Communication (QDM)

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Reviewed by the CQI Workgroup on March 23 based on content posted to the CQI Workgroup document site. Updates based on that discussion and additional considerations entered on this wiki on 18 April 2018

QDM defines Communication as the transmission, receipt, or acknowledgement of information sent from a source to a recipient, such as from one clinician to another regarding findings, assessments, plans of care, consultative advice, instructions, educational resources, etc. It also may include the receipt of response from a patient with respect to any aspect of the care provided. Furthermore, it may include the conveying of information from provider to patient (e.g., results, findings, plans for care, medical advice, instructions, educational resources, appointments). A time and date stamp is required. QDM defines three contexts for communication: Communication, Patient to Provider; Communication, Provider to Patient; Communication, Provider to Provider. For the CQI Work Group, please consider what is intended by the concept of communication as it is identified in FHIR / QI Core, and whether that matches to the intent in QDM.

FHIR Communication Resource
This resource is a record of a communication. A communication is a conveyance of information from one entity, a sender, to another entity, a receiver. The sender and receivers may be patients, practitioners, related persons, organizations, or devices. Communication use cases include:

• A reminder or alert delivered to a responsible provider
• A recorded notification from the nurse that a patient's temperature exceeds a value
• A notification to a public health agency of a patient presenting with a communicable disease reportable to the public health agency
• Patient educational material sent by a provider to a patient
• Non-patient specific communication use cases may include:
• A nurse call from a hall bathroom
• Advisory for battery service from a pump
  
  

HL7 FHIR Procedure Resource
The boundary between determining whether an action is a Procedure (training or counseling) as opposed to a Communication is based on whether there's a specific intent to change the mind-set of the patient. Mere disclosure of information would be considered a Communication. A process that involves verification of the patient's comprehension or to change the patient's mental state would be a Procedure.

Communication, Patient to Provider

QDM Attribute	QI Core Metadata Element	Comment
Communication, Patient to Provider	Communication.status	QDM matched to FHIR / QI Core (the .status metadata allows conformance to the specific QDM datatype context)
Code	Communication.reasonCode	Note - CommunicationRequest in QI Core could be considered but QDM does not differentiate a Communication recommended or ordered, only communication so the mapping assumes the communication has occurred, with or without a response.
Negation Rationale	Communication.notDoneReason	QDM matched to FHIR / QI Core
Author dateTime	Communication.sent	QDM addresses authorDatetime as the time the communication is sent.
Related to	Communication.basedOn	An order, proposal or plan fulfilled in whole or in part by this Communication.
id	Communication.id	QDM matched to FHIR / QI Core
Source	Communication.sender	The entity (e.g. person, organization, clinical information system, or device) which was the source of the communication.

Communication, Provider to Patient

QDM Attribute	QI Core Metadata Element	Comment
Communication, Provider to Patient	Communication.status	QDM matched to FHIR / QI Core (the .status metadata allows conformance to the specific QDM datatype context)
Code	Communication.reasonCode	Note - CommunicationRequest in QI Core could be considered but QDM does not differentiate a Communication recommended or ordered, only communication so the mapping assumes the communication has occurred, with or without a response.
Negation Rationale	Communication.notDoneReason	QDM matched to FHIR / QI Core
Author dateTime	Communication.sent	QDM addresses authorDatetime as the time the communication is sent.
Related to	Communication.basedOn	An order, proposal or plan fulfilled in whole or in part by this Communication.
id	Communication.id	QDM matched to FHIR / QI Core
Source	Communication.sender	The entity (e.g. person, organization, clinical information system, or device) which was the source of the communication.

Communication, Provider to Provider

QDM Attribute	QI Core Metadata Element	Comment
Communication, Provider to Provider	Communication.status	QDM matched to FHIR / QI Core (the .status metadata allows conformance to the specific QDM datatype context)
Code	Communication.reasonCode	Note - CommunicationRequest in QI Core could be considered but QDM does not differentiate a Communication recommended or ordered, only communication so the mapping assumes the communication has occurred, with or without a response.
Negation Rationale	Communication.notDoneReason	QDM matched to FHIR / QI Core
Author dateTime	Communication.sent	QDM addresses authorDatetime as the time the communication is sent.
Related to	Communication.basedOn	An order, proposal or plan fulfilled in whole or in part by this Communication.
id	Communication.id	QDM matched to FHIR / QI Core
Source	Communication.sender	The entity (e.g. person, organization, clinical information system, or device) which was the source of the communication.