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Procedure (QDM)
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The CQI Workgroup reviewed this page in April 2018 consistent with QDM version 5.3. QDM version 5.4 updates were applied on June 7, 2018:
- Removal of "anatomical approach site" from "Procedure, Performed", "Procedure, Order", and "Procedure, Recommended"
- Removal of "method" from "Procedure, Order" and "Procedure, Recommended"
Note that while the QDM categories Intervention and Procedure are modeled identically and interoperability standards do not differentiate between them, both are retained in the QDM as they are more clinically expressive for clinicians to understand the measure intent.
QDM defines Procedure as “An Act whose immediate and primary outcome (post-condition) is the alteration of the physical condition of the subject. … Procedure is but one among several types of clinical activities such as observation, substance-administrations, and communicative interactions … Procedure does not comprise all acts of [sic] whose intent is intervention or treatment.” A procedure may be a surgery or other type of physical manipulation of a person’s body in whole or in part for purposes of making observations and diagnoses or providing treatment. QDM defines three contexts for Procedure: Procedure, Order; Procedure, Performed; Procedure, Recommended.
Procedure, Order
| QDM Attribute | QI Core Metadata Element | Comment |
| Procedure, 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 |
| AnatomicalLocation | ProcedureRequest.bodySite | QDM matched to QI Core / FHIR |
| Ordinality | . | Not addressed in FHIR ProcedureRequest |
| 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 |
Procedure, Recommended
| QDM Attribute | QI Core Metadata Element | Comment |
| Procedure, 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 |
| AnatomicalLocation | ProcedureRequest.bodySite | QDM matched to QI Core / FHIR |
| Ordinality | . | Not addressed in FHIR ProcedureRequest |
| 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 |
Procedure, Performed
| QDM Attribute | QI Core Metadata Element | Comment |
| Procedure, 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 |
| AnatomicalLocation | Procedure.bodySite | QDM matched to QI Core / FHIR |
| IncisionDateTime | Procedure.extension ([CanonicalType[1]] | QDM matched to QI Core / FHIR |
| Method | . | Not addressed in FHIR |
| Ordinality | . | Not addressed in FHIR |
| Components | . | Not addressed in FHIR |
| Author dateTime | FHIR.provenance.recorded | FHIR references authorDatetime as part of the provenance resource for all resources. |
| 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 |
