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Substance (QDM)
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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.
Substance, 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 |
| Supply | Not addressed in QI Core | |
| 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 |
| 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. Is authorDatetime still appropriate for this datatype? |
| Code | MedicationAdministration.medication[x] | QDM matched to QI Core / FHIR |
| id | MedicationAdministration.id | QDM matched to QI Core / FHIR |
Substance, Order
| 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 |
| Method | MedicationRequest.dosageInstruction.method | 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 |
| 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
| 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 |
| Method | MedicationRequest.dosageInstruction.method | 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 |
| 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 |
