Da Vinci Risk Adjustment Implementation Guide
2.0.0-preview - STU2 United States of America flag

Da Vinci Risk Adjustment Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 2.0.0-preview built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-ra/ and changes regularly. See the Directory of published versions

Resource Profile: Risk Adjustment Data Exchange MeasureReport

Official URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-datax-measurereport Version: 2.0.0-preview
Active as of 2024-11-04 Computable Name: RiskAdjustmentDataExchangeMeasureReport

Copyright/Legal: Used by permission of HL7 International - Clinical Quality Information Work Group, all rights reserved Creative Commons License

This profile is based on the MeasureReport. It is used for Provider to submit data such as clinical evaluation evidence to Payer.

Usage:

Formal Views of Profile Content

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

This structure is derived from MeasureReport

NameFlagsCard.TypeDescription & Constraintsdoco
.. MeasureReport 0..* MeasureReport This is a risk adjustment data exchange MeasureReport.
... Slices for extension Content/Rules for all slices
.... measurereport-category S 1..1 (Complex) What category is this measure report
URL: http://hl7.org/fhir/StructureDefinition/measurereport-category
..... value[x]
...... coding 1..1 Coding Code defined by a terminology system
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: ra
.... payerCodingGapReportId S 0..1 id Payer generated coding gap report id
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-payerCodingGapReportId
.... software S 0..* Reference(CRMI Software System Device) Extension
URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem
.... vendor S 0..1 Reference(US Core Organization Profile) Vendor information
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-reportingVendor
... status S 1..1 code complete | pending | error
... type S 1..1 code The type code is fixed to 'data-collection' for a risk adjustment data exchange measure report
Fixed Value: data-collection
... subject S 1..1 Reference(US Core Patient Profile) What individual(s) the report is for
... date S 1..1 dateTime When the report was generated
... reporter S 1..1 Reference(US Core Organization Profile) Organization that generated the MeasureReport
... period SC 1..1 Period Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes.
ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
.... start S 1..1 dateTime Starting time with inclusive boundary
.... end S 1..1 dateTime End time with inclusive boundary, if not ongoing
... group S 0..* BackboneElement Condition Category
.... id S 1..1 string Unique id for inter-element referencing
.... code S 0..1 CodeableConcept Condition Category (CC) code for a Risk Adjustment Model
Binding: Sample CMS Hierarchical Condition Category (example)
... evaluatedResource S 0..* Reference(Resource) An evaluated resource in a risk adjusstment data exchange MeasureReport is any data Provider submits to Payer as clinical evaluation evidence, such as a Consolidated Clinical Document Architecture (C-CDA) document, enounters, and diagnoses.
.... Slices for extension Content/Rules for all slices
..... groupReference S 0..* string This references the MeasureReport.group.id.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
MeasureReport.group.codeexampleSampleCMSHCC
http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc
from this IG

Constraints

IdGradePath(s)DetailsRequirements
ra-1errorMeasureReport.periodDate precision SHALL be at least to day ( YYYY-MM-DD )
: start.toString().length()>9 and end.toString().length()>9
NameFlagsCard.TypeDescription & Constraintsdoco
.. MeasureReport C 0..* MeasureReport This is a risk adjustment data exchange MeasureReport.
mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information
mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... measurereport-category S 1..1 (Complex) What category is this measure report
URL: http://hl7.org/fhir/StructureDefinition/measurereport-category
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/measurereport-category"
..... value[x] 1..1 CodeableConcept Value of extension
Binding: MeasureReportCategory (extensible)
...... coding Σ 1..1 Coding Code defined by a terminology system
....... code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: ra
.... payerCodingGapReportId S 0..1 id Payer generated coding gap report id
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-payerCodingGapReportId
.... software S 0..* Reference(CRMI Software System Device) Extension
URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem
.... vendor S 0..1 Reference(US Core Organization Profile) Vendor information
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-reportingVendor
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... type SΣC 1..1 code The type code is fixed to 'data-collection' for a risk adjustment data exchange measure report
Binding: MeasureReportType (required): The type of the measure report.


Fixed Value: data-collection
... measure SΣ 1..1 canonical(Risk Adjustment Model Measure) This references a measure that represents a risk adjustment model, such as CMS-HCC V24, CMS-HCC V28.
... subject SΣ 1..1 Reference(US Core Patient Profile) What individual(s) the report is for
... date SΣ 1..1 dateTime When the report was generated
... reporter SΣ 1..1 Reference(US Core Organization Profile) Organization that generated the MeasureReport
... period SΣC 1..1 Period Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes.
ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
.... start SΣC 1..1 dateTime Starting time with inclusive boundary
.... end SΣC 1..1 dateTime End time with inclusive boundary, if not ongoing
... improvementNotation ?!Σ 0..1 CodeableConcept increase | decrease
Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.

... group SC 0..* BackboneElement Condition Category
.... id S 1..1 string Unique id for inter-element referencing
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣ 0..1 CodeableConcept Condition Category (CC) code for a Risk Adjustment Model
Binding: Sample CMS Hierarchical Condition Category (example)
... evaluatedResource S 0..* Reference(Resource) An evaluated resource in a risk adjusstment data exchange MeasureReport is any data Provider submits to Payer as clinical evaluation evidence, such as a Consolidated Clinical Document Architecture (C-CDA) document, enounters, and diagnoses.
.... Slices for extension Content/Rules for all slices
..... groupReference S 0..* string This references the MeasureReport.group.id.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
MeasureReport.extension:measurereport-category.value[x]extensibleMeasureReportCategory
http://hl7.org/fhir/ValueSet/measurereport-category
MeasureReport.statusrequiredMeasureReportStatus
http://hl7.org/fhir/ValueSet/measure-report-status|4.0.1
from the FHIR Standard
MeasureReport.typerequiredFixed Value: data-collection
http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1
from the FHIR Standard
MeasureReport.improvementNotationrequiredMeasureImprovementNotation
http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1
from the FHIR Standard
MeasureReport.group.codeexampleSampleCMSHCC
http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc
from this IG

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMeasureReportIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMeasureReportIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMeasureReportIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMeasureReportIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMeasureReportA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mrp-1errorMeasureReportMeasure Reports used for data collection SHALL NOT communicate group and score information
: (type != 'data-collection') or group.exists().not()
mrp-2errorMeasureReportStratifiers SHALL be either a single criteria or a set of criteria components
: group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1errorMeasureReport.periodDate precision SHALL be at least to day ( YYYY-MM-DD )
: start.toString().length()>9 and end.toString().length()>9
NameFlagsCard.TypeDescription & Constraintsdoco
.. MeasureReport C 0..* MeasureReport This is a risk adjustment data exchange MeasureReport.
mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information
mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... measurereport-category S 1..1 (Complex) What category is this measure report
URL: http://hl7.org/fhir/StructureDefinition/measurereport-category
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/measurereport-category"
..... value[x] 1..1 CodeableConcept Value of extension
Binding: MeasureReportCategory (extensible)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 1..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 0..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: ra
....... display Σ 0..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
.... payerCodingGapReportId S 0..1 id Payer generated coding gap report id
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-payerCodingGapReportId
.... software S 0..* Reference(CRMI Software System Device) Extension
URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem
.... vendor S 0..1 Reference(US Core Organization Profile) Vendor information
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-reportingVendor
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Additional identifier for the MeasureReport
... status ?!SΣ 1..1 code complete | pending | error
Binding: MeasureReportStatus (required): The status of the measure report.

... type SΣC 1..1 code The type code is fixed to 'data-collection' for a risk adjustment data exchange measure report
Binding: MeasureReportType (required): The type of the measure report.


Fixed Value: data-collection
... measure SΣ 1..1 canonical(Risk Adjustment Model Measure) This references a measure that represents a risk adjustment model, such as CMS-HCC V24, CMS-HCC V28.
... subject SΣ 1..1 Reference(US Core Patient Profile) What individual(s) the report is for
... date SΣ 1..1 dateTime When the report was generated
... reporter SΣ 1..1 Reference(US Core Organization Profile) Organization that generated the MeasureReport
... period SΣC 1..1 Period Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes.
ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... start SΣC 1..1 dateTime Starting time with inclusive boundary
.... end SΣC 1..1 dateTime End time with inclusive boundary, if not ongoing
... improvementNotation ?!Σ 0..1 CodeableConcept increase | decrease
Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.

... group SC 0..* BackboneElement Condition Category
.... id S 1..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣ 0..1 CodeableConcept Condition Category (CC) code for a Risk Adjustment Model
Binding: Sample CMS Hierarchical Condition Category (example)
.... population 0..* BackboneElement The populations in the group
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... code Σ 0..1 CodeableConcept initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: MeasurePopulationType (extensible): The type of population (e.g. initial, numerator, denominator, etc.).

..... count 0..1 integer Size of the population
..... subjectResults 0..1 Reference(List) For subject-list reports, the subject results in this population
.... measureScore Σ 0..1 Quantity What score this group achieved
.... stratifier 0..* BackboneElement Stratification results
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... code 0..* CodeableConcept What stratifier of the group
..... stratum 0..* BackboneElement Stratum results, one for each unique value, or set of values, in the stratifier, or stratifier components
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... value 0..1 CodeableConcept The stratum value, e.g. male
...... component 0..* BackboneElement Stratifier component values
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... code 1..1 CodeableConcept What stratifier component of the group
....... value 1..1 CodeableConcept The stratum component value, e.g. male
...... population 0..* BackboneElement Population results in this stratum
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... code 0..1 CodeableConcept initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: MeasurePopulationType (extensible): The type of population (e.g. initial, numerator, denominator, etc.).

....... count 0..1 integer Size of the population
....... subjectResults 0..1 Reference(List) For subject-list reports, the subject results in this population
...... measureScore 0..1 Quantity What score this stratum achieved
... evaluatedResource S 0..* Reference(Resource) An evaluated resource in a risk adjusstment data exchange MeasureReport is any data Provider submits to Payer as clinical evaluation evidence, such as a Consolidated Clinical Document Architecture (C-CDA) document, enounters, and diagnoses.
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... groupReference S 0..* string This references the MeasureReport.group.id.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
MeasureReport.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
MeasureReport.extension:measurereport-category.value[x]extensibleMeasureReportCategory
http://hl7.org/fhir/ValueSet/measurereport-category
MeasureReport.statusrequiredMeasureReportStatus
http://hl7.org/fhir/ValueSet/measure-report-status|4.0.1
from the FHIR Standard
MeasureReport.typerequiredFixed Value: data-collection
http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1
from the FHIR Standard
MeasureReport.improvementNotationrequiredMeasureImprovementNotation
http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1
from the FHIR Standard
MeasureReport.group.codeexampleSampleCMSHCC
http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc
from this IG
MeasureReport.group.population.codeextensibleMeasurePopulationType
http://hl7.org/fhir/ValueSet/measure-population
from the FHIR Standard
MeasureReport.group.stratifier.stratum.population.codeextensibleMeasurePopulationType
http://hl7.org/fhir/ValueSet/measure-population
from the FHIR Standard
MeasureReport.evaluatedResource.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMeasureReportIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMeasureReportIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMeasureReportIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMeasureReportIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMeasureReportA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mrp-1errorMeasureReportMeasure Reports used for data collection SHALL NOT communicate group and score information
: (type != 'data-collection') or group.exists().not()
mrp-2errorMeasureReportStratifiers SHALL be either a single criteria or a set of criteria components
: group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1errorMeasureReport.periodDate precision SHALL be at least to day ( YYYY-MM-DD )
: start.toString().length()>9 and end.toString().length()>9

Differential View

This structure is derived from MeasureReport

NameFlagsCard.TypeDescription & Constraintsdoco
.. MeasureReport 0..* MeasureReport This is a risk adjustment data exchange MeasureReport.
... Slices for extension Content/Rules for all slices
.... measurereport-category S 1..1 (Complex) What category is this measure report
URL: http://hl7.org/fhir/StructureDefinition/measurereport-category
..... value[x]
...... coding 1..1 Coding Code defined by a terminology system
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: ra
.... payerCodingGapReportId S 0..1 id Payer generated coding gap report id
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-payerCodingGapReportId
.... software S 0..* Reference(CRMI Software System Device) Extension
URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem
.... vendor S 0..1 Reference(US Core Organization Profile) Vendor information
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-reportingVendor
... status S 1..1 code complete | pending | error
... type S 1..1 code The type code is fixed to 'data-collection' for a risk adjustment data exchange measure report
Fixed Value: data-collection
... subject S 1..1 Reference(US Core Patient Profile) What individual(s) the report is for
... date S 1..1 dateTime When the report was generated
... reporter S 1..1 Reference(US Core Organization Profile) Organization that generated the MeasureReport
... period SC 1..1 Period Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes.
ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
.... start S 1..1 dateTime Starting time with inclusive boundary
.... end S 1..1 dateTime End time with inclusive boundary, if not ongoing
... group S 0..* BackboneElement Condition Category
.... id S 1..1 string Unique id for inter-element referencing
.... code S 0..1 CodeableConcept Condition Category (CC) code for a Risk Adjustment Model
Binding: Sample CMS Hierarchical Condition Category (example)
... evaluatedResource S 0..* Reference(Resource) An evaluated resource in a risk adjusstment data exchange MeasureReport is any data Provider submits to Payer as clinical evaluation evidence, such as a Consolidated Clinical Document Architecture (C-CDA) document, enounters, and diagnoses.
.... Slices for extension Content/Rules for all slices
..... groupReference S 0..* string This references the MeasureReport.group.id.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
MeasureReport.group.codeexampleSampleCMSHCC
http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc
from this IG

Constraints

IdGradePath(s)DetailsRequirements
ra-1errorMeasureReport.periodDate precision SHALL be at least to day ( YYYY-MM-DD )
: start.toString().length()>9 and end.toString().length()>9

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MeasureReport C 0..* MeasureReport This is a risk adjustment data exchange MeasureReport.
mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information
mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... measurereport-category S 1..1 (Complex) What category is this measure report
URL: http://hl7.org/fhir/StructureDefinition/measurereport-category
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/measurereport-category"
..... value[x] 1..1 CodeableConcept Value of extension
Binding: MeasureReportCategory (extensible)
...... coding Σ 1..1 Coding Code defined by a terminology system
....... code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: ra
.... payerCodingGapReportId S 0..1 id Payer generated coding gap report id
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-payerCodingGapReportId
.... software S 0..* Reference(CRMI Software System Device) Extension
URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem
.... vendor S 0..1 Reference(US Core Organization Profile) Vendor information
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-reportingVendor
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... type SΣC 1..1 code The type code is fixed to 'data-collection' for a risk adjustment data exchange measure report
Binding: MeasureReportType (required): The type of the measure report.


Fixed Value: data-collection
... measure SΣ 1..1 canonical(Risk Adjustment Model Measure) This references a measure that represents a risk adjustment model, such as CMS-HCC V24, CMS-HCC V28.
... subject SΣ 1..1 Reference(US Core Patient Profile) What individual(s) the report is for
... date SΣ 1..1 dateTime When the report was generated
... reporter SΣ 1..1 Reference(US Core Organization Profile) Organization that generated the MeasureReport
... period SΣC 1..1 Period Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes.
ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
.... start SΣC 1..1 dateTime Starting time with inclusive boundary
.... end SΣC 1..1 dateTime End time with inclusive boundary, if not ongoing
... improvementNotation ?!Σ 0..1 CodeableConcept increase | decrease
Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.

... group SC 0..* BackboneElement Condition Category
.... id S 1..1 string Unique id for inter-element referencing
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣ 0..1 CodeableConcept Condition Category (CC) code for a Risk Adjustment Model
Binding: Sample CMS Hierarchical Condition Category (example)
... evaluatedResource S 0..* Reference(Resource) An evaluated resource in a risk adjusstment data exchange MeasureReport is any data Provider submits to Payer as clinical evaluation evidence, such as a Consolidated Clinical Document Architecture (C-CDA) document, enounters, and diagnoses.
.... Slices for extension Content/Rules for all slices
..... groupReference S 0..* string This references the MeasureReport.group.id.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
MeasureReport.extension:measurereport-category.value[x]extensibleMeasureReportCategory
http://hl7.org/fhir/ValueSet/measurereport-category
MeasureReport.statusrequiredMeasureReportStatus
http://hl7.org/fhir/ValueSet/measure-report-status|4.0.1
from the FHIR Standard
MeasureReport.typerequiredFixed Value: data-collection
http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1
from the FHIR Standard
MeasureReport.improvementNotationrequiredMeasureImprovementNotation
http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1
from the FHIR Standard
MeasureReport.group.codeexampleSampleCMSHCC
http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc
from this IG

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMeasureReportIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMeasureReportIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMeasureReportIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMeasureReportIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMeasureReportA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mrp-1errorMeasureReportMeasure Reports used for data collection SHALL NOT communicate group and score information
: (type != 'data-collection') or group.exists().not()
mrp-2errorMeasureReportStratifiers SHALL be either a single criteria or a set of criteria components
: group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1errorMeasureReport.periodDate precision SHALL be at least to day ( YYYY-MM-DD )
: start.toString().length()>9 and end.toString().length()>9

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. MeasureReport C 0..* MeasureReport This is a risk adjustment data exchange MeasureReport.
mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information
mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... measurereport-category S 1..1 (Complex) What category is this measure report
URL: http://hl7.org/fhir/StructureDefinition/measurereport-category
..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/measurereport-category"
..... value[x] 1..1 CodeableConcept Value of extension
Binding: MeasureReportCategory (extensible)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ 1..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ 0..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
Fixed Value: ra
....... display Σ 0..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text Σ 0..1 string Plain text representation of the concept
.... payerCodingGapReportId S 0..1 id Payer generated coding gap report id
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-payerCodingGapReportId
.... software S 0..* Reference(CRMI Software System Device) Extension
URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem
.... vendor S 0..1 Reference(US Core Organization Profile) Vendor information
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-reportingVendor
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Additional identifier for the MeasureReport
... status ?!SΣ 1..1 code complete | pending | error
Binding: MeasureReportStatus (required): The status of the measure report.

... type SΣC 1..1 code The type code is fixed to 'data-collection' for a risk adjustment data exchange measure report
Binding: MeasureReportType (required): The type of the measure report.


Fixed Value: data-collection
... measure SΣ 1..1 canonical(Risk Adjustment Model Measure) This references a measure that represents a risk adjustment model, such as CMS-HCC V24, CMS-HCC V28.
... subject SΣ 1..1 Reference(US Core Patient Profile) What individual(s) the report is for
... date SΣ 1..1 dateTime When the report was generated
... reporter SΣ 1..1 Reference(US Core Organization Profile) Organization that generated the MeasureReport
... period SΣC 1..1 Period Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes.
ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD )
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... start SΣC 1..1 dateTime Starting time with inclusive boundary
.... end SΣC 1..1 dateTime End time with inclusive boundary, if not ongoing
... improvementNotation ?!Σ 0..1 CodeableConcept increase | decrease
Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.

... group SC 0..* BackboneElement Condition Category
.... id S 1..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code SΣ 0..1 CodeableConcept Condition Category (CC) code for a Risk Adjustment Model
Binding: Sample CMS Hierarchical Condition Category (example)
.... population 0..* BackboneElement The populations in the group
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... code Σ 0..1 CodeableConcept initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: MeasurePopulationType (extensible): The type of population (e.g. initial, numerator, denominator, etc.).

..... count 0..1 integer Size of the population
..... subjectResults 0..1 Reference(List) For subject-list reports, the subject results in this population
.... measureScore Σ 0..1 Quantity What score this group achieved
.... stratifier 0..* BackboneElement Stratification results
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... code 0..* CodeableConcept What stratifier of the group
..... stratum 0..* BackboneElement Stratum results, one for each unique value, or set of values, in the stratifier, or stratifier components
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... value 0..1 CodeableConcept The stratum value, e.g. male
...... component 0..* BackboneElement Stratifier component values
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... code 1..1 CodeableConcept What stratifier component of the group
....... value 1..1 CodeableConcept The stratum component value, e.g. male
...... population 0..* BackboneElement Population results in this stratum
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... code 0..1 CodeableConcept initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: MeasurePopulationType (extensible): The type of population (e.g. initial, numerator, denominator, etc.).

....... count 0..1 integer Size of the population
....... subjectResults 0..1 Reference(List) For subject-list reports, the subject results in this population
...... measureScore 0..1 Quantity What score this stratum achieved
... evaluatedResource S 0..* Reference(Resource) An evaluated resource in a risk adjusstment data exchange MeasureReport is any data Provider submits to Payer as clinical evaluation evidence, such as a Consolidated Clinical Document Architecture (C-CDA) document, enounters, and diagnoses.
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... groupReference S 0..* string This references the MeasureReport.group.id.
URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
MeasureReport.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
MeasureReport.extension:measurereport-category.value[x]extensibleMeasureReportCategory
http://hl7.org/fhir/ValueSet/measurereport-category
MeasureReport.statusrequiredMeasureReportStatus
http://hl7.org/fhir/ValueSet/measure-report-status|4.0.1
from the FHIR Standard
MeasureReport.typerequiredFixed Value: data-collection
http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1
from the FHIR Standard
MeasureReport.improvementNotationrequiredMeasureImprovementNotation
http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1
from the FHIR Standard
MeasureReport.group.codeexampleSampleCMSHCC
http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc
from this IG
MeasureReport.group.population.codeextensibleMeasurePopulationType
http://hl7.org/fhir/ValueSet/measure-population
from the FHIR Standard
MeasureReport.group.stratifier.stratum.population.codeextensibleMeasurePopulationType
http://hl7.org/fhir/ValueSet/measure-population
from the FHIR Standard
MeasureReport.evaluatedResource.typeextensibleResourceType
http://hl7.org/fhir/ValueSet/resource-types
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorMeasureReportIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorMeasureReportIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorMeasureReportIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorMeasureReportIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceMeasureReportA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()
mrp-1errorMeasureReportMeasure Reports used for data collection SHALL NOT communicate group and score information
: (type != 'data-collection') or group.exists().not()
mrp-2errorMeasureReportStratifiers SHALL be either a single criteria or a set of criteria components
: group.stratifier.stratum.all(value.exists() xor component.exists())
ra-1errorMeasureReport.periodDate precision SHALL be at least to day ( YYYY-MM-DD )
: start.toString().length()>9 and end.toString().length()>9

 

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