Data Exchange For Quality Measures Implementation Guide
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Data Exchange For Quality Measures Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 4.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-deqm/ and changes regularly. See the Directory of published versions

Resource Profile: DEQM Gaps In Care Detected Issue Profile

Official URL: http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-detectedissue-deqm Version: 4.0.0
Active as of 2021-04-23 Computable Name: DEQMGapsInCareDetectedIssueProfile

The DEQM Gaps In Care DetectedIssue Profile indicates that the measure reported has an open gap or a closed gap as identified in the gapStatus modifier extension.

This profile builds on DetectedIssue.

Mandatory Data Elements and Terminology

The following data-elements are mandatory (i.e data MUST be present).

Each must have:

  1. A modifier extension: DEQMGapStatusModifierExtension
  2. A DetectedIssue.code
  3. The DetectedIssue.evidence.detail either references the measure to which the detected issue applies by referencing the DEQM Individual Measure Report or references the GuidanceResponse resource
  4. A DetectedIssue.patient references the patient for which the detected issue applies

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from DetectedIssue

NameFlagsCard.TypeDescription & Constraintsdoco
.. DetectedIssue 0..*DetectedIssueClinical issue with action
... modifierExtension:gapStatus ?!S1..1DEQMGapStatusModifierExtensionGap Status
... code S1..1CodeableConceptIssue Category, e.g. drug-drug, duplicate therapy, etc.
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: CAREGAP
... patient S1..1Reference(QICore Patient)Associated patient
... evidence S1..*BackboneElementSupporting evidence
.... detail S1..1Reference(DEQM Individual MeasureReport Profile | Detailed Care Gap Guidance Response)This references either a DEQM Individual MeasureReport or a GuidanceResponse resource. Note that referencing the GuidanceResponse resource allows potential profiling on GuidanceResponse in the future without breaking backward compatibility.

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. DetectedIssue 0..*DetectedIssueClinical issue with action
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for modifierExtension ?!1..*ExtensionExtension
Slice: Unordered, Open by value:url
... modifierExtension:gapStatus ?!S1..1DEQMGapStatusModifierExtensionGap Status
... status ?!Σ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required): Indicates the status of the identified issue.

... code SΣ1..1CodeableConceptIssue Category, e.g. drug-drug, duplicate therapy, etc.
Binding: DetectedIssueCategory (preferred): Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.


Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: CAREGAP
... patient SΣ1..1Reference(QICore Patient)Associated patient
... evidence S1..*BackboneElementSupporting evidence
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... detail S1..1Reference(DEQM Individual MeasureReport Profile | Detailed Care Gap Guidance Response)This references either a DEQM Individual MeasureReport or a GuidanceResponse resource. Note that referencing the GuidanceResponse resource allows potential profiling on GuidanceResponse in the future without breaking backward compatibility.

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
DetectedIssue.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
DetectedIssue.codepreferredPattern: CAREGAP
http://hl7.org/fhir/ValueSet/detectedissue-category
from the FHIR Standard
NameFlagsCard.TypeDescription & Constraintsdoco
.. DetectedIssue 0..*DetectedIssueClinical issue with action
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... Slices for modifierExtension ?!1..*ExtensionExtension
Slice: Unordered, Open by value:url
... modifierExtension:gapStatus ?!S1..1DEQMGapStatusModifierExtensionGap Status
... identifier Σ0..*IdentifierUnique id for the detected issue
... status ?!Σ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required): Indicates the status of the identified issue.

... code SΣ1..1CodeableConceptIssue Category, e.g. drug-drug, duplicate therapy, etc.
Binding: DetectedIssueCategory (preferred): Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.


Required Pattern: At least the following
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... version0..1stringVersion of the system - if relevant
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: CAREGAP
..... display0..1stringRepresentation defined by the system
..... userSelected0..1booleanIf this coding was chosen directly by the user
.... text0..1stringPlain text representation of the concept
... severity Σ0..1codehigh | moderate | low
Binding: DetectedIssueSeverity (required): Indicates the potential degree of impact of the identified issue on the patient.

... patient SΣ1..1Reference(QICore Patient)Associated patient
... identified[x] Σ0..1When identified
.... identifiedDateTimedateTime
.... identifiedPeriodPeriod
... author Σ0..1Reference(Practitioner | PractitionerRole | Device)The provider or device that identified the issue
... implicated Σ0..*Reference(Resource)Problem resource
... evidence S1..*BackboneElementSupporting evidence
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code 0..*CodeableConceptManifestation
Binding: ManifestationAndSymptomCodes (example): Codes that describes the types of evidence for a detected issue.


.... detail S1..1Reference(DEQM Individual MeasureReport Profile | Detailed Care Gap Guidance Response)This references either a DEQM Individual MeasureReport or a GuidanceResponse resource. Note that referencing the GuidanceResponse resource allows potential profiling on GuidanceResponse in the future without breaking backward compatibility.
... detail 0..1stringDescription and context
... reference 0..1uriAuthority for issue
... mitigation 0..*BackboneElementStep taken to address
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... action 1..1CodeableConceptWhat mitigation?
Binding: DetectedIssueMitigationAction (preferred): Codes describing steps taken to resolve the issue or other circumstances that mitigate the risk associated with the issue; e.g. 'added concurrent therapy', 'prior therapy documented', etc.

.... date 0..1dateTimeDate committed
.... author 0..1Reference(Practitioner | PractitionerRole)Who is committing?

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
DetectedIssue.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
DetectedIssue.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
DetectedIssue.codepreferredPattern: CAREGAP
http://hl7.org/fhir/ValueSet/detectedissue-category
from the FHIR Standard
DetectedIssue.severityrequiredDetectedIssueSeverity
http://hl7.org/fhir/ValueSet/detectedissue-severity|4.0.1
from the FHIR Standard
DetectedIssue.evidence.codeexampleManifestationAndSymptomCodes
http://hl7.org/fhir/ValueSet/manifestation-or-symptom
from the FHIR Standard
DetectedIssue.mitigation.actionpreferredDetectedIssueMitigationAction
http://hl7.org/fhir/ValueSet/detectedissue-mitigation-action
from the FHIR Standard

Differential View

This structure is derived from DetectedIssue

NameFlagsCard.TypeDescription & Constraintsdoco
.. DetectedIssue 0..*DetectedIssueClinical issue with action
... modifierExtension:gapStatus ?!S1..1DEQMGapStatusModifierExtensionGap Status
... code S1..1CodeableConceptIssue Category, e.g. drug-drug, duplicate therapy, etc.
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: CAREGAP
... patient S1..1Reference(QICore Patient)Associated patient
... evidence S1..*BackboneElementSupporting evidence
.... detail S1..1Reference(DEQM Individual MeasureReport Profile | Detailed Care Gap Guidance Response)This references either a DEQM Individual MeasureReport or a GuidanceResponse resource. Note that referencing the GuidanceResponse resource allows potential profiling on GuidanceResponse in the future without breaking backward compatibility.

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. DetectedIssue 0..*DetectedIssueClinical issue with action
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for modifierExtension ?!1..*ExtensionExtension
Slice: Unordered, Open by value:url
... modifierExtension:gapStatus ?!S1..1DEQMGapStatusModifierExtensionGap Status
... status ?!Σ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required): Indicates the status of the identified issue.

... code SΣ1..1CodeableConceptIssue Category, e.g. drug-drug, duplicate therapy, etc.
Binding: DetectedIssueCategory (preferred): Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.


Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: CAREGAP
... patient SΣ1..1Reference(QICore Patient)Associated patient
... evidence S1..*BackboneElementSupporting evidence
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... detail S1..1Reference(DEQM Individual MeasureReport Profile | Detailed Care Gap Guidance Response)This references either a DEQM Individual MeasureReport or a GuidanceResponse resource. Note that referencing the GuidanceResponse resource allows potential profiling on GuidanceResponse in the future without breaking backward compatibility.

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
DetectedIssue.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
DetectedIssue.codepreferredPattern: CAREGAP
http://hl7.org/fhir/ValueSet/detectedissue-category
from the FHIR Standard

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. DetectedIssue 0..*DetectedIssueClinical issue with action
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... Slices for modifierExtension ?!1..*ExtensionExtension
Slice: Unordered, Open by value:url
... modifierExtension:gapStatus ?!S1..1DEQMGapStatusModifierExtensionGap Status
... identifier Σ0..*IdentifierUnique id for the detected issue
... status ?!Σ1..1coderegistered | preliminary | final | amended +
Binding: ObservationStatus (required): Indicates the status of the identified issue.

... code SΣ1..1CodeableConceptIssue Category, e.g. drug-drug, duplicate therapy, etc.
Binding: DetectedIssueCategory (preferred): Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.


Required Pattern: At least the following
.... id0..1stringUnique id for inter-element referencing
.... extension0..*ExtensionAdditional content defined by implementations
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... system1..1uriIdentity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... version0..1stringVersion of the system - if relevant
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: CAREGAP
..... display0..1stringRepresentation defined by the system
..... userSelected0..1booleanIf this coding was chosen directly by the user
.... text0..1stringPlain text representation of the concept
... severity Σ0..1codehigh | moderate | low
Binding: DetectedIssueSeverity (required): Indicates the potential degree of impact of the identified issue on the patient.

... patient SΣ1..1Reference(QICore Patient)Associated patient
... identified[x] Σ0..1When identified
.... identifiedDateTimedateTime
.... identifiedPeriodPeriod
... author Σ0..1Reference(Practitioner | PractitionerRole | Device)The provider or device that identified the issue
... implicated Σ0..*Reference(Resource)Problem resource
... evidence S1..*BackboneElementSupporting evidence
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code 0..*CodeableConceptManifestation
Binding: ManifestationAndSymptomCodes (example): Codes that describes the types of evidence for a detected issue.


.... detail S1..1Reference(DEQM Individual MeasureReport Profile | Detailed Care Gap Guidance Response)This references either a DEQM Individual MeasureReport or a GuidanceResponse resource. Note that referencing the GuidanceResponse resource allows potential profiling on GuidanceResponse in the future without breaking backward compatibility.
... detail 0..1stringDescription and context
... reference 0..1uriAuthority for issue
... mitigation 0..*BackboneElementStep taken to address
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... action 1..1CodeableConceptWhat mitigation?
Binding: DetectedIssueMitigationAction (preferred): Codes describing steps taken to resolve the issue or other circumstances that mitigate the risk associated with the issue; e.g. 'added concurrent therapy', 'prior therapy documented', etc.

.... date 0..1dateTimeDate committed
.... author 0..1Reference(Practitioner | PractitionerRole)Who is committing?

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
DetectedIssue.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
DetectedIssue.statusrequiredObservationStatus
http://hl7.org/fhir/ValueSet/observation-status|4.0.1
from the FHIR Standard
DetectedIssue.codepreferredPattern: CAREGAP
http://hl7.org/fhir/ValueSet/detectedissue-category
from the FHIR Standard
DetectedIssue.severityrequiredDetectedIssueSeverity
http://hl7.org/fhir/ValueSet/detectedissue-severity|4.0.1
from the FHIR Standard
DetectedIssue.evidence.codeexampleManifestationAndSymptomCodes
http://hl7.org/fhir/ValueSet/manifestation-or-symptom
from the FHIR Standard
DetectedIssue.mitigation.actionpreferredDetectedIssueMitigationAction
http://hl7.org/fhir/ValueSet/detectedissue-mitigation-action
from the FHIR Standard

 

Other representations of profile: CSV, Excel, Schematron