Allergy/Intolerance (QDM)

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This QDM to QI Core Mapping for the QDM Datatype "Allergy/Intolerance" was reviewed by the CQI WG on March 9, 2018 for QDM 5.3 and updated to QDM 5.4 on June 7, 2018. QDM for "Allergy Intolerance" has no changes between versions 5.3 and 5.4.

Allergy is used to address immune-mediated reactions to a substance such as type 1 hypersensitivity reactions, other allergy-like reactions, including pseudo-allergy.

Intolerance is a record of a clinical assessment of a propensity, or a potential risk to an individual, to have a non-immune mediated adverse reaction on future exposure to the specified substance, or class of substance.

Allergy / Intolerance

QDM Attribute	QI Core Metadata Element	Comment
Author dateTime	FHIR Provenance.recorded	FHIR provenance.recorded was chosen since the definition of AllergyIntolerance.assertedDate may not be a direct match to authorDatetime. Different clinical software products address asserted date indicating the time at which the allergy or intolerance is known. That may be the same as the date entered into the software (i.e., authorDatetime). However, providers have the option of entering the time the allergy or intolerance was known to occur. The definition of the FHIR resource is ambiguous, i.e., asserted by whom (the patient or the provider), and is it the date the patient informed the provider or the date (approximate) that the allergy or intolerance occurred. Entering FHIR tracker comment for improvement in clarity of definition. QDM Guidance – add asserted date Vs modify authorDatetime to assertedDatetime. (FHIR tracker 15781 15March2018).Please advise if the definition in QI Core/FHIR is consistent with the authorDatetime reference in QDM and whether QDM requires greater clarity in definition (i.e., potentially change authorDatetime to Asserted dateTime).
Prevalence Period	AllergyIntolerance.onset[x] AllergyIntolerance-resolutionAge	QDM Prevalence Period addresses the onset dateTime and the abatement dateTime for an allergy. The options provided in QI Core / FHIR include AllergyIntolerance.reaction.onset, AllergyIntolerance.onset(x) (which allows a period) to allow expression of a timeframe during which the allergy began, AllergyIntolerance.reaction.allergyintoleranceduration (the time the allergyIntolerance persisted, and allergyintolerance-resolutionAge (limited to age rather than dateTime). In general, patients may remember the age at which an allergy was determined to have abated, but not a dateTime. QDM Guidance: The QDM Prevalence Period start should map to AllergyIntolerance.onset[x] and reference the start of the AllergyIntolerance.onset period. the QDM Allergy/Intolerance Prevalence Period end should map to allergyintolerance-resolutionAge, but the age is an extension (i.e., QI Core only) and implementers would potentially need to map an age to a year and default a month and day. The definition of AllergyIntolerance.assertedDate may not be a direct match to authorDatetime. Different clinical software products address asserted date indicating the time at which the allergy or intolerance is known. That may be the same as the date entered into the software (i.e., authorDatetime). However, providers have the option of entering the time the allergy or intolerance was known to occur. The definition of the FHIR resource is ambiguous, i.e., asserted by whom (the patient or the provider), and is it the date the patient informed the provider or the date (approximate) that the allergy or intolerance occurred. Entering FHIR tracker comment for improvement in clarity of definition. QDM Guidance – add asserted date Vs modify authorDatetime to assertedDatetime. (FHIR tracker 15781 15March2018).Please advise if the definition in QI Core/FHIR is consistent with the authorDatetime reference in QDM and whether QDM requires greater clarity in definition (i.e., potentially change authorDatetime to Asserted dateTime).
Code	AllergyIntolerance.code	The AllergyIntolerance.code should reference the class of substance (perhaps using the substance hierarchy of SNOMED). The QDM "Type" attribute definition addresses a value set (or a direct referenced code) that describes the reaction. Hence the mapping of QDM "type" to AllergyIntolerance.reaction.manifestation in QI Core. QI Core and FHIR use "type" to describe the underlying physiologic mechanism for the reaction (i.e., allergy or intolerance). More clarity in the next version of Greater clarity in definition in QDM descriptions in the CQL-based HQMF and in the QDM publication should be helpful.
Type	AllergyIntolerance.reaction.manifestation	In the future, QDM might consider adding the FHIR concept AllergyIntolerance.type (Allergy, Intolerance) and AllergyIntolerance.category (food, medication, environment, biologic).
Severity	Allergyintolerance.reaction.severity	Note the comment in QI Core/FHIR --- "It is acknowledged that this assessment is very subjective. There may be some specific practice domains where objective scales have been applied. Objective scales can be included in this model as extensions." In the future, consider addressing criticality in QDM as well (i.e., low risk, high risk)."
Source	AllergyIntolerance.asserter	QDM matched to QI Core / FHIR
Recorder	AllergyIntolerance.recorder	QDM matched to QI Core / FHIR
id	Allergyintolerance.id	QDM matched to QI Core / FHIR