Quality Measure Implementation Guide
1.0.0 - STU 1

Quality Measure Implementation Guide - Downloaded Version null See the Directory of published versions

## Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

### Behavior: Capability Statements

The following artifacts define the specific capabilities that different types of systems are expected to have in order to comply with this implementation guide. Systems conforming to this implementation guide are expected to declare conformance to one or more of the following capability statements.

CQF Measures Authoring Measure Repository Capability Statement | Capability statement for a repository service supporting additional authoring and content workflow capabilities for FHIR-based measure specifications above the basic ShareableMeasureRepository.
CQF Measures Publishable Measure Repository Capability Statement | Capability statement for a repository service supporting additional publishing capabilities for FHIR-based measure specifications above the basic ShareableMeasureRepository.
CQF Measures Shareable Measure Repository Capability Statement | Capability statement for a repository service supporting minimum required capabilities to share FHIR-based measure specifications. See the Publishable and Authoring Measure Repository capability statements for more comprehensive support for publishing and authoring workflows.
Measure Calculation Service Capability Statement Example | Basic conformance statement for a Measure Calculation Service. A server can support more functionality than defined here, but this is the minimum amount

### Behavior: Operation Definitions

These are custom operations that can be supported by and/or invoked by systems conforming to this implementation guide.

CQM Package | Packages a specified canonical resource with dependencies.

### Knowledge Artifacts: Libraries

These define logic, asset collections and other libraries as part of content in this implementation guide.

Adult Outpatient Encounters Common Library | This library is used as an example in the FHIR Quality Measure Implementation Guide
Advanced Illness and Frailty Exclusion Library | Advanced Illness and Frailty Exclusion Example Library
Age Stratification Example | This library provides an illustration of using the ISO-8601-Dervied Periods code system to construct computable age ranges as a stratification for measures.
BCS Component Library | This library is the primary measure library for the Breast Cancer Screening component of the composite measure examples in this implementation guide.
CCS Component Library | This library is the primary measure library for the Cervical Cancer Screening component of the composite measure examples in this implementation guide.
Common Library | This library is used as an example in the FHIR Quality Measure Implementation Guide
Common Terminology Library | This library is the common library for the terminology example measure
EXM Aggregate | This library provides an example of logic for computing aggregates based on the results of measure calculations (i.e. aggregate calculation using MeasureReport resources).
EXM Improvement Activities | This library provides an example of logic for an IA (Improvement Activities) measure.
EXM108 - Venous Thromboembolism Prophylaxis Library | This library is used as an example in the FHIR Quality Measure Implementation Guide
EXM124 - Cervical Cancer Screening Library | This library is used as an example in the FHIR Quality Measure Implementation Guide
EXM125 - Breast Cancer Screening Library | This library is used as an example in the FHIR Quality Measure Implementation Guide
EXM130 - Colorectal Cancer Screening Library | This library is used as an example in the FHIR Quality Measure Implementation Guide
EXM146 - Example Proportion Measure Library | This library is used as an example in the FHIR Quality Measure Implementation Guide
EXM55 - Median Emergency Department Visit Duration Library (Example Continuous Variable Measure Library) | This library is used as an example in the FHIR Quality Measure Implementation Guide
EXMRatio - Example Ratio Measure Library | This library is used as an example in the FHIR Quality Measure Implementation Guide
Example Computable Library | This library is used as an example in the FHIR Quality Measure Implementation Guide
Example Executable Library | This library is used as an example in the FHIR Quality Measure Implementation Guide
Example Logic Library | This library is used as an example in the FHIR Quality Measure Implementation Guide
Example Logic Library - Module Definition | This library is used as an example module definition in the FHIR Quality Measure Implementation Guide
Example Logic Library - Module Definition Direct Reference | This library is used as an example module definition in the FHIR Quality Measure Implementation Guide
Example Publishable Library | This library is used as an example in the FHIR Quality Measure Implementation Guide
HBP Component Library | Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
Hospice FHIR Library | This library is used as an example in the FHIR Quality Measure Implementation Guide
MAT Global Common Functions FHIR Library | This library is used as an example in the FHIR Quality Measure Implementation Guide
Module Definition Example Logic Library | This library is used as an example module definition in the FHIR Quality Measure Implementation Guide
Multi Rate Example Logic Library | This library is used as an example in the FHIR Quality Measure Implementation Guide
PVS Component Library | Pneumococcal Vaccination Status for Older Adults
Quality Program Example | This library is an example quality program illustrating the use of a library to identify the set of measures that are specified for use in a quality program. The measures specified here are expected to be used with the version information specified in the eCQM Update 2024 content release manifest, as indicated by the dependency on that library.
Supplemental Data Elements | This example illustrates logic for sharing supplemental data element calculation between multiple measures.
TJC Overall Library | This library is used as an example in the FHIR Quality Measure Implementation Guide
TSC Component Library | Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Terminology Library | This library is the primary measure library for the terminology example measure
VTE ICU Library | This library is used as an example in the FHIR Quality Measure Implementation Guide
eCQM Update 2024 - Final Draft | This library is an example final draft of a version manifest (also referred to as an expansion profile) that specifies expansion rules for a set of value sets used for an example set of quality measures.
eCQM Update 2024 - Initial Draft | This library is an example initial draft of a version manifest (also referred to as an expansion profile) that specifies expansion rules for a set of value sets used for an example set of CMS measures.
eCQM Update 2024 - Release | This library is an example release of a version manifest (also referred to as an expansion profile) that specifies expansion rules for a set of value sets used for an example set of EP/EC measures.

### Structures: Resource Profiles

These define constraints on FHIR resources for systems conforming to this implementation guide.

CQM Attestation Measure | The CQM Attestation Measure Profile describes an attestation scoring measure.
CQM CQL Measure | The cqm CQL Measure Profile describes minimum expectations for a computable electronic Quality Measure (QM) that uses Clinical Quality Language to represent computable logic in the measure.
CQM Cohort Measure | The CQM Cohort Measure Profile describes a cohort scoring measure. For more information on the usage of this profile, refer to the Profiles and Packaging pages in this implementation guide.
CQM Composite Measure | The CQM Composite Measure Profile describes minimum expectations for a composite electronic Quality Measure (QM). For more information on the usage of this profile, refer to the Profiles and Packaging pages in this implementation guide.
CQM Computable Measure | The CQM Computable Measure Profile describes minimum expectations for a computable electronic Quality Measure (QM), including the use of a computable library. For more information on the usage of this profile, refer to the Profiles and Packaging pages in this implementation guide. Implementations SHOULD support using the `id` elements of group, population, stratifier, and supplementalData as a backwards-compatible mechanism for linking between Measure and MeasureReport
CQM Continuous Variable Measure | The CQM Continuous Variable Measure Profile describes a continuous variable scoring measure. For more information on the usage of this profile, refer to the Profiles and Packaging pages in this implementation guide.
CQM ELM Measure | The cqm ELM Measure Profile describes minimum expectations for an executable electronic Clinical Quality Measure (eCQM) that uses ELM (i.e. compiled CQL) to represent the logic of the measure.
CQM Executable Measure | The CQM Executable Measure Profile describes minimum expectations for an executable electronic Quality Measure (QM), including a reference to an executable library. For more information on the usage of this profile, refer to the Profiles and Packaging pages in this implementation guide.
CQM Proportion Measure | The CQM Proportion Measure Profile describes a proportion scoring measure. For more information on the usage of this profile, refer to the Profiles and Packaging pages in this implementation guide.
CQM Publishable Measure | The CQM Publishable Measure profile defines the minimum expectations to enable appropriate content management, discovery, and utilization of published Quality Measures (QMs). For more information on the usage of this profile, refer to the Profiles and Packaging pages in this implementation guide.
CQM Ratio Measure | The CQM Ratio Measure Profile describes a ratio scoring measure. For more information on the usage of this profile, refer to the Profiles and Packaging pages in this implementation guide.
CQM Test Case | The cqm Test Case Profile describes expectations for the definition and exchange of a measure test case, including input data and parameters, as well as expected outcome

### Structures: Extension Definitions

These define constraints on FHIR data types for systems conforming to this implementation guide.

CQM Aggregate Method | Specifies which method to be used to aggregate the measure observation values.
CQM Applies To | Indicates the population that this stratifier should apply to. If no appliesTo extension is present, the stratifier is calculated based on the result of the population calculation (e.g. the calculated numerator for a proportion scoring).
CQM Component | Specifies an artifact this is a component of a composite artifact.
CQM Composite Scoring | Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented. When present on a group, specifies the scoring to be used for this group, overriding the scoring specified for the overall measure.
CQM Effective Period Anchor | Specifies the anchor date for the effective period as defined by a starting date and a range.
CQM Effective Period Duration | Specifies the reporting period for the measure.
CQM Group Id | Specifies the id of a particular group within the measure referenced by the related artifact resource.
CQM Improvement Notation | Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range). Additional Guidance: improvementNotation `Reference range` with definition of score within a defined interval (or a “passing score” over or under a certain threshold) indicates better quality to the improvement notation value set.
CQM Include In Report Type | Indicates what types of report the element on which it appears should be included in. If no values are specified, the default behavior is that elements are included in all report types
CQM Is Test Case | Indicates whether this instance represents the definition of a test case.
CQM Limitations | The CQM Limitations profile identifies what limitations should be noted, including potential selection biases and confounding factors when interpreting indicator results or comparing results across the country.
CQM Operation | Specifies the operation definition
CQM Population Basis | The population basis specifies the type of elements in the population. For a subject-based measure, this is boolean (because the subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and a population basis of Encounter, and the population criteria all return lists of Encounters. Note that the subject of a measure can be found in the element subject[x].
CQM Rate Aggregation | Describes how to combine the information calculated, based on logic in each of several populations, into one summarized result.
CQM Risk Adjustment | A description of the risk adjustment factors that may impact the resulting score for the measure and how they may be accounted for when computing and reporting measure results.
CQM Scoring | Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented. When present on a group, specifies the scoring to be used for this group, overriding the scoring specified for the overall measure.
CQM Scoring Precision | The number of decimal places to include in the score when the score is a decimal-valued result.
CQM Scoring Unit | Defines the expected units of measure for the measure score.
CQM Supplemental Data Guidance | Provides additional guidance on the meaning and reporting of supplemental data elements included in the measure overall.
CQM Test Case Description | Provides a clear description of the test case.
CQM Trending Issues | identifies what issues might affect the interpretation of trending results, including changes in geographic coverage, data quality, coding standards and classification changes (for example, a new ICD standard)
CQM Type | Indicates the type of quality measure based on the observation value.
CQM Value Set | A value set defining the set of possible values that can be used to represent supplemental data or stratifier elements.
CQM Weight | What is the weight of the contribution of this measure to the overall score.

### Terminology: Value Sets

These define sets of codes used by systems conforming to this implementation guide.

Age Stratified Example Age Groups | establishes types of stratification for use in identifying subgroups of populations. These stratifications are often, but not exclusively, used in quality measurement.
Chronic Liver Disease Legacy Example | This is an example value set consisting of a subset of codes selected from Chronic Liver Disease (2.16.840.1.113883.3.464.1003.199.11.1065) for the purposes of illustrating a value set containing Legacy Codes.
ISO-8601-Derived Periods | All codes in the ISO-8601-Derived Periods code system. Note that this value set cannot be expanded because this set is effectively infinite, the set of all possible intervals of time.
Intended Venue | The Intended Venue value set identifies codes used to distinguish measures that are developed with the intent to be used in a particular venue, establishing expectations for the types of data that will be available from systems in that environment.
Measure Stratifier Type | establishes types of stratification for use in identifying subgroups of populations. These stratifications are often, but not exclusively, used in quality measurement.
Subject Type Value Set | This value set incorporates all codes from the FHIR value set subject-type in addition to PractitionerRole and RelatedPerson from the FHIR resource-types code system.

### Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide.

ISO-8601-Derived Periods Codes | Defines codes for the representation of age ranges that are unambiguous, human readable and machine-readable as a compositional grammar (i.e. the code system defines rules for constructing codes, rather than explicitly enumerating the possible codes). Age ranges are expressed through two simple durations as defined in the ISO 8601 specification. Codes in the code system are defined according to the grammar: An age range is defined as two durations: `[duration1]--[duration2]`, where `duration1` specifies the lower inclusive bound of the age range (everyone who is this age and above) and `duration2` specifies the upper exclusive bound of the age range. For example, the age range "1-9 years" means everyone who is at least one year old and less than 10 years old represented as `P1Y--P10Y`. The age range "10-14 years" means everyone who is at least 10 years old and less than 15 years old and is represented as `P10Y--P15Y`. Durations define the amount of time between two time points. These durations are represented in the form `P[n]Y[n]M[n]DT[n]H[n]M[n]S` or `P[n]W`. The `[n]` is replaced by the value for each of the time elements that follow the `[n]` and the letters have the meaning: `P` is the duration designator (for period) placed at the start of the duration representation. `Y` is the year designator that follows the value for the number of years. `M` is the month designator that follows the value for the number of months. `W` is the week designator that follows the value for the number of weeks. `D` is the day designator that follows the value for the number of days. `T` is the time designator that precedes the time components of the representation. `H` is the hour designator that follows the value for the number of hours. `M` is the minute designator that follows the value for the number of minutes. `S` is the second designator that follows the value for the number of seconds. (Note that seconds can be a decimal in this format to allow for milliseconds) For example, `P3Y6M4DT12H30M5S` represents a duration of three years, six months, four days, twelve hours, thirty minutes, and five seconds. Date and time elements including their designator may be omitted if their value is zero, and lower-order elements may also be omitted for reduced precision. For example, `P23DT23H` and `P4Y` are both acceptable duration representations. However, at least one element must be present, thus `P` is not a valid representation for a duration of 0 seconds. `PT0S` or `P0D`, however, are both valid and represent the same duration. Note that the designator `M` is used for both months and minutes, but this is not ambiguous because the minutes designator must be preceded by the time designator `T`. For example `P1M` is one month, while `PT1M` is one minute. Content for this code system is adapted from the definition in the IHE-ADX profile: https://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_ADX.pdf (Appendix 8K Representation of Age Groups in ADX). In addition, the code system definition is adapted from similar content published as part of the SANER implementation guide. See Age Range Coding System.
Intended Venue Codes | The Intended Venue code system defines codes used to distinguish measures that are developed with the intent to be used in a particular venue, establishing expectations for the types of data that will be available from systems in that environment.
Measure Stratifier Type Codes | This code system establishes types of stratification for use in identifying subgroups of populations. These stratifications are often, but not exclusively, used in quality measurement.

### Terminology: Concept Maps

These define transformations to convert between codes by systems conforming with this implementation guide.

Aggregate Method mapping | The mapping of FHIR aggregate method codes to the corresponding HL7 V3 code used in HQMF for each type of aggregate method
Composite Measure Scoring mapping | The mapping of FHIR composite measure scoring codes to the corresponding HL7 V3 code used in HQMF for each type of composite measure scoring
Data Usage Mapping | The mapping of FHIR measure data usage codes to the corresponding HL7 V3 code used in HQMF for each of the measure data usages
Improvement Notation Mapping | The mapping of FHIR improvement notation codes to the corresponding HL7 V3 code used in HQMF for each of the improvement notations
Measure Population criteria mapping | The mapping of FHIR measure population criteria codes to the corresponding HL7 V3 code used in HQMF for each of the measure population criteria components
Measure Scoring mapping | The mapping of FHIR measure scoring codes to the corresponding HL7 V3 code used in HQMF for each type of measure scoring
Measure Type mapping | The mapping of FHIR measure type codes to the corresponding HL7 V3 code used in HQMF for each of the measure type

### Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.

Age Stratified Example | This example illustrates the use of codesystem and valueset measure-stratifier-ages-example.
Breast Cancer Screening | This is an example only.
Bundle example | Example of a transaction bundle
Cervical Cancer Screening | This is only an example.
Device - Software System Example | Example of a Software System Device used to illustrate tooling, testing, or authoring system
EXM Measure | An example FHIR-based measure.
EXM Promoting Interoperability Measure | An example FHIR-based attestation measure - Promoting Interoperability.
EXM Publishable Measure | An example FHIR-based publishable measure
EXM Ratio Measure | An example FHIR-based ratio measure.
EXM108 - Venous Thromboembolism Prophylaxis | This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission.
EXM124 - Cervical Cancer Screening | Percentage of women 21-64 years of age who were screened for cervical cancer.
EXM125 - Breast Cancer Screening | Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer.
EXM130 - Colorectal Cancer Screening Measure | Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer.
EXM146 - Appropriate Testing for Children with Pharyngitis | Percentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode.
EXM55 - Median Emergency Department Visit Duration | This example illustrates a continuous variable measure represented as a FHIR eCQM
Measure Content Bundle - Additional Supplemental Data Example | Example of a Measure illustrating the use of supplemental data elements to gather additional information about a population
MeasureCQMPublishableExample | A measure to demonstrate limitations and trendingIssues extensions.
MeasureReport - Test Case Example | Example of a MeasureReport illustrating a test case
Multi-Rate Example Measure | This measure example illustrates the use of the group-level computation extensions to describe a multi-rate measure with mixed population bases.
Pneumococcal Vaccination Status for Older Adults | This is an example only.
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented | This is an example only.
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | This is an example only.
Preventive Care and Wellness All-Or-Nothing Composite | This artifact is an example of an all-or-nothing composite measure that uses a mixture of single-rate or multi-rate component measures that have different measure bases.
Preventive Care and Wellness Opportunity Composite | This artifact is an example of an opportunity composite measure that uses a mixture of single-rate or multi-rate component measures that have different measure bases.
Preventive Care and Wellness Patient-level Linear Composite | This artifact is an example of a patient-level linear composite measure that uses a mixture of single-rate or multi-rate component measures that have different measure bases.
Preventive Care and Wellness Weighted Composite | This artifact is an example of a weighted composite measure that uses a mixture of single-rate or multi-rate component measures that have different measure bases.
Search Parameter - Library contained parameter name | Example of a search parameter for a parameter name in a library
Search Parameter - Library expansion identifier | Example of a search paramter for an expansion identifier in a library
Search Parameter - Valuset Keyword | Example of a search parameter for a keyword in a value set
Terminology FHIR | This example illustrates the use of terminology within a measure represented as a FHIR eCQM.

### Other

These are resources that are used within this implementation guide that do not fit into one of the other categories.

Input Expansion Parameters | The input expansion parameters resource for this implementation guide, specifying SNOMED Edition and version. This resource will be contained within the published implementation guide with all pinned references.