QI-Core Implementation Guide: STU 4 (v4.0.0 for FHIR 4.0.0)

QI-Core Implementation Guide, Clinical Quality Improvement WG - CI build for vesion 4.0.0). This version is based on the current content of https://github.com/cqframework/qi-core/ and changes regularly. See the Directory of published versions

7.6.0 Communication

QDM defines Communication as the transmission, receipt, or acknowledgement of information sent from a source to a recipient, such as from one clinician to another regarding findings, assessments, plans of care, consultative advice, instructions, educational resources, etc. The following text from the FHIR Communication and Procedure Resources may help to differentiate when to use Communication.

FHIR Communication Resource

This resource is a record of a communication. A communication is a conveyance of information from one entity, a sender, to another entity, a receiver. The sender and receivers may be patients, practitioners, related persons, organizations, or devices. Communication use cases include:

  • A reminder or alert delivered to a responsible provider
  • A recorded notification from the nurse to the on-call physician (or any other specified person) that a patient's temperature exceeds a value
  • A notification to a public health agency of a patient presenting with a communicable disease reportable to the public health agency
  • Patient educational material sent by a provider to a patient
  • Unable to deliver lab results to ordering physician

Non-patient specific communication use cases may include:

  • A nurse call from a hall bathroom
  • Advisory for battery service from a pump

Boundaries and Relationships (Section 8.20.2) - Communication and Encounter

  • The Communication is about the transfer of information (which might or might not occur as part of an encounter), while Encounter is about the coming together (in person or virtually) of a Patient with a Practitioner. Communication does not deal with the duration of a call, it represents the fact that information was transferred at a particular point in time.
  • The phone calls involving the Patient should be handled using Encounter. Phone calls not involving the patient (e.g. between practitioners or practitioner to relative) that are tracked for billing or other purposes can use Communication to represent the information transferred but are not ideal to represent the call itself. A better mechanism for handling such calls will be explored in a future release.

HL7 FHIR Procedure Resource

The boundary between determining whether an action is a Procedure (training or counseling) as opposed to a Communication is based on whether there's a specific intent to change the mind-set of the patient. Mere disclosure of information would be considered a Communication. A process that involves verification of the patient's comprehension or to change the patient's mental state would be a Procedure.

7.6.1 Communication

QDM Context QI-Core R4 Comments
Communication, Performed Communication
Communication.status consider constraining to in-progress, completed, on-hold
QDM Attributes
Code Communicatoin.reasonCode
id Communication.id
category Communication.category alert, notification, reminder, instruction
medium Communciation.medium
sent dateTime Communication.sent
received dateTime Communicaton.received
author dateTime N/A No timing exists in FHIR to address timing of negation (i.e., Communication.status = not-done
relatedTo Communication.basedOn An order, proposal or plan fulfilled in whole or in part by this Communication.
Communication.inResponseTo Response to a communication
sender Communicatoin.sender
recipient Communication.recipient
negation rationale Communication.status Constrain status to "not-done"