Diagnostic Study (QDM)
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QDM defines Diagnostic Study as any kind of medical test performed as a specific test or series of steps to aid in diagnosing or detecting disease (e.g., to establish a diagnosis, measure the progress or recovery from disease, confirm that a person is free from disease). The QDM defines diagnostic studies as those that are not performed in organizations that perform testing on samples of human blood, tissue, or other substance from the body. Diagnostic studies may make use of digital images and textual reports. Such studies include but are not limited to imaging studies, cardiology studies (electrocardiogram, treadmill stress testing), pulmonary-function testing, vascular laboratory testing, and others. QDM defines three contexts for Diagnostic Study: Diagnostic Study, Order; Diagnostic Study, Performed; and Diagnostic Study, Recommended. Note that QI Core maps for imaging type diagnostic studies are mapped to DiagnosticReport; QI Core maps for non-imaging type diagnostic studies are mapped to Observation.
Diagnostic Study, Order
| QDM Attribute | QI Core Metadata Element | Comment |
| Diagnostic Study, 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. |
| Method | This item is not found in QI Core. In most instances, quality measure developers address procedure methods by using specific, pre-coordinated terminology (e.g., specific LOINC codes indicating the test and the method) | |
| Negation Rationale | ProcedureRequest.extension (http://hl7.org/fhir/StructureDefinition/procedurerequest-reasonRefused) | QDM matched to QI Core / FHIR |
| Reason | ProcedureRequest.reasonCode, Use http://hl7.org/fhir/us/qicore/qicore-procedurerequest-appropriatenessScore.html to address RAND criteria for appropriate imaging usage criteria. | QDM matched to QI Core / FHIR |
| Author dateTime | ProcedureRequest.AuthoredOn | QDM matched to QI Core/FHIR. Note - ProcedureRequest.occurrence(x) defines a dateTime when the event should occur - not addressed in QDM |
| Code | ProcedureRequest.code | See also, Observation.category |
| 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 on whose behalf the device or practitioner was acting |
Diagnostic Study, Performed (Imaging Studies)
| QDM Attribute | QI Core Metadata Element | Comment |
| Diagnostic Study, Performed (Specific to Imaging Studies) | DiagnosticReport (the .status metadata allows conformance to the specific QDM datatype context) | QDM matched to QI Core / FHIR. Quality measures and CDS artifacts may need to address which status is desired: Partial, preliminary, final, amended, corrected, appended. Most quality measures will address final, amended, corrected, appended. |
| FacilityLocation | DiagnosticReport.extension (diagnosticReport-locationPerformed) | QDM matched to QI Core / FHIR |
| Method | This item is not found in QI Core. In most instances, quality measure developers address procedure methods by using specific, pre-coordinated terminology (e.g., specific LOINC codes indicating the test and the method) | |
| Negation Rationale | None | FHIR DiagnosticReport does not address negation since there would be no report. QDM usage to indicate studies that have not been done should address negation rationale for the order or the recommendation (i.e., ProcedureRequest.extension (reasonRefused). |
| Reason | None | FHIR DiagnosticReport does not address reason since reason is a function of the order or recommendation. QDM reference to indicate the reason for imaging studies should reference qicore-procedurerequest-appropriatenessScore. |
| Result | DiagnosticReport.result | Note - QI Core also includes Observation.interpretation and Observation.comment - eCQMs have addressed interpretation as an implementation issue. Perhaps that approach should be reconsidered. |
| Result dateTime | DiagnosticReport.issued | QDM matched to QI Core / FHIR |
| Relevant Period | DiagnosticReport.effective(x) | QDM addresses a Period; QI Core allows an effective time. Consider addressing the difference. |
| Status | DiagnosticReport.status | QDM matched to QI Core / FHIR |
| Code | DiagnosticReport.code | Note - QI Core includes DiagnosticReport.specimen - eCQMs use the LOINC value set to determine the specimen source |
| Author dateTime | part of FHIR Provenance Resource | FHIR references authorDatetime as part of the provenance resource for all resources. Is author dateTime still appropriate for this QDM datatype? |
| Components | Components for imaging studies not addressed in QI Core | |
| Component Code | Component code for imaging studies is not addressed in QI Core | |
| Component Result | Component result for imaging studies is not addressed in QI Core | |
| id | DiagnosticReport.id | QDM matched to QI Core / FHIR |
| Source | DiagnosticReport.performer | Source is addressed by either DiagnosticReport.performer or Observation.device |
