Data Exchange For Quality Measures STU3 for FHIR R4
2.1.0 - Ballot
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 
ONLY the new content for Gaps in Care is in the scope for ballot for the September, 2020 Ballot Cycle.
A gap in care is defined as a discrepancy between recommended best practices and the services that are actually provided and documented. Gaps in care can adversely affect member outcomes and contribute to inappropriate costs. Identifying, anticipating, and communicating gaps in care to provider practices, at the point of care, is critical for providing opportunities to improve quality of care and reduce cost of care. To succeed in the population health and value-based care, gaps in care must be addressed efficiently and in a timely manner.
For providers and payers to improve population health and value-based care, the following two items must be addressed: gaps in care information and incomplete healthcare information.
Research has shown that care gaps can be both harmful and costly when they are not properly managed. For example, not managing specific aspects of chronic diseases (e.g., hemoglobin A1C and diabetes) can lead to serious complications and escalate healthcare costs. Resolving the gaps in care is important to payers, providers, and the patients they serve. Performing gaps in care can positively influence patient health and improve quality scores and reimbursement under risk-sharing arrangements such as Medicare.
Gaps in care may be caused by several potential reasons. The most straight forward reason is that the care needed has not yet been provided for the patient. While providers cannot always control closing the gaps, most scenarios can be easily remedied with an office visit, lab order, prescription or other clinical care practices.
An organization or tool that collects the data, may have updated information on the patient care in which the provider may not be aware of. For example, a payer might have paid a claim for a self-ordered mammogram and the provider may not be aware that test was completed. Using the Gaps in Care Reporting, it allows the payer to share that information with the provider managing the patient’s care and provides an opportunity to help address incomplete healthcare information. Alternatively, a provider may have data that the payer may not know about at the time a report was run.
In Figure 2-12, the cloud represents the Gaps in Care Reporting portion of the Quality Improvement Ecosystem. The scenario is between a clinician and a measurement organization, such as a payer, or quality measurement/ population health tool. Note that a measurement organization might also make the request within their own system.
The Gaps in Care Reporting is built on the Individual Reporting, where a new DEQM Gaps In Care Individual MeasureReport Profile is created based on the DEQM Individual MeasureReport Profile by adding extensions to support Gaps in Care Reporting specific requirements. This allows the Gaps in Care Reporting to use the same machinery as the Individual Reporting to calculate measures and represent the results of individual calculation.
The following resources are used in the Gaps in Care Reporting scenario:
| Resource Type | Profile Name | Link to Profile |
|---|---|---|
| Bundle | DEQM Gaps In Care Bundle Profile | DEQM Gaps In Care Bundle Profile |
| Composition | DEQM Gaps In Care Composition Profile | DEQM Gaps In Care Composition Profile |
| DetectedIssue | DEQM Gaps In Care DetectedIssue Profile | DEQM Gaps In Care DetectedIssue Profile |
| Group | DEQM Gaps In Care Group Profile | DEQM Gaps In Care Group Profile |
| MeasureReport | DEQM Gaps In Care Individual MeasureReport Profile | DEQM Gaps In Care Individual MeasureReport Profile |
Figure 2-12 provides a graphical view of how these resources are related.
Gaps through period is the time period defined by a Client for running the gaps in care report. When the gaps through period ends on a date that is in the future, the Gaps in Care Reporting is said to look for care gaps prospectively. In this scenario, it provides providers with opportunities to assess anticipated open gaps and take proper actions to close the gaps. When the gaps through period ends on a date that is in the past, the Gaps in Care Reporting is said to look for care gaps retrospectively. In the retrospective scenario, identified open gaps can no longer be acted upon.
| Use Case | care-gaps Operation | Gaps Through Period Start Date | Gaps Through Period End Date | Report Creation Date | Colorectal Cancer Screening - Colonscopy Date | Gaps in Care Report |
|---|---|---|---|---|---|---|
| Prospective Use Case | $care-gaps?periodStart=2020-01-01&periodEnd=2020-09-30&subject=Patient/123&measure=CMS130v8 | 2020-01-01 | 2020-09-30 | 2020-07-01 | Example: patient had colonscopy on 2010-07-03 | Returns gaps through 2020-09-30. The gaps in care report indicates the patient has an open gap for the colorectal cancer screening measure. Since by 2020-09-30, the colonoscopy would be over 10 years. |
| Retrospective Use Case | $care-gaps?periodStart=2020-01-01&periodEnd=2020-06-30&subject=Patient/123&measure=CMS130v8 | 2020-01-01 | 2020-06-30 | 2020-07-01 | Example: patient had colonscopy on 2010-07-03 | Returns gaps through 2020-06-30. The gaps in care report indicates the patient has a closed gap for the colorectal cancer screening measure. Since on 2020-07-01, the procedure would have occurred within the specified 10-year timeframe. |
We seek examples of continuous variable measure where prospective use case might be applicable.
The care-gaps operation is used to run a gaps in care report. In this guide, we have extended the base care-gaps operation in the R4 Release of the FHIR (FHIR R4) Specification to allow for the specification of additional parameters that will be useful to the communities needing this report. This operation is run on the Measure resource and allows a Server to create a gaps in care report based on the quality measures available in the Server’s system.
The extended operation, care-gaps, makes the following changes to the existing input parameters in the base operation:
Several new input parameters are specified and added to the care-gaps operation defined in this guide:
The care-gaps operation has an out parameter: return. In comparison to the return output parameter specified in the base care-gaps operation, the return here returns 0 to many Bundle resource that conforms to the DEQM Gaps In Care Bundle Profile.
Through the requirement analysis of the Gaps in Care Reporting for this ballot, it is determined that existing care-gaps operation in FHIR R4 requires a re-design. The plan is to promote the care-gaps operation specified in this guide to the next release of the base FHIR specification.
Figure 2-13 shows a workflow for running the care-gaps operation for a single patient.
Figure 2-14 shows a workflow for running the care-gaps operation for a group of patients.
This section describes the profiles used for Gaps in Care Reporting and how they are used to construct a gaps in care report.
The care-gaps operation returns a document bundle for each patient for which a gaps in care report is generated, the bundle shall conform to the DEQM Gaps In Care Bundle Profile. A Gaps In Care Bundle shall contain a Composition entry, which uses the DEQM Gaps In Care Composition Profile.
The DEQM Gaps in Care Composition Profile builds on the base FHIR Composition, where its type code is constrained to a specific code to identify the Composition as a gaps in care report. The subject of a Gaps In Care Composition is required, it is used to reference the patient, QI Core Patient, the gaps in care report is for. The Gaps In Care Composition shall contain one to many section(s). Each section references a Gaps In Care Individual MeasureReport for a specific measure. All Gaps In Care Individual MeasureReport referenced shall be for the same patient specified in the Composition subject.
The Gaps In Care Individual MeasureReport shall conform to the DEQM Gaps In Care Individual MeasureReport Profile. This profile is based on the DEQM Individual MeasureReport Profile and adds an optional extension, DEQM Population Reference Extension, to the evaluatedResource. This extension allows the Server to indicate how an evaluatedResource, such as a colonoscopy procedure, was used to produce the measure calculation results by linking it to a specific population criteria identified by the measure population type, i.e. initial population, numerator, denominator, numerator-exclusion, etc.
If an open gap is identified for a measure that is included in the Gaps In Care Composition, then this Composition shall also contain an entry of DetectedIssue using the DEQM Gaps In Care DetectedIssue Profile for the measure. There shall be one DetectedIssue entry for each measure that has open gaps. This resource should only be created when there is an open gap. In addition to being a simplistic way to determine if the patient has an open gap (MeasureReport contains this information as well in measureScore), it can also be loaded by the Client and used as a way to track the open gap to resolution. Note that the code in the DetectedIssue contains the value “care-gap”, which was added to the referenced code system as an extension. The evidence element of the DetectedIssue resource points to the DEQM Gaps In Care Individual MeasureReport which will identify the specific measure that has not been closed.
The DEQM Gaps in Care Composition Profile may also contain all supporting resources referenced by the composition and its contained measure reports. As with other compositions, this resource can contain a narrative which can be displayed as a textual report.
Member attribution establishes associations between providers and payers. The process of establishing and exchanging member lists for gaps in care reports is not in the scope of the DEQM IG. Gaps in Care Reporting references the standards specified in the Da Vinci - Risk Based Contracts Member Attribution (ATR) List IG for exchanging Member Attribution Lists between providers and payers.
GET|[base]
Scenario:
A Client would like to know if the patient, gaps-patient01, has any open or closed gaps for the colorectal cancer screening measure and the cervical cancer screening measure for the period from 2020-01-01 to 2020-12-31. The Client requested a gaps in care report from a Server’s system on 2020-06-30.
GET Gaps In Care Report
GET [base]/Measure/$care-gaps?subject=Patient/gaps-patient01&periodStart=2020-01-01&periodEnd=2020-12-31&measure=CMS130v8&measure=CMS124v8
Request body
(Note that request body is not applicable in this example)
Response
HTTP/1.1 200
Date: Wed, 22 July 2020 01:02:06 GMT
Content-Type: application/fhir+json;charset=UTF-8
...Other Headers...
{
"resourceType": "Bundle",
"id": "single-gaps-open-indv-report01",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-bundle-deqm"
]
},
"identifier": {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:77f43ef5-8c60-4222-ae58-36969063a093"
},
"type": "document",
"timestamp": "2020-06-30T13:08:53+00:00",
"entry": [
{
"fullUrl": "http://example.org/fhir/gaps/Composition/gaps-composition01",
"resource": {
"resourceType": "Composition",
"id": "gaps-composition01",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-composition-deqm"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>id</b>: gaps-composition01</p><p><b>meta</b>: </p><p><b>status</b>: final</p><p><b>type</b>: <span title=\"Codes: {http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-doc-type gaps-doc}\">Gaps in Care Report</span></p><p><b>date</b>: Jun 30, 2020, 7:08:53 AM</p><p><b>author</b>: <a href=\"Organization-gaps-organization-reportingvendor.html\">Generated Summary: id: gaps-organization-reportingvendor; Tax ID number = 123446789 (OFFICIAL); active; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/organization-type pay}\">Payer</span>; name: GapsReportingVendor01; ph: (+1) 401-545-1212</a></p><p><b>title</b>: Care Gap Report for patient gaps-patient01</p></div>"
},
"status": "final",
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-doc-type",
"code": "gaps-doc",
"display": "Gaps in Care Report"
}
]
},
"subject": {
"reference": "Patient/gaps-patient01"
},
"date": "2020-06-30T13:08:53+00:00",
"author": [
{
"reference": "Organization/gaps-organization-reportingvendor"
}
],
"title": "Care Gap Report for patient gaps-patient01",
"section": [
{
"title": "Colorectal Cancer Screening",
"focus": {
"reference": "MeasureReport/gaps-indv-measurereport01"
},
"entry": [
{
"reference": "DetectedIssue/gaps-detectedissue01"
}
]
},
{
"title": "Cervical Cancer Screening",
"focus": {
"reference": "MeasureReport/gaps-indv-measurereport02"
},
"entry": [
{
"reference": "DetectedIssue/gaps-detectedissue02"
}
]
}
]
}
},
{
"fullUrl": "http://example.org/fhir/gaps/MeasureReport/gaps-indv-measurereport01",
"resource": {
"resourceType": "MeasureReport",
"id": "gaps-indv-measurereport01",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-indv-measurereport-deqm"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>id</b>: gaps-indv-measurereport01</p><p><b>meta</b>: </p><p><b>status</b>: complete</p><p><b>type</b>: individual</p><p><b>measure</b>: <a href=\"http://hl7.org/fhir/us/davinci-deqm/Measure/measure-exm130-example\">http://hl7.org/fhir/us/davinci-deqm/Measure/measure-exm130-example</a></p><p><b>subject</b>: <a href=\"Patient-gaps-patient01.html\">Generated Summary: id: gaps-patient01; Medical Record Number = 999995992 (USUAL); Parker Susan ; gender: female; birthDate: 1965-01-01</a></p><p><b>date</b>: Jun 30, 2020, 7:08:52 AM</p><p><b>reporter</b>: <a href=\"Organization-organization01.html\">Generated Summary: id: organization01; Tax ID number = 123456789 (OFFICIAL); active; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/organization-type prov}\">Healthcare Provider</span>; name: DaVinciHospital01; ph: (+1) 401-555-1212</a></p><p><b>period</b>: Dec 31, 2019, 5:00:00 PM --> Dec 30, 2020, 5:00:00 PM</p><p><b>improvementNotation</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-improvement-notation increase}\">Increased score indicates improvement</span></p><blockquote><p><b>group</b></p><p><b>id</b>: group-exm130</p><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-population initial-population}\">Initial Population</span></p><p><b>count</b>: 1</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-population numerator}\">Numerator</span></p><p><b>count</b>: 0</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-population denominator}\">Denominator</span></p><p><b>count</b>: 1</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-population denominator-exclusion}\">Denominator Exclusion</span></p><p><b>count</b>: 0</p></blockquote><p><b>measureScore</b>: 0.0</p></blockquote><p><b>evaluatedResource</b>: </p><ul><li><a href=\"Encounter-gaps-encounter01.html\">Generated Summary: id: gaps-encounter01; status: finished; <span title=\"{http://terminology.hl7.org/CodeSystem/v3-ActCode AMB}\">ambulatory</span>; <span title=\"Codes: {http://www.ama-assn.org/go/cpt 99201}\">Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.</span>; period: May 29, 2020, 6:00:00 PM --> May 30, 2020, 6:00:00 PM</a></li><li><a href=\"Patient-gaps-patient01.html\">Generated Summary: id: gaps-patient01; Medical Record Number = 999995992 (USUAL); Parker Susan ; gender: female; birthDate: 1965-01-01</a></li></ul></div>"
},
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
"code": "proportion"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-certificationIdentifier",
"valueIdentifier": {
"system": "urn:oid:2.16.840.1.113883.3.2074.1",
"value": "0015HQN9BD3304E"
}
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-reportingVendor",
"valueReference": {
"reference": "Organization/gaps-organization-reportingvendor"
}
}
],
"status": "complete",
"type": "individual",
"measure": "http://hl7.org/fhir/us/davinci-deqm/Measure/measure-exm130-example",
"subject": {
"reference": "Patient/gaps-patient01"
},
"date": "2020-06-30T13:08:52+00:00",
"reporter": {
"reference": "Organization/organization01"
},
"period": {
"start": "2020-01-01T00:00:00+00:00",
"end": "2020-12-31T00:00:00+00:00"
},
"improvementNotation": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
"code": "increase"
}
]
},
"group": [
{
"id": "group-exm130",
"population": [
{
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "initial-population",
"display": "Initial Population"
}
]
},
"count": 1
},
{
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "numerator",
"display": "Numerator"
}
]
},
"count": 0
},
{
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator",
"display": "Denominator"
}
]
},
"count": 1
},
{
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator-exclusion",
"display": "Denominator Exclusion"
}
]
},
"count": 0
}
],
"measureScore": {
"value": 0.0
}
}
],
"evaluatedResource": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "initial-population"
}
]
}
}
],
"reference": "Encounter/gaps-encounter01"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "initial-population"
}
]
}
}
],
"reference": "Patient/gaps-patient01"
}
]
}
},
{
"fullUrl": "http://example.org/fhir/gaps/MeasureReport/gaps-indv-measurereport02",
"resource": {
"resourceType": "MeasureReport",
"id": "gaps-indv-measurereport02",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-indv-measurereport-deqm"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>id</b>: gaps-indv-measurereport02</p><p><b>meta</b>: </p><p><b>status</b>: complete</p><p><b>type</b>: individual</p><p><b>measure</b>: <a href=\"http://hl7.org/fhir/us/davinci-deqm/Measure/measure-exm124-example\">http://hl7.org/fhir/us/davinci-deqm/Measure/measure-exm124-example</a></p><p><b>subject</b>: <a href=\"Patient-gaps-patient01.html\">Generated Summary: id: gaps-patient01; Medical Record Number = 999995992 (USUAL); Parker Susan ; gender: female; birthDate: 1965-01-01</a></p><p><b>date</b>: Jul 2, 2020, 7:08:52 AM</p><p><b>reporter</b>: <a href=\"Organization-organization01.html\">Generated Summary: id: organization01; Tax ID number = 123456789 (OFFICIAL); active; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/organization-type prov}\">Healthcare Provider</span>; name: DaVinciHospital01; ph: (+1) 401-555-1212</a></p><p><b>period</b>: Dec 31, 2019, 5:00:00 PM --> Dec 30, 2020, 5:00:00 PM</p><p><b>improvementNotation</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-improvement-notation increase}\">Increased score indicates improvement</span></p><blockquote><p><b>group</b></p><p><b>id</b>: group-exm124</p><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-population initial-population}\">Initial Population</span></p><p><b>count</b>: 1</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-population numerator}\">Numerator</span></p><p><b>count</b>: 0</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-population denominator}\">Denominator</span></p><p><b>count</b>: 1</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-population denominator-exclusion}\">Denominator Exclusion</span></p><p><b>count</b>: 0</p></blockquote><p><b>measureScore</b>: 0.0</p></blockquote><p><b>evaluatedResource</b>: </p><ul><li><a href=\"Encounter-gaps-encounter01.html\">Generated Summary: id: gaps-encounter01; status: finished; <span title=\"{http://terminology.hl7.org/CodeSystem/v3-ActCode AMB}\">ambulatory</span>; <span title=\"Codes: {http://www.ama-assn.org/go/cpt 99201}\">Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.</span>; period: May 29, 2020, 6:00:00 PM --> May 30, 2020, 6:00:00 PM</a></li><li><a href=\"Patient-gaps-patient01.html\">Generated Summary: id: gaps-patient01; Medical Record Number = 999995992 (USUAL); Parker Susan ; gender: female; birthDate: 1965-01-01</a></li></ul></div>"
},
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
"code": "proportion"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-certificationIdentifier",
"valueIdentifier": {
"system": "urn:oid:2.16.840.1.113883.3.2074.1",
"value": "0015HQN9BD3304E"
}
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-reportingVendor",
"valueReference": {
"reference": "Organization/gaps-organization-reportingvendor"
}
}
],
"status": "complete",
"type": "individual",
"measure": "http://hl7.org/fhir/us/davinci-deqm/Measure/measure-exm124-example",
"subject": {
"reference": "Patient/gaps-patient01"
},
"date": "2020-07-02T13:08:52+00:00",
"reporter": {
"reference": "Organization/organization01"
},
"period": {
"start": "2020-01-01T00:00:00+00:00",
"end": "2020-12-31T00:00:00+00:00"
},
"improvementNotation": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
"code": "increase"
}
]
},
"group": [
{
"id": "group-exm124",
"population": [
{
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "initial-population",
"display": "Initial Population"
}
]
},
"count": 1
},
{
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "numerator",
"display": "Numerator"
}
]
},
"count": 0
},
{
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator",
"display": "Denominator"
}
]
},
"count": 1
},
{
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator-exclusion",
"display": "Denominator Exclusion"
}
]
},
"count": 0
}
],
"measureScore": {
"value": 0.0
}
}
],
"evaluatedResource": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "initial-population"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator"
}
]
}
}
],
"reference": "Encounter/gaps-encounter01"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "initial-population"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator"
}
]
}
}
],
"reference": "Patient/gaps-patient01"
}
]
}
},
{
"fullUrl": "http://example.org/fhir/gaps/DetectedIssue/gaps-detectedissue01",
"resource": {
"resourceType": "DetectedIssue",
"id": "gaps-detectedissue01",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-detectedissue-deqm"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>id</b>: gaps-detectedissue01</p><p><b>meta</b>: </p><p><b>status</b>: final</p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/detectedissue-category care-gap}\">Gap in Care Detected</span></p><p><b>patient</b>: <a href=\"Patient-gaps-patient01.html\">Generated Summary: id: gaps-patient01; Medical Record Number = 999995992 (USUAL); Parker Susan ; gender: female; birthDate: 1965-01-01</a></p><h3>Evidences</h3><table class=\"grid\"><tr><td>-</td><td><b>Detail</b></td></tr><tr><td>*</td><td><a href=\"MeasureReport-gaps-indv-measurereport01.html\">Generated Summary: id: gaps-indv-measurereport01; status: complete; type: individual; measure: http://hl7.org/fhir/us/cqfmeasures/Measure/measure-exm130-FHIR; date: Jul 2, 2020, 7:08:52 AM; period: Dec 31, 2018, 5:00:00 PM --> Dec 30, 2019, 5:00:00 PM; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-improvement-notation increase}\">Increased score indicates improvement</span></a></td></tr></table></div>"
},
"status": "final",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/detectedissue-category",
"code": "care-gap",
"display": "Gap in Care Detected"
}
]
},
"patient": {
"reference": "Patient/gaps-patient01"
},
"evidence": [
{
"detail": [
{
"reference": "MeasureReport/gaps-indv-measurereport01"
}
]
}
]
}
},
{
"fullUrl": "http://example.org/fhir/gaps/DetectedIssue/gaps-detectedissue02",
"resource": {
"resourceType": "DetectedIssue",
"id": "gaps-detectedissue02",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-detectedissue-deqm"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>id</b>: gaps-detectedissue02</p><p><b>meta</b>: </p><p><b>status</b>: final</p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/detectedissue-category care-gap}\">Gap in Care Detected</span></p><p><b>patient</b>: <a href=\"Patient-gaps-patient01.html\">Generated Summary: id: gaps-patient01; Medical Record Number = 999995992 (USUAL); Parker Susan ; gender: female; birthDate: 1965-01-01</a></p><h3>Evidences</h3><table class=\"grid\"><tr><td>-</td><td><b>Detail</b></td></tr><tr><td>*</td><td><a href=\"MeasureReport-gaps-indv-measurereport02.html\">Generated Summary: id: gaps-indv-measurereport02; status: complete; type: individual; measure: http://hl7.org/fhir/us/cqfmeasures/Measure/measure-exm124-FHIR; date: Jul 2, 2020, 7:08:52 AM; period: Dec 31, 2018, 5:00:00 PM --> Dec 30, 2019, 5:00:00 PM; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-improvement-notation increase}\">Increased score indicates improvement</span></a></td></tr></table></div>"
},
"status": "final",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/detectedissue-category",
"code": "care-gap",
"display": "Gap in Care Detected"
}
]
},
"patient": {
"reference": "Patient/gaps-patient01"
},
"evidence": [
{
"detail": [
{
"reference": "MeasureReport/gaps-indv-measurereport02"
}
]
}
]
}
},
{
"fullUrl": "http://example.org/fhir/gaps/Encounter/gaps-encounter01",
"resource": {
"resourceType": "Encounter",
"id": "gaps-encounter01",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>id</b>: gaps-encounter01</p><p><b>meta</b>: </p><p><b>status</b>: finished</p><p><b>class</b>: <span title=\"{http://terminology.hl7.org/CodeSystem/v3-ActCode AMB}\">ambulatory</span></p><p><b>type</b>: <span title=\"Codes: {http://www.ama-assn.org/go/cpt 99201}\">Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.</span></p><p><b>subject</b>: <a href=\"Patient-gaps-patient01.html\">Generated Summary: id: gaps-patient01; Medical Record Number = 999995992 (USUAL); Parker Susan ; gender: female; birthDate: 1965-01-01</a></p><p><b>period</b>: May 29, 2020, 6:00:00 PM --> May 30, 2020, 6:00:00 PM</p></div>"
},
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB",
"display": "ambulatory"
},
"type": [
{
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99201",
"display": "Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family."
}
]
}
],
"subject": {
"reference": "Patient/gaps-patient01"
},
"period": {
"start": "2020-05-30T00:00:00-00:00",
"end": "2020-05-31T00:00:00-00:00"
}
}
},
{
"fullUrl": "http://example.org/fhir/gaps/Patient/gaps-patient01",
"resource": {
"resourceType": "Patient",
"id": "gaps-patient01",
"meta": {
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>id</b>: gaps-patient01</p><p><b>meta</b>: </p><p><b>identifier</b>: Medical Record Number = 999995992 (USUAL)</p><p><b>name</b>: Parker Susan </p><p><b>gender</b>: female</p><p><b>birthDate</b>: 1965-01-01</p></div>"
},
"extension": [
{
"extension": [
{
"url": "ombCategory",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2028-9",
"display": "Asian"
}
},
{
"url": "text",
"valueString": "Asian"
}
],
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race"
},
{
"extension": [
{
"url": "ombCategory",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2135-2",
"display": "Hispanic or Latino"
}
},
{
"url": "text",
"valueString": "Hispanic or Latino"
}
],
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity"
}
],
"identifier": [
{
"use": "usual",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MR",
"display": "Medical Record Number"
}
]
},
"system": "http://hospital.smarthealthit.org",
"value": "999995992"
}
],
"name": [
{
"family": "Susan",
"given": [
"Parker"
]
}
],
"gender": "female",
"birthDate": "1965-01-01"
}
},
{
"fullUrl": "http://example.org/fhir/gaps/Organization/gaps-organization-reportingvendor",
"resource": {
"resourceType": "Organization",
"id": "gaps-organization-reportingvendor",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/organization-deqm"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>id</b>: gaps-organization-reportingvendor</p><p><b>meta</b>: </p><p><b>identifier</b>: Tax ID number = 123446789 (OFFICIAL)</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/organization-type pay}\">Payer</span></p><p><b>name</b>: GapsReportingVendor01</p><p><b>telecom</b>: ph: (+1) 401-545-1212</p><p><b>address</b>: 13 Drive Street Cityplace MA 01101 USA </p></div>"
},
"identifier": [
{
"use": "official",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "TAX",
"display": "Tax ID number"
}
]
},
"system": "urn:oid:2.16.840.1.113883.4.4",
"value": "123446789",
"assigner": {
"display": "www.irs.gov"
}
}
],
"active": true,
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/organization-type",
"code": "pay",
"display": "Payer"
}
]
}
],
"name": "GapsReportingVendor01",
"telecom": [
{
"system": "phone",
"value": "(+1) 401-545-1212"
}
],
"address": [
{
"line": [
"13 Drive Street"
],
"city": "Cityplace",
"state": "MA",
"postalCode": "01101",
"country": "USA"
}
]
}
}
]
}
If Clients are requesting gaps in care reports for many patients/members, they may consider using the FHIR Asynchronous Request Patterns for the Bulk Data exchange operation.
GET|[base]
Scenario:
The Client would like to request gaps in care reports on many patients. They have created a FHIR Group Resource using the DEQM Gaps In Care Group Profile with the id of 123. Because they expect the creation of the reports to take a while and many FHIR bundles will be returned and be processed, they would like to make the request in an asynchronous manner returning NDJSON that will be easier for them to process.
The request below asks for Group id of 123 to be run asynchronously with FHIR+ndjson as the output format. The header portions should be entered in the API client header section. For example, in the Postman tool, enter “Prefer” in Key and “respond-async” in Value as an entry in the Headers tab.
GET Gaps In Care Report Using Bulk Data
Run $care-gaps operation in an asynchronous mode:
GET [base]/Measure/$care-gaps?subject=Group/123&periodStart=2020-01-01&periodEnd=2020-09-30&_outputFormat=application/fhir+ndjson
Headers:
Prefer respond-asyncAccept application/fhir+jsonNote that both Prefer and Accept are required. Prefer specifies the response is immediate or asynchronous, which SHALL be set to respond-async. Accept specifies the format of the optional OperationOutcome response to the kick-off request. Currently, only application/fhir+json is supported. See the base FHIR specification Asynchronous Request Patterns for details.
Query Parameters:
_outputFormat (string, optional, defaults to application/fhir+ndjson)
IG © 2020+ HL7 International - Clinical Quality Information Work Group. Package hl7.fhir.us.davinci-deqm#2.1.0 based on FHIR 4.0.1. Generated 2020-08-15
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