Data Exchange For Quality Measures STU3 for FHIR R4
2.1.0 - Ballot

This page is part of the Da Vinci Data Exchange for Quality Measures (DEQM) FHIR IG (v2.1.0: STU 3) based on FHIR R4. The current version which supercedes this version is 3.1.0. For a full list of available versions, see the Directory of published versions

OperationDefinition: Care Gaps Operation

ONLY the new content for Gaps in Care is in the scope for ballot for the September, 2020 Ballot Cycle.

This is the new $care-gaps operation. The intent is to replace the existing $care-gaps operation in the Clinical Reasoning module with this new $care-gaps operation when FHIR R4 moves to the next version.

We seek comments on the use of practitioner and organization parameters. The assumption is that patients would have been attributed properly to practitioner and/or organization when these parameters are used. Such attribution varies greatly and is not defined in this guide.

Conformance Requirement 1:
A $care-gaps operation SHALL provide at least periodStart, periodEnd, and subject|practitioner|organization, which could be one of the following:

  • A $care-gaps operation SHALL provide periodStart, periodEnd, and a subject; OR
  • A $care-gaps operation SHALL provide periodStart, periodEnd, and an organization; OR
  • A $care-gaps operation SHALL provide periodStart, periodEnd, and a practitioner and an organization

CareGaps

OPERATION: CareGaps

The official URL for this operation definition is: 

http://hl7.org/fhir/us/davinci-deqm/OperationDefinition/care-gaps

The care-gaps operation is used to determine gaps in care for a specified gaps through period based on the results of quality measures.

URL: [base]/Measure/$care-gaps

Parameters

UseNameCardinalityTypeBindingDocumentation
INperiodStart1..1date

The start of a gaps through period. This maybe the start of the measurement period defined by a measure, or a customized desired performance period start date determined by a payer, a provider, a measure program, and etc.

INperiodEnd1..1date

The end of a gaps through period (the gaps through date). The gaps through date could be a past date or a future date. For example, today's date is 2020-06-18, 1) if periodEnd date is 2020-09-30, it returns gaps through 2020-09-30, and 2) if the periodEnd date is 2020-05-31, it returns gaps through 2020-05-31.

INtopic0..*stringhttp://hl7.org/fhir/ValueSet/definition-topic (Example)

The category of the measures that is of interest for the care gaps report. This references the topic element in the Measure Resource. Examples of topic may be screening measures, HEDIS measure domains, chronic disease measures. For example, setting topic to be a screening caregory will run care gaps on all screening measures. Topic may also be a "value set" that is defined with a list of domains/categories, etc. Topic examples: "screening", "pediatric". When multiple topics are provided, it is expected to be union of measures in those topics.

INsubject0..1string
(reference)

Subject will be a reference to either Patient QI Core Patient or Group DEQM Gaps In Care Group Profile. Must provide either Patient/123 or Group/123, cannot simply provide 123. If only provide 123, then the operation would not know if it is a Patient reference or a Group reference.

INpractitioner0..1string

Reference to a practitioner DEQM Practitioner for which the gaps in care report will be created. For a practitioner focused gaps in care report, this is a required In Parameter. The Server needs to make sure that practitioner is authorized to get the gaps in care report for and know what measures the practitioner are eligible or qualified.

INorganization0..1string

Reference to an organization DEQM Organization for which the gaps in care report will be created. For a provider organization focused gaps in care report, this is a required In Parameter.

INstatus0..1codehttp://hl7.org/fhir/us/davinci-deqm/ValueSet/gaps-status (Required)

Indicates status of a care gap. Status can be either open gap or closed gap. If no status is provided, the default is all gaps including both open and closed gaps. For a positive proportion measure, gap means the patient is not in the numerator. For an inverse (negative) proportion measure (e.g., Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)), gap means the patient is in the numerator.

INmeasure0..*string

The measure(s) for which the gaps in care will be reported. E.g., Breast Cancer Screening measure, Colorectal Cancer Screening measure

INprogram0..*string

The programs that a provider (either practitioner or provider organization) participates in, e.g., risk based, value based, or other performance program such as CMS Merit-based Incentive Payment Program (MIPS), Hospital Quality Reporting (HQR) programs. Program is represented in Measure using element useContext (useageContext). When the code attribute of useContext is program, then the value attribute of useContext represents a specific program.

OUTreturn0..*Bundle

The result of the care-gaps operation will be returned as a document bundle using the DEQM Gaps In Care Bundle Profile.

The effect of invoking this operation is to calculate a measure or a set of measures based on the In Parameters provided and return a document bundle describing the gaps in care results of each measure for the specified gaps through period for the given subject (a patient or a group of patients). Note that it is up to the Server to determine whether or not the generated gaps in care report is persisted. If the Server does not persist the results, the operation does not affect state and can be invoked with a GET. Note that this operation is intended to replace the existing Measure $care-gaps operation.