HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) - US Realm
2.1.2 - STU 2 United States of America flag

HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) - US Realm, published by HL7 International / Public Health. This guide is not an authorized publication; it is the continuous build for version 2.1.2 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/case-reporting/ and changes regularly. See the Directory of published versions

Example Library: Rule Filters Example Library

Active as of 2024-10-30
Id: library-RuleFilters-2.1.0
Type: logic-library
Version: 2.1.0
Status: active
Data Requirements:

type: ValueSet

type: Observation

type: Encounter

type: Location

type: CodeSystem

type: Organization

type: Organization

Content: type: text/cql
                    library RuleFilters version '2.1.0'

  using FHIR version '4.0.1'

  include FHIRHelpers version '4.0.1'

  codesystem "LOINC": 'http://loinc.org'
  codesystem "UsageContext": 'http://hl7.org/fhir/us/ecr/CodeSystem/us-ph-usage-context-type'
  codesystem "JurisdictionsList": 'http://hl7.org/fhir/us/ecr/CodeSystem/ersd-jurisdictions-example'

  // Overall triggering value sets, groupings of all condition-specific value sets, grouped by representation in the information model
  valueset "Diagnosis Trigger Codes": 'http://hl7.org/fhir/us/ecr/ValueSet/valueset-dxtc-example'
  valueset "Medication Trigger Codes": 'http://hl7.org/fhir/us/ecr/ValueSet/valueset-mrtc-example'
  valueset "Laboratory Order Trigger Codes": 'http://hl7.org/fhir/us/ecr/ValueSet/valueset-lotc-example'
  valueset "Laboratory Result Trigger Codes": 'http://hl7.org/fhir/us/ecr/ValueSet/valueset-lrtc-example'
  valueset "Organism Substance Trigger Codes": 'http://hl7.org/fhir/us/ecr/ValueSet/valueset-ostc-example'
  valueset "Procedure Trigger Codes": 'http://hl7.org/fhir/us/ecr/ValueSet/valueset-pctc-example'
  valueset "Suspected Disorder Trigger Codes": 'http://hl7.org/fhir/us/ecr/ValueSet/valueset-sdtc-example'

  // Condition-specific triggering codes, these would be listed for each condition
  valueset "Chlamydia Laboratory Result Trigger Codes": 'http://hl7.org/fhir/us/ecr/ValueSet/valueset-chlamydia-example'

  // Supplemental (or operational) value sets used in suspected reportability determination logic
  valueset "Indeterminate or Equivocal Lab Result Value": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1035'
  valueset "Negative or Undetected Lab Result Value": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1034'

  code "eICRComposition": '55751-2' from "LOINC"

  parameter "Triggering Encounter" Encounter
  parameter "normalReportingDuration" default 14 days

  context Patient

  define "Chlamydia Test Results":
    [Observation: "Chlamydia Laboratory Result Trigger Codes"] O
      where O.status in { 'registered', 'preliminary', 'final', 'amended', 'corrected' }

  define "Triggering Encounters":
    [Encounter] E

  define "Encounter Location References":
    flatten("Triggering Encounters" TriggeringEncounter
      return TriggeringEncounter.location.location)

  define "Locations Matching Encounter Location References":
    [Location] Location
      where exists (
          "Encounter Location References" LocationReference
            where ('Location/' + Location.id) ~ LocationReference.reference
        )

  define "Encounter Location Address":
    "Locations Matching Encounter Location References" Address
      return Tuple { state: Address.address.state,  postalCode: Address.address.postalCode }

  define "Patient Address":
    Patient.address PA
    return Tuple { state: PA.state, postalCode: PA.postalCode }

  define "Jurisdictions":
    flatten([CodeSystem] C
      return C.concept Cpt
        return Tuple { jurisdictionCode: Cpt.code,
          definition: Cpt.definition,
          jurisdictionType: Cpt.property P where P.code='type' return P.value as FHIR.string,
          stateCode: Cpt.property P where P.code = 'state' return P.value as FHIR.code,
          postalCode: Cpt.property P where P.code = 'postalcode' return P.value as FHIR.code
          })

  define "Encounter Address Postal Code is in Jurisdiction Codes":
    "Jurisdictions" J
      with "Encounter Location Address" LocationAddress
        such that LocationAddress.postalCode in J.postalCode

  define "Encounter Address State is in Jurisdiction Codes":
      "Jurisdictions" J
        with "Encounter Location Address" LocationAddress
          such that LocationAddress.state in J.stateCode
            and 'STATE' in J.jurisdictionType

  define "Patient Address Postal Code is in Jurisdiction Codes":
    "Jurisdictions" J
      with "Patient Address" PA
        such that PA.postalCode in J.postalCode

  define "Patient Address State is in Jurisdiction Codes":
  "Jurisdictions" J
    with "Patient Address" PA
      such that (PA.state.value in J.stateCode
        and 'STATE' in J.jurisdictionType)

  define "Address Exists in Jurisdiction Codes":
    exists (
      "Encounter Address State is in Jurisdiction Codes"
        union "Encounter Address Postal Code is in Jurisdiction Codes"
          union "Patient Address State is in Jurisdiction Codes"
            union "Patient Address Postal Code is in Jurisdiction Codes"
      )

  define function EncounterAddressJurisdictions():
    if exists ("Encounter Address Postal Code is in Jurisdiction Codes")
      then "Encounter Address Postal Code is in Jurisdiction Codes"
        else "Encounter Address State is in Jurisdiction Codes"

  define function PatientAddressJurisdictions():
    if exists ("Patient Address Postal Code is in Jurisdiction Codes")
      then "Patient Address Postal Code is in Jurisdiction Codes"
        else "Patient Address State is in Jurisdiction Codes"

  define "Jurisdiction Codes Relevant to Encounter Addresses":
    EncounterAddressJurisdictions()

  define "Jurisdiction Codes Relevant to Patient Addresses":
    PatientAddressJurisdictions()

  define "Indeterminate Chlamydia Test Results":
    "Chlamydia Test Results" O
      let organization: [Organization]
      where (
        (
          exists (
              O.interpretation interpretationConcept
                where interpretationConcept as CodeableConcept in "Indeterminate or Equivocal Lab Result Value"
          )
            or O.value as CodeableConcept in "Indeterminate or Equivocal Lab Result Value"
        )
          and "Address Exists in Jurisdiction Codes"
      )

  define "Negative Chlamydia Test Results":
    "Chlamydia Test Results" O
      let organization: [Organization]
      where (
        (
          exists (
              O.interpretation interpretationConcept
                where interpretationConcept as CodeableConcept in "Negative or Undetected Lab Result Value"
          )
            or O.value as CodeableConcept in "Negative or Undetected Lab Result Value"
        )
          and "Address Exists in Jurisdiction Codes"
      )

  define "Reportable Triggering Codes":
    flatten ("Indeterminate Chlamydia Test Results" O return O.code.coding)
      union flatten ("Negative Chlamydia Test Results" O return O.code.coding)
      // ... reportable triggering codes for other conditions

  define "Is Encounter Within Normal Reporting Duration?":
    "Current Encounter Duration"("Encounter In Context") <= "normalReportingDuration"

  define "Is Encounter Reportable and Within Normal Reporting Duration?":
    exists (
      "Reportable Triggering Codes"
        except "Existing Reportable Triggering Codes"
    )
      and "Is Encounter Within Normal Reporting Duration?"

  define "Existing Reportable Triggering Codes":
    flatten (
      "eICR Compositions" C
        return
          C.section.entry.extension E
            where E.url = 'http://hl7.org/fhir/us/ecr/StructureDefinition/eicr-trigger-code-flag-extension'
              return (singleton from (E.extension SE where SE.url = 'triggerCode')).value as Coding
    )

  define function "Current Encounter Duration"(encounter Encounter):
    Quantity {
      value: decimal {
        value: duration in days between encounter.period.start and Coalesce(encounter.period.end.value, Now())
      },
      unit: string { value: 'days' }
    }

  define "Encounter In Context":
    if "Triggering Encounter" is not null
      then "Triggering Encounter"
        else singleton from "Triggering Encounters"

  define "Is Encounter Longer Than Normal Reporting Duration?":
    "Current Encounter Duration"("Encounter In Context") > "normalReportingDuration"

  define "Is Encounter In Progress":
    "Encounter In Context".status ~ 'in-progress'

  define "Is Encounter Complete":
    "Encounter In Context".status ~ 'finished'

  define "Is Encounter In Progress and Within Normal Reporting Duration or 72h or less after end of encounter?":
    (
      "Is Encounter In Progress"
        and "Is Encounter Within Normal Reporting Duration?"
    )
      or (not IsNull("Triggering Encounter") and "Triggering Encounter".period.end 72 hours or less before Now())
      or (exists ("Triggering Encounters") and singleton from "Triggering Encounters".period.end 72 hours or less before Now())

  define "eICR Compositions":
    [Composition : "eICRComposition"]

  define "Most recent eICR sent over 72 hours ago?":
    if "Most recent eICR" is not null
      then "Most recent eICR".date 72 hours or more before Now()
      else false

  define "Most recent eICR":
    First (
      "eICR Compositions" eICRs
        sort by date desc
    )

  define "Suspected Disorder Test Results":
    [Observation] O
      where O.status in { 'registered', 'preliminary', 'final', 'amended', 'corrected' }
        and O.value as CodeableConcept in "Laboratory Order Trigger Codes"

  define "Suspected Disorders":
    [Condition: "Suspected Disorder Trigger Codes"]
      union [MedicationRequest: "Medication Trigger Codes"]
      union "Suspected Disorder Test Results"

  define "Is Suspected Disorder?":
    exists (
      "Suspected Disorders"
    )