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Difference between revisions of "Immunization (QDM)"

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[http://wiki.hl7.org/index.php?title=Harmonization_of_Health_Quality_Information_models Back to Harmonization of Health Quality Information Models Page] <br><br>
 
[http://wiki.hl7.org/index.php?title=Harmonization_of_Health_Quality_Information_models Back to Harmonization of Health Quality Information Models Page] <br><br>
 
QDM defines Immunization as vaccines administered to patients in healthcare settings but does not include non-vaccine agents. QDM defines two contexts for immunization: Immunization, Administered; Immunization, Order.<br> <br>
 
QDM defines Immunization as vaccines administered to patients in healthcare settings but does not include non-vaccine agents. QDM defines two contexts for immunization: Immunization, Administered; Immunization, Order.<br> <br>
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This mapping was first published on 9 April 2018 and updated 15 April 2018 and again 24 April 2018 based on discussion and further modeling considerations. Note FHIR tracker items in May ballot added based on the content for Immunization, Administered and Immunization, Order - 15930, 15931, 15932 - details described in the tables below. <br><br>
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The HL7 CQI Workgroup reviewed and updated this content on April 24, 2018 based on QDM version 5.3. The content was updated on June 7, 2018 consistent with QDM version 5.4.  The only change between QDM versions 5.3 and 5.4 is that version 5.4 removes the "supply" attribute from "Immunization, Administered" and retains the "supply" attribute for "Immunization, Order"<br><br>
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Note, the work initially mapped Immunization, Order to the FHIR resource Immunization Recommendation; however, it is clear that the FHIR Immunization Recommendation resource is specifically designed to provide an immunization forecast from a forecasting engine to a provider, basically to carry clinical decision support recommendations specific to immunizations. Therefore, the most closely associated resource for the QDM datatype Immunization, Order is MedicationRequest. There is no comparable FHIR resource to specify ImmunizationRequest. Hence, the mapping for Immunization, Order uses MedicationRequest (24 April 2018).
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 +
FHIR Immunization Recommendation resource is specifically designed to provide an immunization forecast from a forecasting engine to a provider, basically to carry clinical decision support recommendations specific to immunizations and, therefore, is not consistent with the intent of the QDM datatype "Immunization, Order". The most closely associated resource is MedicationRequest. There is no comparable FHIR resource to specify ImmunizationRequest.  
 
__FORCETOC__
 
__FORCETOC__
 
== Immunization, Administered ==
 
== Immunization, Administered ==
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| row2cell1 | Author dateTime
 
| row2cell1 | Author dateTime
 
| row2cell2 | Immunization.date
 
| row2cell2 | Immunization.date
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| row2cell3 | QDM matched to QI Core / FHIR
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| row2cell3 | QDM matched to QI Core / FHIR<br>
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|-
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NOTE: See QDM Known Issues for update – Immunization, Administered should include only the dateTime of the immunization administration. Until QDM 5.5 version, implementers should map Immunization, Administered author dateTime to administrationTime. [https://github.com/esacinc/CQL-Formatting-and-Usage-Wiki/wiki/eCQM-Known-Issues#qdm-immunization-administered-timing-attribute-advisory]
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| row2cell1 | Supply
 
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| row2cell2 |
 
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| row2cell3 | Not addressed in QI Core. Discussion in the HL7 CQI Workgroup (13April2108) suggested that supply might assist with determining the lot number and the stock from which the vaccine administered was taken (e.g., a guarantee program such as Vaccines for Children).  Immunization.vaccineCode specifies the vaccine but not the source of the vaccine. The FHIR Immunization resource does not seem to have a way to indicate the source of the vaccine. See [https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemBrowse&feedback=Successfully+added+%5B%2315930%5D&tracker_id=677 FHIR Tracker item 15930].
 
 
|-
 
|-
 
| row2cell1 | Code
 
| row2cell1 | Code
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| row1cell1 | Immunization, Order
 
| row1cell1 | Immunization, Order
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| row1cell2 | Immunization (the .status metadata allows conformance to the specific QDM datatype context)
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| row1cell2 | MedicationRequest.intent
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| row1cell3 | Note - FHIR 3.0 ImmunizationRecommendation modeling is consistent with information provided by clinical decision support for immunization forecasting. (Definition: A patient's point-in-time immunization and recommendation (i.e. forecasting a patient's immunization eligibility according to a published schedule) with optional supporting justification.- [http://hl7.org/fhir/immunizationrecommendation-definitions.html#ImmunizationRecommendation ImmunizationRecommendation]. There is no concept comparable to MedicationRequest which includes an .intent metadata element allows reference to "proposal" consistent with clinical decision support forecasting, "plan" consistent with a recommendation a clinician provides to a patient, and "order" consistent with an order placed in EHRs or other clinical software. This is an important distinction since in some practices, the physician sends a prescription (order) to a pharmacy for the patient to pick up, bring back to the practice for it to be administered. Thus, Immunization, Order should have a ImmunizationRecommendation.intent to indicate the "order" which is distinct from an ImmunizationRecommendation.intent proposal for forecasting and ImmunizationRecommendation.plan for a recommendation to a patient which may or may not be heeded.  See [https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemBrowse&feedback=Successfully+added+%5B%2315931%5D&tracker_id=677 FHIR Tracker Item 15931].
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| row1cell3 | 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.
 
|-
 
|-
 
| row2cell1 | Active dateTime
 
| row2cell1 | Active dateTime
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| row2cell2 | IImmunizationRecommendation.recommendation.dateCriterion
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| row2cell2 | MedicationRequest.dispenseRequest.validityPeriod
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| row2cell3 | QDM matched to QI Core / FHIR
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| row2cell3 | This indicates the validity period of a prescription (stale dating the Prescription).
 
|-
 
|-
 
| row2cell1 | Dosage
 
| row2cell1 | Dosage
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| row2cell2 | Immunization.doseQuantity
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| row2cell2 | MedicationRequest.dosageInstruction
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| row2cell3 | There is no QI Core Counterpart for immunization order. ImmunizationRecommendation allows specification of a forecast that includes dose number and sequence in a series, but it does not indicate Immunization dose. Immunization includes a doseQuantity, but Immunization is used to indicate immunizations that have ben administered; it does not reference orders for immunizations. See [https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemBrowse&feedback=Successfully+added+%5B%2315932%5D&tracker_id=677 FHIR Tracker Item 15932].
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| row2cell3 | Indicates how the medication is to be used by the patient.
 
|-
 
|-
 
| row2cell1 | Negation Rationale
 
| row2cell1 | Negation Rationale
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| row2cell2 | ProcedureRequest.extension (http://hl7.org/fhir/StructureDefinition/procedurerequest-reasonRefused)
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| row2cell2 | MedicationStatement.reasonNotTaken
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| row2cell3 | QDM matched to QI Core / FHIR
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| row2cell3 | Medication Request in QI Core does not reference negation rationale. See FHIR Tracker Item [https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=15941 15941] addressing notDoneReason requirement.
 
|-
 
|-
 
| row2cell1 | Reason
 
| row2cell1 | Reason
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| row2cell2 | ImmunizationRecommendation.recommendation.protocol
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| row2cell2 | MedicationRequest.reasonCode
 
| row2cell3 | QDM matched to QI Core / FHIR
 
| row2cell3 | QDM matched to QI Core / FHIR
 
|-
 
|-
 
| row2cell1 | Route
 
| row2cell1 | Route
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| row2cell2 | Immunization.route
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| row2cell2 | MedicationRequest.dosageInstruction.route
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| row2cell3 | There is no QI Core Counterpart for immunization order. ImmunizationRecommendation allows specification of a forecast that includes dose number and sequence in a series, but it does not indicate the anticipated Immunization route. Immunization includes a .route, but Immunization is used to indicate immunizations that have ben administered; it does not reference orders for immunizations. See [https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemBrowse&feedback=Successfully+added+%5B%2315932%5D&tracker_id=677 FHIR Tracker Item 15932].
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| row2cell3 | QDM matched to QI Core / FHIR.
 
|-
 
|-
 
| row2cell1 | Author dateTime
 
| row2cell1 | Author dateTime
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| row2cell2 | ImmunizationRecommendation.date
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| row2cell2 | MedicationRequest.authoredOn
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| row2cell3 | QDM matched to QI Core / FHIR
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| row2cell3 | QDM matched to QI Core / FHIR<br>
 +
Note: FHIR Provenance generally addresses the author of the message; the identifier/source of the original resource element is defined by the resource. Individual resource element provenance is summarized in the FHIR W5 Report (http://hl7.org/fhir/w5.html).
 
|-
 
|-
 
| row2cell1 | Supply
 
| row2cell1 | Supply
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| row2cell2 |  
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| row2cell2 | MedicationRequest.dispenseRequest.quantity
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| row2cell3 | Not addressed in QI Core. Discussion in the HL7 CQI Workgroup (13April2108) suggested that supply might assist with determining the lot number and the stock from which the vaccine administered was taken (e.g., a guarantee program such as Vaccines for Children).  Immunization.vaccineCode specifies the vaccine but not the source of the vaccine.  The FHIR Immunization resource does not seem to have a way to indicate the source of the vaccine. See [https://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemBrowse&feedback=Successfully+added+%5B%2315930%5D&tracker_id=677 FHIR Tracker item 15930].
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| row2cell3 | QDM matched to QI Core / FHIR.
 
|-
 
|-
 
| row2cell1 | Code
 
| row2cell1 | Code
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| row2cell2 | ImmunizationRecommendation.recommendation.vaccineCode
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| row2cell2 | MedicationRequest.medication
 
| row2cell3 | QDM matched to QI Core / FHIR
 
| row2cell3 | QDM matched to QI Core / FHIR
 
|-
 
|-
 
| row2cell1 | id
 
| row2cell1 | id
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| row2cell2 | ImmunizationRecommendation.id
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| row2cell2 | MedicationRequest.id
 
| row2cell3 | QDM matched to QI Core / FHIR
 
| row2cell3 | QDM matched to QI Core / FHIR
 
|-
 
|-
 
| row2cell1 | Source
 
| row2cell1 | Source
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| row2cell2 | ImmunizationRecommendation.recommendation.protocol.authority
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| row2cell2 | MedicationRequest.requester
 
| row2cell3 | QDM matched to FHIR
 
| row2cell3 | QDM matched to FHIR
 
|-
 
|-
 
|}
 
|}

Latest revision as of 04:12, 28 November 2018

Back to Harmonization of Health Quality Information Models Page

QDM defines Immunization as vaccines administered to patients in healthcare settings but does not include non-vaccine agents. QDM defines two contexts for immunization: Immunization, Administered; Immunization, Order.

The HL7 CQI Workgroup reviewed and updated this content on April 24, 2018 based on QDM version 5.3. The content was updated on June 7, 2018 consistent with QDM version 5.4. The only change between QDM versions 5.3 and 5.4 is that version 5.4 removes the "supply" attribute from "Immunization, Administered" and retains the "supply" attribute for "Immunization, Order"

FHIR Immunization Recommendation resource is specifically designed to provide an immunization forecast from a forecasting engine to a provider, basically to carry clinical decision support recommendations specific to immunizations and, therefore, is not consistent with the intent of the QDM datatype "Immunization, Order". The most closely associated resource is MedicationRequest. There is no comparable FHIR resource to specify ImmunizationRequest.

Immunization, Administered

QDM Attribute QI Core Metadata Element Comment
Immunization, Administered Immunization (the .status metadata allows conformance to the specific QDM datatype context) QDM matched to QI Core / FHIR
Dosage Immunization.doseQuantity QDM matched to QI Core / FHIR
Negation Rationale Immunization.explanation.reasonNotGiven QDM matched to QI Core / FHIR
Reason Immunization.explanation.reason QDM matched to QI Core / FHIR
Route Immunization.route QDM matched to QI Core / FHIR
Author dateTime Immunization.date QDM matched to QI Core / FHIR

NOTE: See QDM Known Issues for update – Immunization, Administered should include only the dateTime of the immunization administration. Until QDM 5.5 version, implementers should map Immunization, Administered author dateTime to administrationTime. [1]

Code Immunization.vaccineCode QDM matched to QI Core / FHIR
id Immunization.id QDM matched to QI Core / FHIR
Source Immunization.primarySource Source addressed by primarySource or reportOrigin

Immunization, Order

QDM Attribute QI Core Metadata Element Comment
Immunization, 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.
Active dateTime MedicationRequest.dispenseRequest.validityPeriod This indicates the validity period of a prescription (stale dating the Prescription).
Dosage MedicationRequest.dosageInstruction Indicates how the medication is to be used by the patient.
Negation Rationale MedicationStatement.reasonNotTaken Medication Request in QI Core does not reference negation rationale. See FHIR Tracker Item 15941 addressing notDoneReason requirement.
Reason MedicationRequest.reasonCode 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

Note: FHIR Provenance generally addresses the author of the message; the identifier/source of the original resource element is defined by the resource. Individual resource element provenance is summarized in the FHIR W5 Report (http://hl7.org/fhir/w5.html).

Supply MedicationRequest.dispenseRequest.quantity QDM matched to QI Core / FHIR.
Code MedicationRequest.medication QDM matched to QI Core / FHIR
id MedicationRequest.id QDM matched to QI Core / FHIR
Source MedicationRequest.requester QDM matched to FHIR
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