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
Official URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-measurereport | Version: 2.0.0-preview | |||
Active as of 2024-09-05 | Computable Name: RiskAdjustmentCodingGapMeasureReport | |||
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 to represent a risk adjustment coding gap report. Payer runs risk adjustment engine and uses this profile to represent the risk adjustment Condition Category (CC) coding gaps and their detailed information for a patient.
The following data-elements must always be present (Mandatory) or must be supported (Must Support). The Formal Views below provides the formal summary, definitions, and terminology requirements.
Each MeasureReport must have:
MeasureReport.status
elementMeasureReport.type
element hard coded to “individual”MeasureReport.measure
element references a Risk Adjustment Model MeasureMeasureReport.subject
element references a US Core Patient profileMeasureReport.period
element for the clinical evaluation period for which the risk adjustment coding gap report was generated.MeasureReport.group
is present, each MeasureReport.group
must have a MeasureReport.group.ccType
elementEach MeasureReport should have ([Must Support]):
MeasureReport.group
elementMeasureReport.group
should have a MeasureReport.group.code
elementMeasureReport.group
should have a MeasureReport.group.evidenceStatus
elementMeasureReport.group
should have a MeasureReport.group.evidenceStatusDate
elementMeasureReport.group
should have a MeasureReport.group.hierarchicalStatus
elementMeasureReport.group
should have zero to many MeasureReport.evalautedResource
elementEach MeasureReport may have ([Must Support]):
MeasureReport.group
may have zero to one MeasureReport.group.confidenceScale
elementMeasureReport.group
may have zero to many MeasureReport.group.ccRemark
elementAdditional Profile specific implementation guidance:
evaluatedResource
SHALL reference resources using USCore profiles where applicableThe Clinical Data Collection Deadline element, clinicalDataCollectionDeadline
, was added as an extension to MeasureReport. We are seeking comment from implementers if they intend to use this element when communicating risk adjustment coding gap reports from payers to providers.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from MeasureReport
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
MeasureReport | 0..* | MeasureReport | This is a risk adjustment coding gap report. | |
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 | |
clinicalDataCollectionDeadline | S | 0..1 | date | This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline |
status | S | 1..1 | code | complete | pending | error |
type | S | 1..1 | code | The type code is fixed to 'individual' for a risk adjustment coding gap report Fixed Value: individual |
measure | S | 1..1 | canonical(Risk Adjustment Model Measure) | This references a measure that represents a risk adjustment model, such as CMS-HCC V24. |
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 | A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category. |
id | S | 1..1 | string | Unique id for inter-element referencing |
Slices for extension | Content/Rules for all slices | |||
ccType | S | 1..1 | CodeableConcept | Condition Category type: historic|suspected|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Risk Adjustment Conditioin Category Type ValueSet (extensible) |
dxCode | S | 0..* | CodeableConcept | diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxcode profiled by http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: US Core Condition Code (preferred) |
evidenceStatus | S | 0..1 | CodeableConcept | This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|invalid-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Risk Adjustment Evidence Status ValueSet (extensible) |
evidenceStatusDate | S | 0..1 | date | When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate |
hierarchicalStatus | S | 0..1 | CodeableConcept | How hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Risk Adjustment Hierarchical Status ValueSet (extensible) |
confidenceScale | S | 0..1 | CodeableConcept | Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: Confidence Scale Value Set (extensible) |
ccRemark | S | 0..* | (Complex) | Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark |
code | S | 0..1 | CodeableConcept | Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example) |
stratifier | ||||
code | 0..1 | CodeableConcept | What stratifier of the group | |
evaluatedResource | S | 0..* | Reference(Resource) | An evaluated resource is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap. |
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 |
Documentation for this format |
Path | Conformance | ValueSet | URI |
MeasureReport.group.code | example | SampleCMSHCChttp://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc from this IG |
Id | Grade | Path(s) | Details | Requirements |
ra-1 | error | MeasureReport.period | Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9 |
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
MeasureReport | C | 0..* | MeasureReport | This is a risk adjustment coding gap report. 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 |
clinicalDataCollectionDeadline | S | 0..1 | date | This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
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 'individual' for a risk adjustment coding gap report Binding: MeasureReportType (required): The type of the measure report. Fixed Value: individual |
measure | SΣ | 1..1 | canonical(Risk Adjustment Model Measure) | This references a measure that represents a risk adjustment model, such as CMS-HCC V24. |
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 | A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category. |
id | S | 1..1 | string | Unique id for inter-element referencing |
Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
ccType | S | 1..1 | CodeableConcept | Condition Category type: historic|suspected|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Risk Adjustment Conditioin Category Type ValueSet (extensible) |
dxCode | S | 0..* | CodeableConcept | diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxcode profiled by http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: US Core Condition Code (preferred) |
evidenceStatus | S | 0..1 | CodeableConcept | This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|invalid-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Risk Adjustment Evidence Status ValueSet (extensible) |
evidenceStatusDate | S | 0..1 | date | When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate |
hierarchicalStatus | S | 0..1 | CodeableConcept | How hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Risk Adjustment Hierarchical Status ValueSet (extensible) |
confidenceScale | S | 0..1 | CodeableConcept | Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: Confidence Scale Value Set (extensible) |
ccRemark | S | 0..* | (Complex) | Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark |
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 is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap. |
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 |
Documentation for this format |
Path | Conformance | ValueSet / Code | URI |
MeasureReport.extension:measurereport-category.value[x] | extensible | MeasureReportCategoryhttp://hl7.org/fhir/ValueSet/measurereport-category | |
MeasureReport.status | required | MeasureReportStatushttp://hl7.org/fhir/ValueSet/measure-report-status|4.0.1 from the FHIR Standard | |
MeasureReport.type | required | Fixed Value: individualhttp://hl7.org/fhir/ValueSet/measure-report-type|4.0.1 from the FHIR Standard | |
MeasureReport.improvementNotation | required | MeasureImprovementNotationhttp://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1 from the FHIR Standard | |
MeasureReport.group.code | example | SampleCMSHCChttp://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc from this IG |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | MeasureReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | MeasureReport | If 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-4 | error | MeasureReport | If 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-5 | error | MeasureReport | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | MeasureReport | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
mrp-1 | error | MeasureReport | Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not() | |
mrp-2 | error | MeasureReport | Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists()) | |
ra-1 | error | MeasureReport.period | Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9 |
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
MeasureReport | C | 0..* | MeasureReport | This is a risk adjustment coding gap report. 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 | ||||
language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
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 | ||||
clinicalDataCollectionDeadline | S | 0..1 | date | This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline | ||||
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 'individual' for a risk adjustment coding gap report Binding: MeasureReportType (required): The type of the measure report. Fixed Value: individual | ||||
measure | SΣ | 1..1 | canonical(Risk Adjustment Model Measure) | This references a measure that represents a risk adjustment model, such as CMS-HCC V24. | ||||
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 | A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category. | ||||
id | S | 1..1 | string | Unique id for inter-element referencing | ||||
Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
ccType | S | 1..1 | CodeableConcept | Condition Category type: historic|suspected|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Risk Adjustment Conditioin Category Type ValueSet (extensible) | ||||
dxCode | S | 0..* | CodeableConcept | diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxcode profiled by http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: US Core Condition Code (preferred) | ||||
evidenceStatus | S | 0..1 | CodeableConcept | This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|invalid-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Risk Adjustment Evidence Status ValueSet (extensible) | ||||
evidenceStatusDate | S | 0..1 | date | When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate | ||||
hierarchicalStatus | S | 0..1 | CodeableConcept | How hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Risk Adjustment Hierarchical Status ValueSet (extensible) | ||||
confidenceScale | S | 0..1 | CodeableConcept | Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: Confidence Scale Value Set (extensible) | ||||
ccRemark | S | 0..* | (Complex) | Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark | ||||
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..1 | 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 is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap. | ||||
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 | ||||
Documentation for this format |
Path | Conformance | ValueSet / Code | URI | |||
MeasureReport.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languages from the FHIR Standard | ||||
MeasureReport.extension:measurereport-category.value[x] | extensible | MeasureReportCategoryhttp://hl7.org/fhir/ValueSet/measurereport-category | ||||
MeasureReport.status | required | MeasureReportStatushttp://hl7.org/fhir/ValueSet/measure-report-status|4.0.1 from the FHIR Standard | ||||
MeasureReport.type | required | Fixed Value: individualhttp://hl7.org/fhir/ValueSet/measure-report-type|4.0.1 from the FHIR Standard | ||||
MeasureReport.improvementNotation | required | MeasureImprovementNotationhttp://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1 from the FHIR Standard | ||||
MeasureReport.group.code | example | SampleCMSHCChttp://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc from this IG | ||||
MeasureReport.group.population.code | extensible | MeasurePopulationTypehttp://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard | ||||
MeasureReport.group.stratifier.stratum.population.code | extensible | MeasurePopulationTypehttp://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard | ||||
MeasureReport.evaluatedResource.type | extensible | ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | MeasureReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | MeasureReport | If 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-4 | error | MeasureReport | If 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-5 | error | MeasureReport | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | MeasureReport | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
mrp-1 | error | MeasureReport | Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not() | |
mrp-2 | error | MeasureReport | Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists()) | |
ra-1 | error | MeasureReport.period | Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9 |
This structure is derived from MeasureReport
Summary
Mandatory: 9 elements(2 nested mandatory elements)
Must-Support: 23 elements
Fixed: 2 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Differential View
This structure is derived from MeasureReport
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
MeasureReport | 0..* | MeasureReport | This is a risk adjustment coding gap report. | |
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 | |
clinicalDataCollectionDeadline | S | 0..1 | date | This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline |
status | S | 1..1 | code | complete | pending | error |
type | S | 1..1 | code | The type code is fixed to 'individual' for a risk adjustment coding gap report Fixed Value: individual |
measure | S | 1..1 | canonical(Risk Adjustment Model Measure) | This references a measure that represents a risk adjustment model, such as CMS-HCC V24. |
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 | A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category. |
id | S | 1..1 | string | Unique id for inter-element referencing |
Slices for extension | Content/Rules for all slices | |||
ccType | S | 1..1 | CodeableConcept | Condition Category type: historic|suspected|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Risk Adjustment Conditioin Category Type ValueSet (extensible) |
dxCode | S | 0..* | CodeableConcept | diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxcode profiled by http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: US Core Condition Code (preferred) |
evidenceStatus | S | 0..1 | CodeableConcept | This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|invalid-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Risk Adjustment Evidence Status ValueSet (extensible) |
evidenceStatusDate | S | 0..1 | date | When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate |
hierarchicalStatus | S | 0..1 | CodeableConcept | How hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Risk Adjustment Hierarchical Status ValueSet (extensible) |
confidenceScale | S | 0..1 | CodeableConcept | Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: Confidence Scale Value Set (extensible) |
ccRemark | S | 0..* | (Complex) | Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark |
code | S | 0..1 | CodeableConcept | Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example) |
stratifier | ||||
code | 0..1 | CodeableConcept | What stratifier of the group | |
evaluatedResource | S | 0..* | Reference(Resource) | An evaluated resource is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap. |
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 |
Documentation for this format |
Path | Conformance | ValueSet | URI |
MeasureReport.group.code | example | SampleCMSHCChttp://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc from this IG |
Id | Grade | Path(s) | Details | Requirements |
ra-1 | error | MeasureReport.period | Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9 |
Key Elements View
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
MeasureReport | C | 0..* | MeasureReport | This is a risk adjustment coding gap report. 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 |
clinicalDataCollectionDeadline | S | 0..1 | date | This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
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 'individual' for a risk adjustment coding gap report Binding: MeasureReportType (required): The type of the measure report. Fixed Value: individual |
measure | SΣ | 1..1 | canonical(Risk Adjustment Model Measure) | This references a measure that represents a risk adjustment model, such as CMS-HCC V24. |
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 | A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category. |
id | S | 1..1 | string | Unique id for inter-element referencing |
Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
ccType | S | 1..1 | CodeableConcept | Condition Category type: historic|suspected|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Risk Adjustment Conditioin Category Type ValueSet (extensible) |
dxCode | S | 0..* | CodeableConcept | diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxcode profiled by http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: US Core Condition Code (preferred) |
evidenceStatus | S | 0..1 | CodeableConcept | This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|invalid-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Risk Adjustment Evidence Status ValueSet (extensible) |
evidenceStatusDate | S | 0..1 | date | When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate |
hierarchicalStatus | S | 0..1 | CodeableConcept | How hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Risk Adjustment Hierarchical Status ValueSet (extensible) |
confidenceScale | S | 0..1 | CodeableConcept | Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: Confidence Scale Value Set (extensible) |
ccRemark | S | 0..* | (Complex) | Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark |
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 is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap. |
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 |
Documentation for this format |
Path | Conformance | ValueSet / Code | URI |
MeasureReport.extension:measurereport-category.value[x] | extensible | MeasureReportCategoryhttp://hl7.org/fhir/ValueSet/measurereport-category | |
MeasureReport.status | required | MeasureReportStatushttp://hl7.org/fhir/ValueSet/measure-report-status|4.0.1 from the FHIR Standard | |
MeasureReport.type | required | Fixed Value: individualhttp://hl7.org/fhir/ValueSet/measure-report-type|4.0.1 from the FHIR Standard | |
MeasureReport.improvementNotation | required | MeasureImprovementNotationhttp://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1 from the FHIR Standard | |
MeasureReport.group.code | example | SampleCMSHCChttp://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc from this IG |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | MeasureReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | MeasureReport | If 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-4 | error | MeasureReport | If 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-5 | error | MeasureReport | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | MeasureReport | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
mrp-1 | error | MeasureReport | Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not() | |
mrp-2 | error | MeasureReport | Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists()) | |
ra-1 | error | MeasureReport.period | Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9 |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
MeasureReport | C | 0..* | MeasureReport | This is a risk adjustment coding gap report. 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 | ||||
language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
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 | ||||
clinicalDataCollectionDeadline | S | 0..1 | date | This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline | ||||
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 'individual' for a risk adjustment coding gap report Binding: MeasureReportType (required): The type of the measure report. Fixed Value: individual | ||||
measure | SΣ | 1..1 | canonical(Risk Adjustment Model Measure) | This references a measure that represents a risk adjustment model, such as CMS-HCC V24. | ||||
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 | A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category. | ||||
id | S | 1..1 | string | Unique id for inter-element referencing | ||||
Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
ccType | S | 1..1 | CodeableConcept | Condition Category type: historic|suspected|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Risk Adjustment Conditioin Category Type ValueSet (extensible) | ||||
dxCode | S | 0..* | CodeableConcept | diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxcode profiled by http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: US Core Condition Code (preferred) | ||||
evidenceStatus | S | 0..1 | CodeableConcept | This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|invalid-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Risk Adjustment Evidence Status ValueSet (extensible) | ||||
evidenceStatusDate | S | 0..1 | date | When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate | ||||
hierarchicalStatus | S | 0..1 | CodeableConcept | How hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Risk Adjustment Hierarchical Status ValueSet (extensible) | ||||
confidenceScale | S | 0..1 | CodeableConcept | Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: Confidence Scale Value Set (extensible) | ||||
ccRemark | S | 0..* | (Complex) | Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark | ||||
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..1 | 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 is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap. | ||||
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 | ||||
Documentation for this format |
Path | Conformance | ValueSet / Code | URI | |||
MeasureReport.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languages from the FHIR Standard | ||||
MeasureReport.extension:measurereport-category.value[x] | extensible | MeasureReportCategoryhttp://hl7.org/fhir/ValueSet/measurereport-category | ||||
MeasureReport.status | required | MeasureReportStatushttp://hl7.org/fhir/ValueSet/measure-report-status|4.0.1 from the FHIR Standard | ||||
MeasureReport.type | required | Fixed Value: individualhttp://hl7.org/fhir/ValueSet/measure-report-type|4.0.1 from the FHIR Standard | ||||
MeasureReport.improvementNotation | required | MeasureImprovementNotationhttp://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1 from the FHIR Standard | ||||
MeasureReport.group.code | example | SampleCMSHCChttp://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc from this IG | ||||
MeasureReport.group.population.code | extensible | MeasurePopulationTypehttp://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard | ||||
MeasureReport.group.stratifier.stratum.population.code | extensible | MeasurePopulationTypehttp://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard | ||||
MeasureReport.evaluatedResource.type | extensible | ResourceTypehttp://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | MeasureReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | MeasureReport | If 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-4 | error | MeasureReport | If 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-5 | error | MeasureReport | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | MeasureReport | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() | |
mrp-1 | error | MeasureReport | Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not() | |
mrp-2 | error | MeasureReport | Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists()) | |
ra-1 | error | MeasureReport.period | Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9 |
This structure is derived from MeasureReport
Summary
Mandatory: 9 elements(2 nested mandatory elements)
Must-Support: 23 elements
Fixed: 2 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Other representations of profile: CSV, Excel, Schematron