Laboratory Test (QDM)

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The content on this page was updated on 6 April 2018 based on discussion on the CQI Workgroup Conference call on April 6, 2018.

QDM defines Laboratory Test as a medical procedure that involves testing a sample of blood, urine, or other substance from the body. Tests can help determine a diagnosis, plan treatment, check to see if treatment is working, or monitor the disease over time. This QDM data category for Laboratory Test is only used for information about the subject of record. QDM defines three contexts for Laboratory Test: Laboratory Test, Order; Laboratory Test, Performed; Laboratory Test, Recommended.

Laboratory Test, Order

QDM Attribute	QI Core Metadata Element	Comment
Laboratory Test, Order	ProcedureRequest.intent	Procedure Request intent uses the concepts proposal, plan, order, original-order, reflex-order, filler-order, instance-order, option. Constrain to "order" from the intent value set for QDM datatypes with the order context.
Method		This item is not found in QI Core. In most instances, quality measure developers address procedure methods by using specific, pre-coordinated terminology (e.g., specific LOINC codes indicating the test and the method)
Negation Rationale	ProcedureRequest.extension (http://hl7.org/fhir/StructureDefinition/procedurerequest-reasonRefused)	QDM matched to QI Core / FHIR
Reason	ProcedureRequest.reasonCode, Use http://hl7.org/fhir/us/qicore/qicore-procedurerequest-appropriatenessScore.html to address RAND criteria for appropriate imaging usage criteria.	QDM matched to QI Core / FHIR
Author dateTime	ProcedureRequest.AuthoredOn	QDM matched to QI Core/FHIR. Note - ProcedureRequest.occurrence(x) defines a dateTime when the event should occur - not addressed in QDM
Code	ProcedureRequest.code	See also, Observation.category
id	ProcedureRequest.id	QDM matched to QI Core / FHIR
Source	ProcedureRequest.requester	Author, orderer - note also, ProcedureRequest.requester.agent for device, practitioner or organization who initiated the request; or ProcedureRequest.requester.onBehalfOf - the organization on whose behalf the device or practitioner was acting

Laboratory Test, Recommended

QDM Attribute	QI Core Metadata Element	Comment
Laboratory Test, Recommended	ProcedureRequest.intent	Procedure Request intent uses the concepts proposal, plan, order, original-order, reflex-order, filler-order, instance-order, option. "Proposal" is most consistent with the ProcedureRequest when applied to clinical decision support (CDS) in which the CDS proposes an action to a provider or to a patient. The QDM concept Recommended addresses expectations a provider gives to a patient. Such recommendations are most consistent with the ProcedureRequest.intent value of "plan" (an intension to ensure something occurs without providing an authorization to act).
Method		This item is not found in QI Core. In most instances, quality measure developers address procedure methods by using specific, pre-coordinated terminology (e.g., specific LOINC codes indicating the test and the method)
Negation Rationale	ProcedureRequest.extension (http://hl7.org/fhir/StructureDefinition/procedurerequest-reasonRefused)	QDM matched to QI Core / FHIR
Reason	ProcedureRequest.reasonCode, Use http://hl7.org/fhir/us/qicore/qicore-procedurerequest-appropriatenessScore.html to address RAND criteria for appropriate imaging usage criteria.	QDM matched to QI Core / FHIR
Author dateTime	ProcedureRequest.AuthoredOn	QDM matched to QI Core/FHIR. Note - ProcedureRequest.occurrence(x) defines a dateTime when the event should occur - not addressed in QDM
Code	ProcedureRequest.code	See also, Observation.category
id	ProcedureRequest.id	QDM matched to QI Core / FHIR
Source	ProcedureRequest.requester	Author, orderer - note also, ProcedureRequest.requester.agent for device, practitioner or organization who initiated the request; or ProcedureRequest.requester.onBehalfOf - the organization on whose behalf the device or practitioner was acting

Laboratory Test, Performed

QDM Attribute	QI Core Metadata Element	Comment
Laboratory Test, Performed	Observation (the .status metadata allows conformance to the specific QDM datatype context)	QDM matched to QI Core / FHIR
Method	Observaton.method	QDM matched to QI Core / FHIR
Negation Rationale	Observation.dataAbsentReason	The value set is required. Many eCQMs use a measure developer-specific value set. Note, component also has a Observation.component.dataAbsentReason in QI Core.
Reason	Observation.basedOn	This is the best fit in QI Core
Reference Range High	Observation.referenceRange.high	QI Core also references Observation.referenceRange.type - i.e. what part of the referenced target population it applies to (e.g., normal or therapeutic range); and Observation.referenceRange.appliesTo - i.e., the target population (normal population, or particular sex or race), and Observation.referenceRange.age. QI Core also addresses Observation.component.referenceRange. Should these options be considered for QDM?
Reference Range Low	Observation.referenceRange.low	QI Core also references Observation.referenceRange.type - i.e. what part of the referenced target population it applies to (e.g., normal or therapeutic range); and Observation.referenceRange.appliesTo - i.e., the target population (normal population, or particular sex or race), and Observation.referenceRange.age. QI Core also addresses Observation.component.referenceRange. Should these options be considered for QDM?
Result	Observation.value(x)	Observation.value(x) refers to QI Core Observation which is noted here. Note - QI Core also includes Observation.interpretation and Observation.comment - eCQMs have addressed interpretation as an implementation issue. Perhaps that approach should be reconsidered.
Result dateTime	Observation.issued	QDM matched to QI Core / FHIR
Relevant Period	Observaton.effective[x]	QDM matched to QI Core / FHIR
Status	Observation.status	QDM matched to QI Core / FHIR
Code	Observation.code	Note - QI Core includes Observation.specimen - eCQMs use the LOINC value set to determine the specimen source
Author dateTime	FHIR.provenance.recorded	QDM matched to QI Core / FHIR
Components	Observation.component	QDM uses components to combine related observations to each other, e.g., a set of independent observations performed within an admission assessment for an inpatient admission. Each observation is unique (e.g., questions about tobacco usage, other substance usage, blood pressure, pulse, skin turgor, etc., etc.) but they are captured during the same patient-provider interaction. Such QDM components should map directly to QI Core / FHIR observations that can be linked to other observations. Other QDM component examples include multiple questions that are part of a validated evaluation tool (e.g., a Braden skin assessment scale). This latter example indicates individual questions that are inherently tied to the Braden scale instrument and the questions and answers do not have inherent value without being part of the instrument. QI Core / FHIR considers each such question as an Observation.component. A general rule of thumb is QI Core / FHIR components apply only when the inherent value of the observation is defined by the parent observation. The result is that the content will determine if a QDM component maps to Observation.code or to Observation.component.code.
Component Code	Observation.component.code	See "Component" - Content-specific
Component Result	Observation.component.value(x)	See "Component" - Content-specific
Component Reference Range High	Observation.component.referenceRange	Refers back to Component.referenceRange
Component Reference Range Low	Observation.component.referenceRange	Refers back to Component.referenceRange
id	Observation.id	QDM matched to QI Core / FHIR
Source	Observation.performer	Note - QI Core includes Observation.subject - QDM should consider adding subject instead of health record field