Data Exchange For Quality Measures Implementation Guide
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This page is part of the Da Vinci Data Exchange for Quality Measures (DEQM) FHIR IG (v5.0.0-ballot: STU5 (v5.0.0) Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 4.0.0. For a full list of available versions, see the Directory of published versions

Resource Profile: DEQM Gaps In Care Detected Issue Profile

Official URL: http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-detectedissue-deqm Version: 5.0.0-ballot
Active as of 2021-04-23 Computable Name: DEQMGapsInCareDetectedIssueProfile
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.23

The DEQM Gaps In Care DetectedIssue Profile indicates that the measure reported has an open gap or a closed gap as identified in the gapStatus modifier extension.

Mandatory Data Elements and Terminology

The following data-elements are mandatory (i.e data MUST be present).

Each DetectedIssue Must Have:

  1. modifierExtension: Extension
  2. modifierExtension: Gap Status
  3. status: registered | preliminary | final | amended +
  4. code: Issue Category, e.g. drug-drug, duplicate therapy, etc.
  5. patient: Associated patient
  6. evidence: Supporting evidence
  7. evidence.detail: This references either a DEQM Individual MeasureReport or a GuidanceResponse resource. Note that referencing the GuidanceResponse resource allows potential profiling on GuidanceResponse in the future without breaking backward compatibility.
  8. mitigation.action: What mitigation?

This profile builds on DetectedIssue.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from DetectedIssue

NameFlagsCard.TypeDescription & Constraintsdoco
.. DetectedIssue 0..* DetectedIssue Clinical issue with action
... Slices for modifierExtension Content/Rules for all slices
.... modifierExtension:gapStatus ?!S 1..1 DEQMGapStatusModifierExtension Gap Status
... code S 1..1 CodeableConcept Issue Category, e.g. drug-drug, duplicate therapy, etc.
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: CAREGAP
... patient S 1..1 Reference(QICore Patient) Associated patient
... evidence S 1..* BackboneElement Supporting evidence
.... detail S 1..1 Reference(DEQM Individual MeasureReport Profile | Detailed Care Gap Guidance Response) This references either a DEQM Individual MeasureReport or a GuidanceResponse resource. Note that referencing the GuidanceResponse resource allows potential profiling on GuidanceResponse in the future without breaking backward compatibility.

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. DetectedIssue 0..* DetectedIssue Clinical issue with action
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for modifierExtension ?! 1..* Extension Extension
Slice: Unordered, Open by value:url
.... modifierExtension:gapStatus ?!S 1..1 DEQMGapStatusModifierExtension Gap Status
... status ?!Σ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): Indicates the status of the identified issue.

... code SΣ 1..1 CodeableConcept Issue Category, e.g. drug-drug, duplicate therapy, etc.
Binding: DetectedIssueCategory (preferred): Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.


Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: CAREGAP
... patient SΣ 1..1 Reference(QICore Patient) Associated patient
... evidence S 1..* BackboneElement Supporting evidence
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... detail S 1..1 Reference(DEQM Individual MeasureReport Profile | Detailed Care Gap Guidance Response) This references either a DEQM Individual MeasureReport or a GuidanceResponse resource. Note that referencing the GuidanceResponse resource allows potential profiling on GuidanceResponse in the future without breaking backward compatibility.

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
DetectedIssue.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
DetectedIssue.codepreferredPattern: CAREGAP
http://hl7.org/fhir/ValueSet/detectedissue-category
from the FHIR Standard
NameFlagsCard.TypeDescription & Constraintsdoco
.. DetectedIssue 0..* DetectedIssue Clinical issue with action
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... Slices for modifierExtension ?! 1..* Extension Extension
Slice: Unordered, Open by value:url
.... modifierExtension:gapStatus ?!S 1..1 DEQMGapStatusModifierExtension Gap Status
... identifier Σ 0..* Identifier Unique id for the detected issue
... status ?!Σ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): Indicates the status of the identified issue.

... code SΣ 1..1 CodeableConcept Issue Category, e.g. drug-drug, duplicate therapy, etc.
Binding: DetectedIssueCategory (preferred): Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.


Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: CAREGAP
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... severity Σ 0..1 code high | moderate | low
Binding: DetectedIssueSeverity (required): Indicates the potential degree of impact of the identified issue on the patient.

... patient SΣ 1..1 Reference(QICore Patient) Associated patient
... identified[x] Σ 0..1 When identified
.... identifiedDateTime dateTime
.... identifiedPeriod Period
... author Σ 0..1 Reference(Practitioner | PractitionerRole | Device) The provider or device that identified the issue
... implicated Σ 0..* Reference(Resource) Problem resource
... evidence S 1..* BackboneElement Supporting evidence
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code 0..* CodeableConcept Manifestation
Binding: ManifestationAndSymptomCodes (example): Codes that describes the types of evidence for a detected issue.


.... detail S 1..1 Reference(DEQM Individual MeasureReport Profile | Detailed Care Gap Guidance Response) This references either a DEQM Individual MeasureReport or a GuidanceResponse resource. Note that referencing the GuidanceResponse resource allows potential profiling on GuidanceResponse in the future without breaking backward compatibility.
... detail 0..1 string Description and context
... reference 0..1 uri Authority for issue
... mitigation 0..* BackboneElement Step taken to address
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... action 1..1 CodeableConcept What mitigation?
Binding: DetectedIssueMitigationAction (preferred): Codes describing steps taken to resolve the issue or other circumstances that mitigate the risk associated with the issue; e.g. 'added concurrent therapy', 'prior therapy documented', etc.

.... date 0..1 dateTime Date committed
.... author 0..1 Reference(Practitioner | PractitionerRole) Who is committing?

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
DetectedIssue.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
DetectedIssue.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
DetectedIssue.codepreferredPattern: CAREGAP
http://hl7.org/fhir/ValueSet/detectedissue-category
from the FHIR Standard
DetectedIssue.severityrequiredDetectedIssueSeverity
http://hl7.org/fhir/ValueSet/detectedissue-severity|4.0.1
from the FHIR Standard
DetectedIssue.evidence.codeexampleManifestationAndSymptomCodes
http://hl7.org/fhir/ValueSet/manifestation-or-symptom
from the FHIR Standard
DetectedIssue.mitigation.actionpreferredDetectedIssueMitigationAction
http://hl7.org/fhir/ValueSet/detectedissue-mitigation-action
from the FHIR Standard

Differential View

This structure is derived from DetectedIssue

NameFlagsCard.TypeDescription & Constraintsdoco
.. DetectedIssue 0..* DetectedIssue Clinical issue with action
... Slices for modifierExtension Content/Rules for all slices
.... modifierExtension:gapStatus ?!S 1..1 DEQMGapStatusModifierExtension Gap Status
... code S 1..1 CodeableConcept Issue Category, e.g. drug-drug, duplicate therapy, etc.
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: CAREGAP
... patient S 1..1 Reference(QICore Patient) Associated patient
... evidence S 1..* BackboneElement Supporting evidence
.... detail S 1..1 Reference(DEQM Individual MeasureReport Profile | Detailed Care Gap Guidance Response) This references either a DEQM Individual MeasureReport or a GuidanceResponse resource. Note that referencing the GuidanceResponse resource allows potential profiling on GuidanceResponse in the future without breaking backward compatibility.

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. DetectedIssue 0..* DetectedIssue Clinical issue with action
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for modifierExtension ?! 1..* Extension Extension
Slice: Unordered, Open by value:url
.... modifierExtension:gapStatus ?!S 1..1 DEQMGapStatusModifierExtension Gap Status
... status ?!Σ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): Indicates the status of the identified issue.

... code SΣ 1..1 CodeableConcept Issue Category, e.g. drug-drug, duplicate therapy, etc.
Binding: DetectedIssueCategory (preferred): Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.


Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: CAREGAP
... patient SΣ 1..1 Reference(QICore Patient) Associated patient
... evidence S 1..* BackboneElement Supporting evidence
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... detail S 1..1 Reference(DEQM Individual MeasureReport Profile | Detailed Care Gap Guidance Response) This references either a DEQM Individual MeasureReport or a GuidanceResponse resource. Note that referencing the GuidanceResponse resource allows potential profiling on GuidanceResponse in the future without breaking backward compatibility.

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
DetectedIssue.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
DetectedIssue.codepreferredPattern: CAREGAP
http://hl7.org/fhir/ValueSet/detectedissue-category
from the FHIR Standard

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. DetectedIssue 0..* DetectedIssue Clinical issue with action
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... Slices for modifierExtension ?! 1..* Extension Extension
Slice: Unordered, Open by value:url
.... modifierExtension:gapStatus ?!S 1..1 DEQMGapStatusModifierExtension Gap Status
... identifier Σ 0..* Identifier Unique id for the detected issue
... status ?!Σ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): Indicates the status of the identified issue.

... code SΣ 1..1 CodeableConcept Issue Category, e.g. drug-drug, duplicate therapy, etc.
Binding: DetectedIssueCategory (preferred): Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.


Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: CAREGAP
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... severity Σ 0..1 code high | moderate | low
Binding: DetectedIssueSeverity (required): Indicates the potential degree of impact of the identified issue on the patient.

... patient SΣ 1..1 Reference(QICore Patient) Associated patient
... identified[x] Σ 0..1 When identified
.... identifiedDateTime dateTime
.... identifiedPeriod Period
... author Σ 0..1 Reference(Practitioner | PractitionerRole | Device) The provider or device that identified the issue
... implicated Σ 0..* Reference(Resource) Problem resource
... evidence S 1..* BackboneElement Supporting evidence
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code 0..* CodeableConcept Manifestation
Binding: ManifestationAndSymptomCodes (example): Codes that describes the types of evidence for a detected issue.


.... detail S 1..1 Reference(DEQM Individual MeasureReport Profile | Detailed Care Gap Guidance Response) This references either a DEQM Individual MeasureReport or a GuidanceResponse resource. Note that referencing the GuidanceResponse resource allows potential profiling on GuidanceResponse in the future without breaking backward compatibility.
... detail 0..1 string Description and context
... reference 0..1 uri Authority for issue
... mitigation 0..* BackboneElement Step taken to address
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... action 1..1 CodeableConcept What mitigation?
Binding: DetectedIssueMitigationAction (preferred): Codes describing steps taken to resolve the issue or other circumstances that mitigate the risk associated with the issue; e.g. 'added concurrent therapy', 'prior therapy documented', etc.

.... date 0..1 dateTime Date committed
.... author 0..1 Reference(Practitioner | PractitionerRole) Who is committing?

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
DetectedIssue.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
DetectedIssue.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
DetectedIssue.codepreferredPattern: CAREGAP
http://hl7.org/fhir/ValueSet/detectedissue-category
from the FHIR Standard
DetectedIssue.severityrequiredDetectedIssueSeverity
http://hl7.org/fhir/ValueSet/detectedissue-severity|4.0.1
from the FHIR Standard
DetectedIssue.evidence.codeexampleManifestationAndSymptomCodes
http://hl7.org/fhir/ValueSet/manifestation-or-symptom
from the FHIR Standard
DetectedIssue.mitigation.actionpreferredDetectedIssueMitigationAction
http://hl7.org/fhir/ValueSet/detectedissue-mitigation-action
from the FHIR Standard

 

Other representations of profile: CSV, Excel, Schematron