Data Exchange For Quality Measures STU2 for FHIR R4 Implementation Guide CI Build

Data Exchange For Quality Measures STU2 for FHIR R4, published by HL7 International - Clinical Quality Information Work Group. This is not an authorized publication; it is the continuous build for version 1.1.1). This version is based on the current content of https://github.com/HL7/davinci-deqm/ and changes regularly. See the Directory of published versions

Summary Measure Reporting Interactions

Introduction

A summary report contains calculated summary data for one or more Clinical Quality Measures (CQMs) for a specified population of patients within a particular health system over a specific period of time. For example, for a colorectal cancer screening CQM, “the data-of-interest” is the patient counts of initial population, denominator, denominator exclusions, and numerator respectively for a specified population of patients. Summary reports may also contain summary data for stratifier criteria (such as gender or age) as defined in a CQM.

The Summary reporting scenario is supported by the DEQM Summary MeasureReport Profile. Transactions between Reporters (for example, organizations that deliver care to patients, such as a practice or hospital) and Receivers (organizations that want to evaluate CQMs, such as quality reporting programs) are triggered by specific administrative events such as the submission of summary level quality reports for CQMs to various quality reporting programs.

Profiles

The following resources are used in the summary reporting scenario:

Resource Type Profile Name Link to Profile
Measure CQFM Measure Profile CQFM Measure
Summary MeasureReport DEQM Summary MeasureReport Profile DEQM Summary MeasureReport Profile
Organization DEQM Organization Profile DEQM Organization

Summary Measure Reporting

When the results of a quality measure are completed for a population at the end of a reporting period, they are POSTed to the quality measure Receiver’s FHIR Server. The report may only consist of the Summary MeasureReport in which case it is POSTed to the MeasureReport endpoint. If there are other referenced resources all the resources are bundled together as a set of POST interactions and sent as a single transaction interaction using the Standard FHIR API.

Figure 2-11 POST Summary Report
summ_report_post.jpg

Usage

for a single MeasureReport:

POST|[base]/MeasureReport

for a Bundle Transaction:

POST|[base]

Examples

Scenario:

Payer X who is acting in the role of a Reporter submits a MRP Summary Report for MRP for period P to Receiver Z. The body of the request is MeasureReport resource containing the required summary data for MRP attestation for the period. An HTTP Status success code is returned on successful submission.

POST Summary Report

POST [base]/MeasureReport

Request body

{
  "resourceType": "MeasureReport",
  "id": "summ-measurereport01",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/summary-measurereport-deqm"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: summ-measurereport01</p><p><b>meta</b>: </p><p><b>status</b>: complete</p><p><b>type</b>: summary</p><p><b>measure</b>: <a href=\"http://hl7.org/fhir/us/davinci-deqm/Measure/measure-mrp-example\">http://hl7.org/fhir/us/davinci-deqm/Measure/measure-mrp-example</a></p><p><b>date</b>: Sep 5, 2018, 4:59:52 PM</p><p><b>reporter</b>: <a href=\"Organization-organization01.html\">Generated Summary: id: organization01; Tax ID number = 123456789 (OFFICIAL); active; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/organization-type prov}\">Healthcare Provider</span>; name: DaVinciHospital01; ph: (+1) 401-555-1212</a></p><p><b>period</b>: Aug 1, 2018, 12:00:00 AM --&gt; Sep 1, 2018, 12:00:00 AM</p><blockquote><p><b>group</b></p><p><b>code</b>: 112 <span style=\"background: LightGoldenRodYellow\">(Details : {http://example.org code '112' = '112', given as '112'})</span></p><h3>Populations</h3><table class=\"grid\"><tr><td>-</td><td><b>Code</b></td><td><b>Count</b></td></tr><tr><td>*</td><td>Initial Population <span style=\"background: LightGoldenRodYellow\">(Details : {http://example.org code 'initial-population' = 'initial-population', given as 'Initial Population'})</span></td><td>100</td></tr></table><p><b>measureScore</b>: 100</p><blockquote><p><b>stratifier</b></p><p><b>code</b>: 4456 <span style=\"background: LightGoldenRodYellow\">(Details : {http://example.org code '4456' = '4456', given as '4456'})</span></p><blockquote><p><b>stratum</b></p><p><b>value</b>: Male <span style=\"background: LightGoldenRodYellow\">(Details : {http://hl7.org/fhir/administrative-gender code 'male' = 'Male', given as 'Male'})</span></p><h3>Populations</h3><table class=\"grid\"><tr><td>-</td><td><b>Code</b></td><td><b>Count</b></td></tr><tr><td>*</td><td>Initial Population <span style=\"background: LightGoldenRodYellow\">(Details : {http://example.org code 'initial-population' = 'initial-population', given as 'Initial Population'})</span></td><td>50</td></tr></table><p><b>measureScore</b>: 100</p></blockquote></blockquote></blockquote></div>"
  },
  "status": "complete",
  "type": "summary",
  "measure": "http://hl7.org/fhir/us/davinci-deqm/Measure/measure-mrp-example",
  "date": "2018-09-05T16:59:52.404Z",
  "reporter": {
    "reference": "Organization/organization01"
  },
  "period": {
    "start": "2018-08-01",
    "end": "2018-09-01"
  },
  "group": [
    {
      "code": {
        "coding": [
          {
            "system": "http://example.org",
            "code": "112",
            "display": "112"
          }
        ]
      },
      "population": [
        {
          "code": {
            "coding": [
              {
                "system": "http://example.org",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "count": 100
        }
      ],
      "measureScore": {
        "value": 100
      },
      "stratifier": [
        {
          "code": [
            {
              "coding": [
                {
                  "system": "http://example.org",
                  "code": "4456",
                  "display": "4456"
                }
              ]
            }
          ],
          "stratum": [
            {
              "value": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/administrative-gender",
                    "code": "male",
                    "display": "Male"
                  }
                ]
              },
              "population": [
                {
                  "code": {
                    "coding": [
                      {
                        "system": "http://example.org",
                        "code": "initial-population",
                        "display": "Initial Population"
                      }
                    ]
                  },
                  "count": 50
                }
              ],
              "measureScore": {
                "value": 100
              }
            }
          ]
        }
      ]
    }
  ]
}

Response

HTTP/1.1 200 OK
[other headers]

for an example of a Summary MeasureReport with counts for multiple populations and stratifiers specified in an eCQM see the Medicare Stratification Example and the COL Summary MeasureReport.