ -2,16 +2,16 @@
   <observation classCode="OBS" moodCode="EVN">
     <templateId root="2.16.840.1.113883.10.20.27.3.2"/>
     <code nullFlavor="OTH">
-      <originalText>Time Difference</originalText>
+      <originalText>Other</originalText>
     </code>
     <statusCode code="completed"/>
-    <value xsi:type="PQ" value="{{value}}" unit="min"/>
-    <methodCode code="MEDIAN" displayName="Median" codeSystem="2.16.840.1.113883.5.84" codeSystemName="ObservationMethod"/>
+    <value xsi:type="REAL" value="{{value}}"/>
+    <methodCode code="{{method}}" displayName="{{method}}" codeSystem="2.16.840.1.113883.5.84" codeSystemName="ObservationMethod"/>
     <reference typeCode="REFR">
       <!-- reference to the relevant measure observation in the eMeasure -->
       <externalObservation classCode="OBS" moodCode="EVN">
-        <id root="{{id}}"/>
+        <id root="{{hqmf_id}}"/>
       </externalObservation>
     </reference>
   </observation>
-</entryRelationship>  
+</entryRelationship>

data/lib/qrda-export/catIII-r2-1/_header.mustache

@@ -3,8 +3,14 @@
 <typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
 <!-- US Realm Header Template Id -->
 <templateId root="2.16.840.1.113883.10.20.27.1.1" extension="2017-06-01"/>
-<!-- QRDA Category III Report - CMS (V4) -->
+{{#ry2022_submission?}}
+<!-- QRDA Category III Report - CMS (V6) -->
+<templateId root="2.16.840.1.113883.10.20.27.1.2" extension="2021-07-01"/>
+{{/ry2022_submission?}}
+{{^ry2022_submission?}}
+<!-- QRDA Category III Report - CMS (V5) -->
 <templateId root="2.16.840.1.113883.10.20.27.1.2" extension="2020-05-01"/>
+{{/ry2022_submission?}}
 <!-- This is the globally unique identifier for this QRDA document -->
 <id root="{{random_id}}"/>
 <!-- QRDA III document type code -->

data/lib/qrda-export/catIII-r2-1/_measure_data.mustache

@@ -27,11 +27,9 @@
         {{> _supplemental_data}}
       {{/population_supplemental_data}}
     {{/supplemental_data}}
-    {{#msrpopl?}}
       {{#population_observation}}
         {{> _continuous_variable_value}}
       {{/population_observation}}
-    {{/msrpopl?}}
     <reference typeCode="REFR">
        <externalObservation classCode="OBS" moodCode="EVN">
           <id root="{{id}}"/>

data/lib/qrda-export/catIII-r2-1/_stratification.mustache

@@ -15,11 +15,9 @@
         <methodCode code="COUNT" displayName="Count" codeSystem="2.16.840.1.113883.5.84" codeSystemName="ObservationMethod"/>
       </observation>
     </entryRelationship>
-    {{#msrpopl?}}
-      {{#stratification_observation}}
-        {{> _continuous_variable_value}}
-      {{/stratification_observation}}
-    {{/msrpopl?}}
+    {{#stratification_observation}}
+      {{> _continuous_variable_value}}
+    {{/stratification_observation}}
     <reference typeCode="REFR">
       <externalObservation classCode="OBS" moodCode="EVN">
         <id root="{{id}}"/>

data/lib/qrda-export/catIII-r2-1/qrda3_r21.rb

@@ -27,6 +27,7 @@ class Qrda3R21 < Mustache
     @performance_period_start = options[:start_time]
     @performance_period_end = options[:end_time]
     @submission_program = options[:submission_program]
+    @ry2022_submission = options[:ry2022_submission]
   end
 
   def agg_results(measure_id, cache_entries, population_sets)
@@ -58,14 +59,11 @@ class Qrda3R21 < Mustache
   end
 
   def stratification_observation
-    observation = @measure_result_hash[self['measure_id']].aggregate_count.populations.find {|p| p.type == "OBSERV"}
-    stratification_observation = @measure_result_hash[self['measure_id']].aggregate_count.populations.find {|p| p.type == "OBSERV"}.stratifications.find {|s| s.id == self['id'] }
-    stratification_observation.id = observation.id
-    stratification_observation
+    self['observation']
   end
 
   def population_observation
-    @measure_result_hash[self['measure_id']].aggregate_count.populations.find {|p| p.type == "OBSERV"}
+    self['observation']
   end
 
   def supplemental_template_ids
@@ -90,6 +88,10 @@ class Qrda3R21 < Mustache
     @submission_program == 'CPCPLUS'
   end
 
+  def ry2022_submission?
+    @ry2022_submission
+  end
+
   def payer_code?
     self['type'] == 'PAYER'
   end

data/lib/qrda-export/helper/aggregate_object_helper.rb

@@ -57,23 +57,24 @@ module Qrda
         end
       end
       class Population
-        attr_accessor :type, :value, :id, :stratifications, :supplemental_data
+        attr_accessor :type, :value, :id, :stratifications, :supplemental_data, :observation
 
         def initialize
           @stratifications = []
         end
 
-        def add_stratification(id,value)
-          stratifications << Stratification.new(id,value) unless stratifications.find {|st| st.id == id}
+        def add_stratification(id,value,observation)
+          stratifications << Stratification.new(id,value,observation) unless stratifications.find {|st| st.id == id}
         end
 
       end
 
       class Stratification
-        attr_accessor :id, :value
-        def initialize(id,value)
+        attr_accessor :id, :value, :observation
+        def initialize(id,value, observation)
           @id = id
           @value = value
+          @observation = observation
         end
 
       end
@@ -107,15 +108,17 @@ module Qrda
         def add_entry(cache_entry, population_sets)
           population_set = population_sets.where(population_set_id: cache_entry.pop_set_hash[:population_set_id]).first
           entry_populations = []
-          %w[IPP DENOM NUMER NUMEX DENEX DENEXCEP MSRPOPL MSRPOPLEX OBSERV].each do |pop_code|
-            next unless population_set.populations[pop_code] || pop_code == 'OBSERV'
+          %w[IPP DENOM NUMER NUMEX DENEX DENEXCEP MSRPOPL MSRPOPLEX].each do |pop_code|
+            next unless population_set.populations[pop_code]
 
             population = create_population_from_population_set(pop_code, population_set, cache_entry)
             if cache_entry.pop_set_hash[:stratification_id]
               strat_id = population_set.stratifications.where(stratification_id: cache_entry.pop_set_hash[:stratification_id]).first&.hqmf_id
-              population.add_stratification(strat_id,cache_entry[pop_code])
+              observation = cache_entry['observations'][pop_code] if cache_entry['observations'] && cache_entry['observations'][pop_code]
+              population.add_stratification(strat_id,cache_entry[pop_code], observation)
             else
               population.value = cache_entry[pop_code]
+              population.observation = cache_entry['observations'][pop_code] if cache_entry['observations'] && cache_entry['observations'][pop_code]
               population.supplemental_data = cache_entry.supplemental_data[pop_code]
             end
             entry_populations << population if population
@@ -128,19 +131,12 @@ module Qrda
         end
 
         def create_population_from_population_set(pop_code, population_set, cache_entry)
-          population = if pop_code == 'OBSERV'
-                         populations.find { |pop| pop.id == population_set.observations&.first&.hqmf_id }
-                       elsif pop_code != 'STRAT'
-                         populations.find { |pop| pop.id == population_set.populations[pop_code]&.hqmf_id }
-                       end
+          population = populations.find { |pop| pop.id == population_set.populations[pop_code]&.hqmf_id } if pop_code != 'STRAT'
           return population unless population.nil? && !cache_entry.pop_set_hash[:stratification_id]
+
           population = Population.new
           population.type = pop_code
-          population.id = if pop_code == 'OBSERV'
-                            population_set.observations&.first&.hqmf_id
-                          else
-                            population_set.populations[pop_code]&.hqmf_id
-                          end
+          population.id = population_set.populations[pop_code]&.hqmf_id
           populations << population
           population
         end

data/lib/qrda-export/helper/date_helper.rb

@@ -101,7 +101,7 @@ module Qrda
         end
 
         def relevant_date_period_or_null_flavor
-          return relevant_period if self['relevantPeriod']
+          return relevant_period if self['relevantPeriod'] && (self['relevantPeriod']['low'] || self['relevantPeriod']['high'])
           return relevant_date_time_value if self['relevantDatetime']
           "<effectiveTime nullFlavor='UNK'/>"
         end
@@ -128,4 +128,4 @@ module Qrda
       end
     end
   end
-end
+end

data/lib/qrda-import/base-importers/demographics_importer.rb

@@ -1,7 +1,7 @@
 module QRDA
   module Cat1
     module DemographicsImporter
-      def get_demographics(patient, doc)
+      def get_demographics(patient, doc, codes)
         patient_role_element = doc.at_xpath('/cda:ClinicalDocument/cda:recordTarget/cda:patientRole')
         patient_element = patient_role_element.at_xpath('./cda:patient')
         patient.givenNames = [patient_element.at_xpath('cda:name/cda:given').text]
@@ -9,28 +9,29 @@ module QRDA
         patient.qdmPatient.birthDatetime = DateTime.parse(patient_element.at_xpath('cda:birthTime')['value'])
         pcbd = QDM::PatientCharacteristicBirthdate.new
         pcbd.birthDatetime = patient.qdmPatient.birthDatetime
-        pcbd.dataElementCodes = [{ code: '21112-8', system: '2.16.840.1.113883.6.1' }]
+        pcbd.dataElementCodes = [QDM::Code.new('21112-8', '2.16.840.1.113883.6.1')]
+        codes.add("21112-8:2.16.840.1.113883.6.1")
         patient.qdmPatient.dataElements << pcbd
 
         pcs = QDM::PatientCharacteristicSex.new
         code_element = patient_element.at_xpath('cda:administrativeGenderCode')
-        pcs.dataElementCodes = [code_if_present(code_element)]
+        pcs.dataElementCodes = [code_if_present(code_element, codes)]
         patient.qdmPatient.dataElements << pcs unless pcs.dataElementCodes.compact.blank?
 
         pcr = QDM::PatientCharacteristicRace.new
         code_element = patient_element.at_xpath('cda:raceCode')
-        pcr.dataElementCodes = [code_if_present(code_element)]
+        pcr.dataElementCodes = [code_if_present(code_element, codes)]
         patient.qdmPatient.dataElements << pcr unless pcr.dataElementCodes.compact.blank?
 
         pce = QDM::PatientCharacteristicEthnicity.new
         code_element = patient_element.at_xpath('cda:ethnicGroupCode')
-        pce.dataElementCodes = [code_if_present(code_element)]
+        pce.dataElementCodes = [code_if_present(code_element, codes)]
         patient.qdmPatient.dataElements << pce unless pce.dataElementCodes.compact.blank?
       end
 
-      def code_if_present(code_element)
+      def code_if_present(code_element, codes)
         return unless code_element && code_element['code'] && code_element['codeSystem']
-
+        codes.add("#{code_element['code']}:#{code_element['codeSystem']}")
         QDM::Code.new(code_element['code'], code_element['codeSystem'])
       end
     end

data/lib/qrda-import/base-importers/section_importer.rb

@@ -1,7 +1,7 @@
 module QRDA
   module Cat1
     class SectionImporter
-      attr_accessor :check_for_usable, :status_xpath, :code_xpath, :warnings
+      attr_accessor :check_for_usable, :status_xpath, :code_xpath, :warnings, :codes, :codes_modifiers
 
       def initialize(entry_finder)
         @entry_finder = entry_finder
@@ -10,6 +10,8 @@ module QRDA
         @check_for_usable = true
         @entry_class = QDM::DataElement
         @warnings = []
+        @codes = Set.new
+        @codes_modifiers = {}
       end
 
       # Traverses an HL7 CDA document passed in and creates an Array of Entry
@@ -81,6 +83,7 @@ module QRDA
 
       def code_if_present(code_element)
         return unless code_element && code_element['code'] && code_element['codeSystem']
+        @codes.add("#{code_element['code']}:#{code_element['codeSystem']}")
         QDM::Code.new(code_element['code'], code_element['codeSystem'])
       end
 
@@ -94,7 +97,9 @@ module QRDA
       end
 
       def extract_interval(parent_element, interval_xpath)
-        return nil unless parent_element.at_xpath(interval_xpath)
+        # nil if the time interval does not exist
+        return nil unless time_interval_exists(parent_element, interval_xpath)
+
         if parent_element.at_xpath("#{interval_xpath}/@value")
           low_time = DateTime.parse(parent_element.at_xpath(interval_xpath)['value'])
           high_time = DateTime.parse(parent_element.at_xpath(interval_xpath)['value'])
@@ -131,6 +136,14 @@ module QRDA
         QDM::Interval.new(low_time, high_time).shift_dates(0)
       end
 
+      def time_interval_exists(parent_element, interval_xpath)
+        # false if the time interval does not exist
+        return false unless parent_element.at_xpath(interval_xpath)
+        # false if the time element exists but has a null Flavor
+        return false if parent_element.at_xpath(interval_xpath)['nullFlavor']
+        true
+      end
+
       def extract_time(parent_element, datetime_xpath)
         DateTime.parse(parent_element.at_xpath(datetime_xpath)['value']) if parent_element.at_xpath("#{datetime_xpath}/@value")
       end
@@ -145,6 +158,7 @@ module QRDA
         # If a Direct Reference Code isn't found, return nil
         return nil unless key
         # If a Direct Reference Code is found, return that code
+        @codes.add("#{key}:#{value[:code_system]}")
         QDM::Code.new(key, value[:code_system])
       end
 
@@ -258,7 +272,7 @@ module QRDA
           participant_element = facility_location_element.at_xpath("./cda:participantRole[@classCode='SDLOC']/cda:code")
           facility_location.code = code_if_present(participant_element)
           facility_location.locationPeriod = extract_interval(facility_location_element, './cda:time')
-          facility_locations << facility_location
+          facility_locations << facility_location if facility_location.code
         end
         facility_locations
       end

data/lib/qrda-import/data-element-importers/adverse_event_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.148']/cda:value"
-        @author_datetime_xpath = './cda:author/cda:time'
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @relevant_date_time_xpath = './cda:effectiveTime[@value]'
         @facility_locations_xpath = "./cda:participant[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.100']"
         @severity_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.8']/cda:value"

data/lib/qrda-import/data-element-importers/allergy_intolerance_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = "./cda:participant[@typeCode='CSM']/cda:participantRole/cda:playingEntity/cda:code"
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @prevalence_period_xpath = "./cda:effectiveTime"
         @severity_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.8']/cda:value"
         @type_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.9']/cda:value"

data/lib/qrda-import/data-element-importers/assessment_order_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = './cda:code'
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @entry_class = QDM::AssessmentOrder
       end

data/lib/qrda-import/data-element-importers/assessment_performed_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = './cda:code'
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @result_xpath = "./cda:value"
         @method_xpath = './cda:methodCode'
         @components_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.149']"

data/lib/qrda-import/data-element-importers/assessment_recommended_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = './cda:code'
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @entry_class = QDM::AssessmentRecommended
       end

data/lib/qrda-import/data-element-importers/communication_performed_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = "./cda:entryRelationship[@typeCode='REFR']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @sent_datetime_xpath = "./cda:effectiveTime/cda:low"
         @received_datetime_xpath = "./cda:effectiveTime/cda:high"
         @related_to_xpath = "./sdtc:inFulfillmentOf1/sdtc:actReference"

data/lib/qrda-import/data-element-importers/device_applied_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = './cda:participant/cda:participantRole/cda:playingDevice/cda:code'
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @relevant_period_xpath = "./cda:effectiveTime"
         @relevant_date_time_xpath = './cda:effectiveTime[@value]'
         @anatomical_location_site_xpath = "./cda:targetSiteCode"

data/lib/qrda-import/data-element-importers/device_order_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.9']/cda:id"
         @code_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.9']/cda:participant/cda:participantRole/cda:playingDevice/cda:code"
-        @author_datetime_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.9']/cda:author/cda:time"
+        @author_datetime_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.9']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @reason_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.9']/cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @entry_class = QDM::DeviceOrder
       end

data/lib/qrda-import/data-element-importers/device_recommended_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.10']/cda:id"
         @code_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.10']/cda:participant/cda:participantRole/cda:playingDevice/cda:code"
-        @author_datetime_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.10']/cda:author/cda:time"
+        @author_datetime_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.10']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @reason_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.10']/cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @entry_class = QDM::DeviceRecommended
       end

data/lib/qrda-import/data-element-importers/diagnosis_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:entryRelationship/cda:observation/cda:id'
         @code_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:value"
-        @author_datetime_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:author/cda:time"
+        @author_datetime_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @prevalence_period_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:effectiveTime"
         @anatomical_location_site_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:targetSiteCode"
         @severity_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:entryRelationship/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.22.4.8']/cda:value"

data/lib/qrda-import/data-element-importers/diagnostic_study_order_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = './cda:code'
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @entry_class = QDM::DiagnosticStudyOrder
       end

data/lib/qrda-import/data-element-importers/diagnostic_study_performed_importer.rb

@@ -7,7 +7,7 @@ module QRDA
         @code_xpath = './cda:code'
         @relevant_period_xpath = "./cda:effectiveTime"
         @relevant_date_time_xpath = './cda:effectiveTime[@value]'
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @result_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.2']/cda:value"
         @result_datetime_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.2']/cda:effectiveTime"
         @status_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.93']/cda:value"

data/lib/qrda-import/data-element-importers/diagnostic_study_recommended_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = './cda:code'
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @entry_class = QDM::DiagnosticStudyRecommended
       end
 

data/lib/qrda-import/data-element-importers/encounter_order_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:entryRelationship/cda:encounter/cda:id'
         @code_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.22']/cda:code"
-        @author_datetime_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.22']/cda:author/cda:time"
+        @author_datetime_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.22']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @facility_locations_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.22']/cda:participant[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.100']"
         @reason_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.22']/cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @priority_xpath = './cda:entryRelationship/cda:encounter/cda:priorityCode'

data/lib/qrda-import/data-element-importers/encounter_performed_importer.rb

@@ -6,7 +6,7 @@ module QRDA
         @id_xpath = './cda:entryRelationship/cda:encounter/cda:id'
         @code_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/cda:code"
         @relevant_period_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/cda:effectiveTime"
-        @author_datetime_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/cda:author/cda:time"
+        @author_datetime_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @admission_source_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/cda:participant/cda:participantRole[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.151']/cda:code"
         @discharge_disposition_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/sdtc:dischargeDispositionCode"
         @facility_locations_xpath = "./cda:entryRelationship/cda:encounter/cda:participant[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.100']"
@@ -21,15 +21,25 @@ module QRDA
         encounter_performed.facilityLocations = extract_facility_locations(entry_element)
         encounter_performed.diagnoses = extract_diagnoses(entry_element)
         if encounter_performed&.relevantPeriod&.low && encounter_performed&.relevantPeriod&.high
-          los = encounter_performed.relevantPeriod.high - encounter_performed.relevantPeriod.low
+          los = encounter_performed.relevantPeriod.high.to_date - encounter_performed.relevantPeriod.low.to_date
           encounter_performed.lengthOfStay = QDM::Quantity.new(los.to_i, 'd')
         end
         encounter_performed.participant = extract_entity(entry_element, "./cda:entryRelationship/cda:encounter//cda:participant[@typeCode='PRF']")
+        extract_modifier_code(encounter_performed, entry_element)
         encounter_performed
       end
 
       private
 
+      def extract_modifier_code(encounter_performed, entry_element)
+        code_element = entry_element.at_xpath(@code_xpath)
+        return unless code_element
+
+        qualifier_name = code_element.at_xpath('./cda:qualifier/cda:name')
+        qualifier_value = code_element.at_xpath('./cda:qualifier/cda:value')
+        codes_modifiers[encounter_performed.id] = { name: code_if_present(qualifier_name), value: code_if_present(qualifier_value), xpath_location: entry_element.path } if qualifier_value || qualifier_name
+      end
+
       def extract_diagnoses(parent_element)
         diagnosis_elements = parent_element.xpath(@diagnosis_xpath)
         diagnosis_list = []

data/lib/qrda-import/data-element-importers/encounter_recommended_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:entryRelationship/cda:encounter/cda:id'
         @code_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.24']/cda:code"
-        @author_datetime_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.24']/cda:author/cda:time"
+        @author_datetime_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.24']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @facility_locations_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.24']/cda:participant[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.100']"
         @reason_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.24']/cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @entry_class = QDM::EncounterRecommended

data/lib/qrda-import/data-element-importers/family_history_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = "./cda:component/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.112']/cda:value"
-        @author_datetime_xpath = "./cda:component/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.112']/cda:author/cda:time"
+        @author_datetime_xpath = "./cda:component/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.112']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @relationship_xpath = './cda:subject/cda:relatedSubject/cda:code'
         @entry_class = QDM::FamilyHistory
       end

data/lib/qrda-import/data-element-importers/immunization_administered_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = "./cda:consumable/cda:manufacturedProduct/cda:manufacturedMaterial/cda:code"
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @relevant_date_time_xpath = './cda:effectiveTime'
         @dosage_xpath = "./cda:doseQuantity"
         @route_xpath = "./cda:routeCode"

data/lib/qrda-import/data-element-importers/immunization_order_importer.rb

@@ -6,7 +6,7 @@ module QRDA
         @id_xpath = './cda:id'
         @code_xpath = "./cda:consumable/cda:manufacturedProduct/cda:manufacturedMaterial/cda:code"
         @active_datetime_xpath = "./cda:effectiveTime[@value]"
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @dosage_xpath = "./cda:doseQuantity"
         @supply_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.167']/cda:quantity"
         @route_xpath = "./cda:routeCode"

data/lib/qrda-import/data-element-importers/intervention_order_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = './cda:code'
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @entry_class = QDM::InterventionOrder
       end

data/lib/qrda-import/data-element-importers/intervention_performed_importer.rb

@@ -7,7 +7,7 @@ module QRDA
         @code_xpath = './cda:code'
         @relevant_period_xpath = "./cda:effectiveTime"
         @relevant_date_time_xpath = './cda:effectiveTime'
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @result_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.2']/cda:value"
         @status_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.93']/cda:value"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"

data/lib/qrda-import/data-element-importers/intervention_recommended_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = './cda:code'
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @entry_class = QDM::InterventionRecommended
       end

data/lib/qrda-import/data-element-importers/laboratory_test_order_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = './cda:code'
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @entry_class = QDM::LaboratoryTestOrder
       end

data/lib/qrda-import/data-element-importers/laboratory_test_performed_importer.rb

@@ -7,7 +7,7 @@ module QRDA
         @code_xpath = './cda:code'
         @relevant_period_xpath = "./cda:effectiveTime"
         @relevant_date_time_xpath = './cda:effectiveTime[@value]'
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @status_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.93']/cda:value"
         @method_xpath = './cda:methodCode'
         @result_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.2']/cda:value"

data/lib/qrda-import/data-element-importers/laboratory_test_recommended_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = './cda:code'
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @entry_class = QDM::LaboratoryTestRecommended
       end

data/lib/qrda-import/data-element-importers/medication_administered_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = "./cda:consumable/cda:manufacturedProduct/cda:manufacturedMaterial/cda:code"
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @relevant_period_xpath = "./cda:effectiveTime"
         @relevant_date_time_xpath = './cda:effectiveTime'
         @dosage_xpath = "./cda:doseQuantity"

data/lib/qrda-import/data-element-importers/medication_discharge_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:entryRelationship/cda:substanceAdministration/cda:id'
         @code_xpath = "./cda:entryRelationship/cda:substanceAdministration[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.16']/cda:consumable/cda:manufacturedProduct/cda:manufacturedMaterial/cda:code"
-        @author_datetime_xpath = "./cda:entryRelationship/cda:substanceAdministration[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.16']/cda:author/cda:time"
+        @author_datetime_xpath = "./cda:entryRelationship/cda:substanceAdministration[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.16']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.22.4.119']/cda:time"
         @refills_xpath = "./cda:entryRelationship/cda:substanceAdministration[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.16']/cda:repeatNumber"
         @dosage_xpath = "./cda:entryRelationship/cda:substanceAdministration[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.16']/cda:doseQuantity"
         @supply_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.99']/cda:quantity"

data/lib/qrda-import/data-element-importers/medication_dispensed_importer.rb

@@ -7,7 +7,7 @@ module QRDA
         @code_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:product/cda:manufacturedProduct/cda:manufacturedMaterial/cda:code"
         @relevant_period_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:effectiveTime"
         @relevant_date_time_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:effectiveTime"
-        @author_datetime_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:author/cda:time"
+        @author_datetime_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @refills_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:entryRelationship/cda:substanceAdministration/cda:repeatNumber"
         @dosage_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:entryRelationship/cda:substanceAdministration/cda:doseQuantity"
         @supply_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.18']/cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.99']/cda:quantity"

data/lib/qrda-import/data-element-importers/medication_order_importer.rb

@@ -6,7 +6,7 @@ module QRDA
         @id_xpath = './cda:id'
         @code_xpath = "./cda:consumable/cda:manufacturedProduct/cda:manufacturedMaterial/cda:code"
         @relevant_period_xpath = "./cda:effectiveTime"
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @dosage_xpath = "./cda:doseQuantity"
         @supply_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.99']/cda:quantity"
         @frequency_xpath = "./cda:effectiveTime[@operator='A']/cda:period"

data/lib/qrda-import/data-element-importers/patient_care_experience_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = './cda:value'
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @entry_class = QDM::PatientCareExperience
       end
 

data/lib/qrda-import/data-element-importers/physical_exam_order_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = "./cda:value"
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @anatomical_location_site_xpath = "./cda:targetSiteCode"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @entry_class = QDM::PhysicalExamOrder

data/lib/qrda-import/data-element-importers/physical_exam_performed_importer.rb

@@ -7,7 +7,7 @@ module QRDA
         @code_xpath = "./cda:code"
         @relevant_period_xpath = "./cda:effectiveTime"
         @relevant_date_time_xpath = './cda:effectiveTime'
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @method_xpath = './cda:methodCode'
         @result_xpath = "./cda:value"
         @anatomical_location_site_xpath = "./cda:targetSiteCode"

data/lib/qrda-import/data-element-importers/physical_exam_recommended_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = "./cda:value"
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @anatomical_location_site_xpath = "./cda:targetSiteCode"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @entry_class = QDM::PhysicalExamRecommended

data/lib/qrda-import/data-element-importers/procedure_order_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = './cda:code'
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @anatomical_location_site_xpath = "./cda:targetSiteCode"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @rank_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.166']/cda:value/@value"

data/lib/qrda-import/data-element-importers/procedure_performed_importer.rb

@@ -7,7 +7,7 @@ module QRDA
         @code_xpath = "./cda:code"
         @relevant_period_xpath = "./cda:effectiveTime"
         @relevant_date_time_xpath = './cda:effectiveTime'
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @method_xpath = './cda:methodCode'
         @result_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.2']/cda:value"
         @status_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.93']/cda:value"

data/lib/qrda-import/data-element-importers/procedure_recommended_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = "./cda:code"
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @anatomical_location_site_xpath = "./cda:targetSiteCode"
         @reason_xpath = "./cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
         @rank_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.166']/cda:value/@value"

data/lib/qrda-import/data-element-importers/provider_care_experience_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = "./cda:value"
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @entry_class = QDM::ProviderCareExperience
       end
 

data/lib/qrda-import/data-element-importers/substance_administered_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = "./cda:consumable/cda:manufacturedProduct/cda:manufacturedMaterial/cda:code"
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @relevant_period_xpath = "./cda:effectiveTime"
         @relevant_date_time_xpath = './cda:effectiveTime'
         @dosage_xpath = "./cda:doseQuantity"

data/lib/qrda-import/data-element-importers/substance_order_importer.rb

@@ -6,7 +6,7 @@ module QRDA
         @id_xpath = './cda:id'
         @code_xpath = "./cda:consumable/cda:manufacturedProduct/cda:manufacturedMaterial/cda:code"
         @relevant_period_xpath = "./cda:effectiveTime"
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @dosage_xpath = "./cda:doseQuantity"
         @supply_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.99']/cda:quantity"
         @frequency_xpath = "./cda:effectiveTime[@operator='A']/cda:period"

data/lib/qrda-import/data-element-importers/substance_recommended_importer.rb

@@ -5,7 +5,7 @@ module QRDA
         super(entry_finder)
         @id_xpath = './cda:id'
         @code_xpath = "./cda:consumable/cda:manufacturedProduct/cda:manufacturedMaterial/cda:code"
-        @author_datetime_xpath = "./cda:author/cda:time"
+        @author_datetime_xpath = "./cda:author[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.155']/cda:time"
         @dosage_xpath = "./cda:doseQuantity"
         @frequency_xpath = "./cda:effectiveTime[@operator='A']/cda:period"
         @refills_xpath = "./cda:repeatNumber"

data/lib/qrda-import/patient_importer.rb

@@ -59,19 +59,21 @@ module QRDA
         @data_element_importers << SubstanceOrderImporter.new
         @data_element_importers << SubstanceRecommendedImporter.new
         @data_element_importers << SymptomImporter.new
-      end
+      end 
 
       def parse_cat1(doc)
         patient = CQM::Patient.new
         warnings = []
+        codes = Set.new
+        codes_modifiers = {}
         entry_id_map = {}
-        import_data_elements(patient, doc, entry_id_map, warnings)
+        import_data_elements(patient, doc, entry_id_map, codes, codes_modifiers, warnings)
         normalize_references(patient, entry_id_map)
-        get_demographics(patient, doc)
-        [patient, warnings]
+        get_demographics(patient, doc, codes)
+        [patient, warnings, codes, codes_modifiers]
       end
 
-      def import_data_elements(patient, doc, entry_id_map, warnings = [])
+      def import_data_elements(patient, doc, entry_id_map, codes = Set.new, codes_modifiers = {}, warnings = [])
         context = doc.xpath("/cda:ClinicalDocument/cda:component/cda:structuredBody/cda:component/cda:section[cda:templateId/@root = '2.16.840.1.113883.10.20.24.2.1']")
         nrh = NarrativeReferenceHandler.new
         nrh.build_id_map(doc)
@@ -109,8 +111,12 @@ module QRDA
           patient.qdmPatient.dataElements << new_data_elements
           entry_id_map.merge!(id_map)
           warnings.concat(importer.warnings)
-          # reset warnings after they're captured so that the importer can be re-used
+          codes.merge(importer.codes)
+          codes_modifiers.merge!(importer.codes_modifiers)
+          # reset warnings and codes after they're captured so that the importer can be re-used
           importer.warnings = []
+          importer.codes_modifiers = {}
+          importer.codes = Set.new
         end
       end
 

metadata

@@ -1,14 +1,14 @@
 --- !ruby/object:Gem::Specification
 name: cqm-reports
 version: !ruby/object:Gem::Version
-  version: 3.1.2
+  version: 3.1.6
 platform: ruby
 authors:
 - The MITRE Corporation
 autorequire:
 bindir: bin
 cert_chain: []
-date: 2020-08-24 00:00:00.000000000 Z
+date: 2021-09-20 00:00:00.000000000 Z
 dependencies:
 - !ruby/object:Gem::Dependency
   name: cqm-models
@@ -16,28 +16,28 @@ dependencies:
     requirements:
     - - "~>"
       - !ruby/object:Gem::Version
-        version: 3.0.3
+        version: '3.0'
   type: :runtime
   prerelease: false
   version_requirements: !ruby/object:Gem::Requirement
     requirements:
     - - "~>"
       - !ruby/object:Gem::Version
-        version: 3.0.3
+        version: '3.0'
 - !ruby/object:Gem::Dependency
   name: cqm-validators
   requirement: !ruby/object:Gem::Requirement
     requirements:
     - - "~>"
       - !ruby/object:Gem::Version
-        version: 3.0.0
+        version: '3.0'
   type: :runtime
   prerelease: false
   version_requirements: !ruby/object:Gem::Requirement
     requirements:
     - - "~>"
       - !ruby/object:Gem::Version
-        version: 3.0.0
+        version: '3.0'
 - !ruby/object:Gem::Dependency
   name: mustache
   requirement: !ruby/object:Gem::Requirement
@@ -84,16 +84,22 @@ dependencies:
   name: nokogiri
   requirement: !ruby/object:Gem::Requirement
     requirements:
-    - - "~>"
+    - - ">="
+      - !ruby/object:Gem::Version
+        version: 1.8.5
+    - - "<"
       - !ruby/object:Gem::Version
-        version: '1.10'
+        version: 1.12.0
   type: :runtime
   prerelease: false
   version_requirements: !ruby/object:Gem::Requirement
     requirements:
-    - - "~>"
+    - - ">="
+      - !ruby/object:Gem::Version
+        version: 1.8.5
+    - - "<"
       - !ruby/object:Gem::Version
-        version: '1.10'
+        version: 1.12.0
 - !ruby/object:Gem::Dependency
   name: uuid
   requirement: !ruby/object:Gem::Requirement
@@ -358,7 +364,7 @@ required_rubygems_version: !ruby/object:Gem::Requirement
     - !ruby/object:Gem::Version
       version: '0'
 requirements: []
-rubygems_version: 3.0.8
+rubygems_version: 3.1.4
 signing_key:
 specification_version: 4
 summary: A library for import and export of reports for use with electronic Clinical