The QDM currently represents diagnosis state by having the diagnosis change datatypes as it progresses through state:

• Diagnosis, Active
• Diagnosis, Inactive
• Diagnosis, Resolved

QDM-37 identifies this as an issue and further details the problems it causes.

Other Health IT standards do not represent state in the same way.

For example, FHIR's Condition uses onset and abatement datetimes/ages to determine the Condition's state. C-CDA R2's Problem Observation uses the components of the effectiveTime to determine the state (an absent effectiveTime.high means active).

Furthermore, neither FHIR nor C-CDA appear to support a distinct notion of the Inactive state. In fact, the FHIR description for abatement states:

There is no explicit distinction between resolution and remission because in many cases the distinction is not clear.

The QDM user group should determine how to represent the state of the diagnosis. The following are possibilities:

• Keep the current representation as is (different datatypes for each state)
• Use the datetime attributes to determine state (similar to other models)
• Use an attribute to determine state (but the attribute only makes sense in the context of time)

The QDM user group should also determine if the inactive state is necessary, and if so, how it can be defined in an explicit way.

UG Accepted Solution

Consolidate active, inactive, and resolved datatypes into one Diagnosis datatype. The status is determined by the absence or presence of the "abatement datetime" value:

• abatement datetime is absent: the diagnosis is active
• abatement datetime is present: the diagnosis is inactive/resolved

Note that the separate concept of "inactive" is no longer applicable.