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Care Experience (QDM)

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Reviewed by the CQI Workgroup in April 2018 based on QDM version 5.3. There are no changes to apply for QDM version 5.4.

QDM defines Care Experience as the experience a patient has when receiving care or a provider has when providing care. The individual Care Experience datatypes should be consulted for further details. QDM represents two kinds of care experience: Patient Care Experience and Provider Care Experience. The main question for the CQI Workgroup is whether Care Experience should be considered an observation, or is there some other concept present in or missing from FHIR.


Patient Care Experience

QDM Attribute QI Core Metadata Element Comment
Patient Care Experience Observation.status QDM matched to FHIR / QI Core (the .status metadata allows conformance to the specific QDM datatype context)
Code Observation.code QDM matched to FHIR / QI Core
Author dateTime observation.issued QDM matched to FHIR / QI Core - Note: QDM only addresses authorTime;

Note: FHIR Provenance generally addresses the author of the message; the identifier/source of the original resource element is defined by the resource. Individual resource element provenance is summarized in the FHIR W5 Report (http://hl7.org/fhir/w5.html). The FHIR Observation resource uses .issued for author time. QI Core also allows a Period during which an observation actually occurs (observation.effective[x]). Patient Care Experience generally address specific documentation of observations. However, the experience may be referencing a specific period of time during which the patient was exposed to the healthcare system (e.g., Patient Care Experience during a hospitalization - i.e., with an admission dateTime and discharge dateTime to define the Relevant Period). Such concepts would use observation.effective[x] QDM does not address the time for which the experience is evaluated. Such a concept might be a new consideration for QDM.

id Observation.id QDM matched to FHIR / QI Core
Source Observation.performer QI Core / FHIR does not have a direct concept of "source" but it does list Observation.performer and Observation.device, both of which would address the QDM concept of Source.

Provider Care Experience

QDM Attribute QI Core Metadata Element Comment
Provider Care Experience Observation.status QDM matched to FHIR / QI Core (the .status metadata allows conformance to the specific QDM datatype context)
Code Observation.code QDM matched to FHIR / QI Core
Author dateTime observation.issued QDM matched to FHIR / QI Core – Note: QDM only addresses authorTime;

Note: FHIR Provenance generally addresses the author of the message; the identifier/source of the original resource element is defined by the resource. Individual resource element provenance is summarized in the FHIR W5 Report (http://hl7.org/fhir/w5.html). The FHIR Observation resource uses .issued for author time. QI Core also allows a Period during which an observation actually occurs (observation.effective[x]). Patient Care Experience generally address specific documentation of observations. However, the experience may be referencing a specific period of time during which the patient was exposed to the healthcare system (e.g., Patient Care Experience during a hospitalization - i.e., with an admission dateTime and discharge dateTime to define the Relevant Period). Such concepts would use observation.effective[x]. QDM does not address the time for which the experience is evaluated. Such a concept might be a new consideration for QDM.

id Observation.id QDM matched to FHIR / QI Core
Source Observation.performer QI Core / FHIR does not have a direct concept of "source" but it does list Observation.performer and Observation.device, both of which would address the QDM concept of Source.