Data Exchange For Quality Measures Implementation Guide
3.1.0 - STU 3.1.0 US

This page is part of the Da Vinci Data Exchange for Quality Measures (DEQM) FHIR IG (v3.1.0: STU 3) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: Care Gaps Operation - XML Representation

Draft as of 2021-04-23

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<OperationDefinition xmlns="http://hl7.org/fhir">
  <id value="care-gaps"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p>URL: [base]/Measure/$care-gaps</p><p>Parameters</p><table class="grid"><tr><td><b>Use</b></td><td><b>Name</b></td><td><b>Cardinality</b></td><td><b>Type</b></td><td><b>Binding</b></td><td><b>Documentation</b></td></tr><tr><td>IN</td><td>periodStart</td><td>1..1</td><td><a href="http://hl7.org/fhir/R4/datatypes.html#date">date</a></td><td/><td><div><p>The start of a <a href="index.html#glossary">gaps through period</a>. This may be 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.</p>
</div></td></tr><tr><td>IN</td><td>periodEnd</td><td>1..1</td><td><a href="http://hl7.org/fhir/R4/datatypes.html#date">date</a></td><td/><td><div><p>The end of a <a href="index.html#glossary">gaps through period</a> (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.</p>
</div></td></tr><tr><td>IN</td><td>topic</td><td>0..*</td><td><a href="http://hl7.org/fhir/R4/datatypes.html#string">string</a><br/>(<a href="http://hl7.org/fhir/R4/search.html#token">token</a>)</td><td/><td><div><p>The category of the measures that is of interest for the care gaps report. This references the <a href="https://www.hl7.org/fhir/measure-definitions.html#Measure.topic">topic</a> element in the <a href="https://www.hl7.org/fhir/measure.html">Measure</a> 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 &quot;value set&quot; that is defined with a list of domains/categories, etc. Topic examples: &quot;screening&quot;, &quot;pediatric&quot;. When multiple topics are provided, it is expected to be union of measures in those topics. Note that the type of this parameter is a string with a search type of <a href="https://www.hl7.org/fhir/search.html#token">token</a>, so the $care-gaps operation has only simple input parameters and may be invoked using GET.</p>
</div></td></tr><tr><td>IN</td><td>subject</td><td>0..1</td><td><a href="http://hl7.org/fhir/R4/datatypes.html#string">string</a><br/>(<a href="http://hl7.org/fhir/R4/search.html#reference">reference</a>)</td><td/><td><div><p>Subject will be a reference to either Patient <a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QI Core Patient</a> or Group <a href="StructureDefinition-gaps-group-deqm.html">DEQM Gaps In Care Group Profile</a>. Must provide either Patient/123 or Group/123, cannot simply provide 123. If only 123 is provided, then the operation would not know if it is a Patient reference or a Group reference.</p>
</div></td></tr><tr><td>IN</td><td>practitioner</td><td>0..1</td><td><a href="http://hl7.org/fhir/R4/datatypes.html#string">string</a><br/>(<a href="http://hl7.org/fhir/R4/search.html#reference">reference</a>)</td><td/><td><div><p>Reference to a practitioner <a href="StructureDefinition-practitioner-deqm.html">DEQM Practitioner</a> 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.</p>
</div></td></tr><tr><td>IN</td><td>organization</td><td>0..1</td><td><a href="http://hl7.org/fhir/R4/datatypes.html#string">string</a><br/>(<a href="http://hl7.org/fhir/R4/search.html#reference">reference</a>)</td><td/><td><div><p>Reference to an organization <a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QI Core Organization</a> 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.</p>
</div></td></tr><tr><td>IN</td><td>status</td><td>1..*</td><td><a href="http://hl7.org/fhir/R4/datatypes.html#code">code</a></td><td><a href="ValueSet-gaps-status.html">http://hl7.org/fhir/us/davinci-deqm/ValueSet/gaps-status</a> (Extensible)</td><td><div><p>Indicates status of a care gap. For both <a href="index.html#glossary">open and closed gaps</a>, two seperate status parameters must be provided. 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 (&gt; 9%)), gap means the patient is in the numerator.</p>
</div></td></tr><tr><td>IN</td><td>measureId</td><td>0..*</td><td><a href="http://hl7.org/fhir/R4/datatypes.html#id">id</a></td><td/><td><div><p>The id of a Measure resource that is on the server for which the gaps in care will be reported. E.g., the id of the Measure resource for Breast Cancer Screening measure.</p>
</div></td></tr><tr><td>IN</td><td>measureIdentifier</td><td>0..*</td><td><a href="http://hl7.org/fhir/R4/datatypes.html#string">string</a><br/>(<a href="http://hl7.org/fhir/R4/search.html#token">token</a>)</td><td/><td><div><p>The business identifier of a measure for which the gaps in care will be reported. E.g., CMS125 is a CMS assigned identifier for the Breast Cancer Screening eCQM in their system. Note that the type of this parameter is a string with a search type of <a href="https://www.hl7.org/fhir/search.html#token">token</a>, so the $care-gaps operation has only simple input parameters and may be invoked using GET.</p>
</div></td></tr><tr><td>IN</td><td>measureUrl</td><td>0..*</td><td><a href="http://hl7.org/fhir/R4/datatypes.html#canonical">canonical</a></td><td/><td><div><p>This the the URL of a measure for which the gaps in care will be reported. A measure URL is specified in the <a href="https://www.hl7.org/fhir/measure-definitions.html#Measure.url">url</a> element of the Measure resource. The measure URL remains the same when the measure is stored on different servers.</p>
</div></td></tr><tr><td>IN</td><td>program</td><td>0..*</td><td><a href="http://hl7.org/fhir/R4/datatypes.html#string">string</a><br/>(<a href="http://hl7.org/fhir/R4/search.html#token">token</a>)</td><td/><td><div><p>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 the Measure using element <a href="https://www.hl7.org/fhir/measure-definitions.html#Measure.useContext">useContext</a>. When the code attribute of useContext is program, then the value attribute of useContext represents a specific program. Note that the type of this parameter is a string with a search type of <a href="https://www.hl7.org/fhir/search.html#token">token</a>, so the $care-gaps operation has only simple input parameters and may be invoked using GET.</p>
</div></td></tr><tr><td>OUT</td><td>return</td><td>0..*</td><td><a href="http://hl7.org/fhir/R4/bundle.html">Bundle</a></td><td/><td><div><p>The $care-gaps operation returns <a href="https://www.hl7.org/fhir/parameters.html">Parameters</a> resource, containing zero or more document bundles that conform to the <a href="StructureDefinition-gaps-bundle-deqm.html">DEQM Gaps In Care Bundle Profile</a>. Note that the result of the $care-gaps operation must be returned using the Parameters resource, even when the result contains only one bundle, because the cardinality of the return parameter is specified as 0..*.</p>
</div></td></tr></table><div><p>The effect of invoking this operation is to calculate a measure or a set of measures based on the In Parameters provided and to return Parameters resource containing one or more document bundles describing the gaps in care results      of each measure, for the specified gaps through period and for the given subject (a patient or a group of patients). Because more than one bundle may be returned, the operation parameter must always be returned.  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 base Measure $care-gaps operation in FHIR R5.</p>
</div></div>
  </text>
  <url
       value="http://hl7.org/fhir/us/davinci-deqm/OperationDefinition/care-gaps"/>
  <version value="3.1.0"/>
  <name value="CareGaps"/>
  <title value="Care Gaps Operation"/>
  <status value="draft"/>
  <kind value="operation"/>
  <date value="2021-04-23"/>
  <publisher
             value="HL7 International - Clinical Quality Information Work Group"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/cqi"/>
    </telecom>
  </contact>
  <description
               value="The care-gaps operation is used to determine gaps in care for a specified gaps through period based on the results of quality measures."/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <code value="care-gaps"/>
  <comment
           value="The effect of invoking this operation is to calculate a measure or a set of measures based on the In Parameters provided and to return Parameters resource containing one or more document bundles describing the gaps in care results      of each measure, for the specified gaps through period and for the given subject (a patient or a group of patients). Because more than one bundle may be returned, the operation parameter must always be returned.  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 base Measure $care-gaps operation in FHIR R5."/>
  <base value="http://hl7.org/fhir/OperationDefinition/Measure-care-gaps"/>
  <resource value="Measure"/>
  <system value="false"/>
  <type value="true"/>
  <instance value="false"/>
  <parameter>
    <name value="periodStart"/>
    <use value="in"/>
    <min value="1"/>
    <max value="1"/>
    <documentation
                   value="The start of a [gaps through period](index.html#glossary). This may be 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."/>
    <type value="date"/>
  </parameter>
  <parameter>
    <name value="periodEnd"/>
    <use value="in"/>
    <min value="1"/>
    <max value="1"/>
    <documentation
                   value="The end of a [gaps through period](index.html#glossary) (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."/>
    <type value="date"/>
  </parameter>
  <parameter>
    <name value="topic"/>
    <use value="in"/>
    <min value="0"/>
    <max value="*"/>
    <documentation
                   value="The category of the measures that is of interest for the care gaps report. This references the [topic](https://www.hl7.org/fhir/measure-definitions.html#Measure.topic) element in the [Measure](https://www.hl7.org/fhir/measure.html) 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 &quot;value set&quot; that is defined with a list of domains/categories, etc. Topic examples: &quot;screening&quot;, &quot;pediatric&quot;. When multiple topics are provided, it is expected to be union of measures in those topics. Note that the type of this parameter is a string with a search type of [token](https://www.hl7.org/fhir/search.html#token), so the $care-gaps operation has only simple input parameters and may be invoked using GET."/>
    <type value="string"/>
    <searchType value="token"/>
  </parameter>
  <parameter>
    <name value="subject"/>
    <use value="in"/>
    <min value="0"/>
    <max value="1"/>
    <documentation
                   value="Subject will be a reference to either Patient [QI Core Patient](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html) or Group [DEQM Gaps In Care Group Profile](StructureDefinition-gaps-group-deqm.html). Must provide either Patient/123 or Group/123, cannot simply provide 123. If only 123 is provided, then the operation would not know if it is a Patient reference or a Group reference."/>
    <type value="string"/>
    <searchType value="reference"/>
  </parameter>
  <parameter>
    <name value="practitioner"/>
    <use value="in"/>
    <min value="0"/>
    <max value="1"/>
    <documentation
                   value="Reference to a practitioner [DEQM Practitioner](StructureDefinition-practitioner-deqm.html) 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."/>
    <type value="string"/>
    <searchType value="reference"/>
  </parameter>
  <parameter>
    <name value="organization"/>
    <use value="in"/>
    <min value="0"/>
    <max value="1"/>
    <documentation
                   value="Reference to an organization [QI Core Organization](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html) 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."/>
    <type value="string"/>
    <searchType value="reference"/>
  </parameter>
  <parameter>
    <name value="status"/>
    <use value="in"/>
    <min value="1"/>
    <max value="*"/>
    <documentation
                   value="Indicates status of a care gap. For both [open and closed gaps](index.html#glossary), two seperate status parameters must be provided. 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 (&gt; 9%)), gap means the patient is in the numerator."/>
    <type value="code"/>
    <binding>
      <strength value="extensible"/>
      <valueSet
                value="http://hl7.org/fhir/us/davinci-deqm/ValueSet/gaps-status"/>
    </binding>
  </parameter>
  <parameter>
    <name value="measureId"/>
    <use value="in"/>
    <min value="0"/>
    <max value="*"/>
    <documentation
                   value="The id of a Measure resource that is on the server for which the gaps in care will be reported. E.g., the id of the Measure resource for Breast Cancer Screening measure."/>
    <type value="id"/>
  </parameter>
  <parameter>
    <name value="measureIdentifier"/>
    <use value="in"/>
    <min value="0"/>
    <max value="*"/>
    <documentation
                   value="The business identifier of a measure for which the gaps in care will be reported. E.g., CMS125 is a CMS assigned identifier for the Breast Cancer Screening eCQM in their system. Note that the type of this parameter is a string with a search type of [token](https://www.hl7.org/fhir/search.html#token), so the $care-gaps operation has only simple input parameters and may be invoked using GET."/>
    <type value="string"/>
    <searchType value="token"/>
  </parameter>
  <parameter>
    <name value="measureUrl"/>
    <use value="in"/>
    <min value="0"/>
    <max value="*"/>
    <documentation
                   value="This the the URL of a measure for which the gaps in care will be reported. A measure URL is specified in the [url](https://www.hl7.org/fhir/measure-definitions.html#Measure.url) element of the Measure resource. The measure URL remains the same when the measure is stored on different servers."/>
    <type value="canonical"/>
  </parameter>
  <parameter>
    <name value="program"/>
    <use value="in"/>
    <min value="0"/>
    <max value="*"/>
    <documentation
                   value="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 the Measure using element [useContext](https://www.hl7.org/fhir/measure-definitions.html#Measure.useContext). When the code attribute of useContext is program, then the value attribute of useContext represents a specific program. Note that the type of this parameter is a string with a search type of [token](https://www.hl7.org/fhir/search.html#token), so the $care-gaps operation has only simple input parameters and may be invoked using GET."/>
    <type value="string"/>
    <searchType value="token"/>
  </parameter>
  <parameter>
    <name value="return"/>
    <use value="out"/>
    <min value="0"/>
    <max value="*"/>
    <documentation
                   value="The $care-gaps operation returns [Parameters](https://www.hl7.org/fhir/parameters.html) resource, containing zero or more document bundles that conform to the [DEQM Gaps In Care Bundle Profile](StructureDefinition-gaps-bundle-deqm.html). Note that the result of the $care-gaps operation must be returned using the Parameters resource, even when the result contains only one bundle, because the cardinality of the return parameter is specified as 0..*."/>
    <type value="Bundle"/>
  </parameter>
</OperationDefinition>