Substance (QDM)
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.
Contents
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 |
Substance, Order (Nutrition)
| QDM Attribute | QI Core Metadata Element | Comment |
| Substance, Order | NutritionOrder.status | 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). |
| Dosage | NutritionOrder.oralDiet.nutrient.amount NutritionOrder.supplement.quantity |
NutritionOrder.oralDiet.nutrient.amount (The quantity of the specified nutrient to include in diet.) NutritionOrder.supplement.quantity (The amount of the nutritional supplement to be given.) |
| Frequency | NutritionOrder.oralDiet.schedule NutritionOrder.supplement.schedule |
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.) 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.) |
| Code | NutritionOrder.oralDiet.nutrient Uncertain mapping for QDM code attribute for supplements or enteral formula |
NutritionOrder.oralDiet.nutrient (Class that defines the quantity and type of nutrient modifications (for example carbohydrate, fiber or sodium) required for the oral diet.) Uncertain mapping for QDM code attribute for supplements or enteral formula |
| Reason | NutritionOrder.oralDiet.instruction NutritionOrder.supplement.instruction |
NutritionOrder does not address reason except, perhaps, as .instruction: NutritionOrder.oralDiet.instruction |
| Method | NutritionOrder.oralDiet.instruction NutritionOrder.supplement.instruction |
NutritionOrder.oralDiet.instruction (Free text or additional instructions or information pertaining to the oral diet.) NutritionOrder.supplement.instruction (Free text or additional instructions or information pertaining to the oral supplement.) |
| Negation Rationale | 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. | |
| Reason | NutritionOrder does not address reason. | |
| Refills | NutritionOrder does not address refills. | |
| Author dateTime | NutritionOrder.dateTime | QDM matched to FHIR |
| id | NutritionOrder does not address id. | |
| Source | NutritionOrder.orderer | QDM matched to FHIR |
| Recorder | FHIR.provenance.recorder | Possibly addressed in FHIR Provenance |
Substance, Recommended (Nutrition)
| QDM Attribute | QI Core Metadata Element | Comment |
| Substance, Recommended | NutritionOrder.status | 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). |
| Dosage | NutritionOrder.oralDiet.nutrient.amount NutritionOrder.supplement.quantity |
NutritionOrder.oralDiet.nutrient.amount (The quantity of the specified nutrient to include in diet.) NutritionOrder.supplement.quantity (The amount of the nutritional supplement to be given.) |
| Frequency | NutritionOrder.oralDiet.schedule NutritionOrder.supplement.schedule |
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.) 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.) |
| Code | NutritionOrder.oralDiet.nutrient Uncertain mapping for QDM code attribute for supplements or enteral formula |
NutritionOrder.oralDiet.nutrient (Class that defines the quantity and type of nutrient modifications (for example carbohydrate, fiber or sodium) required for the oral diet.) Uncertain mapping for QDM code attribute for supplements or enteral formula |
| Reason | NutritionOrder.oralDiet.instruction NutritionOrder.supplement.instruction |
NutritionOrder does not address reason except, perhaps, as .instruction: NutritionOrder.oralDiet.instruction |
| Method | NutritionOrder.oralDiet.instruction NutritionOrder.supplement.instruction |
NutritionOrder.oralDiet.instruction (Free text or additional instructions or information pertaining to the oral diet.) NutritionOrder.supplement.instruction (Free text or additional instructions or information pertaining to the oral supplement.) |
| Negation Rationale | 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. | |
| Reason | NutritionOrder does not address reason. | |
| Refills | NutritionOrder does not address refills. | |
| Author dateTime | NutritionOrder.dateTime | QDM matched to FHIR |
| id | NutritionOrder does not address id. | |
| Source | NutritionOrder.orderer | QDM matched to FHIR |
| Recorder | FHIR.provenance.recorder | Possibly addressed in FHIR Provenance |
