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Difference between revisions of "Medication (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>
 +
The CQI Workgroup reviewed this QDM category in April 2018 consistent with QDM version 5.3.  The content is updated on June 7, 2018 consistent with QDM version 5.4. The only differences between the two QDM versions are:
 +
* Removal of the "supply" attribute from "Medication, Active", and "Medication, Administered". ["supply" is retained for "Medication, Order", "Medication, Dispensed", and "Medication, Discharge".
 +
* Addition of a "setting" attribute to "Medication, Order" to allow differentiation of the setting in which the patient is to use the medication (consistent with the MedicationRequest.category FHIR metadata element).<br><br>
 
QDM defines Medication as clinical drugs or chemical substances intended for use in the medical diagnosis, cure, treatment, or prevention of disease. Medications are defined as direct referenced values or value sets containing values derived from code systems such as RxNorm.  QDM defines five contexts for Medication: Medication, Active; Medication, Administered; Medication, Discharge; Medication, Dispensed; Medication, Order.  
 
QDM defines Medication as clinical drugs or chemical substances intended for use in the medical diagnosis, cure, treatment, or prevention of disease. Medications are defined as direct referenced values or value sets containing values derived from code systems such as RxNorm.  QDM defines five contexts for Medication: Medication, Active; Medication, Administered; Medication, Discharge; Medication, Dispensed; Medication, Order.  
 
__FORCETOC__
 
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| row2cell2 | MedicationStatement.dosage.dose
 
| row2cell2 | MedicationStatement.dosage.dose
 
| row2cell3 | QDM matched to QI Core / FHIR
 
| row2cell3 | QDM matched to QI Core / FHIR
−
|-
 
−
| row2cell1 | Supply
 
−
| row2cell2 |
 
−
| row2cell3 | Not addressed in QI Core. The CQI Workgroup discussion on 13 April considered whether a supply attribute is required. Since Medication, Active refers to the active medication list, supply is not relevant, as it is for Medication, Dispensed and Medication, Order, both of which must indicate the supply dispensed or ordered, respectively.
 
 
|-
 
|-
 
| row2cell1 | Frequency
 
| row2cell1 | Frequency
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| row2cell2 | MedicationAdministration.dosage.dose
 
| row2cell2 | MedicationAdministration.dosage.dose
 
| row2cell3 | QDM matched to QI Core / FHIR
 
| row2cell3 | QDM matched to QI Core / FHIR
−
|-
 
−
| row2cell1 | Supply
 
−
| row2cell2 |
 
−
| row2cell3 | Not addressed in QI Core. The CQI Workgroup discussion on 13 April considered whether a supply attribute is required. The use case discussed includes a "single" dose of medication provided as an intravenous infusion. In the use case, due to the nature of the medication requiring a large amount of volume for dilution, the pharmacy provides two one-liter intravenous infusion "bags", one to follow the other to complete the ordered dose. In this use case, should the two infusion "bags" be considered a supply of 2?  The CQI Workgroup considered the issue and determined it is an implementation concern. Some guidance in QDM documentation may be helpful, but the Workgroup consensus was to consider removing supply as a requirement for Medication, Active - for discussion in the QDM User Group on April 18, 2018.
 
 
|-
 
|-
 
| row2cell1 | Frequency
 
| row2cell1 | Frequency
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| row2cell1 | Author dateTime
 
| row2cell1 | Author dateTime
 
| row2cell2 | FHIRprovenance.recorded
 
| row2cell2 | FHIRprovenance.recorded
−
| row2cell3 | FHIR references authorDatetime as part of the provenance resource for all resources. Is authorDatetime still appropriate for this datatype?
+
| row2cell3 | FHIR references authorDatetime as part of the provenance resource for all resources. 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 MedicationAdministration resource does not reference an author dateTime. Hence, the QDM Medication, Administered datatype author dateTime references FHIR provenance.
 
|-
 
|-
 
| row2cell1 | Code
 
| row2cell1 | Code
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|-
 
|-
 
| row2cell1 | Author dateTime
 
| row2cell1 | Author dateTime
−
| row2cell2 | part of FHIR Provenance Resource
+
| row2cell2 | FHIR.provenance.dateTime
−
| row2cell3 | FHIR references authorDatetime as part of the provenance resource for all resources.  
+
| row2cell3 | FHIR references authorDatetime as part of the provenance resource for all resources.<br>
 +
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). FHIR MedicationDispense does not reference an author time. Hence, the QDM Medication, Dispensed datatype references FHIR provenance. 
 
|-
 
|-
 
| row2cell1 | Code
 
| row2cell1 | Code
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| row2cell3 | QDM matched to QI Core / FHIR
 
| row2cell3 | QDM matched to QI Core / FHIR
 
|}
 
|}
 +
 
== Medication, Discharge ==
 
== Medication, Discharge ==
 
{|border="1" cellpadding="2" cellspacing="0"  
 
{|border="1" cellpadding="2" cellspacing="0"  
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| row1cell1 | Medication, Discharge
 
| row1cell1 | Medication, Discharge
 
| row1cell2 | MedicationRequest.intent
 
| row1cell2 | MedicationRequest.intent
−
| row1cell3 | New profile created to address Medication-request-category = dischargeMedication (LOINC code 8654-6 Hospital Discharge medications) bound to RxNorm.   
+
| row1cell3 | New profile created to address Medication-request-category = dischargeMedication (LOINC code 8654-6 Hospital Discharge medications) bound to RxNorm. The MedicationRequest.Intent is constrained to "plan" to address recommendations to the patient.  The MedicationRequest.category content does not yet include discharge medications.
 
|-
 
|-
 
| row2cell1 | Dosage
 
| row2cell1 | Dosage
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| row2cell1 | Supply
 
| row2cell1 | Supply
 
| row2cell2 |  
 
| row2cell2 |  
−
| row2cell3 | Supply shouldn't be required for Medication, Discharge since it is a set of medication instructions for a patient after departing from the hospital. Consider removing this attribute from this QDM datatype. Also- not present in MedicationStatement in QI Core.
+
| row2cell3 | Supply shouldn't be required for Medication, Discharge since it is a set of medication instructions for a patient after departing from the hospital. However, in some cases, EHRs incorporate data from medication orders (prescriptions) written for post-discharge use into the discharge medication list provided to patients. In such cases, the supply may be present for newly prescribed medications. Such information is not covered in MedicationStatement in QI Core.
 
|-
 
|-
 
| row2cell1 | Frequency
 
| row2cell1 | Frequency
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|-
 
|-
 
| row2cell1 | Refills
 
| row2cell1 | Refills
−
| row2cell2 | MedicationStatement.reasonNotTaken
+
| row2cell2 | MedicationRequest.dispenseRequest.numberOfRepeatsAllowed
−
| row2cell3 | Not present in QI Core - refills shouldn't be an attribute for a list of medications intended at discharge - consider retiring this attribute for Medication, Discharge in QDM
+
| row2cell3 | The mapping is somewhat problematic. The Medication, Discharge maps to MedicationRequest using the .intent metadata element constrained the "plan" - i.e., recommendation to the patient about which medications to take after discharge. While MedicationRequest has a .dispenseRequest.numberOfRepeatsAllowed, that metadata element is relevant for a prescription and not a medication list provided as a patient recommendation. Consider retiring this "refills" attribute for Medication, Discharge in QDM
 
|-
 
|-
 
| row2cell1 | Route
 
| row2cell1 | Route
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| row2cell1 | Author dateTime
 
| row2cell1 | Author dateTime
 
| row2cell2 | MedicationRequest.authoredOn
 
| row2cell2 | MedicationRequest.authoredOn
−
| row2cell3 | Start of relevant period - no specific author time in QI Core<br> Note MedicationRequest.dispenseRequest.validityPeriod (Consider prescription validity as a QDM attribute)<br> MedicationRequest.dosageInstruction.timing (Note - MedicationRequest.dosageInstruction.timing includes both the frequency instruction (e.g., every 8 hours) and the start and stop dates for the amount included.)
+
| row2cell3 | Start of relevant period - no specific author time in QI Core. In the case of Medication, Discharge, the "request" is either to the patient (for medications present in the home or those obtained over-the-counter) or a reference to the prescription sent to the pharmacy that is included in the discharge medication instructions.<br> Note MedicationRequest.dispenseRequest.validityPeriod (Consider prescription validity as a QDM attribute)<br> MedicationRequest.dosageInstruction.timing (Note - MedicationRequest.dosageInstruction.timing includes both the frequency instruction (e.g., every 8 hours) and the start and stop dates for the amount included.)
 
|-
 
|-
 
| row2cell1 | Code
 
| row2cell1 | Code
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| row2cell3 | QDM matched to QI Core / FHIR
 
| row2cell3 | QDM matched to QI Core / FHIR
 
|}
 
|}
 +
 
== Medication, Order ==
 
== Medication, Order ==
 
{|border="1" cellpadding="2" cellspacing="0"  
 
{|border="1" cellpadding="2" cellspacing="0"  
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| row2cell1 | Frequency
 
| row2cell1 | Frequency
 
| row2cell2 | MedicationRequest.dosageInstruction.timing
 
| row2cell2 | MedicationRequest.dosageInstruction.timing
 +
| row2cell3 | QDM matched to QI Core / FHIR
 +
|-
 +
| row2cell1 | Setting
 +
| row2cell2 | MedicationRequest.category
 
| row2cell3 | QDM matched to QI Core / FHIR
 
| row2cell3 | QDM matched to QI Core / FHIR
 
|-
 
|-
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| row2cell1 | Negation Rationale
 
| row2cell1 | Negation Rationale
 
| row2cell2 | MedicationStatement.reasonNotTaken
 
| row2cell2 | MedicationStatement.reasonNotTaken
−
| row2cell3 | Medication Request in QI Core does not reference negation rationale
+
| row2cell3 | Medication Request in QI Core does not reference negation rationale. See FHIR Tracker Item [https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=15941 15941] addressing notDoneReason requirement.
 
|-
 
|-
 
| row2cell1 | Reason
 
| row2cell1 | Reason
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| row2cell1 | Relevant Period
 
| row2cell1 | Relevant Period
 
| row2cell2 | MedicationRequest.dispenseRequest.expectedSupplyDuration
 
| row2cell2 | MedicationRequest.dispenseRequest.expectedSupplyDuration
−
| row2cell3 | QDM matched to QI Core / FHIR
+
| row2cell3 | QDM matched to QI Core / FHIR, except that expectedSupplyDuration is an interval, to map to relevantPeriod, it needs to be anchored to a starting date. Use start of dispenseRequest.validityPeriod as the starting date for the expectedSupplyDuration.
 
|-
 
|-
 
| row2cell1 | Route
 
| row2cell1 | Route
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| row2cell1 | Author dateTime
 
| row2cell1 | Author dateTime
 
| row2cell2 | MedicationRequest.authoredOn
 
| row2cell2 | MedicationRequest.authoredOn
−
| row2cell3 | QDM matched to QI Core / FHIR
+
| row2cell3 | QDM matched to QI Core / FHIR<br>
 +
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).
 
|-
 
|-
 
| row2cell1 | id
 
| row2cell1 | id

Latest revision as of 04:34, 28 November 2018

Back to Harmonization of Health Quality Information Models Page

The CQI Workgroup reviewed this QDM category in April 2018 consistent with QDM version 5.3. The content is updated on June 7, 2018 consistent with QDM version 5.4. The only differences between the two QDM versions are:

  • Removal of the "supply" attribute from "Medication, Active", and "Medication, Administered". ["supply" is retained for "Medication, Order", "Medication, Dispensed", and "Medication, Discharge".
  • Addition of a "setting" attribute to "Medication, Order" to allow differentiation of the setting in which the patient is to use the medication (consistent with the MedicationRequest.category FHIR metadata element).

QDM defines Medication as clinical drugs or chemical substances intended for use in the medical diagnosis, cure, treatment, or prevention of disease. Medications are defined as direct referenced values or value sets containing values derived from code systems such as RxNorm. QDM defines five contexts for Medication: Medication, Active; Medication, Administered; Medication, Discharge; Medication, Dispensed; Medication, Order.

Medication, Active

QDM Attribute QI Core Metadata Element Comment
Medication, Active MedicationStatement (the .status metadata allows conformance to the specific QDM datatype context) The Medication, Active datatype requires use of the "active" status code from the FHIR value set
Dosage MedicationStatement.dosage.dose QDM matched to QI Core / FHIR
Frequency MedicationStatement.dosage.timing QDM matched to QI Core / FHIR
Route MedicationStatement.dosage.route QDM matched to QI Core / FHIR
Relevant Period MedicationStatement.effective QDM matched to QI Core / FHIR
Code MedicationStatement.medication[x] QDM matched to QI Core / FHIR
id IMedicationStatement.id QDM matched to QI Core / FHIR
Source MedicationStatement.informationSource Source addressed by primarySource or reportOrigin

Medication, Administered

QDM Attribute QI Core Metadata Element Comment
Medication, Administered MedicationAdministration (the .status metadata allows conformance to the specific QDM datatype context) QDM matched to QI Core / FHIR
Dosage MedicationAdministration.dosage.dose QDM matched to QI Core / FHIR
Frequency MedicationStatement.dosage.timing Medication Administration documents a single administration, thus frequency is not a concept in the Medication Administered resource.
Negation Rationale MedicationAdministration.reasonNotGiven QDM matched to QI Core / FHIR
Reason MedicationAdministration.reasonCode QDM matched to QI Core / FHIR
Route MedicationAdministration.dosage.route QDM matched to QI Core / FHIR
Relevant Period MedicationAdministration.effective[x] QDM matched to QI Core / FHIR
Author dateTime FHIRprovenance.recorded FHIR references authorDatetime as part of the provenance resource for all resources. 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 MedicationAdministration resource does not reference an author dateTime. Hence, the QDM Medication, Administered datatype author dateTime references FHIR provenance.
Code MedicationAdministration.medication[x] QDM matched to QI Core / FHIR
id MedicationAdministration.id QDM matched to QI Core / FHIR

Medication, Dispensed

QDM Attribute QI Core Metadata Element Comment
Medication, Dispensed MedicationDispense (the .status metadata allows conformance to the specific QDM datatype context) QDM matched to QI Core / FHIR
Dosage MedicationDispense.quantity QDM matched to QI Core / FHIR
Supply MedicationDispense.daysSupply QDM matched to QI Core / FHIR
Frequency MedicationDispense.dosageInstruction.timing QDM matched to QI Core / FHIR
Negation Rationale MedicationDispense.notDoneReason[x] QDM matched to QI Core / FHIR
Refills MedicationDispense.extension (http://hl7.org/fhir/StructureDefinition/pharmacy-core-refillsRemaining) QDM matched to QI Core / FHIR
Route MedicationDispense.dosageInstruction.route QDM matched to QI Core / FHIR
Relevant Period MedicationDispense.extension (http://hl7.org/fhir/StructureDefinition/medicationdispense-validityPeriod) QDM matched to QI Core / FHIR
Author dateTime FHIR.provenance.dateTime FHIR references authorDatetime as part of the provenance resource for all resources.

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). FHIR MedicationDispense does not reference an author time. Hence, the QDM Medication, Dispensed datatype references FHIR provenance.

Code MedicationDispense.medication[x] QDM matched to QI Core / FHIR
id MedicationDispense.id QDM matched to QI Core / FHIR
Source MedicationDispense.performer QDM matched to QI Core / FHIR

Medication, Discharge

QDM Attribute QI Core Metadata Element Comment
Medication, Discharge MedicationRequest.intent New profile created to address Medication-request-category = dischargeMedication (LOINC code 8654-6 Hospital Discharge medications) bound to RxNorm. The MedicationRequest.Intent is constrained to "plan" to address recommendations to the patient. The MedicationRequest.category content does not yet include discharge medications.
Dosage MedicationRequest.dosageInstruction.dose[x] Note - modeled using MedicationRequest - could also be modeled as MedicationStatement with a status of "intended". May be modeled better as a component of a discharge instruction set but I can't find that in QI Core or FHIR
Supply Supply shouldn't be required for Medication, Discharge since it is a set of medication instructions for a patient after departing from the hospital. However, in some cases, EHRs incorporate data from medication orders (prescriptions) written for post-discharge use into the discharge medication list provided to patients. In such cases, the supply may be present for newly prescribed medications. Such information is not covered in MedicationStatement in QI Core.
Frequency MedicationRequest.dosageInstruction.timing Note - MedicationRequest.dosageInstruction.timing includes both the frequency instruction (e.g., every 8 hours) and the start and stop dates for the amount included.
Negation Rationale MedicationStatement.reasonNotTaken Medication Request in QI Core does not reference negation rationale
Refills MedicationRequest.dispenseRequest.numberOfRepeatsAllowed The mapping is somewhat problematic. The Medication, Discharge maps to MedicationRequest using the .intent metadata element constrained the "plan" - i.e., recommendation to the patient about which medications to take after discharge. While MedicationRequest has a .dispenseRequest.numberOfRepeatsAllowed, that metadata element is relevant for a prescription and not a medication list provided as a patient recommendation. Consider retiring this "refills" attribute for Medication, Discharge in QDM
Route MedicationRequest.dosageInstruction.route QDM matched to QI Core / FHIR
Author dateTime MedicationRequest.authoredOn Start of relevant period - no specific author time in QI Core. In the case of Medication, Discharge, the "request" is either to the patient (for medications present in the home or those obtained over-the-counter) or a reference to the prescription sent to the pharmacy that is included in the discharge medication instructions.
Note MedicationRequest.dispenseRequest.validityPeriod (Consider prescription validity as a QDM attribute)
MedicationRequest.dosageInstruction.timing (Note - MedicationRequest.dosageInstruction.timing includes both the frequency instruction (e.g., every 8 hours) and the start and stop dates for the amount included.)
Code MedicationRequest.reasonCode QDM matched to QI Core / FHIR
id MedicationRequest.id QDM matched to QI Core / FHIR

Medication, Order

QDM Attribute QI Core Metadata Element Comment
Medication, Order MedicationRequest.intent Medication 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.
Dosage MedicationRequest.dosageInstruction.dose[x] QDM matched to QI Core / FHIR
Supply MedicationRequest.dispenseRequest.quantity QDM matched to QI Core / FHIR
Frequency MedicationRequest.dosageInstruction.timing QDM matched to QI Core / FHIR
Setting MedicationRequest.category QDM matched to QI Core / FHIR
Code MedicationRequest.medication QDM matched to QI Core / FHIR
Method MedicationRequest.dosageInstruction.method QDM matched to QI Core / FHIR
Negation Rationale MedicationStatement.reasonNotTaken Medication Request in QI Core does not reference negation rationale. See FHIR Tracker Item 15941 addressing notDoneReason requirement.
Reason MedicationRequest.reasonCode QDM matched to QI Core / FHIR
Refills MedicationRequest.dispenseRequest.numberOfRepeatsAllowed QDM matched to QI Core / FHIR
Relevant Period MedicationRequest.dispenseRequest.expectedSupplyDuration QDM matched to QI Core / FHIR, except that expectedSupplyDuration is an interval, to map to relevantPeriod, it needs to be anchored to a starting date. Use start of dispenseRequest.validityPeriod as the starting date for the expectedSupplyDuration.
Route MedicationRequest.dosageInstruction.route QDM matched to QI Core / FHIR
Author dateTime MedicationRequest.authoredOn QDM matched to QI Core / FHIR

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).

id MedicationRequest.id QDM matched to QI Core / FHIR
Source MedicationRequest.requester QDM matched to QI Core / FHIR
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