Quality Measure Implementation Guide (STU5)
5.0.0-ballot - ballot United States of America flag

Quality Measure Implementation Guide (STU5), published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 5.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/cqf-measures/ and changes regularly. See the Directory of published versions

Example Library: Example Computable Library

Active as of 2019-09-03
Id: Example Computable Library
Url: Example Computable Library
Version: 5.0.0-ballot

value: EXMComputableLogic

Name: EXMComputableLibrary
Title: Example Computable Library
Status: active
Experimental: true

system: LibraryType

code: logic-library

Date: 2019-09-03
Publisher: HL7 International / Clinical Quality Information

This library is used as an example in the FHIR Quality Measure Implementation Guide

Use Context:
program eh-cah EH/CAH
Jurisdiction: US
Approval Date: 2019-08-03
Last Review Date: 2019-08-03
Related Artifacts:


Measurement PeriodPeriod01in
Inpatient EncounterEncounter0*out
Initial PopulationEncounter0*out
Measure PopulationEncounter0*out
Stratifier 1Encounter0*out
Stratifier 2Encounter0*out
Stratifier 3Encounter0*out
Stratifier 4Encounter0*out
SDE EthnicityCoding0*out
SDE PayerResource0*out
SDE RaceCoding0*out
SDE SexCoding01out
Data Requirements:
TypeProfileMSCode Filter
Encounter http://hl7.org/fhir/StructureDefinition/Encounter
Encounter http://hl7.org/fhir/StructureDefinition/Encounter code filter:
path: type
value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.
Condition http://hl7.org/fhir/StructureDefinition/Condition code filter:
path: id
Coverage http://hl7.org/fhir/StructureDefinition/Coverage code filter:
path: type
value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Content: text/cql
library EXMComputableLibrary version '2.0.0'

This example is purely for illustration purposes to show how all the elements of a
FHIR-based quality measure are represented. It is intentionally simplified to show
specific aspects of a measure, and is not intended as an example of a clinically
meaningful measure.

NOTE: This is the same library as EXMLogic, being used to illustrate the different flavors of profiles:
* Computable: Focusing on computable/design-time aspects
* Executable: Focusing on run-time aspects
* Publishable: Focusing on knowledge management aspects

using FHIR version '4.0.1'

include FHIRHelpers version '4.0.1' called FHIRHelpers

codesystem "Diagnosis Role": 'http://terminology.hl7.org/CodeSystem/diagnosis-role'

valueset "Emergency Department Visit" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.'
valueset "Psychiatric/Mental Health Patient" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.'
valueset "Hospital Settings" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.126'

valueset "ONC Administrative Sex": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1'
valueset "Race": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.836'
valueset "Ethnicity": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.837'
valueset "Payer": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591'

code "Billing": 'billing' from "Diagnosis Role" display 'Billing'

parameter "Measurement Period" Interval<DateTime>

context Patient

define "Initial Population" :
  "Inpatient Encounter" Encounter

define "Measure Population" :
  "Initial Population"

define function "Measure Observation" (Encounter "Encounter" ) :
  duration in minutes of "Related ED Visit"(Encounter).period

define "Stratifier 1" :
  "Inpatient Encounter" Encounter
    where not (PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient")

define "Stratifier 2" :
  "Inpatient Encounter" Encounter
    where PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient"

define "Stratifier 3" :
  "Inpatient Encounter" Encounter
    where PrincipalDiagnosis(Encounter) is null

define "Stratifier 4" :
  "Inpatient Encounter" Encounter
    where PrincipalDiagnosis(Encounter) is null

define "Inpatient Encounter" :
  ["Encounter"] Encounter
    where LengthInDays(Encounter.period) <= 120
      and Encounter.period ends during "Measurement Period"

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)])

define function "LengthInDays"(Value Interval<DateTime>):
	difference in days between start of Value and end of Value

define function "GetId"(uri String):
	Last(Split(uri, '/'))

//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 )

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

define "SDE Payer":
    [Coverage: type in "Payer"] Payer
      return {
        code: Payer.type,
        period: Payer.period

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

define "SDE Sex":
    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