Quality Measure Implementation Guide
1.0.0 - STU 1

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

## Measure: EXM Measure (Experimental)

Official URL: http://hl7.org/fhir/uv/cqm/Measure/EXMLogic-FHIR | Version: 2.0.0
Standards status: Informative | Computable Name: MeasureEXM
Other Identifiers: http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm#EXM, OID:2.16.840.1.113883.4.642.40.61.29.9
Usage:Clinical Venue: EC
Copyright/Legal: Example Copyright Statement

An example FHIR-based measure

This measure has been developed to support improvement in clinical care.

Metadata
Title | EXM Measure
Version | 2.0.0
Identifier | EXM
Identifier | urn:oid:2.16.840.1.113883.4.642.40.61.29.9
Effective Period | 2018-01-01 + 1 year(s)
Approval Date | 2019-02-17
Last Review Date | 2019-02-17
Experimental | true
Use Context | Clinical Venue = EC
Jurisdiction | Global (Whole world)
Topic | Health Quality Measure Document
Steward (Publisher) | HL7 International / Clinical Quality Information
Developer | Example Measure Content Developer
Description | An example FHIR-based measure
Purpose | This measure has been developed to support improvement in clinical care.
Copyright | Example Copyright Statement
Disclaimer | Example disclaimer
Measure Basis | Encounter
Measure Scoring | Continuous Variable
Measure Scoring Precision | 2
Measure Type | Process
Risk Adjustment | Risk adjustment for this measure is performed by...
Rate Aggregation | Rate aggregation for this measure is performed by...
Rationale | The purpose of this measure is to show how all the elements of a FHIR-based quality measure are represented.
Clinical Recommendation Statement | The clinical recommendation statement for this measure is...
Improvement Notation | Increased score indicates improvement
Guidance (Usage) | Users of this measure should be aware that this is intentionally simplified to show specific aspects of a measure.
Measure Group (Rate) (ID: primary)
Initial Population | ID: primary-exmlogic-initial-population Description: No description provided Criteria: Initial Population
Measure Population | ID: primary-exmlogic-measure-population Description: No description provided Criteria: Measure Population
Measure Observation | ID: primary-exmlogic-measure-observation Description: No description provided Criteria: Measure Observation Input Population: measure-population AggregateMethod: median
Stratifier | ID: stratifier-1 Code: Stratifier 1
Stratifier | ID: stratifier-2 Code: Stratifier 2
Stratifier | ID: stratifier-3 Code: Stratifier 3
Stratifier | ID: stratifier-4 Code: Stratifier 4
Supplemental Data Elements
Supplemental Data Element | ID: sde-ethnicity Usage Code: Supplemental Data Description: No description provided Logic Definition: SDE Ethnicity
Supplemental Data Element | ID: sde-race Usage Code: Supplemental Data Description: No description provided Logic Definition: SDE Race
Supplemental Data Element | ID: sde-payer Usage Code: Supplemental Data Description: No description provided Logic Definition: SDE Payer
Supplemental Data Element | ID: sde-sex Usage Code: Supplemental Data Description: No description provided Logic Definition: SDE Sex
Measure Logic
Primary Library | Example Logic Library
Contents | Population Criteria Logic Definitions Terminology Dependencies Data Requirements
Population Criteria
Measure Group (Rate) (ID: primary)
Initial Population
    define "Initial Population" :
      "Inpatient Encounter" Encounter
Definition
Measure Population
    define "Measure Population" :
      "Initial Population"
Definition
Measure Observation
    define function "Measure Observation" (Encounter "Encounter" ) :
      duration in minutes of "Related ED Visit"(Encounter).period
Definition
Stratifier
    define "Stratifier 1" :
      "Inpatient Encounter" Encounter
        where not (PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient")
Definition
Stratifier
    define "Stratifier 2" :
      "Inpatient Encounter" Encounter
        where PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient"
Definition
Stratifier
    define "Stratifier 3" :
      "Inpatient Encounter" Encounter
        where PrincipalDiagnosis(Encounter) is null
Definition
Stratifier
    define "Stratifier 4" :
      "Inpatient Encounter" Encounter
        where PrincipalDiagnosis(Encounter) is null
Definition
Logic Definitions
Logic Definition | Library Name: EXMLogic
    define "SDE Sex":
      case
        when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }
        when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }
        else null
      end
Logic Definition | Library Name: EXMLogic
    define "Inpatient Encounter" :
      ["Encounter"] Encounter
        where LengthInDays(Encounter.period) <= 120
          and Encounter.period ends during "Measurement Period"
Logic Definition | Library Name: EXMLogic
    define "Stratifier 3" :
      "Inpatient Encounter" Encounter
        where PrincipalDiagnosis(Encounter) is null
Logic Definition | Library Name: EXMLogic
    define "Stratifier 4" :
      "Inpatient Encounter" Encounter
        where PrincipalDiagnosis(Encounter) is null
Logic Definition | Library Name: EXMLogic
    define "SDE Payer":
        [Coverage: type in "Payer"] Payer
          return {
            code: Payer.type,
            period: Payer.period
          }
Logic Definition | Library Name: EXMLogic
    define "Initial Population" :
      "Inpatient Encounter" Encounter
Logic Definition | Library Name: EXMLogic
    define "SDE Ethnicity":
      (flatten (
        Patient.extension Extension
          where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity'
            return Extension.extension
      )) E
        where E.url = 'ombCategory'
          or E.url = 'detailed'
        return E.value as Coding
Logic Definition | Library Name: EXMLogic
    define "SDE Race":
      (flatten (
        Patient.extension Extension
          where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race'
            return Extension.extension
      )) E
        where E.url = 'ombCategory'
          or E.url = 'detailed'
        return E.value as Coding
Logic Definition | Library Name: EXMLogic
    define "Measure Population" :
      "Initial Population"
Logic Definition | Library Name: EXMLogic
    define "Stratifier 1" :
      "Inpatient Encounter" Encounter
        where not (PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient")
Logic Definition | Library Name: EXMLogic
    define "Stratifier 2" :
      "Inpatient Encounter" Encounter
        where PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient"
Logic Definition | Library Name: EXMLogic
    define function "LengthInDays"(Value Interval<DateTime>):
    	difference in days between start of Value and end of Value
Logic Definition | Library Name: EXMLogic
    define function "PrincipalDiagnosis"(Encounter Encounter):
    	(singleton from (Encounter.diagnosis D where D.use ~ ToConcept("Billing") and D.rank.value = 1)) PD
    		return singleton from ([Condition: id in "GetId"(PD.condition.reference)])
Logic Definition | Library Name: EXMLogic
    define function "GetId"(uri String):
    	Last(Split(uri, '/'))
Logic Definition | Library Name: EXMLogic
    define function "Measure Observation" (Encounter "Encounter" ) :
      duration in minutes of "Related ED Visit"(Encounter).period
Logic Definition | Library Name: EXMLogic
    //Measure Observation
    define function "Related ED Visit" (Encounter "Encounter" ) :
      Last(["Encounter" : "Emergency Department Visit"] ED
        where ED.status = 'finished'
          and ED.period ends 1 hour or less before start of Encounter.period
        sort by start of period )
Logic Definition | Library Name: FHIRHelpers
    define function ToString(value AdministrativeGender): value.value
Logic Definition | Library Name: FHIRHelpers
    /*
    @description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
    value to a CQL DateTime Interval
    @comment: If the start value of the given period is unspecified, the starting
    boundary of the resulting interval will be open (meaning the start of the interval
    is unknown, as opposed to interpreted as the beginning of time).
    */
    define function ToInterval(period FHIR.Period):
        if period is null then
            null
        else
            if period."start" is null then
                Interval(period."start".value, period."end".value]
            else
                Interval[period."start".value, period."end".value]
Logic Definition | Library Name: FHIRHelpers
    /*
    @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
    */
    define function ToConcept(concept FHIR.CodeableConcept):
        if concept is null then
            null
        else
            System.Concept {
                codes: concept.coding C return ToCode(C),
                display: concept.text.value
            }
Logic Definition | Library Name: FHIRHelpers
    /*
    @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
    */
    define function ToCode(coding FHIR.Coding):
        if coding is null then
            null
        else
            System.Code {
              code: coding.code.value,
              system: coding.system.value,
              version: coding.version.value,
              display: coding.display.value
            }
Logic Definition | Library Name: FHIRHelpers
    define function ToString(value string): value.value
Logic Definition | Library Name: FHIRHelpers
    define function ToString(value uri): value.value
Logic Definition | Library Name: FHIRHelpers
    define function ToString(value EncounterStatus): value.value
Terminology
Code System | Description: Code system Diagnosis Role Resource: Diagnosis Role Canonical URL: `http://terminology.hl7.org/CodeSystem/diagnosis-role`
Value Set | Description: Value set Payer Resource: Payer Type Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591`
Value Set | Description: Value set Emergency Department Visit Resource: Emergency Department Visit Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292`
Value Set | Description: Value set Psychiatric/Mental Health Patient Resource: Psychiatric/Mental Health Diagnosis Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.299`
Direct Reference Code | Display: Billing Code: billing System: `http://terminology.hl7.org/CodeSystem/diagnosis-role`
Dependencies
Dependency | Description: Library FHIRHelpers Resource: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1 Canonical URL: `http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1`
Data Requirements
Data Requirement | Type: Patient Profile(s): Patient Must Support Elements: url, extension, value
Data Requirement | Type: Encounter Profile(s): Encounter Must Support Elements: type, status, period, use, rank, rank.value, condition, condition.reference Code Filter(s): Path: type ValueSet: Emergency Department Visit
Data Requirement | Type: Encounter Profile(s): Encounter Must Support Elements: period, use, rank, rank.value, condition, condition.reference
Data Requirement | Type: Condition Profile(s): Condition Must Support Elements: id Code Filter(s): Path: id
Data Requirement | Type: Coverage Profile(s): Coverage Must Support Elements: type, period Code Filter(s): Path: type ValueSet: Payer Type
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