Metadata Title EXM Measure Version 2.0.0 Identifier EXM Identifier urn:oid:2.16.840.1.113883.4.642.40.61.29.9 Approval Date 2019-02-17 Last Review Date 2019-02-17 Experimental true Use Context Clinical Venue = EC Jurisdiction 001 from http://unstats.un.org/unsd/methods/m49/m49.htm Topic Health Quality Measure Document Steward (Publisher) HL7 International / Clinical Quality Information Developer Example Measure Content Developer Description An example FHIR-based measure Purpose This measure has been developed to support improvement in clinical care. Copyright Example Copyright Statement Disclaimer Example disclaimer Measure Basis Encounter Measure Scoring Continuous Variable Measure Scoring Precision 2 Improvement Notation Increased score indicates improvement Measure Type process from http://terminology.hl7.org/CodeSystem/measure-type Risk Adjustment Risk adjustment for this measure is performed by... Rate Aggregation Rate aggregation for this measure is performed by... Rationale The purpose of this measure is to show how all the elements of a FHIR-based quality measure are represented. Clinical Recommendation Statement The clinical recommendation statement for this measure is... Guidance (Usage) Users of this measure should be aware that this is intentionally simplified to show specific aspects of a measure. Measure Group (Rate) (ID: primary) Stratifier ID: stratifier-1 Code: Stratifier 1 Stratifier ID: stratifier-2 Code: Stratifier 2 Stratifier ID: stratifier-3 Code: Stratifier 3 Stratifier ID: stratifier-4 Code: Stratifier 4 Supplemental Data Elements Supplemental Data Element ID: sde-ethnicity Usage Code: Supplemental Data Description: No description provided Logic Definition: SDE Ethnicity Supplemental Data Element ID: sde-race Usage Code: Supplemental Data Description: No description provided Logic Definition: SDE Race Supplemental Data Element ID: sde-payer Usage Code: Supplemental Data Description: No description provided Logic Definition: SDE Payer Supplemental Data Element ID: sde-sex Usage Code: Supplemental Data Description: No description provided Logic Definition: SDE Sex Measure Logic Primary Library Example Logic Library Contents Population Criteria Logic Definitions Terminology Dependencies Data Requirements Parameters Population Criteria Measure Group (Rate) (ID: primary) Stratifier define "Stratifier 1" : "Inpatient Encounter" Encounter where not (PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient") Definition Stratifier define "Stratifier 2" : "Inpatient Encounter" Encounter where PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient" Definition Stratifier define "Stratifier 3" : "Inpatient Encounter" Encounter where PrincipalDiagnosis(Encounter) is null Definition Stratifier define "Stratifier 4" : "Inpatient Encounter" Encounter where PrincipalDiagnosis(Encounter) is null Definition Logic Definitions Logic Definition Library Name: EXMLogic define "SDE Sex": case when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' } when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' } else null end Logic Definition Library Name: EXMLogic define "Inpatient Encounter" : ["Encounter"] Encounter where LengthInDays(Encounter.period) <= 120 and Encounter.period ends during "Measurement Period" Logic Definition Library Name: EXMLogic define "Stratifier 3" : "Inpatient Encounter" Encounter where PrincipalDiagnosis(Encounter) is null Logic Definition Library Name: EXMLogic define "Stratifier 4" : "Inpatient Encounter" Encounter where PrincipalDiagnosis(Encounter) is null Logic Definition Library Name: EXMLogic define "SDE Payer": [Coverage: type in "Payer"] Payer return { code: Payer.type, period: Payer.period } Logic Definition Library Name: EXMLogic define "Initial Population" : "Inpatient Encounter" Encounter Logic Definition Library Name: EXMLogic define "SDE Ethnicity": (flatten ( Patient.extension Extension where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity' return Extension.extension )) E where E.url = 'ombCategory' or E.url = 'detailed' return E.value as Coding Logic Definition Library Name: EXMLogic define "SDE Race": (flatten ( Patient.extension Extension where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race' return Extension.extension )) E where E.url = 'ombCategory' or E.url = 'detailed' return E.value as Coding Logic Definition Library Name: EXMLogic define "Measure Population" : "Initial Population" Logic Definition Library Name: EXMLogic define "Stratifier 1" : "Inpatient Encounter" Encounter where not (PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient") Logic Definition Library Name: EXMLogic define "Stratifier 2" : "Inpatient Encounter" Encounter where PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient" Logic Definition Library Name: EXMLogic define function "LengthInDays"(Value Interval<DateTime>): difference in days between start of Value and end of Value Logic Definition Library Name: EXMLogic define function "PrincipalDiagnosis"(Encounter Encounter): (singleton from (Encounter.diagnosis D where D.use ~ ToConcept("Billing") and D.rank.value = 1)) PD return singleton from ([Condition: id in "GetId"(PD.condition.reference)]) Logic Definition Library Name: EXMLogic define function "GetId"(uri String): Last(Split(uri, '/')) Logic Definition Library Name: EXMLogic define function "Measure Observation" (Encounter "Encounter" ) : duration in minutes of "Related ED Visit"(Encounter).period Logic Definition Library Name: EXMLogic //Measure Observation define function "Related ED Visit" (Encounter "Encounter" ) : Last(["Encounter" : "Emergency Department Visit"] ED where ED.status = 'finished' and ED.period ends 1 hour or less before start of Encounter.period sort by start of period ) Logic Definition Library Name: FHIRHelpers define function ToString(value AdministrativeGender): value.value Logic Definition Library Name: FHIRHelpers /* @description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period) value to a CQL DateTime Interval @comment: If the start value of the given period is unspecified, the starting boundary of the resulting interval will be open (meaning the start of the interval is unknown, as opposed to interpreted as the beginning of time). */ define function ToInterval(period FHIR.Period): if period is null then null else if period."start" is null then Interval(period."start".value, period."end".value] else Interval[period."start".value, period."end".value] Logic Definition Library Name: FHIRHelpers /* @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept. */ define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value } Logic Definition Library Name: FHIRHelpers /* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value } Logic Definition Library Name: FHIRHelpers define function ToString(value string): value.value Logic Definition Library Name: FHIRHelpers define function ToString(value uri): value.value Logic Definition Library Name: FHIRHelpers define function ToString(value EncounterStatus): value.value Terminology Code System Description: Code system Diagnosis Role Resource: Diagnosis Role Canonical URL: http://terminology.hl7.org/CodeSystem/diagnosis-role Value Set Description: Value set Payer Resource: Payer Type Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 Value Set Description: Value set Emergency Department Visit Resource: Emergency Department Visit Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292 Value Set Description: Value set Psychiatric/Mental Health Patient Resource: Psychiatric/Mental Health Diagnosis Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.299 Direct Reference Code Display: Billing Code: billing System: http://terminology.hl7.org/CodeSystem/diagnosis-role Dependencies Dependency Description: FHIR model information Resource: http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1 Canonical URL: http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1 Dependency Description: Library FHIRHelpers Resource: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1 Canonical URL: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1 Data Requirements Data Requirement Type: Patient Profile(s): Patient Must Support Elements: url, extension, value Data Requirement Type: Encounter Profile(s): Encounter Must Support Elements: type, status, period, use, rank, rank.value, condition, condition.reference Code Filter(s): Path: type ValueSet: Emergency Department Visit Data Requirement Type: Encounter Profile(s): Encounter Must Support Elements: period, use, rank, rank.value, condition, condition.reference Data Requirement Type: Condition Profile(s): Condition Must Support Elements: id Code Filter(s): Path: id Data Requirement Type: Coverage Profile(s): Coverage Must Support Elements: type, period Code Filter(s): Path: type ValueSet: Payer Type Parameters Name Use Card. Type Documentation Measurement Period In 0..1 Period SDE Sex Out 0..1 Coding Stratifier 3 Out 0..* Encounter Stratifier 4 Out 0..* Encounter SDE Payer Out 0..* Resource Initial Population Out 0..* Encounter SDE Ethnicity Out 0..* Coding SDE Race Out 0..* Coding Measure Population Out 0..* Encounter Stratifier 1 Out 0..* Encounter Stratifier 2 Out 0..* Encounter Generated using version 0.5.4 of the sample-content-ig Liquid templates
define "SDE Sex": case when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' } when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' } else null end
define "Inpatient Encounter" : ["Encounter"] Encounter where LengthInDays(Encounter.period) <= 120 and Encounter.period ends during "Measurement Period"
define "Stratifier 3" : "Inpatient Encounter" Encounter where PrincipalDiagnosis(Encounter) is null
define "Stratifier 4" : "Inpatient Encounter" Encounter where PrincipalDiagnosis(Encounter) is null
define "SDE Payer": [Coverage: type in "Payer"] Payer return { code: Payer.type, period: Payer.period }
define "Initial Population" : "Inpatient Encounter" Encounter
define "SDE Ethnicity": (flatten ( Patient.extension Extension where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity' return Extension.extension )) E where E.url = 'ombCategory' or E.url = 'detailed' return E.value as Coding
define "SDE Race": (flatten ( Patient.extension Extension where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race' return Extension.extension )) E where E.url = 'ombCategory' or E.url = 'detailed' return E.value as Coding
define "Measure Population" : "Initial Population"
define "Stratifier 1" : "Inpatient Encounter" Encounter where not (PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient")
define "Stratifier 2" : "Inpatient Encounter" Encounter where PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient"
define function ToString(value AdministrativeGender): value.value
define function "LengthInDays"(Value Interval<DateTime>): difference in days between start of Value and end of Value
/* @description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period) value to a CQL DateTime Interval @comment: If the start value of the given period is unspecified, the starting boundary of the resulting interval will be open (meaning the start of the interval is unknown, as opposed to interpreted as the beginning of time). */ define function ToInterval(period FHIR.Period): if period is null then null else if period."start" is null then Interval(period."start".value, period."end".value] else Interval[period."start".value, period."end".value]
define function "PrincipalDiagnosis"(Encounter Encounter): (singleton from (Encounter.diagnosis D where D.use ~ ToConcept("Billing") and D.rank.value = 1)) PD return singleton from ([Condition: id in "GetId"(PD.condition.reference)])
/* @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept. */ define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value }
/* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value }
define function "GetId"(uri String): Last(Split(uri, '/'))
define function ToString(value string): value.value
define function ToString(value uri): value.value
define function "Measure Observation" (Encounter "Encounter" ) : duration in minutes of "Related ED Visit"(Encounter).period
//Measure Observation define function "Related ED Visit" (Encounter "Encounter" ) : Last(["Encounter" : "Emergency Department Visit"] ED where ED.status = 'finished' and ED.period ends 1 hour or less before start of Encounter.period sort by start of period )
define function ToString(value EncounterStatus): value.value
Value set Psychiatric/Mental Health Patient
HL7 International / Clinical Quality Information
This measure has been developed to support improvement in clinical care.
Users of this measure should be aware that this is intentionally simplified to show specific aspects of a measure.
Risk adjustment for this measure is performed by...
Rate aggregation for this measure is performed by...
The purpose of this measure is to show how all the elements of a FHIR-based quality measure are represented.
The clinical recommendation statement for this measure is...
Additional guidance provided to help communicate the intent of the measure