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This QDM to QI Core Mapping for the QDM Datatype "Symptom" was reviewed by the CQI WG on March 30, 2018 based on QDM version 5.3. There is no change in the structure of "Symptom" in QDM version 5.4. QDM version 5.4 includes the guidance, "Note that while many symptoms are entered as findings as part of assessments and, therefore, may not be included in a specific EHR “symptom” section, QDM 5.4 retains the QDM datatype, Symptom, for clarity of expression in the human readable eCQM."
QDM defines Symptom as an indication that a person has a condition or disease. Some examples are headache, fever, fatigue, nausea, vomiting, and pain. Also, symptoms are subjective manifestations of the disease perceived by the patient. As an example to differentiate symptom from finding, the patient’s subjective symptom of fever is distinguished from the temperature (a finding). For a finding, there is either a source of either a temperature-measuring device together with a recorder of the device (electronically) or an individual (healthcare provider, patient, etc.).
- Note: Definitions regarding symptom on the FHIR condition resource (http://hl7.org/fhir/condition.html):
- Use the Observation resource when a symptom is resolved without long term management, tracking, or when a symptom contributes to the establishment of a condition.
- Use Condition when a symptom requires long term management, tracking, or is used as a proxy for a diagnosis or problem that is not yet determined.
- The QDM User Group will review the use of the Symptom QDM datatype. For now, the mapping below, references symptom as an observation (option 1 above).
|QDM Attribute||QI Core Metadata Element||Comment|
|Symptom||Symptom maps to Observation [Observation.status]||Constrain status as “final”|
|Prevalence Period||Observation.effective(x)||Observation.effective(x) The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time".|
|Severity||There is no clear observation severity concept in the FHIR observation resource||Consider the value set binding may allow a measure developer to indicate symptom severity as a pre-coordinated concept or set of concepts|
|Code||Observation.code||QDM matched to QI Core / FHIR|
|id||Observation.id||QDM matched to QI Core / FHIR|
|Source||Observation.performer||QDM matched to QI Core / FHIR|