Data Exchange For Quality Measures Implementation Guide
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## 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.

Consumer Client CapabilityStatement | This profile defines the expected capabilities of a Da Vinci DEQM Consumer Client when conforming to the Da Vinci DEQM Implementation Guide. Consumers include systems that are primary consumers of patient healthcare information and systems that consume data from Producers. This CapabilityStatement resource includes the complete list of the recommended Da Vinci DEQM profiles and RESTful operations that a Da Vinci DEQM Consumer Client could support. Clients have the option of choosing from this list based on their local use cases and other contextual requirements.
Consumer Server CapabilityStatement | This profile defines the expected capabilities of a Da Vinci DEQM Consumer Server when conforming to the Da Vinci DEQM Implementation Guide. Consumers include systems that are primary consumers of patient healthcare information and systems that consume data from Producers. This CapabilityStatement resource includes the complete list of the recommended Da Vinci DEQM profiles and RESTful operations that a Da Vinci DEQM Consumer Server could support. Servers have the option of choosing from this list based on their local use cases and other contextual requirements.
Gaps In Care Client CapabilityStatement | This profile defines the expected capabilities of a Da Vinci DEQM Gaps In Care Client when conforming to the Da Vinci DEQM Implementation Guide for interactions between Clients and Servers to exchange the Gaps in Care Reports for a measure. Clients are the actors requesting the gaps in care results of quality measure(s). This CapabilityStatement resource includes the complete list of the recommended Da Vinci DEQM profiles and RESTful operations that a Da Vinci DEQM Gaps In Care Client could support. Clients have the option of choosing from this list based on their local use cases and other contextual requirements.
Gaps In Care Server CapabilityStatement | This profile defines the expected capabilities of a Da Vinci DEQM Gaps In Care Server when conforming to the Da Vinci DEQM Implementation Guide for interactions between Clients and Servers to exchange the Gaps in Care Reports for a measure. Servers are the actors receiving the request for Gaps in Care Reports for quality measure(s). This CapabilityStatement resource includes the complete list of the recommended Da Vinci DEQM profiles and RESTful operations that a Gaps In Care Server could support. Servers have the option of choosing from this list based on their local use cases and other contextual requirements.
Producer Client CapabilityStatement | This profile defines the expected capabilities of a Da Vinci DEQM Producer Client when conforming to the Da Vinci DEQM Implementation Guide. Producers include systems that are primary producers of patient healthcare information. This CapabilityStatement resource includes the complete list of the recommended Da Vinci DEQM profiles and RESTful operations that are Da Vinci DEQM Producer Client could support. Clients have the option of choosing from this list based on their local use cases and other contextual requirements.
Producer Server CapabilityStatement | This profile defines the expected capabilities of a Da Vinci DEQM Producer Server when conforming to the Da Vinci DEQM Implementation Guide. Producers include systems that are primary producers of patient healthcare information. This CapabilityStatement resource includes the complete list of the recommended Da Vinci DEQM profiles and RESTful operations that a Da Vinci DEQM Producer Server could support. Servers have the option of choosing from this list based on their local use cases and other contextual requirements.
Receiver Server CapabilityStatement | This profile defines the expected capabilities of a Da Vinci DEQM Receiver Server when conforming to the Da Vinci DEQM Implementation Guide. Receivers include systems that are primary receivers of Measure data such as payers as well as public health agencies and other healthcare-related agencies. This CapabilityStatement resource includes the complete list of the recommended Da Vinci DEQM profiles and RESTful operations that a Da Vinci DEQM Receiver Server could support. Servers have the option of choosing from this list based on their local use cases and other contextual requirements.
Reporter Client CapabilityStatement | This profile defines the expected capabilities of a Da Vinci DEQM Reporter Client when conforming to the Da Vinci DEQM Implementation Guide. Reporters include systems that are primary reporters of patient healthcare information and systems that consume data from Producers. This CapabilityStatement resource includes the complete list of the recommended Da Vinci DEQM profiles and RESTful operations that a Da Vinci DEQM Reporter Client could support. Clients have the option of choosing from this list based on their local use cases and other contextual requirements.

### Behavior: Operation Definitions

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

Bulk Submit Data | The bulk-submit-data operation sends a bulk import request based on the data requirements of a FHIR Measure. This operation is modeled off the existing draft of the Bulk Data Import Ping and Pull Approach.
Care Gaps Operation | The care-gaps operation is used to determine gaps in care for a specified gaps through period based on the results of quality measures. It is often the case that the operation should not be performed from the server's timezone, rather the client's timezone is typically a more correct option. Note that even this isn't always correct because the evaluation may be running over data from multiple sources in different timezones. Providing guidance to the measure evaluator with the timezone header can facilitate consistent behavior.
Collect Data | The collect-data operation is used to collect the data-of-interest for the given measure.
Evaluate Operation | The evaluate operation is used to calculate an eMeasure and obtain the results. It is often the case that the operation should not be performed from the server's timezone, rather the client's timezone is typically a more correct option. Note that even this isn't always correct because the evaluation may be running over data from multiple sources in different timezones. Providing guidance to the measure evaluator with the timezone header can facilitate consistent behavior.
Submit Data | The submit-data operation is used to submit MeasureReports and any data of interest for one or more measures for one or more subjects. Each submitted Bundle SHOULD contain resources for a single subject and SHOULD contain all of the MeasureReport and data of interest related to that subject. (This OperationDefinition has been DEPRECATED.)

### Behavior: Search Parameters

These define the properties by which a RESTful server can be searched. They can also be used for sorting and including related resources.

Measure Report Category Search Parameter | Search based on the measurereport-category extension

### Knowledge Artifacts: Measure

These define measures as part of content in this implementation guide.

Immunization Registry Reporting | Measure: Immunization Registry Reporting: The eligible hospital or CAH is in active engagement with a public health agency (PHA) to submit immunization data and receive immunization forecasts and histories from the public health immunization registry/immunization information system (IIS). Exclusion: Any eligible hospital or CAH meeting one or more of the following criteria may be excluded from the immunization registry reporting measure if the eligible hospital or CAH: i. Does not administer any immunizations to any of the populations for which data is collected by their jurisdiction’s immunization registry or IIS during the electronic health record (EHR) reporting period; ii. Operates in a jurisdiction for which no immunization registry or IIS is capable of accepting the specific standards required to meet the certified electronic health record technology (CEHRT) definition at the start of the EHR reporting period; or iii. Operates in a jurisdiction where no immunization registry or IIS has declared readiness to receive immunization data as of six

### Structures: Resource Profiles

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

DEQM Care Gap Remark Patch Parameters Profile | A Parameters profile that defines structures of multi-part Parameters to be used for sending Condition Category Remarks to a Risk Adjustment Coding Gap Report using the PATCH operation.
DEQM Data Exchange MeasureReport Profile | MeasureReport is used as an organizer for both data exchange for measure and for measure reporting. Three profiles on the MeasureReport resource are defined in this guide to delineate these different uses. When a data producer needs to send data to a data consumer, they use the DEQM Data-Exchange MeasureReport Profile defined here. The `type` element in this profile is set to "data-collection". Along with the MeasureReport profile, the data producer sends the reporter, subject, and any relevant resources for the measure they have produced data on. When a data producer sends a MeasureReport and the associated data, they may not have all the data that is required to calculate the measure report. Additional data may need to be collected later or there may be additional data used in the measure that the aggregator owns such as a continuous coverage period requirement.
DEQM Detailed Care Gap Guidance Response | Derived from the GuidanceResponse resource, the Detailed Care Gap Guidance Response profile supports the functionality of providing reason for guidance and detailed guidance to help address care gaps and close open gaps.
DEQM Gaps In Care Bundle | The DEQM Gaps In Care Bundle describes a bundle returned by the Measure care-gaps operation. This bundle consists of a document composition for gaps in care and supporting resources referenced by the composition.
DEQM Gaps In Care Composition Profile | The DEQM Gaps In Care Composition Profile defines a document composition consisting of one or more individual MeasureReport(s). Each section of this composition corresponds to an individual MeasureReport for a specific measure. The subject of each individual MeasureReport referenced by the section must be for the same individual specified in the subject of this Composition.
DEQM Gaps In Care Detected Issue Profile | The DEQM Gaps In Care DetectedIssue Profile indicates that the measure reported has an open gap, prospective-gap or a closed gap as identified in the gapStatus modifier extension.
DEQM Individual MeasureReport List | A list that contains entries of referencing DEQM Individual MeasureReport resources for the same measure, one for each subject in the overall population.
DEQM Individual MeasureReport Profile | MeasureReport is used as an organizer for both data exchange for measure and for measure reporting. Three profiles on the MeasureReport resource are defined in this guide to delineate these different uses. The DEQM Individual MeasureReport Profile defined here is used when a measure is reported to an aggregator for one specific subject. It contains all of the data that is relevant to generate the report including the measure outcome and is similar to a QRDA Category 1 report. In addition to the MeasureReport, the report would be collected in a Bundle with the reporter, subject, and any other resources that were used to calculate this measure.
DEQM Subject List MeasureReport | Subject List MeasureReport is for data exchange and reporting on a list of subjects, which also allows individual MeasureReports be provided for each of the subjects in the population.
DEQM Summary MeasureReport Profile | MeasureReport is used as an organizer for both data exchange for measure and for measure reporting. Three profiles on the MeasureReport resource are defined in this guide to delineate these different uses. The DEQM Summary MeasureReport Profile defined here is used when a measure is reported to an aggregator for a group of subjects. It contains all of the data that is relevant to generate the report including the measure outcome and is similar to a QRDA Category 3 report. Unlike the DEQM Individual MeasureReport Profile, the report is typically transacted as a single MeasureReport report.

### Structures: Extension Definitions

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

DEQM Alternate Score Type Extension | Possible value types for the measureScore elements in addition to the standard Quantity type. For continuous variable measures, the alternate type is determined by the Quality Measure Aggregate Method extension used on the Measure. The reported type of the measureScore for continuous variable measures is determined by the result type of the aggregate method operation. This extension corresponds to the measureScore types in the FHIR R5 version of MeasureReport.
DEQM Calculated Date Extension | This extension applies to the date the metric was actually calculated. If your measure calculation draws on stored calculations and there are multiple calculation dates, this extension would not apply, as in the example of a composite measure where the individual measures were calculated on different dates. This would only cover the case where there is only one calculation date.
DEQM Care Gap Remark Extension | This extension allows a coded and/or narrative remark be added to a Care Gap's Individual Measure Report that adds context from a Provider about the gap.
DEQM Certification Identifier Extension | An identifier that represents the EHR certication number (CERHT). See Certified EHR Technology For more information. This Extension is used when the receiver is interested in getting EHR certification information in the report.
DEQM Data Location Extension | Location from which reported data was gathered. This extension is used to provide the location(s) from which reported data was gathered in a MeasureReport, such as individual, summary and data exchange measure report.
DEQM Gap Status Modifier Extension | Identifies detected care gap status.
DEQM Group Improvement Notation Extension | Indicates whether improvement in the measure group is noted by an increase or decrease in the measure score.
DEQM Measure Scoring Extension | 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. It is expected to be the same as the scoring element on the referenced Measure
DEQM Population Description | DEPRECATED in favor of the measurereport-populationDescription extension: The human readable description of this population criteria.
DEQM Reason Detail | Reason Detail Extension
DEQM Reporting Program Extension | Extension that supports the reporting program as a reference to the CRMI Manifest Library, as well as an identifier of the reporting program, for which measures are being evaluated
DEQM Reporting Vendor Extension | A reference to the vendor who queried the data, calculated results and/or generated the report. The 'reporting vendor' is intended to represent the submitting entity when it is not the same as the reporting entity. This extension is used when the Receiver is interested in getting vendor information in the report.
DEQM Submit Data Update Type Extension | This Extension supports the concepts 'incremental' and 'snapshot' and corresponds to the measureScore types in the FHIR R5 version of MeasureReport. The DEQM Consumer Server SHALL use this Extension to advertise whether it supports snapshot or incremental updates for the DEQM Submit Data transaction. The DEQM Producer Client SHALL use this Extension to indicate whether the payload is a snapshot or incremental update for DEQM Submit Data transaction. When responding to the DEQM Collect Data transaction, the DEQM Producer Server SHALL value it 'incremental' if the `lastReceivedOn` parameter is present or 'snapshot if the `lastReceivedOn` parameter is absent.

### Terminology: Value Sets

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

Care Gap Remark Value Set | This is a ValueSet for Care Gap Remark
DEQM Care Gap Reasons Value Set | This is a ValueSet for Care Gap Reasons
DEQM Gaps In Care Gap Status Value Set | Concepts for care gap status
DEQM Remark Reason | Reason for the remark
DEQM Update Type Value Set | Concepts for how a DEQM Consumer supports data exchange updates. The choices are snapshot or incremental updates

### Terminology: Code Systems

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

DEQM Care Gap Reasons Code System | This is a code system for Care Gap Reasons
DEQM Care Gap Remark Code System | This is a code system for Care Gap Remark
DEQM Gaps In Care Gap Status Code System | This is a code system for Gaps in Care gap status.
DEQM Remark Reason CodeSystem | Reason codes for remark
DEQM Update Type Code System | Concepts for how a DEQM Consumer supports data exchange updates. The choices are snapshot or incremental updates

### Example: Example Instances

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

Ad Hoc Operation Input Example | Ad Hoc Operation Input Example
Additional Supplemental Data Example | Illustration of using supplemental data elements to gather additional information about a patient population
Additional Supplemental Data Example - Artifact Bundle | Artifact bundle for a measure illustrating the use of supplemental data elements to gather additional information about a patient population
Additional Supplemental Data Example - Patient Bundle | Patient data bundle for a measure illustrating the use of supplemental data elements to gather additional information about a patient population
Col Collect Obs | DEQM Col Collect Obs example
Col Submit Obs | DEQM Col Submit Obs example
Condition nhsn-iip-con101 | Condition example
Coverage01 | DEQM Coverage01 example
DEQM Software System Example | DEQM DEQM Software System Example example
DNA Occult Blood | DEQM DNA Occult Blood example
Datax Measurereport01 | DEQM Datax Measurereport01 example
Datax Measurereport02 | DEQM Datax Measurereport02 example
Datax Measurereport03 | DEQM Datax Measurereport03 example
DetailedGuidanceResponse01 | DEQM DetailedGuidanceResponse01 example
DetailedGuidanceResponse02 | DEQM DetailedGuidanceResponse02 example
EXMPromotingInteroperabilityMeasure | DEQM Promoting Interoperability (PI) Measure example
Encounter nhsn-iip-en101 | Encounter example
Encounter01 | DEQM Encounter01 example
Encounter02 | DEQM Encounter02 example
Encounter03 | DEQM Encounter03 example
Gaps Bundle Closed Individual MeasureReport01 | GIC Bundle Closed Individual MeasureReport01 example
Gaps Bundle Closed Individual MeasureReport02 | GIC Bundle Closed Individual MeasureReport02 example
Gaps Bundle Open Individual MeasureReports | GIC Bundle Open Individual MeasureReports example
Gaps Composition01 | GIC Composition01 example
Gaps Composition02 | GIC Composition02 example
Gaps Composition03 | GIC Composition03 example
Gaps DetectedIssue01 | GIC DetectedIssue01 example
Gaps DetectedIssue02 | GIC DetectedIssue02 example
Gaps DetectedIssue03 | GIC DetectedIssue03 example
Gaps DetectedIssue04 | GIC DetectedIssue04 example
Gaps DetectedIssue05 | GIC DetectedIssue05 example
Gaps Encounter01 | GIC Encounter01 example
Gaps Encounter02 | GIC Encounter02 example
Gaps Encounter03 | GIC Encounter03 example
Gaps Group01 subject | GIC Group01 subject example
Gaps Individual MeasureReport01 | GIC Individual MeasureReport01 example
Gaps Individual MeasureReport02 | GIC Individual MeasureReport02 example
Gaps Individual MeasureReport03 | GIC Individual MeasureReport03 example
Gaps Individual MeasureReport04 | GIC Individual MeasureReport04 example
Gaps Multiple Parameters Individual MeasureReports01 | GIC Gaps Multiple Parameters Individual MeasureReports01 example
Gaps Multiple Parameters Individual MeasureReports02 | GIC Gaps Multiple Parameters Individual MeasureReports02 example
Gaps Non-Document Gaps In Care Report | GIC Gaps Illustrating DetectedIssue-only Approach
Gaps Parameters Closed Individual MeasureReport01 | GIC Parameters Closed Individual MeasureReport01 example
Gaps Parameters Closed Individual MeasureReport02 | GIC Parameters Closed Individual MeasureReport02 example
Gaps Parameters Open Individual MeasureReports | GIC Parameters Open Individual MeasureReports example
Gaps Patient01 | GIC Patient01 example
Gaps Patient02 | GIC Patient02 example
Gaps Procedure01 | GIC Procedure01 example
Gaps Procedure02 | GIC Procedure02 example
Gaps Ratio MeasureReport01 | GIC Ratio MeasureReport01 example
Gaps Reporting Vendor Organization | GIC Reporting Vendor Organization example
Group01 | DEQM Group01 example
Guidance Response Example | Guidance Response example
Indv MeasureReport - Patient-level linear | MeasureReport example for an individual Preventive Care and Wellness (Patient-level linear) measure.
Indv MeasureReport - Weighted Composite | MeasureReport example for an individual a Preventive Care and Wellness (Component-level weighted) measure.
Indv Measurereport01 | DEQM Indv Measurereport01 example
Indv Measurereport02 | DEQM Indv Measurereport02 example
Indv Measurereport03 | DEQM Indv Measurereport03 example
Indv Measurreport Stratification Example | DEQM Indv Measurreport Stratification Example
Library Cervical Cancer Screening (EXM124) | Library Cervical Cancer Screening (EXM124) example
Library Colorectal Cancer Screening (EXM130) | Library Colorectal Cancer Screening (EXM130) example
Library Mrp Example | DEQM Library Mrp Example example
Library Venous Thromboembolism Prophylaxis (EXM108) | Library Venous Thromboembolism Prophylaxis (EXM108) example
Location nhsn-iip-loc101 | Location example
Location01 | DEQM Location01 example
Location02 | DEQM Location02 example
Location03 | DEQM Location03 example
Measure - FHIRPath Example | Example of a FHIRPath Measure
Measure Date of Last Power Outage | DEQM Measure Date of Last Power Outage example
Measure Mrp Example | DEQM Measure Mrp Example example
MeasureReport - Individual FHIRPath Example | Example of a FHIRPath (individual) MeasureReport
MeasureReport - Supporting Evidence | Example showing cqf-supportingEvidenceDefinition extension on a MeasureReport.
MeasureReport 01 Patch | Parameters: PATCH example for sending Condition Category Remark.
MeasureReport 01 Patch Mult | Parameters: PATCH example for sending Condition Category Remark with multiple value.
MeasureReport Attestation Boolean | DEQM Attestation Boolean example. This example also illustrates a backwards-compatible linking (i.e. correlation of the components based on `id` because the source Measure does not have `linkId` elements)
MeasureReport-PI-example | DEQM MeasureReport Promoting Interoperability (PI) example
Measurereport with contained data | Measurereport with contained supplemental data
MedicationRequest nhsn-iip-add101 | MedicationRequest example
MedicationRequest nhsn-iip-add101-10 | MedicationRequest example
Mrp Submit Obs | DEQM Mrp Submit Obs example
Mrp Submit Task | DEQM Mrp Submit Task example
Multiple Indv Mrp Obs Report | DEQM Multiple Indv Mrp Obs Report example
Multiple Indv Mrp Task Report | DEQM Multiple Indv Mrp Task Report example
Multiple Summ Report | DEQM Multiple Summ Report example
Observation01 | DEQM Observation01 example
Observation02 | DEQM Observation02 example
Observation03 | DEQM Observation03 example
Organization01-001 | DEQM Organization01 example
Organization02 | DEQM Organization02 example
Organization03 | DEQM Organization03 example
Organization04 | DEQM Organization04 example
Patient nhsn-iip-ip101 | Patient example
Patient01 | DEQM Patient01 example
Patient02 | DEQM Patient02 example
Patient03 | DEQM Patient03 example
Practitioner01 | DEQM Practitioner01 example
Practitioner02 | DEQM Practitioner02 example
Practitioner03 | DEQM Practitioner03 example
Single Indv Col Obs Report | DEQM Single Indv Col Obs Report example
Single Indv Mrp Obs Report | DEQM Single Indv Mrp Obs Report example
Single Indv Mrp Task Report | DEQM Single Indv Mrp Task Report example
Single Indv Vte Report Option 1 | DEQM Single Indv Vte Report example using MedicationAdministration
Single Indv Vte Report Option 7 | DEQM Single Indv Vte Report example using MedicationRequest
Subject List MeasureReport01 | Subject List MeasureReport01 example
Summ MeasureReport - Patient-level linear | MeasureReport example for a summary Preventive Care and Wellness (Patient-level linear) measure.
Summ MeasureReport - Weighted Composite | MeasureReport example for a Preventive Care and Wellness (Component-level weighted) measure.
Summ Measurereport01 | DEQM Summ Measurereport01 example
Summ Measurereport02 | DEQM Summ Measurereport02 example
Summ Medicare Stratification Example | DEQM Summ Medicare Stratification Example example
Summary MeasureReport Date of Last Power Outage | DEQM Summary Measurereport Date of Last Power Outage example
Task01 | DEQM Task01 example
Task02 | DEQM Task02 example
Task03 | DEQM Task03 example
list2 | DEQM Individual MeasureReport List example

### 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.