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

7.13.0 Individual Characteristic

QDM's approach to defining information about participants In the healthcare process by defining Individual Characteristics. These properties of a patient, clinician, provider, or facility include demographics, behavioral factors, social or cultural factors, available resources, and preferences. Behaviors reference responses or actions that affect (either positively or negatively) health or healthcare. Included in this category are mental health issues, adherence issues unrelated to other factors or resources, coping ability, grief issues, and substance use/abuse. Social/cultural factors are characteristics of an individual related to family/caregiver support, education, and literacy (including health literacy), primary language, cultural beliefs (including health beliefs), persistent life stressors, spiritual and religious beliefs, immigration status, and history of abuse or neglect. Resources are means available to a patient to meet health and healthcare needs, which might include caregiver support, insurance coverage, financial resources, and community resources to which the patient is already connected and from which the patient is receiving benefit. Preferences are choices made by patients and their caregivers relative to options for care or treatment (including scheduling, care experience, and meeting of personal health goals) and the sharing and disclosure of their health information.

FHIR more effectively represents these concepts in the Level 3 Administration Module – base data that is linked into other modules for clinical content, finance/billing, workflow, etc. T he Administration Module specifies information about the patient, related person, practitioner and organization that is the basis of healthcare-related interactions such as encounters. QDM version 5.5 adopted a similar approach to such information by adding a new concept called Entities. Entities  represent concepts that can be used to specify details about an actor (or performer) participant in any activity represented by a QDM datatype. These entities are analogous to the FHIR resources Patient, RelatedPerson, Practitioner, and Organization, respectively called Patient, CarePartner, Practitioner and Organization in QDM. The mapping tables show these direct relationships to FHIR resources. However, to maintain backward compatibility with prior QDM versions, QDM 5.5 retains the concept of Patient Characteristics for some metadata about a patient; most of these characteristics map directly to metadata elements in the FHIR Patient resource. QDM 5.5 removed the Provider Characteristics QDM datatype in favor of the Practitioner and Organization entities since there had been little, if any, use of these QDM elements.

Accommodating patient-related metadata requires QI-Core extensions for several elements including:

  • Clinical Trial – Patients may be excluded from some quality measures or clinical decision support (CDS) workflows if they are participating in clinical trials. It is often necessary to determine the nature of the trial as exclusions may only apply if the clinical trial addresses the same clinical condition as the measure or CDS artifact, or if treatments potentially used in the clinical trial or the measure or CDS intervention conflict.
  • QI-Core also includes extensions to reference a patient military service, nationality or if the patient is a cadaveric donor (i.e., has agreed to be an organ donor). None of these elements is included as metadata elements in FHIR or US-Core. While they might be referenced as observations about a patient, QI-Core includes them as specific patient metadata.

QDM 5.5 also added a new QDM datatype Related Person to allow reference to an individual who has a personal or non-healthcare-specific professional relationship with a patient. Modeled the same as the CarePartner entity, the Related Person is an individual from whose record clinical information should be retrieved to support care provided to the index patient. 

  • Example 1: An infant's gestational age at the time of birth may be calculated as the difference between the days between the mother's estimated date of delivery (EDD) and the actual birth date. The mother's EDD might be entered directly on the infant's record as an observable entity about a Related Person (the infant's mother). Alternatively, a cross-context query might request the information from the Related Person's (mother's) record.
  • Example 2: An organ recipient risk factor may include a donor's positive Hepatitis C antibody result. The result relates to the donor (Related Person) whether that result is present on the recipient's record or if the a cross-context query to the donor's record retrieves the information.

7.13.1 QDM Entities

QDM Entities & Attributes QI-Core R4 Comments
Patient Patient
identifier Patient.identifier
id Patient.id
Care Partner RelatedPerson Related Person
identifier RelatedPerson.identifier
id RelatedPerson.id
Relationship RelatedPerson.relationship
Practitioner Practitioner
identifier Practitioner.identifierValue
id Practitioner id
role Practitioner role
speciality Practitioner specialty
qualification Practitioner.qualificationIdentifier
Organization Organization
identifier Organization.identifier.value
id Organization.id
type Organization.type

7.13.2 Patient Characteristics

QDM Attribute USCore R4 Comments
Race
code Patient.race
code Patient.ExtensionRace-DetailedRace
id
Ethnicity
code Patient.ethnicity
code Patient.ExtensionEthnicity-Detailed
id
Sex
code Patient.birthsex
code Patient.administrativeGender
id
Birth date
Birth dateTime Patient.birthdate
code Birth date Fixed Code 21112-8
id
Clinical Trial Participant
Patient.extension.clinicalTrial
Patient.extension.clinicalTrial.id
Code Patient.extension:clinicalTrial.url
Relevant Period Patient.extension.clinicalTrial.period.valuePeriod
Reason Patient.extension.clinicalTrial.reason.url
Patient.extension.clinicalTrial.reason.valueCodeableConcept
Expired
code Patient.Deceased[x]
id
cause Expiration cause requires use of Observation
expiration dateTime Expiration dateTime requires use of Observation
Payer
Payor Coverage
code Coverage.payor QICore currently maps to policy holder which actually references the person who owns the policy, not the payor.
Relevant Period Coverage.period
id Coverage.id
Patient Characteristic (generic)
N/A Requires definition for modeling a characteristic to QI-Core and FHIR

7.13.3 QDM new datatype (QDM v5.5) - Related Person

QDM Attribute QI-Core R4 Comments
Related Person RelatedPerson
RelatedPerson.Identifier RelatedPerson.identifier
id RelatedPerson.id
RelatedPerson.linkedPatientId RelatedPerson.linkedPatientid
Code RelatedPerson.relationship