Quality Measure STU2 for FHIR R4 Implementation Guide

Quality Measure Implementation Guide, 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


5 Measure Packaging

To facilitate publishing and distribution of quality measures, this Implementation Guide defines several profiles that enable the use of FHIR Bundle to package quality measures, either independently, or as part of a collection of related measures.

5.1 Packaging Artifacts

In general, artifacts such as libraries, measures, and test cases are packaged as a Bundle of type collection, indicating that the Bundle is a collection of resources for distribution and carries no additional processing semantics (as opposed to a transaction, or document bundle).

An artifact bundle contains the artifact as the first entry in the bundle, and optionally the dependencies and associated artifacts as subsequent entries as follows:

  1. Artifact: The main artifact resource for the package (such as a Measure or Library)
  2. Library Dependencies: Any libraries required for the artifact
  3. Terminology Dependencies: Any CodeSystem or ValueSet resources required for the artifact
  4. Test Cases: Any test cases defined for the artifact

5.2 Packaging Libraries

To support usage of a logic library, the library package contains the following general components:

  • Structured representation of the library and associated metadata (the Library resource)
  • Human readable description of the library contents (the Narrative of the Library resource)
  • Machine readable description of the population criteria (in the Library resource as additional attachments containing the Expression Logical Model (ELM) content for the CQL)
  • Optionally, all the required libraries referenced by the library, recursively (included as Library resources)
  • Optionally, all the required terminologies referenced by the library, or any required libraries (included as CodeSystem and/or ValueSet resources)

The CQFMLibraryBundle profile formalizes these components:

Conformance Requirement 32 (Library Packaging):

  1. Libraries SHALL be distributed as a collection bundle conforming to the CQFMLibraryBundle profile
  2. The first entry in a Library bundle SHALL be a Library resource conforming
  3. Library bundles MAY include any libraries referenced by the primary library
  4. Library bundles MAY include any code systems and value sets referenced by the primary library or any required libraries.

5.3 Packaging Measures

To support usage of a quality measure, the quality measure package contains the following general components:

  • Structured representation of the quality measure and associated metadata (the Measure resource)
  • Human readable description of the quality measure and population criteria (the Narrative of the Measure resource)
  • The primary logic library for the quality measure (the Library resource containing at least the Clinical Quality Language (CQL) source)
  • Machine readable description of the population criteria (in the Library resource as additional attachment elements containing the Expression Logical Model (ELM) content for the CQL)
  • Optionally, all the required libraries referenced by the primary library of the quality measure, recursively (included as Library resources)
  • Optionally, all the required terminologies referenced by the primary library or any required libraries (included as CodeSystem and/or ValueSet resources)
  • Optionally, any test cases defined for the quality measure

The CQFMMeasureBundle profile formalizes these components:

Conformance Requirement 33 (Measure Packaging):

  1. Measures SHALL be distributed as a collection bundle conforming to the CQFMMeasureBundle profile
  2. The first entry in a Measure bundle SHALL be a Measure resource
  3. The second entry in a Measure bundle SHALL be the primary Library resource for the measure
  4. Measures bundles MAY include any libraries referenced by the primary library
  5. Library bundles MAY include any code systems and value sets referenced by the primary library or any required libraries.
  6. Library bundles MAY include any test case bundles defined for the measure

5.4 Packaging Test Cases

Basic testing of measure logic should involve at least one positive and negative test of each of the population criteria. A test case is represented as a set of test resources, together with a MeasureReport resource that defines the expected results. The test case bundle can then be used to package and distribute the test case.

Conformance Requirement 34 (Test Case Packaging):

  1. Test Cases SHALL be distributed as a collection bundle conforming to the CQFMTestCaseBundle profile
  2. The first entry in a TestCase bundle SHALL be a MeasureReport resource representing the expected outcome of evaluating the measure, given the test data provided as part of the test case
  3. TestCase bundles SHALL include any resource data required to evaluate the test case

5.5 Intellectual Property of Packaging

Conformance Requirement 35 (Intellectual Property Considerations):

  1. Artifacts distributed in this way SHALL carry the appropriate copyright and intellectual property declarations.

Conformance Requirement 36 (Quality Program):

This implementation guide includes a profile for describing a quality program as a collection of quality measures. This profile is a Library of type asset-collection that uses the relatedArtifact element to indicate which measures are part of the quality program. In addition, measures and libraries can use the useContext element to specify a quality program.

  1. Artifacts SHOULD use the useContext element with the program context type to specify a quality program
  2. Quality program descriptions SHALL use the CQFQualityProgram profile