Data Exchange For Quality Measures STU3 for FHIR R4
3.0.0 - STU 3

This page is part of the Da Vinci Data Exchange for Quality Measures (DEQM) FHIR IG (v3.0.0: STU 3) based on FHIR R4. The current version which supercedes this version is 3.1.0. For a full list of available versions, see the Directory of published versions

Venous Thromboembolism Prophylaxis (VTE-1)

Introduction

The VTE-1 measure assesses the number of patients who received venous thromboembolism (VTE) prophylaxis or have documentation why no venous thromboembolism 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. Note that the Individual Measure Reporting Interaction is the only interaction used for this measure.

The example presented is based on the QDM version of CMS 108v7, which has been represented using profiles derived from QI Core. Additional information regarding the measure specification can be found in the Quality Measure Implementation Guide

FHIR Resource Overview

Resources supported for this Use Case

Resource Type Profile Name Link to Profile
Condition QI Core Condition Profile QI Core Condition
Coverage QI Core Coverage Profile QI Core Coverage
DeviceRequest QI Core DeviceRequest Profile QI Core DeviceRequest
DeviceUseStatement QI Core DeviceUseStatement Profile QI Core DeviceUseStatement
Encounter QI Core Encounter Profile QI Core Encounter
Library CQFM Library Profile CQFM Library
Location QI Core Location Profile QI Core Location
Measure CQFM Measure Profile CQFM Measure
MeasureReport DEQM Individual MeasureReport Profile DEQM Individual MeasureReport Profile
MeasureReport DEQM Summary MeasureReport Profile DEQM Summary MeasureReport Profile
MedicationAdministration DEQM MedicationAdministration Profile DEQM MedicationAdministration
MedicationRequest Qi Core Medication Not Requested QICoreMedicationNotRequested
Observation QI Core Observation Profile QI Core Observation
Organization DEQM Organization Profile DEQM Organization
Patient QI Core Patient Profile QI Core Patient
Practitioner DEQM Practitioner Profile DEQM Practitioner
Procedure QI Core Procedure Profile QI Core Procedure
ServiceRequest QI Core ServiceRequest Profile QI Core ServiceRequest

Graph of VTE-1 Resources

In this section we list resource graph diagrams for 7 clinical scenarios that meet the VTE-1 measure. Note that overlapping boxes in the diagrams represents a choice of one the resources.

Option 1: Measure Report Using MedicationAdministration

VTE-1 has been met when a patient:

  1. has an inpatient encounter such as for a joint replacement procedure
  2. is not pregnant or currently diagnosed with a venous thromboembolism
  3. is administered either Heparin, a Factor Xa Inhibitor, or Warfarin on the calendar day of admission or the day after.

The medications that qualify for the measure are listed in the value sets of codes in the measure documentation. The following resource graph diagram shows what would be included with a DEQM Individual MeasureReport when the patient has been administered one of these medications to meet the measure.

Figure 3-14 MeasureReport Using MedicationAdministration and Condition
DEQM Resource Diagram - VTE1.jpg

Option 2: Measure Report Using DeviceUseStatement and Encounter

VTE-1 has been met when a patient:

  1. has an inpatient encounter such as for a joint replacement procedure
  2. is not pregnant or currently diagnosed with a venous thromboembolism
  3. has a device to prevent venous thromboembolism prophylaxis on the calendar day of admission or the day after.

The devices that qualify for the measure are listed in the value sets of codes in the measure documentation. The following resource graph diagram shows what would be included with a DEQM Individual MeasureReport when the patient has had one of these Devices applied to meet the measure.

Figure 3-15 MeasureReport Using DeviceUseStatement and Encounter
DEQM Resource Diagram - VTE2.jpg

Option 3: Measure Report Using Observation

VTE-1 has been met when a patient:

  1. has an inpatient encounter such as for a joint replacement procedure
  2. is not pregnant or currently diagnosed with a venous thromboembolism
  3. and has been assessed to have a low risk for venous thromboembolism prophylaxis typically through laboratory testing, on the calendar day of admission or the day after.

The result codes that qualify as “low risk for VTE” are listed in the value sets of codes in the measure documentation. The following resource graph diagram shows what would be included with a DEQM Individual MeasureReport when the patient has had this Observation made to meet the measure.

Figure 3-16 MeasureReport Using Observation
DEQM Resource Diagram - VTE3.jpg

Option 4: Measure Report Using Encounter

When a patient has an inpatient encounter where the encounter is <2 days long, or when the encounter includes an ICU stay of 1 or more days, the patient can be can be excluded from the denominator of the measure. Codes for the ICU facility location will come from the HL7 ServiceDeliveryLocationRoleType valueset. The following resource graph diagram shows what would be included with a DEQM Individual MeasureReport when the patient when the patient has these types of encounters.

Figure 3-17 MeasureReport Using Encounter
DEQM Resource Diagram - VTE4.jpg

Option 5: Measure Report Using Encounter and Principal Diagnosis

When a patient has an inpatient encounter and is principally diagnosed with either a mental health condition, or a stroke (either hemorrhagic or ischemic), they are excluded from the denominator of the measure. Codes for the diagnoses will come from the respective valuesets from the measure. The following resource graph diagram shows what would be included with a DEQM Individual MeasureReport when the patient has had this Encounter with these principal diagnosis.

Figure 3-18 MeasureReport Using Encounter with Principal Diagnosis
DEQM Resource Diagram - VTE5.jpg

Option 6: Measure Report Using Procedure/ServiceRequest and Encounter

When a patient has an inpatient encounter, during which they are provided Comfort Measures within 1 day of being admitted or 1 day of a surgical procedure for which they were admitted, these Comfort Measures are excluded from the denominator of the measure. for the measure. The surgical procedure is defined by the presence of a code from the “general or neuraxial anesthesia” value set present in the measure. The Comfort measures are represented by either a Procedure or a ServiceRequest with a code from the “Comfort Measures” value set present in the measure. The following resource graph diagram shows what would be included with a DEQM Individual MeasureReport when the patient has had intervention comfort measures.

Figure 3-19 MeasureReport Using Procedure/ServiceRequest and Encounter
DEQM Resource Diagram - VTE6.jpg

Option 7: Measure Report Using MedicationRequest, DeviceRequest, MedicationStatement or DeviceUseStatement

When a patient has an inpatient encounter, during which they should be given venous thromboembolism prophylaxis, but they are not given said prophylaxis, the patient’s record must document a reason the medication/device was not provided. This reason must be coded, and must come from either the “medical reason” or “patient refusal” value sets, as stated in the measure logic. If these criteria are met, the patient will have been found to satisfy the requirements of the measure. The following resource graph diagram shows what would be included with a DEQM Individual MeasureReport to meet the measure when the venous thromboembolism prophylaxis was not done, for example because of patient refusal.

Figure 3-20 MeasureReport Using MedicationRequest, DeviceRequest, MedicationStatement or DeviceUseStatement
DEQM Resource Diagram - VTE7.jpg

VTE-1 Measure Reporting Interactions

Individual MeasureReport

Reporter pushes the Bundle of supporting resource with VTE-1 Individual MeasureReport Bundle to the end user.

Figure 3-21 Individual Reporting Technical Workflow
vte_indv_report.jpg

Examples

Scenario Option 1:

Payer X who is acting in the role of a Reporter submits a VTE Individual Report for Patient P to Receiver Z. The body of the request is a transaction bundle including the Individual MeasureReport and all the related resources containing the relevant data used to compute the CQM criteria based on option 1 described above. An HTTP Status success code and a transaction-response Bundle is returned on successful submission.

POST Summary Report

POST [base]

Request body

{
  "resourceType": "Bundle",
  "id": "single-indv-vte-report-option1",
  "meta": {
    "source": "http://example.org/fhir/server"
  },
  "type": "transaction",
  "entry": [
    {
      "fullUrl": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc4",
      "resource": {
        "resourceType": "MeasureReport",
        "id": "b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc4",
        "meta": {
          "source": "http://example.org/fhir/server",
          "profile": [
            "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/indv-measurereport-deqm"
          ]
        },
        "text": {
          "status": "extensions",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>DEQM Measure Scoring Extension</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-scoring proportion}\">Proportion</span></p><p><b>status</b>: complete</p><p><b>type</b>: individual</p><p><b>measure</b>: <a href=\"http://hl7.org/fhir/us/cqfmeasures/Measure/measure-vte-1-FHIR\">http://hl7.org/fhir/us/cqfmeasures/Measure/measure-vte-1-FHIR</a></p><p><b>subject</b>: <a href=\"#urnuuidb5cf5a8c-63f0-437f-84fd-dc8a3cf43cc6\">See above (Patient/null)</a></p><p><b>date</b>: 2019-03-14</p><p><b>reporter</b>: <a href=\"#urnuuidb5cf5a8c-63f0-437f-84fd-dc8a3cf43cc5\">See above (Organization/null)</a></p><p><b>period</b>: 2018-12-31 --&gt; 2019-01-01</p><p><b>improvementNotation</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-improvement-notation increase}\">Increased score indicates improvement</span></p><blockquote><p><b>group</b></p><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-population initial-population}\">Initial Population</span></p><p><b>count</b>: 1</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-population numerator}\">Numerator</span></p><p><b>count</b>: 1</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-population denominator}\">Denominator</span></p><p><b>count</b>: 1</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-population denominator-exclusion}\">Denominator Exclusion</span></p><p><b>count</b>: 0</p></blockquote><p><b>measureScore</b>: 1</p></blockquote></div>"
        },
        "extension": [
          {
            "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring",
            "valueCodeableConcept": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
                  "code": "proportion"
                }
              ]
            }
          }
        ],
        "status": "complete",
        "type": "individual",
        "measure": "http://hl7.org/fhir/us/cqfmeasures/Measure/measure-vte-1-FHIR",
        "subject": {
          "reference": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc6"
        },
        "date": "2019-03-14",
        "reporter": {
          "reference": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc5"
        },
        "period": {
          "start": "2018-12-31",
          "end": "2019-01-01"
        },
        "improvementNotation": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
              "code": "increase",
              "display": "Increased score indicates improvement"
            }
          ]
        },
        "group": [
          {
            "population": [
              {
                "code": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                      "code": "initial-population",
                      "display": "Initial Population"
                    }
                  ]
                },
                "count": 1
              },
              {
                "code": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                      "code": "numerator",
                      "display": "Numerator"
                    }
                  ]
                },
                "count": 1
              },
              {
                "code": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                      "code": "denominator",
                      "display": "Denominator"
                    }
                  ]
                },
                "count": 1
              },
              {
                "code": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                      "code": "denominator-exclusion",
                      "display": "Denominator Exclusion"
                    }
                  ]
                },
                "count": 0
              }
            ],
            "measureScore": {
              "value": 1
            }
          }
        ]
      },
      "request": {
        "method": "POST",
        "url": "MeasureReport"
      }
    },
    {
      "fullUrl": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc5",
      "resource": {
        "resourceType": "Organization",
        "meta": {
          "source": "http://example.org/fhir/server",
          "profile": [
            "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/organization-deqm"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>identifier</b>: Tax ID number: 123456789 (OFFICIAL)</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/organization-type prov}\">Healthcare Provider</span></p><p><b>name</b>: DaVinciHospital01</p><p><b>telecom</b>: ph: (+1) 401-555-1212</p><p><b>address</b>: 73 Lakewood Street Warwick RI 02886 USA </p></div>"
        },
        "identifier": [
          {
            "use": "official",
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code": "TAX",
                  "display": "Tax ID number"
                }
              ]
            },
            "system": "urn:oid:2.16.840.1.113883.4.4",
            "value": "123456789",
            "assigner": {
              "display": "www.irs.gov"
            }
          }
        ],
        "active": true,
        "type": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/organization-type",
                "code": "prov",
                "display": "Healthcare Provider"
              }
            ]
          }
        ],
        "name": "DaVinciHospital01",
        "telecom": [
          {
            "system": "phone",
            "value": "(+1) 401-555-1212"
          }
        ],
        "address": [
          {
            "line": [
              "73 Lakewood Street"
            ],
            "city": "Warwick",
            "state": "RI",
            "postalCode": "02886",
            "country": "USA"
          }
        ]
      },
      "request": {
        "method": "POST",
        "url": "Organization"
      }
    },
    {
      "fullUrl": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc6",
      "resource": {
        "resourceType": "Patient",
        "meta": {
          "source": "http://example.org/fhir/server",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ]
        },
        "text": {
          "status": "extensions",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>US Core Birth Sex Extension</b>: F</p><blockquote><p><b>US Core Race Extension</b></p><p><b>value</b>: <span title=\"{urn:oid:2.16.840.1.113883.6.238 2106-3}\">White</span></p><p><b>value</b>: White</p></blockquote><blockquote><p><b>US Core Ethnicity Extension</b></p><p><b>value</b>: <span title=\"{urn:oid:2.16.840.1.113883.6.238 2186-5}\">Not Hispanic or Latino</span></p><p><b>value</b>: Not Hispanic or Latino</p></blockquote><p><b>identifier</b>: Medical record number: 67890 (USUAL)</p><p><b>active</b>: true</p><p><b>name</b>: Thelma Webster (OFFICIAL)</p><p><b>gender</b>: female</p><p><b>birthDate</b>: 1948-04-28</p><p><b>deceased</b>: false</p><p><b>address</b>: 7496 Beaver Ridge Ave Thornton NJ 07003 USA (HOME)</p><p><b>maritalStatus</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-MaritalStatus M}\">Married</span></p><h3>Communications</h3><table class=\"grid\"><tr><td>-</td><td><b>Language</b></td><td><b>Preferred</b></td></tr><tr><td>*</td><td><span title=\"Codes: {urn:ietf:bcp:47 en-US}\">English (Region=United States)</span></td><td>true</td></tr></table></div>"
        },
        "extension": [
          {
            "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
            "valueCode": "F"
          },
          {
            "extension": [
              {
                "url": "ombCategory",
                "valueCoding": {
                  "system": "urn:oid:2.16.840.1.113883.6.238",
                  "code": "2106-3",
                  "display": "White"
                }
              },
              {
                "url": "text",
                "valueString": "White"
              }
            ],
            "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race"
          },
          {
            "extension": [
              {
                "url": "ombCategory",
                "valueCoding": {
                  "system": "urn:oid:2.16.840.1.113883.6.238",
                  "code": "2186-5",
                  "display": "Not Hispanic or Latino"
                }
              },
              {
                "url": "text",
                "valueString": "Not Hispanic or Latino"
              }
            ],
            "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity"
          }
        ],
        "identifier": [
          {
            "use": "usual",
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code": "MR",
                  "display": "Medical record number"
                }
              ]
            },
            "system": "http://hospital.davinci.org",
            "value": "67890"
          }
        ],
        "active": true,
        "name": [
          {
            "use": "official",
            "family": "Webster",
            "given": [
              "Thelma"
            ]
          }
        ],
        "gender": "female",
        "birthDate": "1948-04-28",
        "deceasedBoolean": false,
        "address": [
          {
            "use": "home",
            "line": [
              "7496 Beaver Ridge Ave"
            ],
            "city": "Thornton",
            "state": "NJ",
            "postalCode": "07003",
            "country": "USA"
          }
        ],
        "maritalStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
              "code": "M",
              "display": "Married"
            }
          ]
        },
        "communication": [
          {
            "language": {
              "coding": [
                {
                  "system": "urn:ietf:bcp:47",
                  "code": "en-US",
                  "display": "English (Region=United States)"
                }
              ]
            },
            "preferred": true
          }
        ]
      },
      "request": {
        "method": "POST",
        "url": "Patient"
      }
    },
    {
      "fullUrl": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc7",
      "resource": {
        "resourceType": "Encounter",
        "meta": {
          "source": "http://example.org/fhir/server",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>status</b>: finished</p><p><b>class</b>: <span title=\"{http://terminology.hl7.org/CodeSystem/v3-ActCode IMP}\">inpatient encounter</span></p><p><b>type</b>: <span title=\"Codes: {http://snomed.info/sct 32485007}\">Hospital admission</span></p><p><b>subject</b>: <a href=\"#urnuuidb5cf5a8c-63f0-437f-84fd-dc8a3cf43cc6\">See above (Patient/null)</a></p><p><b>period</b>: Jul 19, 2018 6:10:27 AM --&gt; Jul 19, 2018 6:10:27 AM</p><h3>Locations</h3><table class=\"grid\"><tr><td>-</td><td><b>Location</b></td></tr><tr><td>*</td><td><a href=\"#urnuuidb5cf5a8c-63f0-437f-84fd-dc8a3cf43cc8\">Mother Charity Hospital. Generated Summary: id: 1.2.3.4.181 (OFFICIAL); status: active; name: Mother Charity Hospital; mode: instance; Phone: (313) 555-5671; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/location-physical-type bu}\">Building</span></a></td></tr></table></div>"
        },
        "status": "finished",
        "class": {
          "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "code": "IMP",
          "display": "inpatient encounter"
        },
        "type": [
          {
            "coding": [
              {
                "system": "http://snomed.info/sct",
                "code": "32485007",
                "display": "Hospital admission"
              }
            ]
          }
        ],
        "subject": {
          "reference": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc6"
        },
        "period": {
          "start": "2018-07-19T06:10:27Z",
          "end": "2018-07-19T06:10:27Z"
        },
        "location": [
          {
            "location": {
              "reference": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc8",
              "display": "Mother Charity Hospital"
            }
          }
        ]
      },
      "request": {
        "method": "POST",
        "url": "Encounter"
      }
    },
    {
      "fullUrl": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc8",
      "resource": {
        "resourceType": "Location",
        "meta": {
          "source": "http://example.org/fhir/server"
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>identifier</b>: id: 1.2.3.4.181 (OFFICIAL)</p><p><b>status</b>: active</p><p><b>name</b>: Mother Charity Hospital</p><p><b>mode</b>: instance</p><p><b>telecom</b>: ph: (313) 555-5671(WORK)</p><p><b>address</b>: 869 W Oak Street Royal Oak MI 48073 (WORK)</p><p><b>physicalType</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/location-physical-type bu}\">Building</span></p></div>"
        },
        "identifier": [
          {
            "use": "official",
            "system": "http://www.hl7.org/oid/",
            "value": "1.2.3.4.181"
          }
        ],
        "status": "active",
        "name": "Mother Charity Hospital",
        "mode": "instance",
        "telecom": [
          {
            "system": "phone",
            "value": "(313) 555-5671",
            "use": "work"
          }
        ],
        "address": {
          "use": "work",
          "type": "physical",
          "line": [
            "869 W Oak Street"
          ],
          "city": "Royal Oak",
          "district": "Oakland County",
          "state": "MI",
          "postalCode": "48073"
        },
        "physicalType": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/location-physical-type",
              "code": "bu",
              "display": "Building"
            }
          ]
        }
      },
      "request": {
        "method": "POST",
        "url": "Location"
      }
    },
    {
      "fullUrl": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc9",
      "resource": {
        "resourceType": "MedicationAdministration",
        "meta": {
          "source": "http://example.org/fhir/server",
          "profile": [
            "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/medicationadministration-deqm"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>status</b>: completed</p><p><b>medication</b>: <span title=\"Codes: {http://www.nlm.nih.gov/research/umls/rxnorm 1658634}\">heparin sodium, porcine 5000 UNT per 0.5 ML Injection</span></p><p><b>subject</b>: <a href=\"#urnuuidb5cf5a8c-63f0-437f-84fd-dc8a3cf43cc6\">See above (Patient/null)</a></p><p><b>effective</b>: Dec 5, 2019 6:10:27 AM --&gt; Dec 5, 2019 6:10:27 AM</p><h3>Dosages</h3><table class=\"grid\"><tr><td>-</td><td><b>Route</b></td><td><b>Dose</b></td></tr><tr><td>*</td><td><span title=\"Codes: {http://snomed.info/sct 34206005}\">Subcutaneous route</span></td><td>1 cc</td></tr></table></div>"
        },
        "status": "completed",
        "medicationCodeableConcept": {
          "coding": [
            {
              "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
              "code": "1658634",
              "display": "heparin sodium, porcine 5000 UNT per 0.5 ML Injection"
            }
          ]
        },
        "subject": {
          "reference": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc6"
        },
        "effectivePeriod": {
          "start": "2019-12-05T06:10:27Z",
          "end": "2019-12-05T06:10:27Z"
        },
        "dosage": {
          "route": {
            "coding": [
              {
                "system": "http://snomed.info/sct",
                "code": "34206005",
                "display": "Subcutaneous route"
              }
            ]
          },
          "dose": {
            "value": 1,
            "unit": "cc",
            "system": "http://unitsofmeasure.org",
            "code": "mL"
          }
        }
      },
      "request": {
        "method": "POST",
        "url": "MedicationAdministration"
      }
    }
  ]
}

Response

HTTP/1.1 200 OK
[other headers]

{
"resourceType": "Bundle",
"id": "e9c72d75-2410-45f3-b1cf-eb73d04d3300",
"type": "transaction-response",
"link": [
{
"relation": "self",
"url": "http://hapi.fhir.org/baseR4"
}
],
"entry": [
{
"response": {
"status": "201 Created",
"location": "MeasureReport/223260/_history/1",
"etag": "1",
"lastModified": "2019-12-06T09:11:27.308+00:00"
}
},
{
"response": {
"status": "201 Created",
"location": "Organization/223261/_history/1",
"etag": "1",
"lastModified": "2019-12-06T09:11:27.308+00:00"
}
},
{
"response": {
"status": "201 Created",
"location": "Patient/223262/_history/1",
"etag": "1",
"lastModified": "2019-12-06T09:11:27.308+00:00"
}
},
{
"response": {
"status": "201 Created",
"location": "Encounter/223263/_history/1",
"etag": "1",
"lastModified": "2019-12-06T09:11:27.308+00:00"
}
},
{
"response": {
"status": "201 Created",
"location": "Location/223264/_history/1",
"etag": "1",
"lastModified": "2019-12-06T09:11:27.308+00:00"
}
},
{
"response": {
"status": "201 Created",
"location": "MedicationAdministration/223265/_history/1",
"etag": "1",
"lastModified": "2019-12-06T09:11:27.308+00:00"
}
}
]
}

Scenario Option 7:

Payer X who is acting in the role of a Reporter submits a VTE Individual Report for Patient P to Receiver Z. The body of the request is a transaction bundle including the Individual MeasureReport and all the related resources containing the relevant data used to compute the CQM criteria based on option 7 described above. An HTTP Status success code and a transaction-response Bundle is returned on successful submission.

POST Summary Report

POST [base]

Request body

{
  "resourceType": "Bundle",
  "id": "single-indv-vte-report-option7",
  "meta": {
    "source": "http://example.org/fhir/server"
  },
  "type": "transaction",
  "entry": [
    {
      "fullUrl": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc4",
      "resource": {
        "resourceType": "MeasureReport",
        "id": "b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc4",
        "meta": {
          "source": "http://example.org/fhir/server",
          "profile": [
            "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/indv-measurereport-deqm"
          ]
        },
        "text": {
          "status": "extensions",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>DEQM Measure Scoring Extension</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-scoring proportion}\">Proportion</span></p><p><b>status</b>: complete</p><p><b>type</b>: individual</p><p><b>measure</b>: <a href=\"http://hl7.org/fhir/us/cqfmeasures/Measure/measure-vte-1-FHIR\">http://hl7.org/fhir/us/cqfmeasures/Measure/measure-vte-1-FHIR</a></p><p><b>subject</b>: <a href=\"#urnuuidb5cf5a8c-63f0-437f-84fd-dc8a3cf43cc6\">See above (Patient/null)</a></p><p><b>date</b>: 2019-03-14</p><p><b>reporter</b>: <a href=\"#urnuuidb5cf5a8c-63f0-437f-84fd-dc8a3cf43cc5\">See above (Organization/null)</a></p><p><b>period</b>: 2018-12-31 --&gt; 2019-01-01</p><p><b>improvementNotation</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-improvement-notation increase}\">Increased score indicates improvement</span></p><blockquote><p><b>group</b></p><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-population initial-population}\">Initial Population</span></p><p><b>count</b>: 1</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-population numerator}\">Numerator</span></p><p><b>count</b>: 1</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-population denominator}\">Denominator</span></p><p><b>count</b>: 1</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-population denominator-exclusion}\">Denominator Exclusion</span></p><p><b>count</b>: 0</p></blockquote><p><b>measureScore</b>: 1</p></blockquote></div>"
        },
        "extension": [
          {
            "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring",
            "valueCodeableConcept": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
                  "code": "proportion"
                }
              ]
            }
          }
        ],
        "status": "complete",
        "type": "individual",
        "measure": "http://hl7.org/fhir/us/cqfmeasures/Measure/measure-vte-1-FHIR",
        "subject": {
          "reference": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc6"
        },
        "date": "2019-03-14",
        "reporter": {
          "reference": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc5"
        },
        "period": {
          "start": "2018-12-31",
          "end": "2019-01-01"
        },
        "improvementNotation": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
              "code": "increase",
              "display": "Increased score indicates improvement"
            }
          ]
        },
        "group": [
          {
            "population": [
              {
                "code": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                      "code": "initial-population",
                      "display": "Initial Population"
                    }
                  ]
                },
                "count": 1
              },
              {
                "code": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                      "code": "numerator",
                      "display": "Numerator"
                    }
                  ]
                },
                "count": 1
              },
              {
                "code": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                      "code": "denominator",
                      "display": "Denominator"
                    }
                  ]
                },
                "count": 1
              },
              {
                "code": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                      "code": "denominator-exclusion",
                      "display": "Denominator Exclusion"
                    }
                  ]
                },
                "count": 0
              }
            ],
            "measureScore": {
              "value": 1
            }
          }
        ]
      },
      "request": {
        "method": "POST",
        "url": "MeasureReport"
      }
    },
    {
      "fullUrl": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc5",
      "resource": {
        "resourceType": "Organization",
        "meta": {
          "source": "http://example.org/fhir/server",
          "profile": [
            "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/organization-deqm"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>identifier</b>: Tax ID number: 123456789 (OFFICIAL)</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/organization-type prov}\">Healthcare Provider</span></p><p><b>name</b>: DaVinciHospital01</p><p><b>telecom</b>: ph: (+1) 401-555-1212</p><p><b>address</b>: 73 Lakewood Street Warwick RI 02886 USA </p></div>"
        },
        "identifier": [
          {
            "use": "official",
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code": "TAX",
                  "display": "Tax ID number"
                }
              ]
            },
            "system": "urn:oid:2.16.840.1.113883.4.4",
            "value": "123456789",
            "assigner": {
              "display": "www.irs.gov"
            }
          }
        ],
        "active": true,
        "type": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/organization-type",
                "code": "prov",
                "display": "Healthcare Provider"
              }
            ]
          }
        ],
        "name": "DaVinciHospital01",
        "telecom": [
          {
            "system": "phone",
            "value": "(+1) 401-555-1212"
          }
        ],
        "address": [
          {
            "line": [
              "73 Lakewood Street"
            ],
            "city": "Warwick",
            "state": "RI",
            "postalCode": "02886",
            "country": "USA"
          }
        ]
      },
      "request": {
        "method": "POST",
        "url": "Organization"
      }
    },
    {
      "fullUrl": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc6",
      "resource": {
        "resourceType": "Patient",
        "meta": {
          "source": "http://example.org/fhir/server",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ]
        },
        "text": {
          "status": "extensions",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>US Core Birth Sex Extension</b>: F</p><blockquote><p><b>US Core Race Extension</b></p><p><b>value</b>: <span title=\"{urn:oid:2.16.840.1.113883.6.238 2106-3}\">White</span></p><p><b>value</b>: White</p></blockquote><blockquote><p><b>US Core Ethnicity Extension</b></p><p><b>value</b>: <span title=\"{urn:oid:2.16.840.1.113883.6.238 2186-5}\">Not Hispanic or Latino</span></p><p><b>value</b>: Not Hispanic or Latino</p></blockquote><p><b>identifier</b>: Medical record number: 67890 (USUAL)</p><p><b>active</b>: true</p><p><b>name</b>: Thelma Webster (OFFICIAL)</p><p><b>gender</b>: female</p><p><b>birthDate</b>: 1948-04-28</p><p><b>deceased</b>: false</p><p><b>address</b>: 7496 Beaver Ridge Ave Thornton NJ 07003 USA (HOME)</p><p><b>maritalStatus</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-MaritalStatus M}\">Married</span></p><h3>Communications</h3><table class=\"grid\"><tr><td>-</td><td><b>Language</b></td><td><b>Preferred</b></td></tr><tr><td>*</td><td><span title=\"Codes: {urn:ietf:bcp:47 en-US}\">English (Region=United States)</span></td><td>true</td></tr></table></div>"
        },
        "extension": [
          {
            "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
            "valueCode": "F"
          },
          {
            "extension": [
              {
                "url": "ombCategory",
                "valueCoding": {
                  "system": "urn:oid:2.16.840.1.113883.6.238",
                  "code": "2106-3",
                  "display": "White"
                }
              },
              {
                "url": "text",
                "valueString": "White"
              }
            ],
            "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race"
          },
          {
            "extension": [
              {
                "url": "ombCategory",
                "valueCoding": {
                  "system": "urn:oid:2.16.840.1.113883.6.238",
                  "code": "2186-5",
                  "display": "Not Hispanic or Latino"
                }
              },
              {
                "url": "text",
                "valueString": "Not Hispanic or Latino"
              }
            ],
            "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity"
          }
        ],
        "identifier": [
          {
            "use": "usual",
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code": "MR",
                  "display": "Medical record number"
                }
              ]
            },
            "system": "http://hospital.davinci.org",
            "value": "67890"
          }
        ],
        "active": true,
        "name": [
          {
            "use": "official",
            "family": "Webster",
            "given": [
              "Thelma"
            ]
          }
        ],
        "gender": "female",
        "birthDate": "1948-04-28",
        "deceasedBoolean": false,
        "address": [
          {
            "use": "home",
            "line": [
              "7496 Beaver Ridge Ave"
            ],
            "city": "Thornton",
            "state": "NJ",
            "postalCode": "07003",
            "country": "USA"
          }
        ],
        "maritalStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
              "code": "M",
              "display": "Married"
            }
          ]
        },
        "communication": [
          {
            "language": {
              "coding": [
                {
                  "system": "urn:ietf:bcp:47",
                  "code": "en-US",
                  "display": "English (Region=United States)"
                }
              ]
            },
            "preferred": true
          }
        ]
      },
      "request": {
        "method": "POST",
        "url": "Patient"
      }
    },
    {
      "fullUrl": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc7",
      "resource": {
        "resourceType": "Encounter",
        "meta": {
          "source": "http://example.org/fhir/server",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>status</b>: finished</p><p><b>class</b>: <span title=\"{http://terminology.hl7.org/CodeSystem/v3-ActCode IMP}\">inpatient encounter</span></p><p><b>type</b>: <span title=\"Codes: {http://snomed.info/sct 32485007}\">Hospital admission</span></p><p><b>subject</b>: <a href=\"#urnuuidb5cf5a8c-63f0-437f-84fd-dc8a3cf43cc6\">See above (Patient/null)</a></p><p><b>period</b>: Jul 19, 2018 6:10:27 AM --&gt; Jul 19, 2018 6:10:27 AM</p><h3>Locations</h3><table class=\"grid\"><tr><td>-</td><td><b>Location</b></td></tr><tr><td>*</td><td><a href=\"#urnuuidb5cf5a8c-63f0-437f-84fd-dc8a3cf43cc8\">Mother Charity Hospital. Generated Summary: id: 1.2.3.4.181 (OFFICIAL); status: active; name: Mother Charity Hospital; mode: instance; Phone: (313) 555-5671; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/location-physical-type bu}\">Building</span></a></td></tr></table></div>"
        },
        "status": "finished",
        "class": {
          "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "code": "IMP",
          "display": "inpatient encounter"
        },
        "type": [
          {
            "coding": [
              {
                "system": "http://snomed.info/sct",
                "code": "32485007",
                "display": "Hospital admission"
              }
            ]
          }
        ],
        "subject": {
          "reference": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc6"
        },
        "period": {
          "start": "2018-07-19T06:10:27Z",
          "end": "2018-07-19T06:10:27Z"
        },
        "location": [
          {
            "location": {
              "reference": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc8",
              "display": "Mother Charity Hospital"
            }
          }
        ]
      },
      "request": {
        "method": "POST",
        "url": "Encounter"
      }
    },
    {
      "fullUrl": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc8",
      "resource": {
        "resourceType": "Location",
        "meta": {
          "source": "http://example.org/fhir/server"
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>identifier</b>: id: 1.2.3.4.181 (OFFICIAL)</p><p><b>status</b>: active</p><p><b>name</b>: Mother Charity Hospital</p><p><b>mode</b>: instance</p><p><b>telecom</b>: ph: (313) 555-5671(WORK)</p><p><b>address</b>: 869 W Oak Street Royal Oak MI 48073 (WORK)</p><p><b>physicalType</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/location-physical-type bu}\">Building</span></p></div>"
        },
        "identifier": [
          {
            "use": "official",
            "system": "http://www.hl7.org/oid/",
            "value": "1.2.3.4.181"
          }
        ],
        "status": "active",
        "name": "Mother Charity Hospital",
        "mode": "instance",
        "telecom": [
          {
            "system": "phone",
            "value": "(313) 555-5671",
            "use": "work"
          }
        ],
        "address": {
          "use": "work",
          "type": "physical",
          "line": [
            "869 W Oak Street"
          ],
          "city": "Royal Oak",
          "district": "Oakland County",
          "state": "MI",
          "postalCode": "48073"
        },
        "physicalType": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/location-physical-type",
              "code": "bu",
              "display": "Building"
            }
          ]
        }
      },
      "request": {
        "method": "POST",
        "url": "Location"
      }
    },
    {
      "fullUrl": "urn:uuid:b539747a-ca48-11ea-87d0-0242ac130003",
      "resource": {
        "resourceType": "Practitioner",
        "meta": {
          "source": "http://example.org/fhir/server",
          "profile": [
            "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/practitioner-deqm"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>identifier</b>: Provider number: 345678912 (OFFICIAL), Provider number: 082583 (SECONDARY)</p><p><b>name</b>: Ronald Bone </p><p><b>address</b>: 1003 Healthcare Drive Amherst MA 01002 (HOME)</p></div>"
        },
        "identifier": [
          {
            "use": "official",
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code": "PRN",
                  "display": "Provider number"
                }
              ]
            },
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "345678912",
            "assigner": {
              "display": "www.cms.gov"
            }
          },
          {
            "use": "secondary",
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code": "PRN",
                  "display": "Provider number"
                }
              ]
            },
            "system": "urn:oid:2.16.840.1.113883.4.336",
            "value": "082583",
            "assigner": {
              "display": "www.cms.gov"
            }
          }
        ],
        "name": [
          {
            "family": "Bone",
            "given": [
              "Ronald"
            ],
            "prefix": [
              "Dr"
            ]
          }
        ],
        "address": [
          {
            "use": "home",
            "line": [
              "1003 Healthcare Drive"
            ],
            "city": "Amherst",
            "state": "MA",
            "postalCode": "01002"
          }
        ]
      },
      "request": {
        "method": "POST",
        "url": "Practitioner"
      }
    },
    {
      "fullUrl": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc9",
      "resource": {
        "resourceType": "MedicationRequest",
        "meta": {
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationnotrequested"
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>status</b>: completed</p><p><b>intent</b>: order</p><p><b>doNotPerform</b>: true</p><p><b>medication</b>: <span title=\"Codes: \">Warfarin Value Set</span></p><p><b>subject</b>: <a href=\"#urnuuidb5cf5a8c-63f0-437f-84fd-dc8a3cf43cc6\">See above (Patient/null)</a></p><p><b>encounter</b>: <a href=\"#urnuuidb5cf5a8c-63f0-437f-84fd-dc8a3cf43cc7\">See above (Encounter/null)</a></p><p><b>authoredOn</b>: Dec 5, 2019 6:10:27 AM</p><p><b>requester</b>: <a href=\"#urnuuidb539747a-ca48-11ea-87d0-0242ac130003\">See above (Practitioner/null)</a></p><p><b>reasonCode</b>: <span title=\"Codes: {http://snomed.info/sct 182895007}\">Drug declined by patient (situation)</span></p></div>"
        },
        "status": "completed",
        "intent": "order",
        "doNotPerform": true,
        "medicationCodeableConcept": {
          "coding": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/valueset-reference",
                  "valueUri": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232"
                }
              ]
            }
          ],
          "text": "Warfarin Value Set"
        },
        "subject": {
          "reference": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc6"
        },
        "encounter": {
          "reference": "urn:uuid:b5cf5a8c-63f0-437f-84fd-dc8a3cf43cc7"
        },
        "authoredOn": "2019-12-05T06:10:27Z",
        "requester": {
          "reference": "urn:uuid:b539747a-ca48-11ea-87d0-0242ac130003"
        },
        "reasonCode": [
          {
            "coding": [
              {
                "system": "http://snomed.info/sct",
                "code": "182895007",
                "display": "Drug declined by patient (situation)"
              }
            ]
          }
        ]
      },
      "request": {
        "method": "POST",
        "url": "MedicationRequest"
      }
    }
  ]
}

Response

HTTP/1.1 200 OK
[other headers]

{
"resourceType": "Bundle",
"id": "e9c72d75-2410-45f3-b1cf-eb73d04d3300",
"type": "transaction-response",
"link": [
{
"relation": "self",
"url": "http://hapi.fhir.org/baseR4"
}
],
"entry": [
{
"response": {
"status": "201 Created",
"location": "MeasureReport/223260/_history/1",
"etag": "1",
"lastModified": "2019-12-06T09:11:27.308+00:00"
}
},
{
"response": {
"status": "201 Created",
"location": "Organization/223261/_history/1",
"etag": "1",
"lastModified": "2019-12-06T09:11:27.308+00:00"
}
},
{
"response": {
"status": "201 Created",
"location": "Patient/223262/_history/1",
"etag": "1",
"lastModified": "2019-12-06T09:11:27.308+00:00"
}
},
{
"response": {
"status": "201 Created",
"location": "Encounter/223263/_history/1",
"etag": "1",
"lastModified": "2019-12-06T09:11:27.308+00:00"
}
},
{
"response": {
"status": "201 Created",
"location": "Location/223264/_history/1",
"etag": "1",
"lastModified": "2019-12-06T09:11:27.308+00:00"
}
},
{
"response": {
"status": "201 Created",
"location": "MedicationAdministration/223265/_history/1",
"etag": "1",
"lastModified": "2019-12-06T09:11:27.308+00:00"
}
}
]
}