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Difference between revisions of "Allergy/Intolerance (QDM)"

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[http://wiki.hl7.org/index.php?title=Harmonization_of_Health_Quality_Information_models Back to Harmonization of Health Quality Information Models Page] <br><br>
 
[http://wiki.hl7.org/index.php?title=Harmonization_of_Health_Quality_Information_models Back to Harmonization of Health Quality Information Models Page] <br><br>
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This QDM to QI Core Mapping for the QDM Datatype "Allergy / Intolerance" was updated 16 March 2018 based on discussion in the CQI WG on March 9, 2018. <br><br>
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This QDM to QI Core Mapping for the QDM Datatype "Allergy/Intolerance" was reviewed by the CQI WG on March 9, 2018 for QDM 5.3 and updated to QDM 5.4 on June 7, 2018. QDM for "Allergy Intolerance" has no changes between versions 5.3 and 5.4.<br><br>
 
Allergy is used to address immune-mediated reactions to a substance such as type 1 hypersensitivity reactions, other allergy-like reactions, including pseudo-allergy.<br><br>
 
Allergy is used to address immune-mediated reactions to a substance such as type 1 hypersensitivity reactions, other allergy-like reactions, including pseudo-allergy.<br><br>
 
Intolerance is a record of a clinical assessment of a propensity, or a potential risk to an individual, to have a non-immune mediated adverse reaction on future exposure to the specified substance, or class of substance.
 
Intolerance is a record of a clinical assessment of a propensity, or a potential risk to an individual, to have a non-immune mediated adverse reaction on future exposure to the specified substance, or class of substance.
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| row1cell1 | Author dateTime
 
| row1cell1 | Author dateTime
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| row1cell2 | FHIR Provenance.recorded
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| row1cell2 | AllergyIntolerance.assertedDate
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| row1cell3 | FHIR provenance.recorded was chosen since the definition of AllergyIntolerance.assertedDate may not be a direct match to authorDatetime. Different clinical software products address asserted date indicating the time at which the allergy or intolerance is known.  That may be the same as the date entered into the software (i.e., authorDatetime). However, providers have the option of entering the time the allergy or intolerance was known to occur. The definition of the FHIR resource is ambiguous, i.e., asserted by whom (the patient or the provider), and is it the date the patient informed the provider or the date (approximate) that the allergy or intolerance occurred. Entering FHIR tracker comment for improvement in clarity of definition.
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| row1cell3 | 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).
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QDM Guidance – add asserted date Vs modify authorDatetime to assertedDatetime. (FHIR tracker 15781 15March2018).Please advise if the definition in QI Core/FHIR is consistent with the authorDatetime reference in QDM and whether QDM requires greater clarity in definition (i.e., potentially change authorDatetime to Asserted dateTime).
 
 
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| row2cell1 | Prevalence Period
 
| row2cell1 | Prevalence Period
 
| row2cell2 | AllergyIntolerance.onset[x]<br>
 
| row2cell2 | AllergyIntolerance.onset[x]<br>
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AllergyIntolerance-resolutionAge
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AllergyIntolerance.lastOccurrence
 
| row2cell3 | QDM Prevalence Period addresses the onset dateTime and the abatement dateTime for an allergy.  The options provided in QI Core / FHIR include<br>
 
| row2cell3 | QDM Prevalence Period addresses the onset dateTime and the abatement dateTime for an allergy.  The options provided in QI Core / FHIR include<br>
 
# AllergyIntolerance.reaction.onset,
 
# AllergyIntolerance.reaction.onset,
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# AllergyIntolerance.onset(x) (which allows a period) to allow expression of a timeframe during which the allergy began,
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# AllergyIntolerance.onset(x) (which allows a period) to allow expression of a timeframe during which the allergy began<br>
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# AllergyIntolerance.reaction.allergyintoleranceduration (the time the allergyIntolerance persisted, and
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QDM Guidance: The QDM Prevalence Period start should map to AllergyIntolerance.onset[x] and reference the start of the AllergyIntolerance.onset period. the QDM Allergy/Intolerance Prevalence Period end should map to allergyintolerance.lastOccurrence. Different clinical software products address asserted date indicating the time at which the allergy or intolerance is known.  That may be the same as the date entered into the software (i.e., assertedDate). However, providers have the option of entering the time the allergy or intolerance was known to occur.
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# allergyintolerance-resolutionAge (limited to age rather than dateTime). In general, patients may remember the age at which an allergy was determined to have abated, but not a dateTime.<br>
 
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QDM Guidance: The QDM Prevalence Period start should map to AllergyIntolerance.onset[x] and reference the start of the AllergyIntolerance.onset period. the QDM Allergy/Intolerance Prevalence Period end should map to allergyintolerance-resolutionAge, but the age is an extension (i.e., QI Core only) and implementers would potentially need to map an age to a year and default a month and day. 
 
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The definition of AllergyIntolerance.assertedDate may not be a direct match to authorDatetime. Different clinical software products address asserted date indicating the time at which the allergy or intolerance is known.  That may be the same as the date entered into the software (i.e., authorDatetime). However, providers have the option of entering the time the allergy or intolerance was known to occur. The definition of the FHIR resource is ambiguous, i.e., asserted by whom (the patient or the provider), and is it the date the patient informed the provider or the date (approximate) that the allergy or intolerance occurred. Entering FHIR tracker comment for improvement in clarity of definition.
 
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QDM Guidance – add asserted date Vs modify authorDatetime to assertedDatetime. (FHIR tracker 15781 15March2018).Please advise if the definition in QI Core/FHIR is consistent with the authorDatetime reference in QDM and whether QDM requires greater clarity in definition (i.e., potentially change authorDatetime to Asserted dateTime).
 
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| row2cell1 | Code
 
| row2cell1 | Code
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| row2cell1 | Severity
 
| row2cell1 | Severity
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| row2cell2 | Allergyintolerance.reaction.severity
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| row2cell2 | Allergyintolerance.criticality
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| row2cell3 | Note the comment in QI Core/FHIR --- "It is acknowledged that this assessment is very subjective. There may be some specific practice domains where objective scales have been applied. Objective scales can be included in this model as extensions." In the future, consider addressing criticality in QDM as well (i.e., low risk, high risk)."
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| row2cell3 | QDM severity is more vague than the FHIR concept criticality which is most consistent with the intent of the QDM attribute (i.e., low risk, high risk).
 
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| row2cell1 | Source
 
| row2cell1 | Source

Latest revision as of 03:48, 28 November 2018

Back to Harmonization of Health Quality Information Models Page

This QDM to QI Core Mapping for the QDM Datatype "Allergy/Intolerance" was reviewed by the CQI WG on March 9, 2018 for QDM 5.3 and updated to QDM 5.4 on June 7, 2018. QDM for "Allergy Intolerance" has no changes between versions 5.3 and 5.4.

Allergy is used to address immune-mediated reactions to a substance such as type 1 hypersensitivity reactions, other allergy-like reactions, including pseudo-allergy.

Intolerance is a record of a clinical assessment of a propensity, or a potential risk to an individual, to have a non-immune mediated adverse reaction on future exposure to the specified substance, or class of substance.

Allergy / Intolerance

QDM Attribute QI Core Metadata Element Comment
Author dateTime AllergyIntolerance.assertedDate 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).
Prevalence Period AllergyIntolerance.onset[x]

AllergyIntolerance.lastOccurrence

QDM Prevalence Period addresses the onset dateTime and the abatement dateTime for an allergy. The options provided in QI Core / FHIR include
  1. AllergyIntolerance.reaction.onset,
  2. AllergyIntolerance.onset(x) (which allows a period) to allow expression of a timeframe during which the allergy began

QDM Guidance: The QDM Prevalence Period start should map to AllergyIntolerance.onset[x] and reference the start of the AllergyIntolerance.onset period. the QDM Allergy/Intolerance Prevalence Period end should map to allergyintolerance.lastOccurrence. Different clinical software products address asserted date indicating the time at which the allergy or intolerance is known. That may be the same as the date entered into the software (i.e., assertedDate). However, providers have the option of entering the time the allergy or intolerance was known to occur.

Code AllergyIntolerance.code The AllergyIntolerance.code should reference the class of substance (perhaps using the substance hierarchy of SNOMED). The QDM "Type" attribute definition addresses a value set (or a direct referenced code) that describes the reaction. Hence the mapping of QDM "type" to AllergyIntolerance.reaction.manifestation in QI Core. QI Core and FHIR use "type" to describe the underlying physiologic mechanism for the reaction (i.e., allergy or intolerance). More clarity in the next version of Greater clarity in definition in QDM descriptions in the CQL-based HQMF and in the QDM publication should be helpful.
Type AllergyIntolerance.reaction.manifestation In the future, QDM might consider adding the FHIR concept AllergyIntolerance.type (Allergy, Intolerance) and AllergyIntolerance.category (food, medication, environment, biologic).
Severity Allergyintolerance.criticality QDM severity is more vague than the FHIR concept criticality which is most consistent with the intent of the QDM attribute (i.e., low risk, high risk).
Source AllergyIntolerance.asserter QDM matched to QI Core / FHIR
Recorder AllergyIntolerance.recorder QDM matched to QI Core / FHIR
id Allergyintolerance.id QDM matched to QI Core / FHIR
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