Quality Measure Implementation Guide (STU3)
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Quality Measure Implementation Guide (STU3), published by Clinical Quality Information WG. This is not an authorized publication; it is the continuous build for version 3.0.0). 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 Terminology Service Capability Statement

Capability statement for a terminology service supporting measure authoring and evaulation use cases. A server can support more functionality than defined here, but this defines the minimum expectations.

CQF Measures Shareable Measure Repository Capability Statement

Capability statement for a repository service supporting minimum required capabilities to share FHIR-based measure specifications. See the Publishable and Authoring Measure Repository capability statements for more comprehensive support for publishing and authoring workflows.

CQF Measures Publishable Measure Repository Capability Statement

Capability statement for a repository service supporting additional publishing capabilities for FHIR-based measure specifications above the basic ShareableMeasureRepository.

CQF Measures Authoring Measure Repository Capability Statement

Capability statement for a repository service supporting additional authoring and content workflow capabilities for FHIR-based measure specifications above the basic ShareableMeasureRepository.

Behavior: Operation Definitions

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

Library Data Requirements

Determines the effective data requirements for the library, including known components and dependencies, and optionally informed by a version manifest.

MeasureReport Packaging

Packages a measure report test case artifact for a target environment, optionally including artifact components and dependencies.

Measure Data Requirements

Determines the effective data requirements for the measure, including known components and dependencies, and optionally informed by a version manifest.

Measure Packaging

Packages a measure artifact for a target environment and optionally including artifact components and dependencies.

CQF Measures Extension of Value Set Expansion

The definition of a value set is used to create a simple collection of codes suitable for use for data entry or validation.

If the operation is not called at the instance level, one of the in parameters url, context or valueSet must be provided. An expanded value set will be returned, or an OperationOutcome with an error message.

Library Packaging

Packages the contents referenced by an asset-collection library such as a quality program release or version manifest.

Structures: Resource Profiles

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

CQFM Publishable CodeSystem

Defines the expectations for publishable code systems used with quality measure specifications

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

CQFM Quality Program

Defines and supports the definition of Quality Programs

CQFM Publishable Library

The CQFM Publishable Library profile defines the must support elements in a library used to support eCQM logic

CQFM Library

The CQFM Library profile defines the minimum expectations for a library used to distribute eCQM logic

CQFM Capability Statement

The CQFM Capability Statement Profile allows systems to express their capabilities for handling CQFM profiles.

CQFM Cohort Measure

The CQFM Cohort Measure Profile describes a cohort 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 Library

The CQFM Execuable Library profile defines the must support elements for an executable library used to support eCQM logic

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 Composite Measure

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

CQFM Executable ValueSet

Defines an executable value set as one that SHALL have an expansion included, as well as a usage warning indicating the expansion is a point-in-time snapshot and must be maintained over time for production usage. The value set expansion specifies the timestamp when the expansion was produced, SHOULD contain the parameters used for the expansion, and SHALL contain the codes that are obtained by evaluating the value set definition. If this is ONLY an executable value set, a computable definition of the value set must be obtained to compute the updated expansion.

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 Ratio Measure

The CQFM Ratio Measure Profile describes a ratio scoring measure

CQFM Proportion Measure

The CQFM Proportion Measure Profile describes a proportion scoring measure

CQFM Computable ValueSet

Defines a computable value set as one that SHALL have an expression-based definition (i.e. a value set defined intensionally using expressions of the code systems involved) and MAY have an expansion included. The expression-based definition SHALL be represented in only one of three ways; using the compose element, using the expression extension, or using the rules-text extension to provide a step-by-step process for expanding the value set definition

CQFM Module Definition Library

The CQFM Module Definition Library profile defines the must support elements for a library that communicates the effective data requirements and dependencies of an artifact (or set of artifacts). This is most commonly used as the result of a $data-requirements operation, but could also be persisted statically as a way to persist the calculation of effective data requirements for a specific artifact and input parameters

CQFM Continuous Variable Measure

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

CQFM Computable Library

The CQFM Computable Library profile defines the must support elements for a computable library used to support eCQM logic

CQFM Publishable ValueSet

Defines the expectations for publishable value sets used in quality measurement specifications

CQFM Model Info Library

The CQFM Model Information Library profile defines the must support elements for a computable Model Definition library used to support declaration and distribution of CQL ModelInfo such as the FHIR Model Info Library

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 Measure

The CQFM Measure Profile describes minimum expectations for defining an electronic Clinical Quality Measure (eCQM)

Structures: Extension Definitions

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

CQFM Effective Data Requirements

A module definition library that contains the effective data requirements for the measure (i.e. the calculated data requirements for the expressions referenced by the measure structure).

CQFM Artifact Comment

A comment containing additional documentation, a review comment, usage guidance, or other relevant information from a particular user.

CQFM Publication Status

Specifies the publication status of the referenced artifacts.

CQFM Input Parameters

Specifies the input parameters to the operation (such as a test case or data requirements operation).

CQFM Allocation

Specifies additional guidance for determining how the allocation for the measure specification should be performed.

CQFM Applies To

Indicates the population that this stratifier should apply to.

CQFM Part Of

Specifies an overall quality program that this manifest or release is part of.

CQFM Is Primary Citation

Specifies whether the related artifact is defining a primary citation for the measure (i.e. one that should appear in the narrative for the measure specification.

CQFM FHIR Query Pattern

A FHIR Query URL pattern that corresponds to the data specified by the data requirement. If multiple FHIR Query URLs are present, they each contribute to the data specified by the data requirement (i.e. the union of the results of the FHIR Queries represents the complete data for the data requirement). This is not a resolveable URL, in that it will contain 1) No base canonical (i.e. it’s a relative query), and 2) Parameters using tokens that are delimited using double-braces and the context parameters are dependent solely on the subjectType, according to the following: Patient: context.patientId, Practitioner: context.practitionerId, Organization: context.organizationId, Location: context.locationId, Device: context.deviceId.

CQFM CQL Options

Specifies a parameters (contained) resource that identifies the options for the CQL-to-ELM translator associated with the CQL content.

CQFM Meaningful Measure Area

Specifies the Meaningful Measures Area within the program that the measure covers or is related to.

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 Quality Domain

Specifies the quality domain within the program that the measure covers or is related to.

CQFM Logic Definition

Defines a logic definition used by the measure.

CQFM Definition Term

Specifies a term and its associated definition.

CQFM Software System

Specifies the software systems used in the packaging and testing of measure and library resources. Specifically to know which version of what software was used.

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).

CQFM Component

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

CQFM Test Case Description

Provides a clear description of the test case.

CQFM Value Filter

Allows additional value-based filters to be specified as part of a data requirement.

CQFM Weight

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

CQFM Rate Aggregation

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

CQFM Supported CQL Version

The version of CQL supported.

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.

CQFM Publication Date

Specifies the publication date of the referenced artifacts.

CQFM Expansion Parameters

Specifies the expansion parameters that should be used to expand the ValueSet, or any ValueSets in the Library (or referenced by components of the Library).

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 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 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 Is Test Case

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

CQFM Program Identifier

Provides an identifier for the measure within the program.

CQFM Aggregate Method

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

CQFM Is Selective

Allows a given data requirement to be identified as “selective”, meaning that it can be used as an additive criteria to filter a population. A selective data requirement is guaranteed to define a subset (not necessarily proper) of the initial population of a measure. If multiple data requirements are marked selective, they all apply (i.e. AND semantics).

CQFM Effective Period Anchor

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

CQFM Usage Warning

An extra warning about the correct use of the value set.

CQFM Default Value

Provides a default value for a parameter definition.

CQFM Direct Reference Code

Defines a code directly referenced by measure logic, as opposed to a value set. Direct reference codes may be the target of data requirements.

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 Unit

Defines the expected units of measure for the measure score.

CQFM Criteria Reference

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

Terminology: Value Sets

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

Measure Identifier Type

Identifier types for a measure (e.g. version-independent, version-specific, short-name, endorser, publisher)

Software System Type

The type of software system (authoring, testing, tooling, evaluation)

CQL Version

The version of CQL cupported

Value Filter Comparator

The type of comparator operator to use

Measure Aggregate Method

Aggregation method for a measure (e.g. sum, average, median, minimum, maximum, count)

Quality Programs

Identified quality programs that are not exhaustive nor prescritive

Artifact Comment Type

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

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)

Measure Aggregate Method Codes

Aggregation method for a measure (e.g. sum, average, median, minimum, maximum, count)

Software System Type Codes

The type of software system (authoring, testing, tooling, evaluation)

Measure Identifier Type Codes

Identifier types for a measure (e.g. version-independent, version-specific, short-name, endorser, publisher)

CQL Version Codes

The version of CQL supported

Quality Programs Codes

Defines the programs associated with a measure. Identified quality programs are not exhaustive nor prescritive

Terminology: Concept Maps

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

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

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

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

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

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

Knowledge Artifacts: Libraries

These define logic, asset collections and other libraries as part of content 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.

Example Logic 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

Multi Rate Example Logic Library

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

Terminology Library

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

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.

RiskAdjustment_FHIR2

Example library illustrating risk adjustment with FHIR DSTU2

FHIR Model Definition (STU2)

Model definition for the DSTU2 FHIR Model

Example: Example Instances

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

Device - Software System Example

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

MeasureReport - Test Case Example

Example of a MeasureReport illustrating a test case

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.

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 variables within a measure represented as a FHIR eCQM

CMS eCQM and Hybrid Measures

This library is an example of an overall quality program specification, based on the CMS eCQM and Hybrid Measure quality program, which has a description as follows: eCQMs use data from electronic health records (EHR) and/or health information technology systems to measure health care quality. eCQM value sets specify terminology codes required for eCQM measurement and are updated by CMS one or more times each year.

EXM55 - Example Continuous Variable Measure Library

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

PVS Component Library

Pneumococcal Vaccination Status for Older Adults

HBP Component Library

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

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

This is an example only.

Chronic Liver Disease Legacy Example 2019-09

This is the example result of an expansion that specifies a value set version (2020-05) and a code system version (SNOMED-CT:2019-09).

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

FHIR Helpers DSTU2

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

Terminology FHIR

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

eCQM Update 2020-05-07

This library is an example of a program release that provides versioning information in support of stable expansion of a set of value sets used in a particular quality program.

Example Logic Library - Module Definition

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

Breast Cancer Screening

This is an example only.

Pneumococcal Vaccination Status for Older Adults

This is an example only.

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.

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

Example Executable Library

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

VTE ICU Library

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

Common Library

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

Adult Outpatient Encounters Common Library

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

Quality Program Example - 2020-05

This library is an example of quality program release, specifying a single measure and version, with an example of versioned bindings for code system and value set dependencies.

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.

MAT Global Common Functions FHIR Library

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

EXM Publishable Measure

An example FHIR-based publishable measure

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.

EXM124 - Cervical Cancer Screening 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

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.

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

Measure with default value measurement period

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

EXM125 - Breast Cancer Screening Library

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

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 <br.* Women age 30-64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years
SNOMED CT International Edition

This is an example code system, based on the SNOMED CT Code System to illustrate a publishable code system resource. SNOMED CT is a core clinical healthcare terminology that contains concepts with unique meanings and formal logic based definitions organized into hierarchies.

Chronic Liver Disease Legacy Example Current Active

This is the example result of a default, current expansion that does not specify a code system version, but does specify activeOnly.

TSC Component Library

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

Hospice FHIR Library

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

Example Publishable 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

Breast Cancer Screening FHIR Measure

Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer in the 27 months prior to the end of the Measurement Period

EXM Ratio Measure

An example FHIR-based publishable measure

eCQM Annual Update 2020

This library is an example of a version manifest (also referred to as an expansion profile) that specifies expansion rules for a set of value sets used in a particular quality program.

EXM Measure

An example FHIR-based measure

EXM125 - Breast Cancer Screening Measure

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

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.

Chronic Liver Disease Legacy Example Current

This is the example result of a default, current expansion that does not specify a code system version.

Quality Program Example

This library is an example of quality program release, specifying a single measure without a version, and without version bindings for dependencies.

TJC Overall Library

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

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

This is an example only.

Cervical Cancer Screening

This is only an example.

EP/EC Quality Program

This library is an example of a quality program specification

USCore Model Definition

Model definition for USCore (v3.1.0) Model

Supplemental Data Elements Library

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

EXM55 - Median ED Visit Duration

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

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.

Quality Program CQL Options Example

This library is an example of a quality program with cqlOptions extension.

EXM130 - Colorectal Cancer Screening Measure

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

EXM108 - Venous Thromboembolism Prophylaxis 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

Example Computable Library

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