QI-Core Implementation Guide: STU 3.2 (v3.2.0 for FHIR 3.0.1)

This page is part of the Quality Improvement Core Framework (v3.2.0: STU 3) based on FHIR R3. The current version which supercedes this version is 4.1.1. For a full list of available versions, see the Directory of published versions

7.14.0 Intervention

The CQI Workgroup reviewed this page in April 2018 consistent with QDM version 5.3. There are no updates to the content required based on QDM version 5.4 (reviewed June 7, 2018); however, on June 15, 2018, the CQI Workgroup reviewed the QDM FHIR mappings for Intervention and determined there is some ambiguity requiring implementer comment.

  • Note that while the QDM categories Intervention and Procedure have been modeled identically in previous versions of QI Core, the FHIR Task Resource provides a potentially more effective way to differentiate Interventions from Procedures. Both are retained in the QDM as they are more clinically expressive for clinicians to understand the measure intent.
  • The QDM to FHIR mapping provided here show mapping to both Procedure/ProcedureRequest and to Task.
  • The FHIR resource definitions for Procedure and Task seem to have significant overlap - see FHIR Tracker item 17359
  • Both mappings (i.e., Intervention mapped to Procedure/ProcedureRequest and to Task) are shown here. Comments are welcome regarding the most appropriate use.

QDM defines Intervention as a course of action intended to achieve a result in the care of persons with health problems that does not involve direct physical contact with a patient. Examples include patient education and therapeutic communication. QDM defines three contexts for intervention: Intervention, Order; Intervention, Performed; Intervention, Recommended.

7.14.1 Intervention, Order [Using ProcedureRequest]

QDM Attribute QI Core Metadata Element Comment
Intervention, 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 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).
Code ProcedureRequest.code QDM matched to QI Core / FHIR
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

7.14.2 Intervention, Recommended [Using ProcedureRequest]

QDM Attribute QI Core Metadata Element Comment
Intervention, 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 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).
Code ProcedureRequest.code QDM matched to QI Core / FHIR
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

7.14.3 Intervention, Performed [Using Procedure]

QDM Attribute QI Core Metadata Element Comment
Intervention, 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
Author dateTime FHIR.provenance.recorded FHIR references authorDatetime as part of the provenance resource for all resources. 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). Hence, the QDM Procedure author dateTime references FHIR provenance.
Status Procedure.status QDM matched to QI Core / FHIR Note: Procedure.status allows specification of completed but it does not assure the procedure was completed successfully. The FHIR resource Proecedure.outcome does also specification of successful completion, but that element may be ambiguous. The Patient Care Workgroup is evaluating options to more clearly represent a procedure that successfully achieved its objective (objective is not currently available as a metadata element). Moreover, clinical care capture of success with respect to procedure completion is highly variable. See the QDM Known Issues for a description of the issue and a link to the ONC Jira QDM Issues page to join the discussion for QDM [1].
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

7.14.4 Intervention, Order [Using Task]

QDM Attribute QI Core Metadata Element Comment
Intervention, Order Task.intent Task 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 Task.statusReason QDM matched to QI Core/FHIR - Constrained to instances in which Task.status = rejected, cancelled, or failed Task status value set (required)
Reason Task.reason QDM matched to QI Core / FHIR
Author dateTime Task.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).
Code Task.code QDM matched to QI Core / FHIR
id Task.id QDM matched to QI Core / FHIR
Source Task.requester Task also provides the opportunity to request Task.owner (the person responsible for the task) and task.performerType

7.14.5 Intervention, Recommended [Using Task]

QDM Attribute QI Core Metadata Element Comment
Intervention, Order Task.intent Task intent uses the concepts proposal, plan, order, original-order, reflex-order, filler-order, instance-order, option. Constrain to "plan" from the intent value set for QDM datatypes with the recommended context.
Negation Rationale | row2cell2 | Task.statusReason QDM matched to QI Core/FHIR - Constrained to instances in which Task.status = rejected, cancelled, or failed Task status value set (required)
Reason Task.reason QDM matched to QI Core / FHIR
Author dateTime Task.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).
Code Task.code QDM matched to QI Core / FHIR
id Task.id QDM matched to QI Core / FHIR
Source Task.requester Task also provides the opportunity to request Task.owner (the person responsible for the task) and task.performerType

7.14.6 Intervention, Performed [Using Task]

QDM Attribute QI Core Metadata Element Comment
Intervention, Performed Task (the .status metadata allows conformance to the specific QDM datatype context) QDM matched to QI Core / FHIR
Relevant Period Task.executionPeriod QDM matched to QI Core / FHIR
Negation Rationale Task.statusReason QDM matched to QI Core/FHIR - Constrained to instances in which Task.status = rejected, cancelled, or failed Task status value set (required)
Reason Task.reason QDM matched to QI Core / FHIR
Result Task.output.value[x] QDM matched to QI Core / FHIR
Author dateTime Task.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).
Status Task.status QDM matched to QI Core / FHIR
Code Task.code QDM matched to QI Core / FHIR
id Task.id QDM matched to QI Core / FHIR
Source Task.requester Task also provides the opportunity to request Task.owner (the person responsible for the task) and task.performerType