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17.15.10.6 Operation $care-gaps on Measure

Responsible Owner: Clinical Quality Information icon Work GroupNormative 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

This is an idempotent operation

In Parameters:
Name Scope Cardinality Type Binding Profile Documentation
measureUrl 1..* 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.

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(s) for which the care gaps report will be produced. The subject may be a Patient, Practitioner, PractitionerRole, Organization, Location, Device, or Group. Subjects provided in this parameter SHALL match the subjectType of the measure being evaluated (e.g. if the Measure.group.subjectType is Patient, the subject SHALL be a reference to a Patient or a Group of Patients). If no subject is provided, what subjects are evaluated is up to the server. This parameter cannot be used with the subjectGroup parameter.

subjectGroup 0..1 Group

Subject for which the gaps in care report will be created is provided as a Group resource. Subjects provided in this parameter SHALL match the subjectType of the measure being evaluated. (e.g. if the Measure.group.subjectType is Patient, the subject SHALL be a reference to a Patient or a Group of Patients). If no subject is provided, what subjects are evaluated is up to the server. This parameter cannot be used with the subject parameter.

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.

location 0..* string
(reference)

The location(s) for which the gaps in care report will be run. This parameter is reflected in the location element of the resulting MeasureReport(s).

reporter 0..1 string
(reference)

The provider for which the report will be run. This may be a reference to a Practitioner, PractitionerRole, or Organization. If specified, systems MAY use this information to determine subjects for which the measure will be calculated, but how subjects are determined is implementation-specific. This parameter is reflected in the reporter element of the resulting MeasureReport(s). This parameter cannot be used with the reporterResource parameter.

reporterResource 0..1 Practitioner | PractitionerRole | Organization

The provider for which the report will be run, provided as a Practitioner, PractitionerRole, or Organization resource. This is intended to support the use case in which the organization information is not on the server performing the evaluation, for example an ad-hoc group of practitioners that are part of a provider group. This parameter is reflected in the reporter element of the resulting MeasureReport(s). This parameter cannot be used with the reporter parameter.

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.

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.'

parameters 0..1 Parameters

Any input parameters for the evaluation. Parameters defined in this input will be made available by name to the CQL expression. Parameter types are mapped to CQL as specified in the Using CQL with FHIR icon implementation guide. 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.

manifest 0..1 canonical(Library)

Specifies an asset-collection library that provides dependency version resolution and expansion rules for the operation. See the version manifest discussion in the Canonical Resource Management Infrastructure IG icon 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.

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.\n\nNote 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 response.

The effect of invoking this operation is to calculate the gaps in care for one or more measures and to return one or more Bundles describing the gaps in care results of each measure for the specified gaps through period and for the given subject. Because more than one Bundle may be returned, the result of the operation must be returned using the Parameter resource even if the result is a single Bundle. 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.

17.15.10.6.1 Examples

Request: 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?measureUrl=http://hl7.org/fhir/us/cqfmeasures/Measure/EXM130|7.3.000&periodStart=2014-01&periodEnd=2014-03&status=open-gap&organization=Organization/124&subject=Patient/124

Request: A care gaps report with a subject of group 124.

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&subject=Group/124

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

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

Request: Evaluation with a practitioner and an organization.

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 across two 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/124"/>
                </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/124"/>
                </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/124"/>
                </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.