In looking at QDM datatypes, such as “Procedure,” can you clarify the intent of “Recommended” versus “Ordered” or “Performed”?

Nine QDM datatypes include the action “Recommended” which represents the clinician's proposal to the patient about a specific treatment or action. The meaning is implicit. Electronic health records vary with respect to how they might represent recommendations. However, Health Level Seven International® (HL7®) Fast Healthcare Interoperability Resources® (FHIR®) provides a method to indicate intent in data exchange. An intent = plan represents a recommendation and an intent = order represents an order. Thus, QDM attributes are consistent with evolving HL7 standards for data exchange. “Recommended” does not address a suggested action based on clinical decision support (CDS), represented in HL7 FHIR as intent = proposal. The QDM action “Performed” indicates completion of an action. The comparable concept in HL7 FHIR includes the resource (e.g., Procedure) plus a status = completed.