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14.17.10.6 Operation $care-gaps on Measure

Clinical Quality Information icon Work Group Maturity Level: 3Trial Use Compartments: N/A

The care-gaps operation is used to determine gaps-in-care based on the results of quality measures.

The canonical URL for this operation definition is

 http://hl7.org/fhir/OperationDefinition/Measure-care-gaps

Formal Definition (as a OperationDefinition).

URL: [base]/Measure/$care-gaps

URL: [base]/Measure/[id]/$care-gaps

This is an idempotent operation

In Parameters:
Name Scope Cardinality Type Binding Profile Documentation
periodStart 1..1 date

The start of a gaps through period. This may be the start of the measurement period defined by a measure, or a customized desired performance period start date determined by a payer, a provider, a measure program, and etc.

periodEnd 1..1 date

The end of a gaps through period (the gaps through date). The gaps through date could be a past date or a future date. For example, today's date is 2020-06-18, 1) if periodEnd date is 2020-09-30, it returns gaps through 2020-09-30, and 2) if the periodEnd date is 2020-05-31, it returns gaps through 2020-05-31.

subject 0..1 string
(reference)

Subject for which the care gaps report will be produced

subjectGroup 0..1 Group

Subject for which the gaps in care report will be created is provided as a Group resource.

parameters 0..1 Parameters

Any input parameters for the Measure evaluation. If the measure uses CQL, the parameter types are mapped to CQL as specified in the Parameters and Data Requirements section of the Using CQL with FHIR Implementation Guide. Any parameters defined in this input will be bound by name to parameters defined in the logic library referenced from library element of the Measure. If a parameter appears more than once in the input Parameters resource, it is represented with a List in the input CQL. If a parameter has parts, it is represented as a Tuple in the input CQL.

practitioner 0..1 string
(reference)

Reference to a Practitioner for which the gaps in care report will be created. For a practitioner focused gaps in care report, this is a required In Parameter. The Server needs to make sure that practitioner is authorized to get the gaps in care report for and know what measures the practitioner are eligible or qualified.

organization 0..1 string
(reference)

Reference to an Organization for which the gaps in care report will be created. Either 'organization' or 'organizationResource' SHALL be provided, but not both.

organizationResource 0..1 Organization

Organization for which the gaps in care report will be created is provided as an Organization resource. Either 'organization' or 'organizationResource' SHALL be provided, but not both.

status 1..* code

Indicates status of a care gap. For all [open, closed, and prospective gaps], three seperate status parameters must be provided. For a positive proportion measure, gap means the patient is not in the numerator. For an inverse (negative) proportion measure (e.g., Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)), gap means the patient is in the numerator.

measureId 0..* id

The id of a Measure resource that is on the server for which the gaps in care report will be created. E.g., the id of the Measure resource for Breast Cancer Screening measure.

measureIdentifier 0..* string
(token)

The business identifier of a measure for which the gaps in care will be reported. E.g., CMS125 is a CMS assigned identifier for the Breast Cancer Screening eCQM in their system. Note that the type of this parameter is a string with a search type of token icon, so the $care-gaps operation has only simple input parameters and may be invoked using GET.

measureUrl 0..* canonical

The URL of a measure for which the gaps in care report will be created. A measure URL is specified in the url icon element of the Measure resource. The measure URL remains the same when the measure is stored on different servers.

measureResource 0..* Measure

The measure for which the gaps in care report will be created is provided as a Measure resource.

measure 0..* string
(reference)

The measure for which the gaps in care report will be created. This parameter is only required when the operation is invoked on the resource type, it is not used when invoking the operation on a Measure instance

manifest 0..1 canonical

Specifies an asset-collection library that provides dependency version resolution and expansion rules for the operation. See the description of manifest in the Canonical Resource Management Infrastructure IG for a complete description of how manifest values are used to provide defaults for dependency version resolution and expansion parameters. Parameters specified directly in the operation override behaviors specified by the manifest parameter. In general, if this parameter is supplied, it is expected to be used in nested operation calls. For example, in evaluating a measure, if the expansion of a value set is required, this parameter SHALL be supplied to that expansion.

isDocument 0..1 boolean

The isDocument parameter controls whether a Gaps in Care Composition is returned in the Bundle (i.e. if the Bundle is of type 'Document'). When 'true,' the returned Bundles contain the Gaps in Care Composition. This parameter defaults to 'true.'

Out Parameters:
Name Scope Cardinality Type Binding Profile Documentation
return 0..* Bundle

The $care-gaps operation returns zero or more document Bundles, one for each input subject. Consistent with FHIR Documents generally, each Bundle SHALL have a Composition as the first entry in the document Bundle, and that Composition SHALL be limited to a single subject. See the guidance on Bundle structure icon for discussion about the Bundle content and organization. Note that even though there is a single parameter named return of type Bundle, it is a multi-cardinality parameter, and so will still be returned using a Parameters resource, as described in the general operations framework https://hl7.org/fhir/R4/operations.html#response icon.

The effect of invoking this operation is to calculate a set of measures for a particular topic (e.g. Preventive Care and Screening) and return a document describing the results of each measure for the given subject. Note that it is up to the server to determine whether or not the generated care gaps report is persisted. If the server does not persist the results, the operation does not affect state and can be invoked with a GET

14.17.10.6.1 Examples

Request: A care gaps report for a patient for all Preventive Care and Screening measures

GET [base]/Measure/$care-gaps?periodStart=2014&periodEnd=2014&measureUrl=http://example.org/fhir/Measure/measure-bcs&patient=Patient/123

Request: The evaluation of the CMS130 measure (with measureId EXM130-7.3.000) over a gaps through period of the first 3 months of 2014, with open gaps, for patient 124.

GET [base]/Measure/$care-gaps?measureId=EXM130-7.3.000&periodStart=2014-01&periodEnd=2014-03&status=open-gap&subject=Patient/124

Request: The first example with a topic of 57024-2.

GET [base]/Measure/$care-gaps?measureId=EXM130-7.3.000&periodStart=2014-01&periodEnd=2014-03&status=open-gap&subject=Patient/124&topic=57024-2

Request: The first example with a topic of the code "treatment" in the valueset "definition-topic".

GET [base]/Measure/$care-gaps?measureId=EXM130-7.3.000&periodStart=2014-01&periodEnd=2014-03&status=open-gap&subject=Patient/124&topic=http://hl7.org/fhir/ValueSet/definition-topic|treatment

Request: The first example with a subject of group 124.

GET [base]/Measure/$care-gaps?measureId=EXM130-7.3.000&periodStart=2014-01&periodEnd=2014-03&status=open-gap&subject=Group/124

Request: Evaluation with a status of open gap.

GET [base]/Measure/$care-gaps?measureId=EXM130-7.3.000&periodStart=2014-01&periodEnd=2014-03&subject=Patient/124&status=open-gap

Request: Evaluation with a status of closed gap.

GET [base]/Measure/$care-gaps?measureId=EXM130-7.3.000&periodStart=2014-01&periodEnd=2014-03&subject=Patient/124&status=closed-gap

Request: Evaluation with a status of open or closed gap.

GET [base]/Measure/$care-gaps?measureId=EXM130-7.3.000&periodStart=2014-01&periodEnd=2014-03&subject=Patient/124&status=open-gap&status=closed-gap

Request: Evaluation with a status of open, closed, or prospective gap.

GET [base]/Measure/$care-gaps?measureId=EXM130-7.3.000&periodStart=2014-01&periodEnd=2014-03&subject=Patient/124&status=open-gap&status=closed-gap&status=prospective-gap

Request: The first example with a measureIdentifier.

GET [base]/Measure/$care-gaps?measureIdentifier=http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms|130&periodStart=2014-01&periodEnd=2014-03&status=open-gap&subject=Patient/124

Request: The first example with a measureUrl.

GET [base]/Measure/$care-gaps?measureUrl=http://hl7.org/fhir/us/cqfmeasures/Measure/EXM130|7.3.000&periodStart=2014-01&periodEnd=2014-03&status=open-gap&subject=Patient/124

Request: Request: the first example with an organization instead of a subject.

GET [base]/Measure/$care-gaps?measureIdentifier=http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms|130&periodStart=2014-01&periodEnd=2014-03&status=open-gap&organization=Organization/124

Request: Request the first example with a practitioner and an organization instead of a subject.

GET [base]/Measure/$care-gaps?measureUrl=http://hl7.org/fhir/us/cqfmeasures/Measure/EXM130|7.3.000&periodStart=2014-01&periodEnd=2014-03&status=open-gap&&organization=Organization/124&practitioner=Practitioner/124

Response: Returned on successful evaluation for request for a care gaps report for a patient for all Preventive Care and Screening measures

HTTP/1.1 200 OK

<Bundle xmlns="http://hl7.org/fhir">
    <type value="document"/>
    <entry>
        <resource>
            <Composition xmlns="http://hl7.org/fhir">
                <status value="final"/>
                <type>
                    <coding>
                        <system value="http://loinc.org"/>
                        <code value="57024-2"/>
                    </coding>
                </type>
                <subject>
                    <reference value="Patient/Patient-1153"/>
                </subject>
                <date value="2018-07-22"/>
                <author>
					<reference value="Organization/123"/>
                </author>
                <title value="Preventive Care and Screening Care Gap Report"/>
                <section>
                    <title value="Breast Cancer Screening Cohort Definition"/>
                    <entry>
                        <reference value="MeasureReport/be224ee3-20aa-4058-bf41-52a6be342d81"/>
                    </entry>
                </section>
                <section>
                  <title value="Cervical Cancer Screening Cohort Definition"/>
                  <entry>
                      <reference value="MeasureReport/86fa5aed-8193-4f55-835b-5bbafbd1e7d6"/>
                  </entry>
                </section>
            </Composition>
        </resource>
    </entry>
    <entry>
        <resource>
            <MeasureReport xmlns="http://hl7.org/fhir">
                <id value="be224ee3-20aa-4058-bf41-52a6be342d81"/>
                <contained>
                    <Bundle xmlns="http://hl7.org/fhir">
                        <id value="3eb57f94-7b33-48b1-9673-3b18634dca04"/>
                        <type value="collection"/>
                    </Bundle>
                </contained>
                <status value="complete"/>
                <type value="individual"/>
                <measure value="http://example.org/fhir/Measure/measure-bcs"/>
                <subject>
                    <reference value="Patient/Patient-1153"/>
                </subject>
                <period>
                    <start value="2017-01-01T00:00:00+00:00"/>
                    <end value="2017-12-31T00:00:00+00:00"/>
                </period>
                <group>
                    <population>
                        <code>
                            <coding>
                                <code value="initial-population"/>
                            </coding>
                        </code>
                        <count value="1"/>
                    </population>
                    <population>
                        <code>
                            <coding>
                                <code value="numerator"/>
                            </coding>
                        </code>
                        <count value="0"/>
                    </population>
                    <population>
                        <code>
                            <coding>
                                <code value="denominator"/>
                            </coding>
                        </code>
                        <count value="1"/>
                    </population>
                </group>
                <evaluatedResource>
                    <reference value="#3eb57f94-7b33-48b1-9673-3b18634dca04"/>
                </evaluatedResource>
            </MeasureReport>
        </resource>
    </entry>
    <entry>
      <resource>
        <MeasureReport xmlns="http://hl7.org/fhir">
            <id value="86fa5aed-8193-4f55-835b-5bbafbd1e7d6"/>
            <contained>
                <Bundle xmlns="http://hl7.org/fhir">
                    <id value="8e6e9224-59b6-4edd-b17f-58981a754e57"/>
                    <type value="collection"/>
                </Bundle>
            </contained>
            <status value="complete"/>
            <type value="individual"/>
            <measure value="http://example.org/fhir/Measure/measure-ccs"/>
            <subject>
                <reference value="Patient/Patient-1153"/>
            </subject>
            <period>
                <start value="2017-01-01T00:00:00+00:00"/>
                <end value="2017-12-31T00:00:00+00:00"/>
            </period>
            <group>
                <population>
                    <code>
                        <coding>
                            <code value="initial-population"/>
                        </coding>
                    </code>
                    <count value="1"/>
                </population>
                <population>
                    <code>
                        <coding>
                            <code value="numerator"/>
                        </coding>
                    </code>
                    <count value="1"/>
                </population>
                <population>
                    <code>
                        <coding>
                            <code value="denominator"/>
                        </coding>
                    </code>
                    <count value="1"/>
                </population>
            </group>
            <evaluatedResource>
                <reference value="#8e6e9224-59b6-4edd-b17f-58981a754e57"/>
            </evaluatedResource>
        </MeasureReport>
      </resource>
    </entry>
</Bundle>

 

For more information about operations, including how they are invoked, see Operations.