Common CQL Assets for FHIR (US-Based), published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/us-cql-ig/ and changes regularly. See the Directory of published versions

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Official URL: http://hl7.org/fhir/us/cql/ImplementationGuide/hl7.fhir.us.cql				Version: 1.0.0-ballot
IG Standards status: Trial-use			Maturity Level: 1	Computable Name: CQLUSCommon

Introduction

This implementation guide contains architectural guidance and re-usable libraries that facilitate the use of Clinical Quality Language (CQL) with FHIR in the US Realm, with an initial use case of Prior Authorization Support Questionnaires as described in the DaVinci Documentation Templates and Rules (DTR) implementation guide. Much of the guidance and content presented here is built on work done in the quality measurement domain, including patterns established by measure developers as part of testing and developing quality measures for use with FHIR. These patterns have been generalized to support US Core as well as harmonized to be usable across use cases.

Scope of Use

The intent of this guide is to support the use of CQL with FHIR in the US Realm with a focus on:

• Providing architectural guidance for the evaluation of CQL expressions in the context of artifacts such as questionnaires, quality measures, and decision support rules.
• Providing re-usable libraries of CQL expressions to retrieve data for common use cases in the US Realm
• Providing guidance for managing CQL expressions that may involve retrieval of data from multiple versions of the US Core implementation guide
• Gathering requirements for tooling to simplify the authoring of questionnaires that use CQL

Out of Scope

This implementation guide does not:

• Define or mandate the use of any particular subsets of CQL
• Define functions for the retrieval of simple elements from already retrieved FHIR resources (e.g. Patient.birthDate)
• Define expectations for certification that require the use of any of the helper libraries provided in this implementation guide

Contents

• Background
• Use Cases
  • Prior-Authorization Questionnaires
  • Quality Measurement and Reporting
  • Clinical Decision Support
  • Clinical Guidelines
  • Public Health Case Reporting
• Guidance
  • Architectural Guidance
  • Query Management
  • Authoring
  • Patterns
  • Examples
  • Usage
• Testing
• Tooling Support
• Artifact Index
• Support
  • Changes
  • Downloads
  • License

Acknowledgements

This Implementation Guide was made possible by the thoughtful contributions of the following people and organizations:

• The DaVinci Project Member Organizations
• Raj Godavarthi, MCG Health
• Mike Gould, Zeomega
• Yan Heras, Optimum eHealth
• Kyle Johnsen, Epic
• Crystal Kallem, Point of Care Partners
• Lloyd McKenzie, Dogwood Consulting
• Viet Nguyen, HL7
• Rob Reynolds, Smile Digital Health
• Brenin Rhodes, Smile Digital Health
• Bryn Rhodes, Smile Digital Health
• Raleigh Thompson, Smile Digital Health

Dependencies

Cross Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (hl7.fhir.us.cql.r4) and R4B (hl7.fhir.us.cql.r4b) are available.

Global Profiles

There are no Global profiles defined

IP Statements

This publication includes IP covered under the following statements.

• ISO Maintains the copyright on the country codes, and controls it's use carefully. For futher details see the ISO 3166 web page: https://www.iso.org/iso-3166-country-codes.html
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  • ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code: CQLUSCommon, CumulativeMedicationDuration... Show 15 more, ExamplePatientAndCoverageInitialExpressions, ExamplePatientAndCoverageQuestionnaire, GMTPInitialExpressions, GMTPQuestionnaire, MBODAInitialExpressions, MBODAQuestionnaire, MNACInitialExpressions, MNACQuestionnaire, UPPARFInitialExpressions, UPPARFQuestionnaire, USCoreCommon, USCoreCommonTests, USCoreElements, USCoreModelInfo and USCoreTests
• The UCUM codes, UCUM table (regardless of format), and UCUM Specification are copyright 1999-2009, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures (UCUM) Organization. All rights reserved. https://ucum.org/trac/wiki/TermsOfUse
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  • Unified Code for Units of Measure (UCUM): MBODAQuestionnaire and MNACQuestionnaire
• These codes are excerpted from ASTM Standard, E1762-95(2013) - Standard Guide for Electronic Authentication of Health Care Information, Copyright by ASTM International, 100 Barr Harbor Drive, West Conshohocken, PA 19428. Copies of this standard are available through the ASTM Web Site at www.astm.org.
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  • Signature Type Codes: MBODAQuestionnaire
• This material contains content from LOINC. LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc.
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  • LOINC: USCoreElements
• This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html
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  • LibraryType: CumulativeMedicationDuration, ExamplePatientAndCoverageInitialExpressions... Show 9 more, GMTPInitialExpressions, MBODAInitialExpressions, MNACInitialExpressions, UPPARFInitialExpressions, USCoreCommon, USCoreCommonTests, USCoreElements, USCoreModelInfo and USCoreTests

Many of the examples in this implementation guide are informed by prior-authorization forms freely available on the internet and used with permission.