No interest in merging procedure and intervention. 

The QDM User Group discussed the differences between Intervention and Procedure again on the July 18, 2018 call. The attendees agreed there is a distinction between interventions such as education and counseling and procedures such as invasive surgery. The agenda included the item to continue validation of the solution and to indicate that mapping of Intervention may occur for activities that involve the patient (e.g., education) and for tasks that do not directly involve the patient (e.g., checking a box that medication reconciliation is completed). The former (education) would map QDM Intervention, Performed to FHIR Procedure; the latter would map QDM Intervention to FHIR Task.

Peter Muir (ESAC) confirmed the value of the mappings noted. Specifically for medication reconciliation, he noted that reconciliation of medications in the presence of the patient associated with education and counseling about the medications is the ideal and represents a true intervention. Merely checking a box that two medication lists have been reconciled in the absence of the patient (i.e., confirming the existing EHR med is correct because it corresponds to the hospital formulary alternative) represents a task. The value of checking a box notwithstanding, the current approach is reasonable.

The QDM User Group also discussed the potential value of adding an expectedPeriod attribute for the items noted:

• Assessment, Order
• Care Goal (already has target outcome RelevantPeriod
• Device, Order
• Device, Recommended
• Diagnostic Study, Order
• Encounter, Order
• Encounter, Recommended
• Immunization, Order
• Intervention, Order
• Intervention, Recommended
• Laboratory Test, Order
• Laboratory Test, Recommended
• Medication, Dispensed (added to the list originally provided)
• Medication, Order
• Physical Exam, Order
• Physical Exam, Recommended
• Procedure, Order
• Procedure, Recommended
• Substance, Order
• Substance, Recommended

The QDM User Group attendees did not have specific interest in adding the expectedPeriod attribute at this time.

Action:

 ESAC requested the QDM User Group continue to consider whether such an attribute would be helpful in measure expressions. There is no current use case to require such an attribute.

Consider adding expected timeframe for ordered or recommended activity in QDM.

Additional discussion:

Intervention may more appropriately map to HL7 FHIR Task Resource (http://hl7.org/fhir/task.html).

Also, consider adding an Intervention expected timeframe (Task.restriction.period) - when fulfillment is sought

And a ProcedureRequest.occurrencePeriod (when procedure should occur)

For QDM, that might indicate an ExpectedPeriod for 

• Assessment, Order
• Care Goal (already has target outcome RelevantPeriod
• Device, Order
• Device, Recommended
• Diagnostic Study, Order
• Encounter, Order
• Encounter, Recommended
• Immunization, Order
• Intervention, Order
• Intervention, Recommended
• Laboratory Test, Order
• Laboratory Test, Recommended
• Medication, Order
• Physical Exam, Order
• Physical Exam, Recommended
• Procedure, Order
• Procedure, Recommended
• Substance, Order
• Substance, Recommended

For discussion on QDM User Group call.

The MCCB approved the decision to retain the Intervention and Procedure QDM categories and add guidance for measure developers and implementers. The decision was made on May 24, 2018.

The QDM User Group met on May 23, 2018 and confirmed the decision to retain both the QDM categories 'Intervention' and 'Procedure' and not to merge the two categories. The justification is that there is a clinical distinction even though the boundary between intervention and procedure may not always be clear.  The User Group agreed that retaining the two categories enhances the understanding of the human readable eCQM for clinicians. Based on the decision, some guidance will be added to QDM 5.4.

The Jira options are to accept or reject the recommendations. The QDM User Group basically rejected merging the two QDM categories on April 18, 2018. However, the "reject" option closes the issue. Therefore, to keep the ticket open for potential additional discussion, I will leave the ticket unresolved until the next meeting (May 23, 2018).

The QDM User Group met on April 18, 2018 and considered the option of merging the QDM datatype Intervention with the QDM datatype Procedure. The User Group prefers maintaining the differentiation between Intervention and Procedure with the distinction:

• An Intervention is a course of action intended to achieve a result in the care of persons with health problems the does not involve direct physical contact with the patient (e.g., patient education, therapeutic communication, etc.).
• A procedure is a type of physical manipulation of a person's body in whole or in part for purposes of making observations and diagnosis or providing treatment.

The consolidated clinical document architecture (c-CDA) templates used in the CQL-based HQMF volume 3 and any potential use of HL7 FHIR Resources all use the same constructs to represent interventions and procedures. However, considerations for measure developers and clinicians evaluating the human readable eCQMs and implementers can better understand the measure intent by retaining the two QDM categories, Intervention and Procedure.
The QDM User Group concluded some wordsmithing of the existing Intervention and Procedure guidance may be helpful, but the User Group recommended no change in the QDM structure for the two categories.

Lisa, Thank you for the response. The definitions posted come from the QDM version 5.3 (and earlier versions) to try to differentiate between intervention and procedure. The issue has been considered in a number of HL7 venues. I checked the HL7 FHIR STU 3 (currently published version which is similar to the current ballot STU 4 version). Intervention is not considered in FHIR and the descriptions currently used in eCQMs seem to be covered by the Procedure Resource. Note there is also a clear distinction between Procedure and Communication which requires consideration in the QDM User Group (note - bolding and formatting is mine for emphasis):
http://hl7.org/fhir/procedure.html
9.3.2 Boundaries and Relationships 
The Procedure resource should not be used to capture an event if a more specific resource already exists - i.e. immunizations, drug administrations and communications. The boundary between determining whether an action is a Procedure (training or counseling) as opposed to a Communication is based on whether there's a specific intent to change the mind-set of the patient. Mere disclosure of information would be considered a Communication. A process that involves verification of the patient's comprehension or to change the patient's mental state would be a Procedure.
Note that many diagnostic processes are procedures that generate Observations and DiagnosticReports. In many cases, such an observation does not require an explicit representation of the procedure used to create the observation, but where there are details of interest about how the diagnostic procedure was performed, the procedure resource is used to describe the activity.
Some diagnostic procedures may not have a Procedure record. The Procedure record is only necessary when there is a need to capture information about the physical intervention that was performed to capture the diagnostic information (e.g. anesthetic, incision, scope size, etc.)
This resource is referenced by AdverseEvent, Appointment, ChargeIt

Communication is one of the event resources in the FHIR workflow specification. (http://hl7.org/fhir/communication.html)
This resource is a record of a communication. A communication is a conveyance of information from one entity, a sender, to another entity, a receiver. The sender and receivers may be patients, practitioners, related persons, organizations, or devices. Communication use cases include:
A reminder or alert delivered to a responsible provider
A recorded notification from the nurse that a patient's temperature exceeds a value
A notification to a public health agency of a patient presenting with a communicable disease reportable to the public health agency
Patient educational material sent by a provider to a patient
Non-patient specific communication use cases may include:
A nurse call from a hall bathroom
Advisory for battery service from a pump
em, Claim, ClinicalImpression, Encounter, ExplanationOfBenefit, Flag, ImagingStudy, Medic.ationAdministration, MedicationDispense, MedicationStatement and QuestionnaireResponse

This resource is a record of a communication that has occurred. It does not represent the actual flow of communication. While AuditEvent can track electronic disclosures of information, it cannot track conversations, phone calls, letters and other interactions that are not system-to-system. And even for system-to-system communications, the specific end recipients may not be known. As well, AuditEvents are not considered to be "part" of the patient record, while Communication instances are. The Communication resource is not used as a general audit mechanism to track every disclosure of every record. Rather, it is used when a clinician or other user wants to ensure a record of a particular communication is itself maintained as part of the reviewable health record.
Flag resources represent a continuous ongoing "communication" alerting anyone dealing with the patient of certain precautions to take or issues to be aware of. The flags are continuously present as an ongoing reminder. This is distinct from Communication where there is a specific intended sender and receiver and the information is delivered only once.
Communication and Encounter
The Communication is about the transfer of information (which may or may not occur as part of an encounter), while Encounter is about the coming together (in person or virtually) of a Patient with a Practitioner. Communication does not deal with the duration of a call, it represents the fact that information was transferred at a particular point in time.
The phone calls involving the Patient should be handled using Encounter. Phone calls not involving the patient (e.g. between practitioners or practitioner to relative) that are tracked for billing or other purposes can use Communication to represent the information transferred, but are not ideal to represent the call itself. A better mechanism for handling such calls will be explored in a future release.

Hi Floyd- TJC currently uses Intervention, Performed to represent comfort measures in many of the EH measures, as well as to represent education, like Tobacco Use Cessation Counseling. I understand what you are saying in that the attributes align between what we currently have in Intervention and Procedure datatypes. However, I do want to make sure that if we agree to go forward with Procedure, that it does include things like what is mentioned above.

When I read the definition of Procedure at HL7, I think what is throwing me is this:
Discussion: Applied to clinical medicine, procedure is but one among several types of clinical activities such as observation, substance-administrations, and communicative interactions (e.g. teaching, advice, psychotherapy, represented simply as Acts without special attributes). Procedure does not subsume those other activities nor is procedure subsumed by them. Notably Procedure does not comprise all acts of whose intent is intervention or treatment. Whether the bodily alteration is appreciated or intended as beneficial to the subject is likewise irrelevant, what counts is that the act is essentially an alteration of the physical condition of the subject.

In this definition, it makes me think that there must be an alteration of the physical condition, which doesn't really make sense for providing a patient education.