Data Exchange For Quality Measures STU3 for FHIR R4
3.0.0 - CI Build

Data Exchange For Quality Measures STU3 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 3.0.0). This version is based on the current content of https://github.com/HL7/davinci-deqm/ and changes regularly. See the Directory of published versions

Gaps in Care Example Use Cases

Introduction

The Gaps in Care is a powerful report that when used along with other DEQM functionality can result in better care results for the payer, the provider, and most importantly the patient. A simplistic example described below shows its potential power.

In this scenario, a provider has requested a Gaps in Care Report for the Colorectal Cancer Screening Measure from ABC Insurance for their patients using the care-gaps operation. Since the provider does not specify open or closed gaps, both open and closed gaps will be returned as default. The Gaps in Care Report returns two patients. The first patient has an open gap and the second patient has a closed gap.

The first patient with the open gap had a colonoscopy done recently and the ABC Insurance has not yet been made aware of. The provider uses the DEQM Submit Data functionality to update the payer’s database.

Later, the provider runs the same Gaps in Care Report again, both patients now showing as having their Colorectal Cancer Screening Measure gaps closed.

FHIR Resource Overview

Resources Supported for this Use Case

Resource Type Profile Name Link to Profile
Bundle DEQM Gaps In Care Bundle Profile DEQM Gaps In Care Bundle Profile
Composition DEQM Gaps In Care Composition Profile DEQM Gaps In Care Composition Profile
DetectedIssue DEQM Gaps In Care DetectedIssue Profile DEQM Gaps In Care DetectedIssue Profile
Encounter QI Core Encounter Profile QI Core Encounter
Library CQFM Library Profile CQFM Library
Measure CQFM Measure Profile CQFM Measure
MeasureReport DEQM Individual MeasureReport Profile DEQM Individual MeasureReport Profile
Organization DEQM Organization Profile DEQM Organization
Patient QI Core Patient Profile QI Core Patient
Practitioner DEQM Practitioner Profile DEQM Practitioner
Procedure QI Core Procedure Profile QI Core Procedure

Care Gaps Operation

A Client, such as a provider, will use the care-gaps operation to request a Colorectal Cancer Screening measure Gaps in Care Report for his/her patients from the Server, such as a payer. The provider receives the report from the payer system and notices that the report identifies one of the patients as having an open gap. He/she looks at the chart and sees that a colonoscopy was done previously when the patient had a different payer/insurance. He/she then submits a DEQM Data Exchange MeasureReport and the referenced resources required as supporting evidence for the Colorectal Cancer Screening measure to the payer. Later, the provider repeats the care-gaps operation for Colorectal Cancer Screening to ensure the open gaps is now closed for that patient.

The Figure 3-22 shows the workflow for gaps in care.

Figure 3-22 Gaps in Care Workflow
gaps-swimlane-caregap-report.png

Gaps in Care Report

This section contains an example that begins with a provider requesting a Gaps in Care Report for his/her patients from the payer. The provider receives the report, he/she then submits additional data to the payer for the patient that was identified as having open gaps in the report. He/she then later requests a Gaps in Care Report for these patients again from the payer.

Step 1 - Initial Run for a Gaps in Care Report

The resource graphs below represent the structure of the resources returned from the first care-gaps operation. Figure 3-23 shows the patient, Gaps Patient01, has an open gap because there were no resources in the payer system that would put her in numerator or denominator exclusion of the Colorectal Cancer Screening measure. The DetectedIssue resource contained in this Gaps in Care Report has the code “open-gap” as gap status indicating Gaps Patient01 has an open gap for this measure. Figure 3-24 shows the second patient, Gaps Patient02, that is in the report has a closed gap. The evaluatedResource points to a colonoscopy procedure done in 2018 that had met the numerator criteria and resulted as a closed gap. Notice that the DetectedIssue resource’s gap status code is “closed-gap”, which indicates Gaps Patient02 does not have an open gap.

Figure 3-23 Gaps in Care Resources Colonoscopy Gaps Patient01 Example: Step 1 - Open Gap
gic-colonoscopy-example-pt1-step1-open-gap.png

Figure 3-24 Gaps in Care Resources Colonoscopy Gaps Patient02 Example: Step 1- Closed Gap
gic-colonoscopy-example-pt2-step1-no-gap.png

Examples

Scenario: The provider requested a Gaps in Care Report on 2020-06-30, which was for a group of patients (group id 123) for the gaps through period from 2020-01-01 to 2020-12-31. The provider received the report, which includes two patients: gaps-patient01 and gaps-patient02. The report shows that gaps-patient01 has an open gap and gaps-patient02 has a closed gap for Colorectal Cancer Screening.

Get Gaps in Care Report

GET [base]/Measure/$care-gaps?measureurl=http://hl7.org/fhir/us/davinci-deqm/Measure/measure-exm130-example|2.0.0&subject=Group/123&periodStart=2020-01-01&periodEnd=2020-12-31&status=open-gap&status=closed-gap
{
  "resourceType": "Parameters",
  "id": "multiple-gaps-indv-report01",
  "parameter": [
    {
      "name": "return",
      "resource": {
        "resourceType": "Bundle",
        "id": "single-gaps-open-indv-report01",
        "meta": {
          "profile": [
            "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-bundle-deqm"
          ]
        },
        "identifier": {
          "system": "urn:ietf:rfc:3986",
          "value": "urn:uuid:a11848c9-c9e4-42fc-8f53-cea03782c3e5"
        },
        "type": "document",
        "timestamp": "2020-06-30T13:08:53+00:00",
        "entry": [
          {
            "fullUrl": "http://example.org/fhir/gaps/Composition/gaps-composition01",
            "resource": {
              "resourceType": "Composition",
              "id": "gaps-composition01",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-composition-deqm"
                ]
              },
              "status": "final",
              "type": {
                "coding": [
                  {
                    "system": "http://loinc.org",
                    "code": "96315-7",
                    "display": "Gaps in care report"
                  }
                ]
              },
              "subject": {
                "reference": "Patient/gaps-patient01"
              },
              "date": "2020-06-30T13:08:53+00:00",
              "author": [
                {
                  "reference": "Organization/gaps-organization-reportingvendor"
                }
              ],
              "title": "Care Gap Report for patient gaps-patient01",
              "section": [
                {
                  "title": "Colorectal Cancer Screening",
                  "focus": {
                    "reference": "MeasureReport/gaps-indv-measurereport01"
                  },
                  "entry": [
                    {
                      "reference": "DetectedIssue/gaps-detectedissue01"
                    }
                  ]
                },
                {
                  "title": "Cervical Cancer Screening",
                  "focus": {
                    "reference": "MeasureReport/gaps-indv-measurereport02"
                  },
                  "entry": [
                    {
                      "reference": "DetectedIssue/gaps-detectedissue02"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/MeasureReport/gaps-indv-measurereport01",
            "resource": {
              "resourceType": "MeasureReport",
              "id": "gaps-indv-measurereport01",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/indv-measurereport-deqm"
                ]
              },
              "extension": [
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
                        "code": "proportion"
                      }
                    ]
                  }
                },
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-certificationIdentifier",
                  "valueIdentifier": {
                    "system": "urn:oid:2.16.840.1.113883.3.2074.1",
                    "value": "0015HQN9BD3304E"
                  }
                },
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-reportingVendor",
                  "valueReference": {
                    "reference": "Organization/gaps-organization-reportingvendor"
                  }
                }
              ],
              "status": "complete",
              "type": "individual",
              "measure": "http://hl7.org/fhir/us/davinci-deqm/Measure/measure-exm130-example",
              "subject": {
                "reference": "Patient/gaps-patient01"
              },
              "date": "2020-06-30T13:08:52+00:00",
              "reporter": {
                "reference": "Organization/organization01"
              },
              "period": {
                "start": "2020-01-01T00:00:00+00:00",
                "end": "2020-12-31T00:00:00+00:00"
              },
              "improvementNotation": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                    "code": "increase"
                  }
                ]
              },
              "group": [
                {
                  "id": "group-exm130",
                  "population": [
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "initial-population",
                            "display": "Initial Population"
                          }
                        ]
                      },
                      "count": 1
                    },
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "numerator",
                            "display": "Numerator"
                          }
                        ]
                      },
                      "count": 0
                    },
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "denominator",
                            "display": "Denominator"
                          }
                        ]
                      },
                      "count": 1
                    },
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "denominator-exclusion",
                            "display": "Denominator Exclusion"
                          }
                        ]
                      },
                      "count": 0
                    }
                  ],
                  "measureScore": {
                    "value": 0.0
                  }
                }
              ],
              "evaluatedResource": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
                      "valueString": "initial-population"
                    }
                  ],
                  "reference": "Encounter/gaps-encounter01"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
                      "valueString": "initial-population"
                    }
                  ],
                  "reference": "Patient/gaps-patient01"
                }
              ]
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/MeasureReport/gaps-indv-measurereport02",
            "resource": {
              "resourceType": "MeasureReport",
              "id": "gaps-indv-measurereport02",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/indv-measurereport-deqm"
                ]
              },
              "extension": [
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
                        "code": "proportion"
                      }
                    ]
                  }
                },
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-certificationIdentifier",
                  "valueIdentifier": {
                    "system": "urn:oid:2.16.840.1.113883.3.2074.1",
                    "value": "0015HQN9BD3304E"
                  }
                },
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-reportingVendor",
                  "valueReference": {
                    "reference": "Organization/gaps-organization-reportingvendor"
                  }
                }
              ],
              "status": "complete",
              "type": "individual",
              "measure": "http://hl7.org/fhir/us/davinci-deqm/Measure/measure-exm124-example",
              "subject": {
                "reference": "Patient/gaps-patient01"
              },
              "date": "2020-07-02T13:08:52+00:00",
              "reporter": {
                "reference": "Organization/organization01"
              },
              "period": {
                "start": "2020-01-01T00:00:00+00:00",
                "end": "2020-12-31T00:00:00+00:00"
              },
              "improvementNotation": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                    "code": "increase"
                  }
                ]
              },
              "group": [
                {
                  "id": "group-exm124",
                  "population": [
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "initial-population",
                            "display": "Initial Population"
                          }
                        ]
                      },
                      "count": 1
                    },
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "numerator",
                            "display": "Numerator"
                          }
                        ]
                      },
                      "count": 0
                    },
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "denominator",
                            "display": "Denominator"
                          }
                        ]
                      },
                      "count": 1
                    },
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "denominator-exclusion",
                            "display": "Denominator Exclusion"
                          }
                        ]
                      },
                      "count": 0
                    }
                  ],
                  "measureScore": {
                    "value": 0.0
                  }
                }
              ],
              "evaluatedResource": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
                      "valueString": "initial-population"
                    },
                    {
                      "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
                      "valueString": "denominator"
                    }
                  ],
                  "reference": "Encounter/gaps-encounter01"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
                      "valueString": "initial-population"
                    },
                    {
                      "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
                      "valueString": "denominator"
                    }
                  ],
                  "reference": "Patient/gaps-patient01"
                }
              ]
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/DetectedIssue/gaps-detectedissue01",
            "resource": {
              "resourceType": "DetectedIssue",
              "id": "gaps-detectedissue01",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-detectedissue-deqm"
                ]
              },
              "modifierExtension": [
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-gapStatus",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-status",
                        "code": "open-gap"
                      }
                    ]
                  }
                }
              ],
              "status": "final",
              "code": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                    "code": "CAREGAP",
                    "display": "Care Gaps"
                  }
                ]
              },
              "patient": {
                "reference": "Patient/gaps-patient01"
              },
              "evidence": [
                {
                  "detail": [
                    {
                      "reference": "MeasureReport/gaps-indv-measurereport01"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/DetectedIssue/gaps-detectedissue02",
            "resource": {
              "resourceType": "DetectedIssue",
              "id": "gaps-detectedissue02",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-detectedissue-deqm"
                ]
              },
              "modifierExtension": [
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-gapStatus",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-status",
                        "code": "open-gap"
                      }
                    ]
                  }
                }
              ],
              "status": "final",
              "code": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                    "code": "CAREGAP",
                    "display": "Care Gaps"
                  }
                ]
              },
              "patient": {
                "reference": "Patient/gaps-patient01"
              },
              "evidence": [
                {
                  "detail": [
                    {
                      "reference": "MeasureReport/gaps-indv-measurereport02"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/Encounter/gaps-encounter01",
            "resource": {
              "resourceType": "Encounter",
              "id": "gaps-encounter01",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"
                ]
              },
              "status": "finished",
              "class": {
                "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                "code": "AMB",
                "display": "ambulatory"
              },
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://www.ama-assn.org/go/cpt",
                      "code": "99201",
                      "display": "Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family."
                    }
                  ]
                }
              ],
              "subject": {
                "reference": "Patient/gaps-patient01"
              },
              "period": {
                "start": "2020-05-30T00:00:00-00:00",
                "end": "2020-05-31T00:00:00-00:00"
              }
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/Patient/gaps-patient01",
            "resource": {
              "resourceType": "Patient",
              "id": "gaps-patient01",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
                ]
              },
              "extension": [
                {
                  "extension": [
                    {
                      "url": "ombCategory",
                      "valueCoding": {
                        "system": "urn:oid:2.16.840.1.113883.6.238",
                        "code": "2028-9",
                        "display": "Asian"
                      }
                    },
                    {
                      "url": "text",
                      "valueString": "Asian"
                    }
                  ],
                  "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race"
                },
                {
                  "extension": [
                    {
                      "url": "ombCategory",
                      "valueCoding": {
                        "system": "urn:oid:2.16.840.1.113883.6.238",
                        "code": "2135-2",
                        "display": "Hispanic or Latino"
                      }
                    },
                    {
                      "url": "text",
                      "valueString": "Hispanic or Latino"
                    }
                  ],
                  "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity"
                }
              ],
              "identifier": [
                {
                  "use": "usual",
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "MR",
                        "display": "Medical Record Number"
                      }
                    ]
                  },
                  "system": "http://hospital.smarthealthit.org",
                  "value": "999995992"
                }
              ],
              "name": [
                {
                  "family": "Susan",
                  "given": [
                    "Parker"
                  ]
                }
              ],
              "gender": "female",
              "birthDate": "1965-01-01"
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/Organization/gaps-organization-reportingvendor",
            "resource": {
              "resourceType": "Organization",
              "id": "gaps-organization-reportingvendor",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/organization-deqm"
                ]
              },
              "identifier": [
                {
                  "use": "official",
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "TAX",
                        "display": "Tax ID number"
                      }
                    ]
                  },
                  "system": "urn:oid:2.16.840.1.113883.4.4",
                  "value": "123446789",
                  "assigner": {
                    "display": "www.irs.gov"
                  }
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/organization-type",
                      "code": "pay",
                      "display": "Payer"
                    }
                  ]
                }
              ],
              "name": "GapsReportingVendor01",
              "telecom": [
                {
                  "system": "phone",
                  "value": "(+1) 401-545-1212"
                }
              ],
              "address": [
                {
                  "line": [
                    "13 Drive Street"
                  ],
                  "city": "Cityplace",
                  "state": "MA",
                  "postalCode": "01101",
                  "country": "USA"
                }
              ]
            }
          }
        ]
      }
    },
    {
      "name": "return",
      "resource": {
        "resourceType": "Bundle",
        "id": "single-gaps-closed-indv-report01",
        "meta": {
          "profile": [
            "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-bundle-deqm"
          ]
        },
        "identifier": {
          "system": "urn:ietf:rfc:3986",
          "value": "urn:uuid:66556327-43dc-40fc-b20c-4e31a31e98e0"
        },
        "type": "document",
        "timestamp": "2020-06-30T13:08:53+00:00",
        "entry": [
          {
            "fullUrl": "http://example.org/fhir/gaps/Composition/gaps-composition02",
            "resource": {
              "resourceType": "Composition",
              "id": "gaps-composition02",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-composition-deqm"
                ]
              },
              "status": "final",
              "type": {
                "coding": [
                  {
                    "system": "http://loinc.org",
                    "code": "96315-7",
                    "display": "Gaps in care report"
                  }
                ]
              },
              "subject": {
                "reference": "Patient/gaps-patient02"
              },
              "date": "2020-06-30T13:08:53+00:00",
              "author": [
                {
                  "reference": "Organization/gaps-organization-reportingvendor"
                }
              ],
              "title": "Care Gap Report for patient gaps-patient02",
              "section": [
                {
                  "title": "Colorectal Cancer Screening",
                  "focus": {
                    "reference": "MeasureReport/gaps-indv-measurereport03"
                  },
                  "entry": [
                    {
                      "reference": "DetectedIssue/gaps-detectedissue03"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/DetectedIssue/gaps-detectedissue03",
            "resource": {
              "resourceType": "DetectedIssue",
              "id": "gaps-detectedissue03",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-detectedissue-deqm"
                ]
              },
              "modifierExtension": [
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-gapStatus",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-status",
                        "code": "closed-gap"
                      }
                    ]
                  }
                }
              ],
              "status": "final",
              "code": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                    "code": "CAREGAP",
                    "display": "Care Gaps"
                  }
                ]
              },
              "patient": {
                "reference": "Patient/gaps-patient02"
              },
              "evidence": [
                {
                  "detail": [
                    {
                      "reference": "MeasureReport/gaps-indv-measurereport03"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/MeasureReport/gaps-indv-measurereport03",
            "resource": {
              "resourceType": "MeasureReport",
              "id": "gaps-indv-measurereport03",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/indv-measurereport-deqm"
                ]
              },
              "extension": [
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
                        "code": "proportion"
                      }
                    ]
                  }
                },
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-certificationIdentifier",
                  "valueIdentifier": {
                    "system": "urn:oid:2.16.840.1.113883.3.2074.1",
                    "value": "0015HQN9BD3304E"
                  }
                },
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-reportingVendor",
                  "valueReference": {
                    "reference": "Organization/gaps-organization-reportingvendor"
                  }
                }
              ],
              "status": "complete",
              "type": "individual",
              "measure": "http://hl7.org/fhir/us/davinci-deqm/Measure/measure-exm130-example",
              "subject": {
                "reference": "Patient/gaps-patient02"
              },
              "date": "2020-06-30T13:08:52+00:00",
              "reporter": {
                "reference": "Organization/organization01"
              },
              "period": {
                "start": "2020-01-01T00:00:00+00:00",
                "end": "2020-12-31T00:00:00+00:00"
              },
              "improvementNotation": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                    "code": "increase"
                  }
                ]
              },
              "group": [
                {
                  "id": "group-exm130",
                  "population": [
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "initial-population",
                            "display": "Initial Population"
                          }
                        ]
                      },
                      "count": 1
                    },
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "numerator",
                            "display": "Numerator"
                          }
                        ]
                      },
                      "count": 1
                    },
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "denominator",
                            "display": "Denominator"
                          }
                        ]
                      },
                      "count": 1
                    },
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "denominator-exclusion",
                            "display": "Denominator Exclusion"
                          }
                        ]
                      },
                      "count": 0
                    }
                  ],
                  "measureScore": {
                    "value": 1.0
                  }
                }
              ],
              "evaluatedResource": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
                      "valueString": "initial-population"
                    }
                  ],
                  "reference": "Encounter/gaps-encounter02"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
                      "valueString": "initial-population"
                    }
                  ],
                  "reference": "Patient/gaps-patient02"
                }
              ]
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/Encounter/gaps-encounter02",
            "resource": {
              "resourceType": "Encounter",
              "id": "gaps-encounter02",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"
                ]
              },
              "status": "finished",
              "class": {
                "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                "code": "AMB",
                "display": "ambulatory"
              },
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://www.ama-assn.org/go/cpt",
                      "code": "99201",
                      "display": "Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family."
                    }
                  ]
                }
              ],
              "subject": {
                "reference": "Patient/gaps-patient02"
              },
              "period": {
                "start": "2020-03-05T07:00:00-00:00",
                "end": "2020-03-05T10:00:00-00:00"
              }
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/Procedure/gaps-procedure01",
            "resource": {
              "resourceType": "Procedure",
              "id": "gaps-procedure01",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure"
                ]
              },
              "status": "completed",
              "code": {
                "coding": [
                  {
                    "system": "http://www.ama-assn.org/go/cpt",
                    "code": "45384",
                    "display": "Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique"
                  }
                ]
              },
              "subject": {
                "reference": "Patient/gaps-patient02"
              },
              "performedPeriod": {
                "start": "2018-09-10T08:00:00-00:00",
                "end": "2018-09-10T09:00:00-00:00"
              }
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/Patient/gaps-patient02",
            "resource": {
              "resourceType": "Patient",
              "id": "gaps-patient02",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
                ]
              },
              "extension": [
                {
                  "extension": [
                    {
                      "url": "ombCategory",
                      "valueCoding": {
                        "system": "urn:oid:2.16.840.1.113883.6.238",
                        "code": "2028-9",
                        "display": "Asian"
                      }
                    },
                    {
                      "url": "text",
                      "valueString": "Asian"
                    }
                  ],
                  "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race"
                },
                {
                  "extension": [
                    {
                      "url": "ombCategory",
                      "valueCoding": {
                        "system": "urn:oid:2.16.840.1.113883.6.238",
                        "code": "2135-2",
                        "display": "Hispanic or Latino"
                      }
                    },
                    {
                      "url": "text",
                      "valueString": "Hispanic or Latino"
                    }
                  ],
                  "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity"
                }
              ],
              "identifier": [
                {
                  "use": "usual",
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "MR",
                        "display": "Medical Record Number"
                      }
                    ]
                  },
                  "system": "http://hospital.smarthealthit.org",
                  "value": "999996992"
                }
              ],
              "name": [
                {
                  "family": "Ludwich",
                  "given": [
                    "Thomas"
                  ]
                }
              ],
              "gender": "male",
              "birthDate": "1957-01-01"
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/Organization/gaps-organization-reportingvendor",
            "resource": {
              "resourceType": "Organization",
              "id": "gaps-organization-reportingvendor",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/organization-deqm"
                ]
              },
              "identifier": [
                {
                  "use": "official",
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "TAX",
                        "display": "Tax ID number"
                      }
                    ]
                  },
                  "system": "urn:oid:2.16.840.1.113883.4.4",
                  "value": "123446789",
                  "assigner": {
                    "display": "www.irs.gov"
                  }
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/organization-type",
                      "code": "pay",
                      "display": "Payer"
                    }
                  ]
                }
              ],
              "name": "GapsReportingVendor01",
              "telecom": [
                {
                  "system": "phone",
                  "value": "(+1) 401-545-1212"
                }
              ],
              "address": [
                {
                  "line": [
                    "13 Drive Street"
                  ],
                  "city": "Cityplace",
                  "state": "MA",
                  "postalCode": "01101",
                  "country": "USA"
                }
              ]
            }
          }
        ]
      }
    }
  ]
}

Step 2 - Data Exchange to Submit Data for Closing Gaps

The provider noticed Gaps Patient01 was indicated as having an open gap for Colorectal Cancer Screening. The provider ordered an colonoscopy and the patient was able to get it done in the next few days. Typically a claim by the colonoscopy performer will close the gap. However, the provider may elect to send the submit report data to close the gap. Please see Colorectal Cancer Screening (COL) Use Case for details on how to complete the DEQM Data Exchange.

Step 3 - Rerun for a Gaps in Care Report

The provider rerun the Colorectal Cancer Screening Gaps in Care Report and confirmed that the open gap for Gaps Patient01 was closed. Note that in the Figure 3-25 below, the DetectedIssue resource for Gaps Patient01 now has the gap status code “closed-gap”, because the open gap is now closed. The Gaps Patient01 shows a recent colonoscopy. Figure 3-26 shows that there are no changes to Gaps Patient02 comparing to the initially generated report, it still shows closed gap.

Figure 3-25 Gaps in Care Resources Colonoscopy Gaps Patient01 Example: Step 3 - Open Gap Closed
gic-colonoscopy-example-pt1-step3-gap-closed.png

Figure 3-26 Gaps in Care Resources Colonoscopy Gaps Patient02 Example: Step 3 - Closed Gap
gic-colonoscopy-example-pt2-step1-no-gap.png

Examples

Scenario: After additional data was submitted to the payer system. The provider requested a Gaps in Care Report again on 2020-07-07 for the same group of patients (group id 123) and for the same gaps through period from 2020-01-01 to 2020-12-31. The provider received the report. It showed that gaps-patient01 now has a closed gap for Colorectal Cancer Screening and the gaps-patient02 still has a closed gap.

Get Gaps in Care Report

GET [base]/Measure/$care-gaps?measureurl=http://hl7.org/fhir/us/davinci-deqm/Measure/measure-exm130-example|2.0.0&subject=Group/123&periodStart=2020-01-01&periodEnd=2020-12-31&status=open-gap&status=closed-gap
{
  "resourceType": "Parameters",
  "id": "multiple-gaps-indv-report02",
  "parameter": [
    {
      "name": "return",
      "resource": {
        "resourceType": "Bundle",
        "id": "single-gaps-closed-indv-report02",
        "meta": {
          "profile": [
            "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-bundle-deqm"
          ]
        },
        "identifier": {
          "system": "urn:ietf:rfc:3986",
          "value": "urn:uuid:7396eb14-8f5c-4fe1-b023-1c6838152136"
        },
        "type": "document",
        "timestamp": "2020-07-07T13:08:53+00:00",
        "entry": [
          {
            "fullUrl": "http://example.org/fhir/gaps/Composition/gaps-composition03",
            "resource": {
              "resourceType": "Composition",
              "id": "gaps-composition03",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-composition-deqm"
                ]
              },
              "status": "final",
              "type": {
                "coding": [
                  {
                    "system": "http://loinc.org",
                    "code": "96315-7",
                    "display": "Gaps in care report"
                  }
                ]
              },
              "subject": {
                "reference": "Patient/gaps-patient01"
              },
              "date": "2020-07-07T13:08:53+00:00",
              "author": [
                {
                  "reference": "Organization/gaps-organization-reportingvendor"
                }
              ],
              "title": "Care Gap Report for patient gaps-patient01",
              "section": [
                {
                  "title": "Colorectal Cancer Screening",
                  "focus": {
                    "reference": "MeasureReport/gaps-indv-measurereport04"
                  },
                  "entry": [
                    {
                      "reference": "DetectedIssue/gaps-detectedissue05"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/DetectedIssue/gaps-detectedissue05",
            "resource": {
              "resourceType": "DetectedIssue",
              "id": "gaps-detectedissue05",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-detectedissue-deqm"
                ]
              },
              "modifierExtension": [
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-gapStatus",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-status",
                        "code": "closed-gap"
                      }
                    ]
                  }
                }
              ],
              "status": "final",
              "code": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                    "code": "CAREGAP",
                    "display": "Care Gaps"
                  }
                ]
              },
              "patient": {
                "reference": "Patient/gaps-patient01"
              },
              "evidence": [
                {
                  "detail": [
                    {
                      "reference": "MeasureReport/gaps-indv-measurereport04"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/MeasureReport/gaps-indv-measurereport04",
            "resource": {
              "resourceType": "MeasureReport",
              "id": "gaps-indv-measurereport04",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/indv-measurereport-deqm"
                ]
              },
              "extension": [
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
                        "code": "proportion"
                      }
                    ]
                  }
                },
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-certificationIdentifier",
                  "valueIdentifier": {
                    "system": "urn:oid:2.16.840.1.113883.3.2074.1",
                    "value": "0015HQN9BD3304E"
                  }
                },
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-reportingVendor",
                  "valueReference": {
                    "reference": "Organization/gaps-organization-reportingvendor"
                  }
                }
              ],
              "status": "complete",
              "type": "individual",
              "measure": "http://hl7.org/fhir/us/davinci-deqm/Measure/measure-exm130-example",
              "subject": {
                "reference": "Patient/gaps-patient01"
              },
              "date": "2020-07-07T13:08:52+00:00",
              "reporter": {
                "reference": "Organization/organization01"
              },
              "period": {
                "start": "2020-01-01T00:00:00+00:00",
                "end": "2020-12-31T00:00:00+00:00"
              },
              "improvementNotation": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                    "code": "increase"
                  }
                ]
              },
              "group": [
                {
                  "id": "group-exm130",
                  "population": [
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "initial-population",
                            "display": "Initial Population"
                          }
                        ]
                      },
                      "count": 1
                    },
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "numerator",
                            "display": "Numerator"
                          }
                        ]
                      },
                      "count": 1
                    },
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "denominator",
                            "display": "Denominator"
                          }
                        ]
                      },
                      "count": 1
                    },
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "denominator-exclusion",
                            "display": "Denominator Exclusion"
                          }
                        ]
                      },
                      "count": 0
                    }
                  ],
                  "measureScore": {
                    "value": 1.0
                  }
                }
              ],
              "evaluatedResource": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
                      "valueString": "initial-population"
                    }
                  ],
                  "reference": "Encounter/gaps-encounter03"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
                      "valueString": "initial-population"
                    }
                  ],
                  "reference": "Patient/gaps-patient01"
                }
              ]
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/Encounter/gaps-encounter03",
            "resource": {
              "resourceType": "Encounter",
              "id": "gaps-encounter03",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
                ]
              },
              "status": "finished",
              "class": {
                "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                "code": "AMB",
                "display": "ambulatory"
              },
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://www.ama-assn.org/go/cpt",
                      "code": "99201",
                      "display": "Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family."
                    }
                  ]
                }
              ],
              "subject": {
                "reference": "Patient/gaps-patient01"
              },
              "period": {
                "start": "2020-07-06T07:07:00-00:00",
                "end": "2020-07-06T10:11:00-00:00"
              }
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/Procedure/gaps-procedure02",
            "resource": {
              "resourceType": "Procedure",
              "id": "gaps-procedure02",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
                ]
              },
              "status": "completed",
              "code": {
                "coding": [
                  {
                    "system": "http://www.ama-assn.org/go/cpt",
                    "code": "45384",
                    "display": "Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique"
                  }
                ]
              },
              "subject": {
                "reference": "Patient/gaps-patient01"
              },
              "performedPeriod": {
                "start": "2020-07-06T08:00:00-00:00",
                "end": "2020-07-06T09:00:00-00:00"
              }
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/Patient/gaps-patient01",
            "resource": {
              "resourceType": "Patient",
              "id": "gaps-patient01",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
                ]
              },
              "extension": [
                {
                  "extension": [
                    {
                      "url": "ombCategory",
                      "valueCoding": {
                        "system": "urn:oid:2.16.840.1.113883.6.238",
                        "code": "2028-9",
                        "display": "Asian"
                      }
                    },
                    {
                      "url": "text",
                      "valueString": "Asian"
                    }
                  ],
                  "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race"
                },
                {
                  "extension": [
                    {
                      "url": "ombCategory",
                      "valueCoding": {
                        "system": "urn:oid:2.16.840.1.113883.6.238",
                        "code": "2135-2",
                        "display": "Hispanic or Latino"
                      }
                    },
                    {
                      "url": "text",
                      "valueString": "Hispanic or Latino"
                    }
                  ],
                  "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity"
                }
              ],
              "identifier": [
                {
                  "use": "usual",
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "MR",
                        "display": "Medical Record Number"
                      }
                    ]
                  },
                  "system": "http://hospital.smarthealthit.org",
                  "value": "999995992"
                }
              ],
              "name": [
                {
                  "family": "Susan",
                  "given": [
                    "Parker"
                  ]
                }
              ],
              "gender": "female",
              "birthDate": "1965-01-01"
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/Organization/gaps-organization-reportingvendor",
            "resource": {
              "resourceType": "Organization",
              "id": "gaps-organization-reportingvendor",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/organization-deqm"
                ]
              },
              "identifier": [
                {
                  "use": "official",
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "TAX",
                        "display": "Tax ID number"
                      }
                    ]
                  },
                  "system": "urn:oid:2.16.840.1.113883.4.4",
                  "value": "123446789",
                  "assigner": {
                    "display": "www.irs.gov"
                  }
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/organization-type",
                      "code": "pay",
                      "display": "Payer"
                    }
                  ]
                }
              ],
              "name": "GapsReportingVendor01",
              "telecom": [
                {
                  "system": "phone",
                  "value": "(+1) 401-545-1212"
                }
              ],
              "address": [
                {
                  "line": [
                    "13 Drive Street"
                  ],
                  "city": "Cityplace",
                  "state": "MA",
                  "postalCode": "01101",
                  "country": "USA"
                }
              ]
            }
          }
        ]
      }
    },
    {
      "name": "return",
      "resource": {
        "resourceType": "Bundle",
        "id": "single-gaps-closed-indv-report01",
        "meta": {
          "profile": [
            "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-bundle-deqm"
          ]
        },
        "identifier": {
          "system": "urn:ietf:rfc:3986",
          "value": "urn:uuid:80c493d0-e3c7-4e63-81fe-81fb3b16b9ab"
        },
        "type": "document",
        "timestamp": "2020-07-07T13:08:53+00:00",
        "entry": [
          {
            "fullUrl": "http://example.org/fhir/gaps/Composition/gaps-composition02",
            "resource": {
              "resourceType": "Composition",
              "id": "gaps-composition02",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-composition-deqm"
                ]
              },
              "status": "final",
              "type": {
                "coding": [
                  {
                    "system": "http://loinc.org",
                    "code": "96315-7",
                    "display": "Gaps in care report"
                  }
                ]
              },
              "subject": {
                "reference": "Patient/gaps-patient02"
              },
              "date": "2020-07-07T13:08:53+00:00",
              "author": [
                {
                  "reference": "Organization/gaps-organization-reportingvendor"
                }
              ],
              "title": "Care Gap Report for patient gaps-patient02",
              "section": [
                {
                  "title": "Colorectal Cancer Screening",
                  "focus": {
                    "reference": "MeasureReport/gaps-indv-measurereport03"
                  },
                  "entry": [
                    {
                      "reference": "DetectedIssue/gaps-detectedissue03"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/DetectedIssue/gaps-detectedissue03",
            "resource": {
              "resourceType": "DetectedIssue",
              "id": "gaps-detectedissue03",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-detectedissue-deqm"
                ]
              },
              "modifierExtension": [
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-gapStatus",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-status",
                        "code": "closed-gap"
                      }
                    ]
                  }
                }
              ],
              "status": "final",
              "code": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                    "code": "CAREGAP",
                    "display": "Care Gaps"
                  }
                ]
              },
              "patient": {
                "reference": "Patient/gaps-patient02"
              },
              "evidence": [
                {
                  "detail": [
                    {
                      "reference": "MeasureReport/gaps-indv-measurereport03"
                    }
                  ]
                }
              ]
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/MeasureReport/gaps-indv-measurereport03",
            "resource": {
              "resourceType": "MeasureReport",
              "id": "gaps-indv-measurereport03",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/indv-measurereport-deqm"
                ]
              },
              "extension": [
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
                        "code": "proportion"
                      }
                    ]
                  }
                },
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-certificationIdentifier",
                  "valueIdentifier": {
                    "system": "urn:oid:2.16.840.1.113883.3.2074.1",
                    "value": "0015HQN9BD3304E"
                  }
                },
                {
                  "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-reportingVendor",
                  "valueReference": {
                    "reference": "Organization/gaps-organization-reportingvendor"
                  }
                }
              ],
              "status": "complete",
              "type": "individual",
              "measure": "http://hl7.org/fhir/us/davinci-deqm/Measure/measure-exm130-example",
              "subject": {
                "reference": "Patient/gaps-patient02"
              },
              "date": "2020-07-07T13:08:53+00:00",
              "reporter": {
                "reference": "Organization/organization01"
              },
              "period": {
                "start": "2020-01-01T00:00:00+00:00",
                "end": "2020-12-31T00:00:00+00:00"
              },
              "improvementNotation": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                    "code": "increase"
                  }
                ]
              },
              "group": [
                {
                  "id": "group-exm130",
                  "population": [
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "initial-population",
                            "display": "Initial Population"
                          }
                        ]
                      },
                      "count": 1
                    },
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "numerator",
                            "display": "Numerator"
                          }
                        ]
                      },
                      "count": 1
                    },
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "denominator",
                            "display": "Denominator"
                          }
                        ]
                      },
                      "count": 1
                    },
                    {
                      "code": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                            "code": "denominator-exclusion",
                            "display": "Denominator Exclusion"
                          }
                        ]
                      },
                      "count": 0
                    }
                  ],
                  "measureScore": {
                    "value": 1.0
                  }
                }
              ],
              "evaluatedResource": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
                      "valueString": "initial-population"
                    }
                  ],
                  "reference": "Encounter/gaps-encounter02"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference",
                      "valueString": "initial-population"
                    }
                  ],
                  "reference": "Patient/gaps-patient02"
                }
              ]
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/Encounter/gaps-encounter02",
            "resource": {
              "resourceType": "Encounter",
              "id": "gaps-encounter02",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
                ]
              },
              "status": "finished",
              "class": {
                "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                "code": "AMB",
                "display": "ambulatory"
              },
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://www.ama-assn.org/go/cpt",
                      "code": "99201",
                      "display": "Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family."
                    }
                  ]
                }
              ],
              "subject": {
                "reference": "Patient/gaps-patient02"
              },
              "period": {
                "start": "2020-03-05T07:00:00-00:00",
                "end": "2020-03-05T10:00:00-00:00"
              }
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/Procedure/gaps-procedure01",
            "resource": {
              "resourceType": "Procedure",
              "id": "gaps-procedure01",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
                ]
              },
              "status": "completed",
              "code": {
                "coding": [
                  {
                    "system": "http://www.ama-assn.org/go/cpt",
                    "code": "45384",
                    "display": "Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique"
                  }
                ]
              },
              "subject": {
                "reference": "Patient/gaps-patient02"
              },
              "performedPeriod": {
                "start": "2018-09-10T08:00:00-00:00",
                "end": "2018-09-10T09:00:00-00:00"
              }
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/Patient/gaps-patient02",
            "resource": {
              "resourceType": "Patient",
              "id": "gaps-patient02",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
                ]
              },
              "extension": [
                {
                  "extension": [
                    {
                      "url": "ombCategory",
                      "valueCoding": {
                        "system": "urn:oid:2.16.840.1.113883.6.238",
                        "code": "2028-9",
                        "display": "Asian"
                      }
                    },
                    {
                      "url": "text",
                      "valueString": "Asian"
                    }
                  ],
                  "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race"
                },
                {
                  "extension": [
                    {
                      "url": "ombCategory",
                      "valueCoding": {
                        "system": "urn:oid:2.16.840.1.113883.6.238",
                        "code": "2135-2",
                        "display": "Hispanic or Latino"
                      }
                    },
                    {
                      "url": "text",
                      "valueString": "Hispanic or Latino"
                    }
                  ],
                  "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity"
                }
              ],
              "identifier": [
                {
                  "use": "usual",
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "MR",
                        "display": "Medical Record Number"
                      }
                    ]
                  },
                  "system": "http://hospital.smarthealthit.org",
                  "value": "999996992"
                }
              ],
              "name": [
                {
                  "family": "Ludwich",
                  "given": [
                    "Thomas"
                  ]
                }
              ],
              "gender": "male",
              "birthDate": "1957-01-01"
            }
          },
          {
            "fullUrl": "http://example.org/fhir/gaps/Organization/gaps-organization-reportingvendor",
            "resource": {
              "resourceType": "Organization",
              "id": "gaps-organization-reportingvendor",
              "meta": {
                "profile": [
                  "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/organization-deqm"
                ]
              },
              "identifier": [
                {
                  "use": "official",
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "TAX",
                        "display": "Tax ID number"
                      }
                    ]
                  },
                  "system": "urn:oid:2.16.840.1.113883.4.4",
                  "value": "123446789",
                  "assigner": {
                    "display": "www.irs.gov"
                  }
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/organization-type",
                      "code": "pay",
                      "display": "Payer"
                    }
                  ]
                }
              ],
              "name": "GapsReportingVendor01",
              "telecom": [
                {
                  "system": "phone",
                  "value": "(+1) 401-545-1212"
                }
              ],
              "address": [
                {
                  "line": [
                    "13 Drive Street"
                  ],
                  "city": "Cityplace",
                  "state": "MA",
                  "postalCode": "01101",
                  "country": "USA"
                }
              ]
            }
          }
        ]
      }
    }
  ]
}