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Difference between revisions of "Substance (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>
 
QDM defines Substance as a homogeneous material with definite composition that includes allergens, biological materials, chemicals, foods, drugs and materials.  QDM distinguishes between medications from non-medication substances by separately listing medication datatypes. Substance may or may not have a code or be classified by a code system such RxNorm. Examples of a substance may include environmental agents (e.g., pollen, dust) and food (e.g., vitamins). QDM defines three contexts for Substance: Substance, Administered; Substance, Order; Substance, Recommended. Since QDM addresses substance a something that is administered, ordered or recommended, the actions are analogous to medications. Hence, the QDM category Substance is mapped to QI core Medication concepts.<br><br>
 
QDM defines Substance as a homogeneous material with definite composition that includes allergens, biological materials, chemicals, foods, drugs and materials.  QDM distinguishes between medications from non-medication substances by separately listing medication datatypes. Substance may or may not have a code or be classified by a code system such RxNorm. Examples of a substance may include environmental agents (e.g., pollen, dust) and food (e.g., vitamins). QDM defines three contexts for Substance: Substance, Administered; Substance, Order; Substance, Recommended. Since QDM addresses substance a something that is administered, ordered or recommended, the actions are analogous to medications. Hence, the QDM category Substance is mapped to QI core Medication concepts.<br><br>
−
The mapping was first uploaded to the wiki on April 3, 2018. The CQI Workgroup reviewed the content on 13 April and required additional review and consideration. A QI Core ballot items from the January ballot suggested that NutritionOrder be included in QI Core. The context would be most consistent with Substance, Order and/or Substance, Recommended. Therefore, the following QDM Substance category items address substance similar to medications OR similar to nutrition elements.<br><br>
+
The mapping was reviewed by the CQI Workgroup on April 24, 2018 based on QDM version 5.3. The content on this page was updated on June 7, 2018 consistent with QDM version 5.4. The changes reflected due to QDM version 5.4 include:
−
The NutritionOrder resource is used for requesting oral diets, oral nutrition supplements and enteral feedings in an in-patient setting. The MedicationRequest resource should be used for requesting parenteral (IV) nutrition and prescribing dietary supplements such as vitamin or mineral supplements.
+
* Removal of the "supply" attribute from "Substance, Administered"
 +
* Remove the "method" attribute from "Substance, Order" and "Substance, Recommended"<br> <br>
 +
'''Use of MedicationAdministration and Procedure FHIR Resources to reference QDM Substance datatypes'''''<br>
 +
The current mapping reflects additional considerations in that NutritionOrder and Administration of blood products are not yet mature concepts in FHIR 3.0. The potential mapping considerations remain as points for review and discussion. However, the near-term mapping references for Substance, Administration, Substance, Order and Substance, Recommended for instances inconsistent with the Medication resources should use the QDM datatypes Procedure, Performed; Procedure, Order and Procedure, Recommended.<br>
 +
Instances inconsistent with the Medication resources include the following two use cases:<br>
 +
* Determination that blood products (a biological product in FHIR resources) are ordered or are administered within specific time relationships to other data elements
 +
* Determination that human breast milk (not considered a biological product in the FHIR resource discussions) is used exclusively to feed newborn infants during the initial stay in the hospital after birth.<br>
  
 +
'''''Nutrition [Considerations for Future Use]'''''<br>
 +
The nutrition mappings remain for discussion and review as related FHIR resources become more mature.<br>
 
Note the reference in [http://hl7.org/fhir/nutritionorder.html FHIR NutritionOrder Resource]:<br>
 
Note the reference in [http://hl7.org/fhir/nutritionorder.html FHIR NutritionOrder Resource]:<br>
 
The Nutrition Order is a record of the request for the supply of a diet, oral supplement or enteral formulas for a patient. However, to initiate the request requires the use of the Task resource and its associated workflow with the Nutrition Order referenced from Task.basedOn, or by using the Nutrition Task resource in the context of a messaging or service workflow where the request is explicit or implicit.<br>
 
The Nutrition Order is a record of the request for the supply of a diet, oral supplement or enteral formulas for a patient. However, to initiate the request requires the use of the Task resource and its associated workflow with the Nutrition Order referenced from Task.basedOn, or by using the Nutrition Task resource in the context of a messaging or service workflow where the request is explicit or implicit.<br>
−
Based on the quoted reference, Substance is modeled as either medication or nutrition.
+
Based on the quoted reference, Substance is modeled as either medication or nutrition. The NutritionOrder resource is used for requesting oral diets, oral nutrition supplements and enteral feedings in an in-patient setting. The MedicationRequest resource should be used for requesting parenteral (IV) nutrition and prescribing dietary supplements such as vitamin or mineral supplements.<br>
 +
FHIR Tracker Items [https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=15942 15942] and [https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=15943 15943] address these concerns in current FHIR modeling.<br><br>
 +
'''''Blood Products  [Considerations for Future Use]'''''<br>
 +
The blood product mappings remain for discussion and review as related FHIR resources become more mature.<br>
 +
Also note a different mapping for blood products addressing SupplyRequest, SupplyDelivery and BiologicallyDerivedProducts.<br>
 +
FHIR Tracker Item [https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=15945 15945] addresses concerns about the Supply resources to address blood products.
 +
 
 +
 
 
__FORCETOC__
 
__FORCETOC__
−
== Substance, Administered ==
+
== Substance, Administered [When consistent with medication use cases]==
 
{|border="1" cellpadding="2" cellspacing="0"  
 
{|border="1" cellpadding="2" cellspacing="0"  
 
| align="center" style="background:#f0f0f0;"|'''QDM Attribute'''
 
| align="center" style="background:#f0f0f0;"|'''QDM Attribute'''
Line 21: Line 36:
 
| 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
 
 
|-
 
|-
 
| row2cell1 | Frequency
 
| row2cell1 | Frequency
Line 44: Line 55:
 
| 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.<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 MedicationAdministration does not reference an author dateTime; hence, the mapping addresses FHIR provenance.
 
|-
 
|-
 
| row2cell1 | Code
 
| row2cell1 | Code
Line 55: Line 67:
 
|}
 
|}
  
−
== Substance, Order ==
+
== Substance, Order [when consistent with medication use cases] ==
 
{|border="1" cellpadding="2" cellspacing="0"  
 
{|border="1" cellpadding="2" cellspacing="0"  
 
| align="center" style="background:#f0f0f0;"|'''QDM Attribute'''
 
| align="center" style="background:#f0f0f0;"|'''QDM Attribute'''
Line 84: Line 96:
 
| row2cell1 | Reason
 
| row2cell1 | Reason
 
| row2cell2 | MedicationRequest.reasonCode
 
| row2cell2 | MedicationRequest.reasonCode
−
| row2cell3 | QDM matched to QI Core / FHIR
 
−
|-
 
−
| row2cell1 | Method
 
−
| row2cell2 | MedicationRequest.dosageInstruction.method
 
 
| row2cell3 | QDM matched to QI Core / FHIR
 
| row2cell3 | QDM matched to QI Core / FHIR
 
|-
 
|-
Line 108: Line 116:
 
| 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
Line 124: Line 133:
 
|}
 
|}
  
−
== Substance, Recommended ==
+
== Substance, Recommended [when consistent with medication use cases]==
 
{|border="1" cellpadding="2" cellspacing="0"  
 
{|border="1" cellpadding="2" cellspacing="0"  
 
| align="center" style="background:#f0f0f0;"|'''QDM Attribute'''
 
| align="center" style="background:#f0f0f0;"|'''QDM Attribute'''
Line 149: Line 158:
 
| row2cell1 | Reason
 
| row2cell1 | Reason
 
| row2cell2 | MedicationRequest.reasonCode
 
| row2cell2 | MedicationRequest.reasonCode
−
| row2cell3 | QDM matched to QI Core / FHIR
 
−
|-
 
−
| row2cell1 | Method
 
−
| row2cell2 | MedicationRequest.dosageInstruction.method
 
 
| row2cell3 | QDM matched to QI Core / FHIR
 
| row2cell3 | QDM matched to QI Core / FHIR
 
|-
 
|-
Line 169: Line 174:
 
| 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
Line 181: Line 187:
 
| row2cell1 | Recorder
 
| row2cell1 | Recorder
 
| row2cell2 | MedicationRequest.recorder
 
| row2cell2 | MedicationRequest.recorder
−
| row2cell3 | Possibly addressed in FHIR Provenance
 
−
|-
 
−
|}
 
−
==Substance, Order (Nutrition)==
 
−
{|border="1" cellpadding="2" cellspacing="0"
 
−
| align="center" style="background:#f0f0f0;"|'''QDM Attribute'''
 
−
| align="center" style="background:#f0f0f0;"|'''QI Core Metadata Element'''
 
−
| align="center" style="background:#f0f0f0;"|'''Comment'''
 
−
|-valign="top"
 
−
 
−
| row1cell1 | Substance, Order
 
−
| row1cell2 | NutritionOrder.status
 
−
| row1cell3 | SubstanceOrder.status includes proposed, draft, planned, requested, active, on-hold, completed, cancelled, entered-in-error. "Proposed" is most consistent with the NutritionOrder 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 NutritionOrder.status value of "planned" (an intention to ensure something occurs without providing an authorization to act). The QDM concept Order addresses a request that has been placed, and therefore is expected to be carried out. Such recommendations are most consistent with the NutritionOrder.status value of "requested" (The request has been placed.). Note - the "active" element is consistent with a NutritionOrder that has been reviewed by the dietician and, therefore, can be processed, but processing is not yet complete (the request is 'actionable', but not all actions that are implied by it have occurred yet).
 
−
|-
 
−
| row2cell1 | Dosage
 
−
| row2cell2 | NutritionOrder.oralDiet.nutrient.amount<br>
 
−
NutritionOrder.supplement.quantity<br>
 
−
NutritionOrder.enteralFormula.administration.quantity
 
−
| row2cell3 | NutritionOrder.oralDiet.nutrient.amount (The quantity of the specified nutrient to include in diet.)<br>
 
−
NutritionOrder.supplement.quantity (The amount of the nutritional supplement to be given.)<br>
 
−
NutritionOrder.enteralFormula.administration.quantity (The volume of formula to provide to the patient per the specified administration schedule.)
 
−
|-
 
−
| row2cell1 | Frequency
 
−
| row2cell2 | NutritionOrder.oralDiet.schedule<br>
 
−
NutritionOrder.supplement.schedule<br>
 
−
NutritionOrder.enteralFormula.administration.schedule
 
−
| row2cell3 | NutritionOrder.oralDiet.schedule (The time period and frequency at which the diet should be given. The diet should be given for the combination of all schedules if more than one schedule is present.)<br>
 
−
NutritionOrder.supplement.schedule (The time period and frequency at which the supplement(s) should be given. The supplement should be given for the combination of all schedules if more than one schedule is present.)<br>
 
−
NutritionOrder.enteralFormula.administration.schedule (The time period and frequency at which the enteral formula should be delivered to the patient.)
 
−
|-
 
−
| row2cell1 | Code
 
−
| row2cell2 | NutritionOrder.oralDiet.nutrient<br>
 
−
Uncertain mapping for QDM code attribute for supplements or enteral formula
 
−
| row2cell3 | NutritionOrder.oralDiet.nutrient (Class that defines the quantity and type of nutrient modifications (for example carbohydrate, fiber or sodium) required for the oral diet.)<br>
 
−
Uncertain mapping for QDM code attribute for supplements or enteral formula
 
−
|-
 
−
| row2cell1 | Reason
 
−
| row2cell2 | NutritionOrder.oralDiet.instruction<br>
 
−
NutritionOrder.supplement.instruction<br>
 
−
NutritionOrder.enteralFormula.administration
 
−
| row2cell3 | NutritionOrder does not address reason except, perhaps, as .instruction:<br>
 
−
NutritionOrder.oralDiet.instruction<br>
 
−
NutritionOrder.supplement.instruction<br>
 
−
NutritionOrder.enteralFormula.administration
 
−
|-
 
−
| row2cell1 | Method
 
−
| row2cell2 | NutritionOrder.oralDiet.instruction<br>
 
−
NutritionOrder.supplement.instruction<br>
 
−
NutritionOrder.enteralFormula.administration
 
−
| row2cell3 | NutritionOrder.oralDiet.instruction (Free text or additional instructions or information pertaining to the oral diet.)<br>
 
−
NutritionOrder.supplement.instruction (Free text or additional instructions or information pertaining to the oral supplement.)<br>
 
−
NutritionOrder.enteralFormula.administration (Formula administration instructions as structured data. This repeating structure allows for changing the administration rate or volume over time for both bolus and continuous feeding. An example of this would be an instruction to increase the rate of continuous feeding every 2 hours.)
 
−
|-
 
−
| row2cell1 | Negation Rationale
 
−
| row2cell2 |
 
−
| row2cell3 | NutritionOrder does not address NegationRationale. NutritionOrder.excludeFoodModifier is used to convey order-specific modifiers about the type of food that should NOT be given. These can be derived from patient allergies, intolerances, or preferences such as No Red Meat, No Soy or No Wheat or Gluten-Free. While it should not be necessary to repeat allergy or intolerance information captured in the referenced AllergyIntolerance resource in the excludeFoodModifier, this element may be used to convey additional specificity related to foods that should be eliminated from the patient’s diet for any reason. This modifier applies to the entire nutrition order inclusive of the oral diet, nutritional supplements and enteral formula feedings.
 
−
|-
 
−
| row2cell1 | Reason
 
−
| row2cell2 |
 
−
| row2cell3 | NutritionOrder does not address reason.
 
−
|-
 
−
| row2cell1 | Refills
 
−
| row2cell2 |
 
−
| row2cell3 | NutritionOrder does not address refills.
 
−
|-
 
−
| row2cell1 | Author dateTime
 
−
| row2cell2 | NutritionOrder.dateTime
 
−
| row2cell3 | QDM matched to FHIR
 
−
|-
 
−
| row2cell1 | id
 
−
| row2cell2 |
 
−
| row2cell3 | NutritionOrder does not address id.
 
−
|-
 
−
| row2cell1 | Source
 
−
| row2cell2 | NutritionOrder.orderer
 
−
| row2cell3 | QDM matched to FHIR
 
−
|-
 
−
| row2cell1 | Recorder
 
−
| row2cell2 | FHIR.provenance.recorder
 
−
| row2cell3 | Possibly addressed in FHIR Provenance
 
−
|-
 
−
|}
 
−
==Substance, Recommended (Nutrition)==
 
−
{|border="1" cellpadding="2" cellspacing="0"
 
−
| align="center" style="background:#f0f0f0;"|'''QDM Attribute'''
 
−
| align="center" style="background:#f0f0f0;"|'''QI Core Metadata Element'''
 
−
| align="center" style="background:#f0f0f0;"|'''Comment'''
 
−
|-valign="top"
 
−
 
−
| row1cell1 | Substance, Recommended
 
−
| row1cell2 | NutritionOrder.status
 
−
| row1cell3 | SubstanceOrder.status includes proposed, draft, planned, requested, active, on-hold, completed, cancelled, entered-in-error. "Proposed" is most consistent with the NutritionOrder 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 NutritionOrder.status value of "planned" (an intention to ensure something occurs without providing an authorization to act). The QDM concept Order addresses a request that has been placed, and therefore is expected to be carried out. Such recommendations are most consistent with the NutritionOrder.status value of "requested" (The request has been placed.). Note - the "active" element is consistent with a NutritionOrder that has been reviewed by the dietician and, therefore, can be processed, but processing is not yet complete (the request is 'actionable', but not all actions that are implied by it have occurred yet).
 
−
|-
 
−
| row2cell1 | Dosage
 
−
| row2cell2 | NutritionOrder.oralDiet.nutrient.amount<br>
 
−
NutritionOrder.supplement.quantity<br>
 
−
NutritionOrder.enteralFormula.administration.quantity
 
−
| row2cell3 | NutritionOrder.oralDiet.nutrient.amount (The quantity of the specified nutrient to include in diet.)<br>
 
−
NutritionOrder.supplement.quantity (The amount of the nutritional supplement to be given.)<br>
 
−
NutritionOrder.enteralFormula.administration.quantity (The volume of formula to provide to the patient per the specified administration schedule.)
 
−
|-
 
−
| row2cell1 | Frequency
 
−
| row2cell2 | NutritionOrder.oralDiet.schedule<br>
 
−
NutritionOrder.supplement.schedule<br>
 
−
NutritionOrder.enteralFormula.administration.schedule
 
−
| row2cell3 | NutritionOrder.oralDiet.schedule (The time period and frequency at which the diet should be given. The diet should be given for the combination of all schedules if more than one schedule is present.)<br>
 
−
NutritionOrder.supplement.schedule (The time period and frequency at which the supplement(s) should be given. The supplement should be given for the combination of all schedules if more than one schedule is present.)<br>
 
−
NutritionOrder.enteralFormula.administration.schedule (The time period and frequency at which the enteral formula should be delivered to the patient.)
 
−
|-
 
−
| row2cell1 | Code
 
−
| row2cell2 | NutritionOrder.oralDiet.nutrient<br>
 
−
Uncertain mapping for QDM code attribute for supplements or enteral formula
 
−
| row2cell3 | NutritionOrder.oralDiet.nutrient (Class that defines the quantity and type of nutrient modifications (for example carbohydrate, fiber or sodium) required for the oral diet.)<br>
 
−
Uncertain mapping for QDM code attribute for supplements or enteral formula
 
−
|-
 
−
| row2cell1 | Reason
 
−
| row2cell2 | NutritionOrder.oralDiet.instruction<br>
 
−
NutritionOrder.supplement.instruction<br>
 
−
NutritionOrder.enteralFormula.administration
 
−
| row2cell3 | NutritionOrder does not address reason except, perhaps, as .instruction:<br>
 
−
NutritionOrder.oralDiet.instruction<br>
 
−
NutritionOrder.supplement.instruction<br>
 
−
NutritionOrder.enteralFormula.administration
 
−
|-
 
−
| row2cell1 | Method
 
−
| row2cell2 | NutritionOrder.oralDiet.instruction<br>
 
−
NutritionOrder.supplement.instruction<br>
 
−
NutritionOrder.enteralFormula.administration
 
−
| row2cell3 | NutritionOrder.oralDiet.instruction (Free text or additional instructions or information pertaining to the oral diet.)<br>
 
−
NutritionOrder.supplement.instruction (Free text or additional instructions or information pertaining to the oral supplement.)<br>
 
−
NutritionOrder.enteralFormula.administration (Formula administration instructions as structured data. This repeating structure allows for changing the administration rate or volume over time for both bolus and continuous feeding. An example of this would be an instruction to increase the rate of continuous feeding every 2 hours.)
 
−
|-
 
−
| row2cell1 | Negation Rationale
 
−
| row2cell2 |
 
−
| row2cell3 | NutritionOrder does not address NegationRationale. NutritionOrder.excludeFoodModifier is used to convey order-specific modifiers about the type of food that should NOT be given. These can be derived from patient allergies, intolerances, or preferences such as No Red Meat, No Soy or No Wheat or Gluten-Free. While it should not be necessary to repeat allergy or intolerance information captured in the referenced AllergyIntolerance resource in the excludeFoodModifier, this element may be used to convey additional specificity related to foods that should be eliminated from the patient’s diet for any reason. This modifier applies to the entire nutrition order inclusive of the oral diet, nutritional supplements and enteral formula feedings.
 
−
|-
 
−
| row2cell1 | Reason
 
−
| row2cell2 |
 
−
| row2cell3 | NutritionOrder does not address reason.
 
−
|-
 
−
| row2cell1 | Refills
 
−
| row2cell2 |
 
−
| row2cell3 | NutritionOrder does not address refills.
 
−
|-
 
−
| row2cell1 | Author dateTime
 
−
| row2cell2 | NutritionOrder.dateTime
 
−
| row2cell3 | QDM matched to FHIR
 
−
|-
 
−
| row2cell1 | id
 
−
| row2cell2 |
 
−
| row2cell3 | NutritionOrder does not address id.
 
−
|-
 
−
| row2cell1 | Source
 
−
| row2cell2 | NutritionOrder.orderer
 
−
| row2cell3 | QDM matched to FHIR
 
−
|-
 
−
| row2cell1 | Recorder
 
−
| row2cell2 | FHIR.provenance.recorder
 
 
| row2cell3 | Possibly addressed in FHIR Provenance
 
| row2cell3 | Possibly addressed in FHIR Provenance
 
|-
 
|-
 
|}
 
|}

Latest revision as of 04:24, 28 November 2018

Back to Harmonization of Health Quality Information Models Page

QDM defines Substance as a homogeneous material with definite composition that includes allergens, biological materials, chemicals, foods, drugs and materials. QDM distinguishes between medications from non-medication substances by separately listing medication datatypes. Substance may or may not have a code or be classified by a code system such RxNorm. Examples of a substance may include environmental agents (e.g., pollen, dust) and food (e.g., vitamins). QDM defines three contexts for Substance: Substance, Administered; Substance, Order; Substance, Recommended. Since QDM addresses substance a something that is administered, ordered or recommended, the actions are analogous to medications. Hence, the QDM category Substance is mapped to QI core Medication concepts.

The mapping was reviewed by the CQI Workgroup on April 24, 2018 based on QDM version 5.3. The content on this page was updated on June 7, 2018 consistent with QDM version 5.4. The changes reflected due to QDM version 5.4 include:

  • Removal of the "supply" attribute from "Substance, Administered"
  • Remove the "method" attribute from "Substance, Order" and "Substance, Recommended"

Use of MedicationAdministration and Procedure FHIR Resources to reference QDM Substance datatypes
 The current mapping reflects additional considerations in that NutritionOrder and Administration of blood products are not yet mature concepts in FHIR 3.0. The potential mapping considerations remain as points for review and discussion. However, the near-term mapping references for Substance, Administration, Substance, Order and Substance, Recommended for instances inconsistent with the Medication resources should use the QDM datatypes Procedure, Performed; Procedure, Order and Procedure, Recommended.
Instances inconsistent with the Medication resources include the following two use cases:

  • Determination that blood products (a biological product in FHIR resources) are ordered or are administered within specific time relationships to other data elements
  • Determination that human breast milk (not considered a biological product in the FHIR resource discussions) is used exclusively to feed newborn infants during the initial stay in the hospital after birth.

Nutrition [Considerations for Future Use]
The nutrition mappings remain for discussion and review as related FHIR resources become more mature.
Note the reference in FHIR NutritionOrder Resource:
The Nutrition Order is a record of the request for the supply of a diet, oral supplement or enteral formulas for a patient. However, to initiate the request requires the use of the Task resource and its associated workflow with the Nutrition Order referenced from Task.basedOn, or by using the Nutrition Task resource in the context of a messaging or service workflow where the request is explicit or implicit.
Based on the quoted reference, Substance is modeled as either medication or nutrition. The NutritionOrder resource is used for requesting oral diets, oral nutrition supplements and enteral feedings in an in-patient setting. The MedicationRequest resource should be used for requesting parenteral (IV) nutrition and prescribing dietary supplements such as vitamin or mineral supplements.
FHIR Tracker Items 15942 and 15943 address these concerns in current FHIR modeling.

Blood Products [Considerations for Future Use]
The blood product mappings remain for discussion and review as related FHIR resources become more mature.
Also note a different mapping for blood products addressing SupplyRequest, SupplyDelivery and BiologicallyDerivedProducts.
FHIR Tracker Item 15945 addresses concerns about the Supply resources to address blood products.


Substance, Administered [When consistent with medication use cases]

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 Not referenced 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
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). FHIR MedicationAdministration does not reference an author dateTime; hence, the mapping addresses FHIR provenance.

Code MedicationAdministration.medication[x] QDM matched to QI Core / FHIR
id MedicationAdministration.id QDM matched to QI Core / FHIR

Substance, Order [when consistent with medication use cases]

QDM Attribute QI Core Metadata Element Comment
Substance, 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
Code MedicationRequest.medication QDM matched to QI Core / FHIR
Reason MedicationRequest.reasonCode QDM matched to QI Core / FHIR
Negation Rationale MedicationStatement.reasonNotTaken Medication Request in QI Core does not reference negation rationale
Reason MedicationRequest.reasonCode QDM matched to QI Core / FHIR
Refills MedicationRequest.dispenseRequest.numberOfRepeatsAllowed QDM matched to QI Core / FHIR
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
Recorder MedicationRequest.recorder Possibly addressed in FHIR Provenance

Substance, Recommended [when consistent with medication use cases]

QDM Attribute QI Core Metadata Element Comment
Substance, Recommended MedicationRequest.intent Medication 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 MedicationRequest.intent value of "plan" (an intension to ensure something occurs without providing an authorization to act).
Dosage MedicationRequest.dosageInstruction.dose[x] QDM matched to QI Core / FHIR
Frequency MedicationRequest.dosageInstruction.timing QDM matched to QI Core / FHIR
Code MedicationRequest.medication QDM matched to QI Core / FHIR
Reason MedicationRequest.reasonCode QDM matched to QI Core / FHIR
Negation Rationale MedicationStatement.reasonNotTaken Medication Request in QI Core does not reference negation rationale
Reason MedicationRequest.reasonCode QDM matched to QI Core / FHIR
Refills MedicationRequest.dispenseRequest.numberOfRepeatsAllowed 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
Recorder MedicationRequest.recorder Possibly addressed in FHIR Provenance
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