Using CQL with FHIR
1.0.0-ballot - Ballot International flag

This page is part of the Using CQL with FHIR Implementation Guide (v1.0.0-ballot: STU1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. . For a full list of available versions, see the Directory of published versions

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Official URL: http://hl7.org/fhir/uv/cql/ImplementationGuide/hl7.fhir.uv.cql Version: 1.0.0-ballot
Draft as of 2023-10-23 Computable Name: CQL

This is the first ballot of this implementation guide in this form, but the content has been balloted and published in multiple prior implementation guides, including:

The following changes were made as a result of ballot comments received in the September 2023 ballot of the Canonical Resource Management Infrastructure IG. One of those comments was the suggestion to break this CQL-specific content out into its own implementation guide; this IG is the result of that change.

The following trackers were applied for this version:

Status: Summary:(Jira Issue)

  • Applied: Use a dataAbsentReason extension to indicate missing results(FHIR-43076)
  • Applied: Add guidance on missing information(FHIR-43075)
  • Applied: Consider requiring the use of a SignatureLevel higher than none(FHIR-42921)
  • Applied: Libraries are not required for CQL(FHIR-42574)
  • Applied: Explaing conformance requirement 4.12(FHIR-42573)
  • Applied: Representation in a Library needs clarification(FHIR-42571)
  • Applied: Code URI expectation inconsistent(FHIR-42570)
  • Applied: What is “knowledge artifact CQL”?(FHIR-42569)
  • Applied: Why so much discussion about VSAC in an international spec?(FHIR-42568)
  • Applied: Use a value set avoiding OIDs(FHIR-42567)
  • Applied: Update location of code system URIs(FHIR-42566)
  • Applied: How is the association between a namespace and URI established?(FHIR-42565)
  • Applied: Put versioning stuff together(FHIR-42562)
  • Applied: Explain identifier rules(FHIR-42561)
  • Applied: Better explain library declarations(FHIR-42560)
  • Applied: Clarify language around CQL artifacts(FHIR-42559)
  • Applied: No content in this ModelInfo section of Using CQL(FHIR-41869)
  • Applied: Provide more context in examples(FHIR-41868)

Summary

Clinical Quality Language (CQL) is a clinically-focused query language that can be used to express logic in a broad range of healthcare use cases, including clinical decision and cognitive support, public health and quality reporting, computable clinical guidelines, research trial eligibility, and many others. Several implementation guides have been published that include conformance criteria related to the use of CQL in these contexts. This implementation guide is the result of extracting common aspects of that support to a universal realm, broadly applicable implementation guide that supports the use of CQL with FHIR. Future versions of those implementation guides should consider referencing the conformance and guidance established here.

Scope of Use

The intent of this implementation guide is to support the use of CQL with FHIR in general. It is a universal realm specification and is intended to be broadly applicable to any use case that involves libraries or expressions of CQL evaluating against FHIR resources, including:

  • Library profiles to support packaging of CQL (and compiled CQL, or ELM) as FHIR Library resources
  • Evaluation support profiles to facilitate the representation of structured information about a logic library, as well as the result of evaluating a logic library
  • CQL Evaluation Service capability statement
  • ModelInfo-related profiles to facilitate configuration of ModelInfo for FHIR implementation guides

How to read this Guide

This Guide is divided into several pages which are listed at the top of each page in the menu bar:

  • Home: Summary and background information for the Canonical Resource Management Infrastructure Implementation Guide
  • Using CQL: Using Clinical Quality Language as part of knowledge artifacts
  • Profiles: List of profiles defined for use by knowledge artifacts
  • Extensions: List of extensions defined and used by knowledge artifacts
  • Operations: List of operations and operation pattern profiles
  • Capabilities: Definitions of services and operations in support of authoring, publishing, and distributing canonical resources and knowledge artifacts
  • Downloads: Links to downloadable artifacts for implementations.
  • Acknowledgements

Must Support

Certain elements in the profiles defined in this implementation guide are marked as Must Support. This flag is used to indicate that the element plays a critical role in defining, sharing, and implementing artifacts, and implementations SHALL understand and process the element.

In addition, because artifact specifications typically make use of data implementation guides (e.g. IPS, US Core, QI-Core), the implications of the Must Support flag for profiles used from those implementation guides must be considered.

For more information, see the definition of Must Support in the base FHIR specification.

Conformance Requirement 1.1 (Must Support Elements):

For resource instances claiming to conform to CRMI IG profiles, Must Support on any profile data element SHALL be interpreted as follows:

  • Authoring systems and knowledge repositories SHALL be capable of populating all Must Support data elements.
  • Evaluating systems SHALL be capable of processing resource instances containing Must Support data elements without generating an error or causing the evaluation to fail.
  • In situations where information on a particular data element is not present and the reason for absence is unknown, authoring and repository systems SHALL NOT include the data elements in the resource instance. For example, for systems using ‘9999’ to indicate unknown data values, do not include ‘9999’ in the resource instance.
  • When consuming resource instances, evaluating systems SHALL interpret missing data elements within resource instances as data not present for the artifact.
  • Submitting and receiving systems using knowledge artifacts to perform data exchange or artifact evaluation operations SHALL respect the must support requirements of the profiles used by the artifact to describe the data involved in the operation.

References

Health level seven. Clinical Quality Framework - HL7 Clinical Decision Support Work Group Confluence Page. [Online]. Available from: https://confluence.hl7.org/display/CQIWC/Clinical Quality Framework [Accessed 11 October 2019].

Dependencies

IGPackageFHIRComment
.. Using CQL with FHIRhl7.fhir.uv.cql#1.0.0-ballotR4
... HL7 Terminology (THO)hl7.terminology.r4#5.3.0R4Automatically added as a dependency - all IGs depend on HL7 Terminology
... FHIR Extensions Packhl7.fhir.uv.extensions#5.1.0-ballot1R5

Cross Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (hl7.fhir.uv.cql.r4) and R4B (hl7.fhir.uv.cql.r4b) are available.

Global Profiles

There are no Global profiles defined

IP Statements

No use of external IP