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Difference between revisions of "Intervention (QDM)"

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* '''''For CQI Workgroup Discussion on Friday, June 15, 2018'''''
 
* '''''For CQI Workgroup Discussion on Friday, June 15, 2018'''''
 
* Note that while the QDM categories Intervention and Procedure have been modeled identically in previous versions of QI Core, the [http://hl7.org/fhir/task.html FHIR Task Resource] provides a potentially more effective way to differentiate Interventions from Procedures. Both are retained in the QDM as they are more clinically expressive for clinicians to understand the measure intent.  
 
* Note that while the QDM categories Intervention and Procedure have been modeled identically in previous versions of QI Core, the [http://hl7.org/fhir/task.html FHIR Task Resource] provides a potentially more effective way to differentiate Interventions from Procedures. Both are retained in the QDM as they are more clinically expressive for clinicians to understand the measure intent.  
* The QDM to FHIR mapping provided here show mapping to both Procedure/ProcedureRequest and to Task.<br><br>
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* The QDM to FHIR mapping provided here show mapping to both Procedure/ProcedureRequest and to Task.
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* The FHIR resource definitions for [http://build.fhir.org/procedure.html Procedure] and [http://build.fhir.org/task.html Task] seem to have significant overlap - see [https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=17359&start=50 FHIR Tracker item 17359]
 +
* Both mappings (i.e., Intervention mapped to Procedure/ProcedureRequest and to Task) are shown here. Comments are welcome regarding the most appropriate use.<br><br>
 
QDM defines Intervention as a course of action intended to achieve a result in the care of persons with health problems that does not involve direct physical contact with a patient. Examples include patient education and therapeutic communication. QDM defines three contexts for intervention: Intervention, Order; Intervention, Performed; Intervention, Recommended.
 
QDM defines Intervention as a course of action intended to achieve a result in the care of persons with health problems that does not involve direct physical contact with a patient. Examples include patient education and therapeutic communication. QDM defines three contexts for intervention: Intervention, Order; Intervention, Performed; Intervention, Recommended.
  
  
==Intervention, Order==
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=='''''Intervention, Order (Using ProcedureRequest)'''''==
  
 
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==Intervention, Recommended==
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=='''''Intervention, Recommended (Using ProcedureRequest)''''==
  
 
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| row2cell3 | Author, orderer - note also, ProcedureRequest.requester.agent for device, practitioner or organization who initiated the request; or ProcedureRequest.requester.onBehalfOf  - the organization the device or practitioner was acting on behalf of
 
| row2cell3 | Author, orderer - note also, ProcedureRequest.requester.agent for device, practitioner or organization who initiated the request; or ProcedureRequest.requester.onBehalfOf  - the organization the device or practitioner was acting on behalf of
 
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==Intervention, Performed==
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=='''''Intervention, Performed (Using Procedure)''''==
  
 
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Revision as of 21:16, 15 June 2018

Back to Harmonization of Health Quality Information Models Page

The CQI Workgroup reviewed this page in April 2018 consistent with QDM version 5.3. There are no updates to the content required based on QDM version 5.4 (reviewed June 7, 2018).

  • For CQI Workgroup Discussion on Friday, June 15, 2018
  • Note that while the QDM categories Intervention and Procedure have been modeled identically in previous versions of QI Core, the FHIR Task Resource provides a potentially more effective way to differentiate Interventions from Procedures. Both are retained in the QDM as they are more clinically expressive for clinicians to understand the measure intent.
  • The QDM to FHIR mapping provided here show mapping to both Procedure/ProcedureRequest and to Task.
  • The FHIR resource definitions for Procedure and Task seem to have significant overlap - see FHIR Tracker item 17359
  • Both mappings (i.e., Intervention mapped to Procedure/ProcedureRequest and to Task) are shown here. Comments are welcome regarding the most appropriate use.

QDM defines Intervention as a course of action intended to achieve a result in the care of persons with health problems that does not involve direct physical contact with a patient. Examples include patient education and therapeutic communication. QDM defines three contexts for intervention: Intervention, Order; Intervention, Performed; Intervention, Recommended.


Intervention, Order (Using ProcedureRequest)

QDM Attribute QI Core Metadata Element Comment
Intervention, 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.
Negation Rationale ProcedureRequest.extension (http://hl7.org/fhir/StructureDefinition/procedurerequest-reasonRefused) QDM matched to QI Core / FHIR
Reason ProcedureRequest.reasonCode QDM matched to QI Core / FHIR
Author dateTime ProcedureRequest.AuthoredOn Note - ProcedureRequest.occurrence(x) defines a dateTime when the event should occur - not addressed in QDM
Code ProcedureRequest.code QDM matched to QI Core / FHIR
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 the device or practitioner was acting on behalf of

Intervention, Recommended (Using ProcedureRequest)'

QDM Attribute QI Core Metadata Element Comment
Intervention, 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).
Negation Rationale ProcedureRequest.extension (http://hl7.org/fhir/StructureDefinition/procedurerequest-reasonRefused) QDM matched to QI Core / FHIR
Reason ProcedureRequest.reasonCode QDM matched to QI Core / FHIR
Author dateTime ProcedureRequest.AuthoredOn Note - ProcedureRequest.occurrence(x) defines a dateTime when the event should occur - not addressed in QDM
Code ProcedureRequest.code QDM matched to QI Core / FHIR
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 the device or practitioner was acting on behalf of

Intervention, Performed (Using Procedure)'

QDM Attribute QI Core Metadata Element Comment
Intervention, Performed Procedure (the .status metadata allows conformance to the specific QDM datatype context) QDM matched to QI Core / FHIR
Relevant Period Procedure.performed[x] QDM matched to QI Core / FHIR
Negation Rationale Procedure.notDoneReason QDM matched to QI Core / FHIR
Reason Procedure.reasonCode QDM matched to QI Core / FHIR
Result Procedure.outcome QDM matched to QI Core / FHIR
Author dateTime FHIR.provenance.recorded FHIR references authorDatetime as part of the provenance resource for all resources. Is authorDatetime still appropriate for this datatype?
Status Procedure.status QDM matched to QI Core / FHIR
Code Procedure.code QDM matched to QI Core / FHIR
id Procedure.id QDM matched to QI Core / FHIR
Source Procedure.performer QDM matched to QI Core / FHIR

Intervention, Order [Using Task]

QDM Attribute QI Core Metadata Element Comment
Intervention, Order Task.intent Task 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.
Negation Rationale Task.statusReason QDM matched to QI Core/FHIR - Constrained to instances in which Task.status = rejected, cancelled, or failed Task status value set (required)
Reason Task.reason QDM matched to QI Core / FHIR
Author dateTime Task.AuthoredOn QDM matched to QI Core / FHIR
Code Task.code QDM matched to QI Core / FHIR
id Task.id QDM matched to QI Core / FHIR
Source Task.requester Task also provides the opportunity to request Task.owner (the person responsible for the task) and task.performerType

Intervention, Recommended [Using Task]

QDM Attribute QI Core Metadata Element Comment
Intervention, Order Task.intent Task intent uses the concepts proposal, plan, order, original-order, reflex-order, filler-order, instance-order, option. Constrain to "plan" from the intent value set for QDM datatypes with the recommended context.
Negation Rationale | row2cell2 | Task.statusReason QDM matched to QI Core/FHIR - Constrained to instances in which Task.status = rejected, cancelled, or failed Task status value set (required)
Reason Task.reason QDM matched to QI Core / FHIR
Author dateTime Task.AuthoredOn QDM matched to QI Core / FHIR
Code Task.code QDM matched to QI Core / FHIR
id Task.id QDM matched to QI Core / FHIR
Source Task.requester Task also provides the opportunity to request Task.owner (the person responsible for the task) and task.performerType

Intervention, Performed [Using Task]

QDM Attribute QI Core Metadata Element Comment
Intervention, Performed Task (the .status metadata allows conformance to the specific QDM datatype context) QDM matched to QI Core / FHIR
Relevant Period Task.executionPeriod QDM matched to QI Core / FHIR
Negation Rationale Task.statusReason QDM matched to QI Core/FHIR - Constrained to instances in which Task.status = rejected, cancelled, or failed Task status value set (required)
Reason Task.reason QDM matched to QI Core / FHIR
Result Task.output.value[x] QDM matched to QI Core / FHIR
Author dateTime Task.authoredOn QDM matched to QI Core / FHIR
Status Task.status QDM matched to QI Core / FHIR
Code Task.code QDM matched to QI Core / FHIR
id Task.id QDM matched to QI Core / FHIR
Source Task.requester Task also provides the opportunity to request Task.owner (the person responsible for the task) and task.performerType