The QRDA I document file format is agnostic to the health IT software (e.g., EHR or HIE vendor) used to generate the documents. 

Organizations with multiple facilities under the same CMS CCN and, by default, the same Joint Commission HCO ID which use different EHR systems or use different installations of the same EHR software are still required to combine their patient-level data together into one QRDA I document.

It is possible to generate the documents from the different sources, using the same CCN, as long as:

1. The Patient IDs are different between the sources.

   1. The primary key to the data is the Patient ID (in the PatientRole element) and Quarter (in the effective date in the Reporting Parameters section).

   2. Should both sources generate the same Patient ID during the same quarter, the last QRDA I document processed will overwrite the other document(s). This is true whether the data is for the same patient or different patients.

2. The Encounter data for patients “transferred” between the facilities are combined into one QRDA I document to represent the entire care provided to the patient within the organization identified by the CCN. For example, an emergency department patient “transferred” for stroke care.

   1. A transfer between facilities within the organization defined by the same CCN is not considered a “transfer out”/”transfer in” from the perspective of the eCQMs.

   2. Generating two QRDA I documents for the patient, one from each source, will most likely result in both documents “failing” the measure as each document will not fully represent the care that was provided.

   3. The QRDA I document generated by the discharging facility must contain the eCQM data captured at the first facility to ensure the document generates the correct measure results.

3. If the same patient is seen in both facilities during the quarter and not “transferred” between the facilities, then, for The Joint Commission, two QRDA I documents may be generated where both fully contain the appropriate Encounter data from the separate facilities.

   1. See #1 concerning Patient IDs.

If the above is true, QRDA I documents generated from multiple sources may be combined into one zip file for a single upload or they may be uploaded within separate zip files. If individual zips are uploaded, it is possible to evaluate how the documents within those zips were processed on the Upload Data, Upload Data Summary, and Data Accuracy pages.  This could assist in identifying QRDA I document format issues that are source dependent. 

Given an eCQM combines all QRDA I documents together for a given CCN to generate measure results, the documents cannot be reviewed by zip file on the Quality ImprovementeCQM Quality Improvementor Submit Data pages.  For evaluating how documents from the separate facilities are processing through the eCQM(s) on the Quality Improvement page, it might be beneficial to ensure that the first part of the file name for each QRDA I document identifies the facility.  This could assist in determining if documents that are not processing against the eCQM(s) as expected are being generated by only one of the source system.