Substance

Substance represents a homogeneous material with definite composition that includes allergens, biological materials, chemicals, foods, drugs, and materials. QDM distinguishes between medications from non-medication substances by separately listing medication datatypes. Substance may or may not have a code or be classified by a code system such RxNorm. Examples of a substance may include environmental agents (e.g., pollen, dust) and food (e.g., vitamins).

Measure developers have considered the use of the QDM substance category in light of alignment with existing interoperability data standards. Two use cases require further investigation and effort in the HL7 FHIR realm:

Nutrition [Considerations for Future Use]
The nutrition mappings from QDM to FHIR resources require continued effort as of the printing of this QDM 5.5 version. The FHIR NutritionOrder Resource is a record of the request for the supply of a diet, oral supplement or enteral formulas for a patient, and thus allow specification of a complete diet order, but not an order for an individual nutrient. The NutritionOrder resource is currently at a low maturity level (i.e., it has had limited testing). Therefore, for the current QDM 5.5 reference, substance is modeled similarly to medications.

Blood Products [Considerations for Future Use]
The HL7 FHIR version 4.0 resource for blood products allow specification of the blood product as a biologically derived product, but specification for how such products are administered remains in development. Therefore, for the current QDM 5.5 reference, blood product administration can be managed using QDM datatypes “Procedure, Performed” or “Substance, Administered” based on measure developer findings during measure implementation testing.