[QDM-172] Radiation dose and duration attribute modeling Created: 01/24/17  Updated: 12/22/20  Resolved: 10/19/17

Status: Resolved
Project: QDM Issue Tracker
Component/s: Data Model
Fix Version/s: QDM v5.x

Type: Defect Priority: Moderate
Reporter: Floyd Eisenberg (Inactive) Assignee: Floyd Eisenberg (Inactive)
Resolution: Fixed Votes: 0
Labels: Attributes

QDM Data Types:
Diagnostic Study, Order, Diagnostic Study, Performed, Diagnostic Study, Recommended, Procedure, Order, Procedure, Performed, Procedure, Recommended
Impact: Inconsistent with clinical workflow and standard data models

 Description   

QDM contains attributes of radiation dose and radiation duration in Diagnostic Study, Performed, Diagnostic Study, Recommended, Diagnostic Study, Order, Procedure Performed, Procedure, Order, and Procedure Recommended.

In modeling HL7 concepts in QI Core, these attributes made it into the model. The Imaging Workgroup has requested reconsideration in HL7 and, after looking at the modeling, I think QDM needs some reconsideration as well. The attributes came from an attempt to model radiation dosage and duration in a EP measure when in 2012. At that time the concepts of radiation dose and duration were modeled as attributes. Following is a list of concerns:
(1) The dose and duration are not parts of a recommended or ordered study; it is only something measured when an imaging study is performed. Therefore, if the attributes remain, they should probably be retained only for Diagnostic Study, Performed and Procedure, Performed.
(2) Integrating the Healthcare Enterprise (IHE) profiled “Radiation Exposure Monitoring” in 2015 -
Reference: http://wiki.ihe.net/index.php/Radiation_Exposure_Monitoring. The profile includes a report to a national registry. It seems the information desired might be better expressed as components of a report to the registry (a structured form), thus, an “Assessment, Performed,” and not attributes of “Procedure, Performed” or “Diagnostic Study, Performed.” The profile addresses routine Xray, CT scans, Fluoroscopy, Angiography, Mammography, CR (don’t know what the acronym means), DR (don’t know what the acronym means). It does not address PET or SPECT imaging or radiotherapy or implanted seeds, but I think it is consistent with the original intent of the EP measure that drove the QDM decision.

Consider removing Radiation Dose and Radiation Duration as attributes in QDM and address the issues as components of "Assessment, Performed" based on an assessment of imaging performance.

 Comments   
Comment by Floyd Eisenberg (Inactive) [ 04/20/17 ]

Remove Radiation Dose and Radiation Duration as attributes in QDM based on March 15, 2017 UG discussion.

Comment by Floyd Eisenberg (Inactive) [ 04/20/17 ]

On the March 15 2017 QDM User Group meeting, the UG discussed an update to this issue. No existing MAT measures or CMS program measures use these attributes currently. ESAC reviewed with the issue with the authors of the IHE Radiation Exposure Monitoring Profile (http://wiki.ihe.net/index.php/Radiation_Exposure_Monitoring). IHE is an acronym for Integrating the Healthcare Enterprise. The IHE profile was intended to capture data to support analysis and registry reporting to determine the amount of radiation exposure for each imaging procedure. The science is not yet sufficient to determine if individual imaging procedure thresholds can be set. The profile enables local analysis and registry reporting but application of radiation dose to individual patient care is not clear. The science is also in development to determine the value and use of individual cumulative radiation dose from imaging procedures. Calculation of radiation dose and duration is more complex than can be expressed with attributes of Diagnostic Study, Performed. The information required is specified by DICOM and is included in a report sent by the imaging modality. The content is generally not sent to the patient’s record except where required by law. E.g., California requires imaging reports to include radiation exposure with patient imaging reports although receiving providers have no guidance about how to use the information.
With respect to QDM, once the science is available and a standard report is expressed (likely in LOINC), the QDM datatypes Procedure, Performed or Diagnostic Study, Performed will allow expression of these data elements without a specific attribute. The information would be expressed as components of the report.
Action: Remove Radiation Dose and Radiation Duration from QDM as attributes with the next version of QDM. When the science is available use Procedure, Performed or Diagnostic Study, Performed report components to address the issue in eCQMs.

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