Quality Measure Implementation Guide (STU3 Ballot)
2.1.0 - ballot

Quality Measure Implementation Guide (STU3 Ballot), published by Clinical Quality Information WG. This is not an authorized publication; it is the continuous build for version 2.1.0). 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.

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 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.

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 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.

Measure Calculation Service Conformance Statement

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

MeasureReport Packaging

Packages a measure report test case artifact for a target environment, 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 Data Requirements

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

Library Packaging

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

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.

Structures: Resource Profiles

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

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 Computable Library

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

CQFM Ratio Measure

The CQFM Ratio Measure Profile describes a ratio scoring measure

CQFM Publishable ValueSet

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

CQFM Proportion Measure

The CQFM Proportion Measure Profile describes a proportion scoring measure

CQFM Composite Measure

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

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 Library

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

CQFM Continuous Variable Measure

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

CQFM Measure

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

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 Capability Statement

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

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 Quality Program

Defines and supports the definition of Quality Programs

CQFM Library

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

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 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 Cohort Measure

The CQFM Cohort Measure Profile describes a cohort scoring measure

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 Publishable CodeSystem

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

CQFM Computable Measure

The CQFM Computable Measure Profile describes minimum expectations for a computable electronic Clinical Quality Measure (eCQM)

Structures: Extension Definitions

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

CQFM Usage Warning

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

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 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 CQL Options

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

CQFM Publication Date

Specifies the publication date of the referenced artifacts.

CQFM Weight

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

CQFM Scoring Unit

Defines the expected units of measure for the measure score.

CQFM Program Identifier

Provides an identifier for the measure within the program.

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 Data Requirement

Defines a required data element that must be provided in order to obtain a valid evaluation of the measure logic.

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 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 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 Input Parameters

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

CQFM Effective Period Duration

Specifies the reporting period for the measure.

CQFM Component

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

CQFM Expansion Uri

Specifies a particular expansion identifier that should be used to fulfill the expand request. This can be specified at the quality program level, where it indicates the expansion identifier to be used for all expansions of value sets within the program (i.e. all the ValueSets would have expansions with the same identifier), or it can be specified on a specific ValueSet dependency, where it indicates the expansion identifier to be used for that value set.

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 Artifact Comment

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

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 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 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 Value Filter

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

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 Is Test Case

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

CQFM Allocation

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

CQFM Aggregate Method

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

CQFM Active Only

Specifies whether the expansion behavior for value sets should include active codes only. If this is specified as part of a version manifest, it provides a default for the activeOnly parameter of the ValueSet/$expand operation.

CQFM Test Case Description

Provides a clear description of the test case.

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 Effective Period Anchor

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

CQFM Default Value

Provides a default value for a parameter definition.

CQFM Parameter

Defines a parameter to the measure evaluation, such as a Measurement Period.

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 Part Of

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

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 Applies To

Indicates the population that this stratifier should apply to.

CQFM Meaningful Measure Area

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

CQFM Logic Definition

Defines a logic definition used by the measure.

CQFM Quality Domain

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

CQFM Publication Status

Specifies the publication status of the referenced artifacts.

CQFM Supported CQL Version

The version of CQL supported.

CQFM Group Id

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

CQFM Rate Aggregation

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

Terminology: Value Sets

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

Measure Aggregate Method

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

CQFM Measure Type

The type of measure

Software System Type

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

Value Filter Comparator

The type of comparator operator to use

CQL Version

The version of CQL cupported

Quality Programs

Identified quality programs that are not exhaustive nor prescritive

Measure Identifier Type

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

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

Measure Identifier Type

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

CQL Version

The version of CQL supported

Software System Type

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

Measure Aggregate Method

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

Artifact Comment Type

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

Quality Programs

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

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

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

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

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

Knowledge Artifacts: Libraries

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

FHIR Model Definition

Model definition for the FHIR R4 (v4.0.1) Model

FHIR Model Definition

Model definition for the DSTU2 FHIR Model

Library/AdvancedIllnessandFrailtyExclusion
Library/BCSComponent
Library/Terminology
Library/CCSComponent
FHIR Helpers

This library defines functions to convert between FHIR data types and CQL system-defined types, as well as functions to support FHIRPath implementation. For more information, the FHIRHelpers wiki page: https://github.com/cqframework/clinical_quality_language/wiki/FHIRHelpers

RiskAdjustment_FHIR2

Example library illustrating risk adjustment with FHIR DSTU2

Multi Rate Example Logic 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

Knowledge Artifacts: Measure

These define measures as part of content in this implementation guide

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: 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

Chronic Liver Disease Legacy Example Current

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

EXM146 - Example Proportion Measure Library

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

Median ED Visit Duration

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

Risk Adjustment FHIR DSTU2

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

TJC Overall

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

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.

Example Logic Library - Module Definition

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

Example Computable Library

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

EXM Measure

An example FHIR-based measure

Colorectal Cancer Screening

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

Quality Program CQL Option Example

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

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.

Colorectal Cancer Screening

This is only an example.

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.

EXMRatio - Example Ratio Measure Library

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

FHIR Helpers DSTU2

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

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.

Adult Outpatient Encounters Common Library

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

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.

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.

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.

Hospice FHIR

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

Supplemental Data Elements

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

Measure with default value measurement period

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

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.

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
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

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.

MAT Global Common Functions FHIR

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

Cervical Cancer Screening

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

Venous Thromboembolism Prophylaxis

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

EXM Ratio Measure

An example FHIR-based publishable measure

Example Continuous Variable Measure Library

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

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.

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.

QICore Model Definition

Model definition for QICore (v4.0.0) Model

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).

CMS eCQM and Hybrid Measure

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.

Terminology FHIR

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

Colorectal Cancer Screening

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

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.

Breast Cancer Screening

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

Common Library

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

Breast Cancer Screening

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

VTE ICU

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

EXM Publishable Measure

An example FHIR-based publishable measure

USCore Model Definition

Model definition for USCore (v3.1.0) Model

Breast Cancer Screening

This is an example only.

Example Library - HBPComponent

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

Example Library - TSCComponent

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

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

This is an example only.

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

This is an example only.

Breast Cancer Screening FHIR

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

Example Executable Library

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

Pneumococcal Vaccination Status for Older Adults

This is an example only.

EP/EC Quality Program

This library is an example of a quality program specification

Example Library - PVSComponent

Pneumococcal Vaccination Status for Older Adults

Other

These are resources that are used within this implementation guide that do not fit into one of the other categories

MeasureReport/supplementaldata-example
MeasureReport/supplementaldata-summary-example