Quality Measure Implementation Guide (STU5)
5.0.0-draft - 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-draft 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

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.

Measure Calculation Service Capability Statement Example

Basic conformance statement for a Measure Calculation Service. A server can support more fucntionality than defined here, but this is the minimum amount

Behavior: Operation Definitions

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

CQFM Package

Packages a specified canonical resource with dependencies.

Knowledge Artifacts: Libraries

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

Adult Outpatient Encounters Common Library

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

Advanced Illness and Frailty Exclusion Library

Advanced Illness and Frailty Exclusion Example Library

BCS Component Library

This library is the primary measure library for the Breast Cancer Screening component of the composite measure examples in this implementation guide.

CCS Component Library

This library is the primary measure library for the Cervical Cancer Screening component of the composite measure examples in this implementation guide.

Common Library

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

Common Terminology Library

This library is the common library for the terminology example measure

EXM108 - Venous Thromboembolism Prophylaxis Library

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

EXM124 - Cervical Cancer Screening Library

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

EXM125 - Breast Cancer Screening Library

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

EXM130 - Colorectal Cancer Screening Library

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

EXM146 - Example Proportion Measure Library

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

EXM55 - Median Emergency Department Visit Duration Library (Example Continuous Variable Measure Library)

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

EXMRatio - Example Ratio Measure Library

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

Example Computable Library

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

Example Executable Library

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

Example Logic Library

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

Example Logic Library - Module Definition

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

Example Logic Library - Module Definition Direct Reference

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

Example Publishable Library

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

FHIR Model Definition (STU2)

Model definition for the DSTU2 FHIR Model

HBP Component Library

Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

Hospice FHIR Library

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

MAT Global Common Functions FHIR Library

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

Module Definition Example Logic Library

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

Module Definition Library - EXM Logic

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

Module Definition Library - EXM Ratio

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

Module Definition Library - EXM108

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

Module Definition Library - EXM124

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

Module Definition Library - EXM125

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

Module Definition Library - EXM130

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

Module Definition Library - EXM146

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

Module Definition Library - EXM55

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

Module Definition Library - MultiRateExample

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

Module Definition Library - SDE artifacts

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

Multi Rate Example Logic Library

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

PVS Component Library

Pneumococcal Vaccination Status for Older Adults

RiskAdjustment_FHIR2

Example library illustrating risk adjustment with FHIR DSTU2

Supplemental Data Elements Library

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

TJC Overall Library

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

TSC Component Library

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Terminology Library

This library is the primary measure library for the terminology example measure

VTE ICU Library

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

Structures: Resource Profiles

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

CQFM Cohort Measure

The CQFM Cohort Measure Profile describes a cohort scoring measure

CQFM Composite Measure

The CQFM Composite Measure Profile describes minimum expectations for a composite electronic Clinical Quality Measure (eCQM)

CQFM Computable Measure

The CQFM Computable Measure Profile describes minimum expectations for a computable electronic Clinical Quality Measure (eCQM), including the use of a computable library, and the use of expressions or identifiers for all criteria.

CQFM Continuous Variable Measure

The CQFM Continuous Variable Measure Profile describes a continuous variable scoring measure

CQFM Device

The SoftwareSystem device profile is used to capture software details about the various systems used in authoring, testing, packaging, or evaluation of a knowledge artifact

CQFM Executable Measure

The CQFM Executable Measure Profile describes minimum expectations for an executable electronic Clinical Quality Measure (eCQM), including a reference to an executable library, and restricted to the use of identifier-based expressions only for all criteria.

CQFM Proportion Measure

The CQFM Proportion Measure Profile describes a proportion scoring measure

CQFM Publishable Manifest

The CQFM Publishable Manfiest Profile describes a …..

CQFM Publishable Measure

The CQFM Publishable Measure profile defines the minimum expectations to enable appropriate content management, discovery, and utilization of published electronic Clinical Quality Measures (eCQMs)

CQFM Ratio Measure

The CQFM Ratio Measure Profile describes a ratio scoring measure

CQFM Test Case

The CQFM Test Case Profile describes expectations for the definition and exchange of a measure test case, including input data and parameters, as well as expected outcome

Structures: Extension Definitions

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

CQFM Aggregate Method

Specifies which method to be used to aggregate the measure observation values.

CQFM Applies To

Indicates the population that this stratifier should apply to.

CQFM Component

Specifies an artifact this is a component of a composite artifact.

CQFM Composite Scoring

Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented. When present on a group, specifies the scoring to be used for this group, overriding the scoring specified for the overall measure.

CQFM Criteria Reference

Specifies which population criteria is the input to an observation definition, or the initial population for a ratio numerator or denominator.

CQFM Effective Period Anchor

Specifies the anchor date for the effective period as defined by a starting date and a range.

CQFM Effective Period Duration

Specifies the reporting period for the measure.

CQFM Group Id

Specifies the id of a particular group within the measure referenced by the related artifact resource.

CQFM Improvement Notation

Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).

Additional Guidance: improvementNotation

Reference range with definition of score within a defined interval (or a “passing score” over or under a certain threshold) indicates better quality to the improvement notation value set. Please provide comments on this additional code and if there are other codes needed in this value set.

Please provide comments on this additional code and if there are other codes needed in the improvement notation value set.

If an additional code is added to the improvement notation (like normative reference range as suggested), where is guidance about the reference range best included in the specification for implementer use? Some suggestions include: the guidance field, the rate aggregation field or adding an extension to improvementNotation to add text.

CQFM Include In Report Type

Indicates what types of report the element on which it appears should be included in. If no values are specified, the default behavior is that elements are included in all report types

CQFM Is Test Case

Indicates whether this instance represents the definition of a test case.

CQFM Operation

Specifies the operation definition

CQFM Population Basis
The population basis specifies the type of elements in the population. For a subject-based measure, this is boolean (because the subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and a population basis of Encounter, and the population criteria all return lists of Encounters. Note that the subject of a measure can be found in the element [subject[x] https://hl7.org/fhir/us/cqfmeasures/2024Jan/StructureDefinition-computable-measure-cqfm-definitions.html#Measure.subject[x]]
CQFM Rate Aggregation

Describes how to combine the information calculated, based on logic in each of several populations, into one summarized result.

CQFM Risk Adjustment

A description of the risk adjustment factors that may impact the resulting score for the measure and how they may be accounted for when computing and reporting measure results.

CQFM Scoring

Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented. When present on a group, specifies the scoring to be used for this group, overriding the scoring specified for the overall measure.

CQFM Scoring Precision

The number of decimal places to include in the score when the score is a decimal-valued result.

CQFM Scoring Unit

Defines the expected units of measure for the measure score.

CQFM Supplemental Data Guidance

Provides additional guidance on the meaning and reporting of supplemental data elements included in the measure overall.

CQFM Test Case Description

Provides a clear description of the test case.

CQFM Type

Indicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilization.

CQFM Weight

What is the weight of the contribution of this measure to the overall score.

Terminology: Value Sets

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

Artifact Comment Type

The type of artifact comment (documentation, review, guidance)

CQL Version

The version of CQL cupported

Chronic Liver Disease Legacy Example

This is an example value set consisting of a subset of codes selected from Chronic Liver Disease (2.16.840.1.113883.3.464.1003.199.11.1065) for the purposes of illustrating a value set containing Legacy Codes.

Computable Example

This value set is an illustration of a computable value set, based on the ArtifactCommentType value set, including all codes from the ArtifactCommentType code system.

Executable Example

This value set is an illustration of an executable value set, based on the ArtifactCommentType value set, including all codes from the ArtifactCommentType code system.

Quality Programs Example

The following identified quality programs are neither exhaustive nor prescriptive. Specific quality program codes are not in scope for this IG.

Value Filter Comparator

The type of comparator operator to use

Terminology: Code Systems

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

Artifact Comment Type Codes

The type of artifact comment (documentation, review, guidance)

CQL Version Codes

The version of CQL supported

Quality Programs Codes Example

The following defines the programs associated with a measure. Identified quality programs are neither exhaustive nor prescriptive. Specific quality program codes are not in scope for this IG.

Terminology: Concept Maps

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

Aggregate Method mapping

The mapping of FHIR aggregate method codes to the corresponding HL7 V3 code used in HQMF for each type of aggregate method

Composite Measure Scoring mapping

The mapping of FHIR composite measure scoring codes to the corresponding HL7 V3 code used in HQMF for each type of composite measure scoring

Data Usage Mapping

The mapping of FHIR measure data usage codes to the corresponding HL7 V3 code used in HQMF for each of the measure data usages

Improvement Notation Mapping

The mapping of FHIR improvement notation codes to the corresponding HL7 V3 code used in HQMF for each of the improvement notations

Measure Population criteria mapping

The mapping of FHIR measure population criteria codes to the corresponding HL7 V3 code used in HQMF for each of the measure population criteria components

Measure Scoring mapping

The mapping of FHIR measure scoring codes to the corresponding HL7 V3 code used in HQMF for each type of measure scoring

Measure Type mapping

The mapping of FHIR measure type codes to the corresponding HL7 V3 code used in HQMF for each of the measure type

Example: Example Instances

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

ANCM Danger Signs Package

This library is an example of an artifact manifest for the DT-01 PlanDefinition from the ANC-Mini IG.

Breast Cancer Screening

This is an example only.

Bundle example

Example of a transaction bundle

Cervical Cancer Screening

This is only an example.

Device - Software System Example

Example of a Software System Device used to illustrate tooling, testing, or authoring system

EXM Measure

An example FHIR-based measure

EXM Promoting Interoperability Measure

An example FHIR-based publishable measure - Promoting Interoperability

EXM Ratio Measure

An example FHIR-based publishable measure

EXM108 - Venous Thromboembolism Prophylaxis

This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission

EXM124 - Cervical Cancer Screening

Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria:

  • Women age 21-64 who had cervical cytology performed every 3 years
  • Women age 30-64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years
EXM125 - Breast Cancer Screening

Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer

EXM130 - Colorectal Cancer Screening Measure

Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer

EXM146 - Appropriate Testing for Children with Pharyngitis

Percentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode.

EXM55 - Median Emergency Department Visit Duration

This example illustrates a continuous variable measure represented as a FHIR eCQM

Measure Content Bundle - Additional Supplemental Data Example

Example of a Measure illustrating the use of supplemental data elements to gather additional information about a population

MeasureReport - Test Case Example

Example of a MeasureReport illustrating a test case

Multi-Rate Example Measure

This measure example illustrates the use of the group-level computation extensions to describe a multi-rate measure with mixed population bases

Pneumococcal Vaccination Status for Older Adults

This is an example only.

Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

This is an example only.

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

This is an example only.

Preventive Care and Wellness All-Or-Nothing Composite

This artifact is an example of an all-or-nothing composite measure that uses a mixture of single-rate or multi-rate component measures that have different measure bases.

Preventive Care and Wellness Opportunity Composite

This artifact is an example of an opportunity composite measure that uses a mixture of single-rate or multi-rate component measures that have different measure bases.

Preventive Care and Wellness Patient-level Linear Composite

This artifact is an example of a patient-level linear composite measure that uses a mixture of single-rate or multi-rate component measures that have different measure bases.

Preventive Care and Wellness Weighted Composite

This artifact is an example of a weighted composite measure that uses a mixture of single-rate or multi-rate component measures that have different measure bases.

Risk Adjustment FHIR DSTU2

This example illustrates the use of risk adjustment data within a measure represented as a FHIR eCQM

Search Parameter - Library contained parameter name

Example of a search parameter for a parameter name in a library

Search Parameter - Library expansion identifier

Example of a search paramter for an expansion identifier in a library

Search Parameter - Valuset Keyword

Example of a search parameter for a keyword in a value set

Terminology FHIR

This example illustrates the use of risk adjustment variables within a measure represented as a FHIR eCQM