Metadata Title EXMRatio - Example Ratio Measure Library Version 4.0.0 Identifier EXMRatio Identifier urn:oid:2.16.840.1.113883.4.642.40.61.28.22 Approval Date 2019-08-03 Last Review Date 2019-08-03 Experimental true Jurisdiction 001 from http://unstats.un.org/unsd/methods/m49/m49.htm Topic FHIR Topic CQL Steward (Publisher) HL7 International / Clinical Quality Information Description This library is used as an example in the FHIR Quality Measure Implementation Guide Type logic-library from http://terminology.hl7.org/CodeSystem/library-type 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 Dependency Description: Library Global Resource: MAT Global Common Functions FHIR Library version: 5.0.000 Canonical URL: http://hl7.org/fhir/uv/cqm/Library/MATGlobalCommonFunctions|5.0.000 Dependency Description: Value Set Inpatient Resource: http://example.org/fhir/ValueSet/inpatient Canonical URL: http://example.org/fhir/ValueSet/inpatient Dependency Description: Value Set Fall Resource: http://example.org/fhir/ValueSet/fall Canonical URL: http://example.org/fhir/ValueSet/fall Data Requirement Type: Encounter Profile(s): Encounter Code Filter(s): Path: type ValueSet: http://example.org/fhir/ValueSet/inpatient Data Requirement Type: Observation Profile(s): Observation Code Filter(s): Path: code ValueSet: http://example.org/fhir/ValueSet/fall Parameters Name Use Card. Type Documentation Patient Out 0..1 Patient Qualifying Encounters Out 0..* Encounter Initial Population Out 0..* Encounter Denominator Out 0..* Encounter Numerator Out 0..* Encounter Falls with Major Injury Out 0..* Observation Library Content CQL Content /* Measures the number of inpatient falls with major injury per 1000 patient days. “Patient days” are to be calculated such that: Sum actual hours for all patients, whether in-patient, ED or observation, and divide by 24. The approach we envision is starting from an encounter-based eCQM with numerator and denominator observations to arrive at the following: Patient A has a 10 day inpatient encounter. On day 1 she fell 9 times. No more falls in that stay. Patient B has a 2 day inpatient encounter. On day 2 he fell 1 time. No other falls in that stay Result: 10 falls/12 days = 833/1000 patient days Answer: There are multiple considerations involved in the representation of falls with major injury, this example does not address those considerations, focusing only on the overall structure of the measure and the final calculation. This measure can be represented as an encounter-based ratio measure, with: Numerator Observation: Count(Falls with Major Injury) Denominator Observation: Sum(Encounter Days) This does result in a ratio, but there isn't mechanism in the current FHIR measure to specify that the ratio should be converted to "per 1000 days". To support that aspect, we are proposing a scoringUnit extension of the Quality Measure IG to state the expected units of a ratio measure. This is submitted as a tracker to the quality measure IG here: https://jira.hl7.org/browse/FHIR-30506 The included EXMRatioFHIRv603-Artifacts.zip is an export of this measure expressed in the MAT which includes everything but the proprosed scoringUnit extension. That extension is proposed for inclusion in the May 2021 ballot of the quality measure ig and is not supported by the MAT at this time. */ library EXMRatio using FHIR version '4.0.1' include hl7.fhir.uv.cql.FHIRHelpers version '4.0.1' called FHIRHelpers include MATGlobalCommonFunctions version '5.0.000' called Global valueset "Inpatient": 'http://example.org/fhir/ValueSet/inpatient' valueset "Fall": 'http://example.org/fhir/ValueSet/fall' context Patient define "Initial Population": "Qualifying Encounters" define "Denominator": "Initial Population" define "Numerator": "Initial Population" define "Qualifying Encounters": ["Encounter": "Inpatient"] define "Falls with Major Injury": ["Observation": "Fall"] define function "Denominator Observation"(Encounter "Encounter"): duration in hours of Global.Hospitalization(Encounter) / 24 define function "Numerator Observation"(Encounter "Encounter"): Count( "Falls with Major Injury" Falls where Global."Normalize Interval"(Falls.effective) during Encounter.period ) ELM XML Content Encoded data ELM JSON Content Encoded data Generated using version 0.5.4 of the sample-content-ig Liquid templates
EXMRatio - Example Ratio Measure Library
HL7 International / Clinical Quality Information
This library is used as an example in the FHIR Quality Measure Implementation Guide