Draft Recommendation for Item 4 (David Aronow)

Recommendations to Application Developers

Depending on the specific application context and implementation, you may or may not choose to specify whether a missing value reason (MVR) should be documented during structured data entry.

• For example, it may be important in a particular application to document why a value for Self Reported Sex Type in not known.
• In another application it may not be a requirement that a MVR be entered when a value for Histologic Type is not documented.

Recommendations to CDE Curators

If documentation of a MVR is desired, there are two ways this can be accomplished:

1. The MVR may be included in the permissible values for the data element. For example, the value “Unknown” is included in the permissible values for the data element Self Reported Sex Type
2. MVRs may be enumerated values of a CDE specifically created to record MVR that is associated with the data element for which the value is missing.
   • For example, there might be a data element for summary lab test results with a name such as Lab Test Result Nominal Summary, which has permissible values of: “Normal”, “Abnormal High” and “Abnormal Low”.
     • The CDE curators might create an associated CDE with a name such as Lab Summary Missing Value Reason that could have permissible values such as:
       • “Pending” = test result not yet published
       • “Not available from lab system” = lab system does not supply nominal summary values
   • As another example, consider recording physical exam findings. For each portion of the exam (ignoring important decisions about granularity here) there might be a CDE such as Carotid Artery Bruit with permissible values of “Present”, “Absent”, and “Uncertain”.
     • The CDE curators might create an associated CDE with a name such as Carotid Bruit Missing Value Reason that could have permissible values such as:
       • “Not Done” = explicit declaration that not attempt was made to detect bruits – this value would be relevant both to direct provider clinical encounter documentation and to subsequent abstraction (manual or automated) of the clinical document.
       • “Not Reported” = the clinical encounter document being abstracted did not contain information about the presence of a bruit
       • “Not Sought” = the abstractor did not examine the clinical encounter document being abstracted to see if there was mention of a bruit at all.