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
QDM defines Substance as a homogeneous material with definite composition that includes allergens, biological materials, chemicals, foods, drugs and materials. QDM distinguishes between medications from non-medication substances by separately listing medication datatypes. Substance may or may not have a code or be classified by a code system such RxNorm. Examples of a substance may include environmental agents (e.g., pollen, dust) and food (e.g., vitamins). Where a substance can be addressed using medication terminology (e.g. egg albumin) used the Medication mappings listed in this QDM-to-QI-Core section.
FHIR defines substance as a homogeneous material with a definite composition. Medications are classified as substances. However, to reference other substances, especially using the SubstanceDefinition resource is challenging since the resource is still undergoing development.
Ideally, use of a substance-related resource should be driven by use cases and examples. Two such use cases currently exist in the quality measure community::
To provide some context and guidance, this QDM-to-QI-Core mapping includes reference to the QDM datatypes Substance, Order and Substance, Recommended using the NutritionOrder resource. As noted in the second example provided, the resource is relatively new and it allows expressions to address only the type of diet ordered, not the foods or substances administered to a patient.
The CQI Workgroup seeks comment and advice regarding the best method for addressing existing and new use cases regarding substance administration.
|QDM Context||FHIR R4||Comments|
|Substance, Order/Recommended - For Diet Orders||NutritionOrder||Limited to orders for diets or diets with supplements|
|Substance Order/Recommended Activity||NutritionOrder.status||Constrain to Active, on-hold, Completed|
|Substance, Order||NutritionOrder.intent||Constrain to "plan"|
|Substance, Recommended||NutritionOrder.intent||Constrain to "order" and child concepts|
|code (to represent a diet order)||NutritionOrder.oralDiet.type|
|code (to represent a diet order)||NutritionOrder.enteralFormula.baseFormulaType|
|Additive to diet order||NutritionOrder.enteralFormula.additiveType|