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

7.22.0 Symptom

QDM defines "symptom" as an indication that a person has a condition or disease. Some examples include headache, fever, fatigue, nausea, vomiting, and pain. Also, symptoms are subjective manifestations of the disease perceived by the patient. As an example to differentiate symptom from finding, the patient’s subjective symptom of fever is distinguished from the temperature (a finding). For a finding, there is either a source of either a temperature-measuring device together with a recorder of the device (electronically) or an individual (healthcare provider, patient, etc.).

Note: Definitions regarding symptom on the FHIR condition resource Boundaries and Relationships (Section 9.2.2: http://hl7.org/fhir/condition.html):

  • [The Condition] resource is not typically used to record information about subjective and objective information that might lead to the recording of a Condition resource. Such signs and symptoms are typically captured using the Observation resource; although in some cases a persistent symptom, e.g. fever, headache may be captured as a condition before a definitive diagnosis can be discerned by a clinician. By contrast, headache may be captured as an Observation when it contributes to the establishment of a meningitis Condition.
  • Use the Observation resource when a symptom is resolved without long term management, tracking, or when a symptom contributes to the establishment of a condition.
  • Use Condition when a symptom requires long term management, tracking, or is used as a proxy for a diagnosis or problem that is not yet determined.

Based on the FHIR referenced provided above, the QDM datatype Symptom maps to the FHIR Observation resource.

QDM Context QI-Core R4 Comments
Symptom Observation
Observation.status restrict to preliminary, final, amended, corrected
Observation.category add symptom concept
QDM Attributes
Code Observation.value[x] Use CodeableConcept
id Observation.id
severity Observation.interpretation Definition suggests high, low, normal - perhaps consider severe, moderate, mild.
prevalence period Ovservation.effective[x] dateTime, period, timing, instant
recorder Observation.performer