Data Exchange For Quality Measures Implementation Guide
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Data Exchange For Quality Measures Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 1.0.0-cibuild built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-deqm/ and changes regularly. See the Directory of published versions

Resource Profile: DEQM Gaps In Care Detected Issue Profile

Official URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-gapsincaredetectedissue Version: 1.0.0-cibuild
Standards status: Trial-use Maturity Level: 4 Computable Name: DEQMGapsInCareDetectedIssue

The DEQM Gaps In Care DetectedIssue Profile indicates that the measure reported has an open gap, prospective-gap or a closed gap as identified in the gapStatus modifier extension.

Mandatory Data Elements and Terminology

The following data-elements are mandatory (i.e data MUST be present).

Each DetectedIssue Must Have:

  1. modifierExtension: Gap Status
  2. evidence: Supporting evidence
  3. code: Issue Category, e.g. drug-drug, duplicate therapy, etc.
  4. status: registered | preliminary | final | amended +
  5. evidence.detail: This references either a DEQM Individual MeasureReport or a Detailed Care Gap Guidance Response resource.
  6. patient: Associated patient

Each DetectedIssue Must Support:

  1. criteriaReference: Criteria reference

This profile builds on DetectedIssue.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DetectedIssue 0..* DetectedIssue Clinical issue with action
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for modifierExtension ?! 1..* Extension Extension
Slice: Unordered, Open by value:url
.... modifierExtension:gapStatus ?!S 1..1 CodeableConcept Gap Status
URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-gapStatus
Binding: DEQM Gaps In Care Gap Status Value Set (extensible)
... status ?!Σ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): Indicates the status of the identified issue.
... code SΣ 1..1 CodeableConcept Issue Category, e.g. drug-drug, duplicate therapy, etc.
Binding: DetectedIssueCategory (preferred): Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: CAREGAP
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... patient SΣ 1..1 Reference(Patient) Associated patient
... evidence S 1..* BackboneElement Supporting evidence
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... detail S 1..1 Reference(DEQM Individual MeasureReport Profile | DEQM Detailed Care Gap Guidance Response) This references either a DEQM Individual MeasureReport or a Detailed Care Gap Guidance Response resource.
..... Slices for extension Content/Rules for all slices
...... extension:criteriaReference S 0..1 string Criteria reference
URL: http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DetectedIssue.status Base required ObservationStatus 📍4.0.1 FHIR Std.
DetectedIssue.code Base preferred Detected Issue Category 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DetectedIssue 0..* DetectedIssue Clinical issue with action
... Slices for modifierExtension Content/Rules for all slices
.... modifierExtension:gapStatus ?!S 1..1 CodeableConcept Gap Status
URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-gapStatus
Binding: DEQM Gaps In Care Gap Status Value Set (extensible)
... code S 1..1 CodeableConcept Issue Category, e.g. drug-drug, duplicate therapy, etc.
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: CAREGAP
... patient S 1..1 Reference(Patient) Associated patient
... evidence S 1..* BackboneElement Supporting evidence
.... detail S 1..1 Reference(DEQM Individual MeasureReport Profile | DEQM Detailed Care Gap Guidance Response) This references either a DEQM Individual MeasureReport or a Detailed Care Gap Guidance Response resource.
..... Slices for extension Content/Rules for all slices
...... extension:criteriaReference S 0..1 string Criteria reference
URL: http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DetectedIssue 0..* DetectedIssue Clinical issue with action
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... Slices for modifierExtension ?! 1..* Extension Extension
Slice: Unordered, Open by value:url
.... modifierExtension:gapStatus ?!S 1..1 CodeableConcept Gap Status
URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-gapStatus
Binding: DEQM Gaps In Care Gap Status Value Set (extensible)
... identifier Σ 0..* Identifier Unique id for the detected issue
... status ?!Σ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): Indicates the status of the identified issue.
... code SΣ 1..1 CodeableConcept Issue Category, e.g. drug-drug, duplicate therapy, etc.
Binding: DetectedIssueCategory (preferred): Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: CAREGAP
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... severity Σ 0..1 code high | moderate | low
Binding: DetectedIssueSeverity (required): Indicates the potential degree of impact of the identified issue on the patient.
... patient SΣ 1..1 Reference(Patient) Associated patient
... identified[x] Σ 0..1 When identified
.... identifiedDateTime dateTime
.... identifiedPeriod Period
... author Σ 0..1 Reference(Practitioner | PractitionerRole | Device) The provider or device that identified the issue
... implicated Σ 0..* Reference(Resource) Problem resource
... evidence S 1..* BackboneElement Supporting evidence
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code 0..* CodeableConcept Manifestation
Binding: ManifestationAndSymptomCodes (example): Codes that describes the types of evidence for a detected issue.
.... detail S 1..1 Reference(DEQM Individual MeasureReport Profile | DEQM Detailed Care Gap Guidance Response) This references either a DEQM Individual MeasureReport or a Detailed Care Gap Guidance Response resource.
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... extension:criteriaReference S 0..1 string Criteria reference
URL: http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference
..... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
..... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
..... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
..... display Σ 0..1 string Text alternative for the resource
... detail 0..1 string Description and context
... reference 0..1 uri Authority for issue
... mitigation 0..* BackboneElement Step taken to address
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... action 1..1 CodeableConcept What mitigation?
Binding: DetectedIssueMitigationAction (preferred): Codes describing steps taken to resolve the issue or other circumstances that mitigate the risk associated with the issue; e.g. 'added concurrent therapy', 'prior therapy documented', etc.
.... date 0..1 dateTime Date committed
.... author 0..1 Reference(Practitioner | PractitionerRole) Who is committing?

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DetectedIssue.language Base preferred Common Languages 📍4.0.1 FHIR Std.
DetectedIssue.status Base required ObservationStatus 📍4.0.1 FHIR Std.
DetectedIssue.code Base preferred Detected Issue Category 📍4.0.1 FHIR Std.
DetectedIssue.severity Base required DetectedIssueSeverity 📍4.0.1 FHIR Std.
DetectedIssue.evidence.​code Base example Manifestation and Symptom Codes 📍4.0.1 FHIR Std.
DetectedIssue.evidence.​detail.type Base extensible ResourceType 📍4.0.1 FHIR Std.
DetectedIssue.mitigation.​action Base preferred Detected Issue Mitigation Action 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DetectedIssue 0..* DetectedIssue Clinical issue with action
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for modifierExtension ?! 1..* Extension Extension
Slice: Unordered, Open by value:url
.... modifierExtension:gapStatus ?!S 1..1 CodeableConcept Gap Status
URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-gapStatus
Binding: DEQM Gaps In Care Gap Status Value Set (extensible)
... status ?!Σ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): Indicates the status of the identified issue.
... code SΣ 1..1 CodeableConcept Issue Category, e.g. drug-drug, duplicate therapy, etc.
Binding: DetectedIssueCategory (preferred): Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: CAREGAP
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... patient SΣ 1..1 Reference(Patient) Associated patient
... evidence S 1..* BackboneElement Supporting evidence
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... detail S 1..1 Reference(DEQM Individual MeasureReport Profile | DEQM Detailed Care Gap Guidance Response) This references either a DEQM Individual MeasureReport or a Detailed Care Gap Guidance Response resource.
..... Slices for extension Content/Rules for all slices
...... extension:criteriaReference S 0..1 string Criteria reference
URL: http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DetectedIssue.status Base required ObservationStatus 📍4.0.1 FHIR Std.
DetectedIssue.code Base preferred Detected Issue Category 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DetectedIssue 0..* DetectedIssue Clinical issue with action
... Slices for modifierExtension Content/Rules for all slices
.... modifierExtension:gapStatus ?!S 1..1 CodeableConcept Gap Status
URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-gapStatus
Binding: DEQM Gaps In Care Gap Status Value Set (extensible)
... code S 1..1 CodeableConcept Issue Category, e.g. drug-drug, duplicate therapy, etc.
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: CAREGAP
... patient S 1..1 Reference(Patient) Associated patient
... evidence S 1..* BackboneElement Supporting evidence
.... detail S 1..1 Reference(DEQM Individual MeasureReport Profile | DEQM Detailed Care Gap Guidance Response) This references either a DEQM Individual MeasureReport or a Detailed Care Gap Guidance Response resource.
..... Slices for extension Content/Rules for all slices
...... extension:criteriaReference S 0..1 string Criteria reference
URL: http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference

doco Documentation for this format

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DetectedIssue 0..* DetectedIssue Clinical issue with action
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... Slices for modifierExtension ?! 1..* Extension Extension
Slice: Unordered, Open by value:url
.... modifierExtension:gapStatus ?!S 1..1 CodeableConcept Gap Status
URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-gapStatus
Binding: DEQM Gaps In Care Gap Status Value Set (extensible)
... identifier Σ 0..* Identifier Unique id for the detected issue
... status ?!Σ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): Indicates the status of the identified issue.
... code SΣ 1..1 CodeableConcept Issue Category, e.g. drug-drug, duplicate therapy, etc.
Binding: DetectedIssueCategory (preferred): Codes identifying the general type of detected issue; e.g. Drug-drug interaction, Timing issue, Duplicate therapy, etc.
Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: CAREGAP
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... severity Σ 0..1 code high | moderate | low
Binding: DetectedIssueSeverity (required): Indicates the potential degree of impact of the identified issue on the patient.
... patient SΣ 1..1 Reference(Patient) Associated patient
... identified[x] Σ 0..1 When identified
.... identifiedDateTime dateTime
.... identifiedPeriod Period
... author Σ 0..1 Reference(Practitioner | PractitionerRole | Device) The provider or device that identified the issue
... implicated Σ 0..* Reference(Resource) Problem resource
... evidence S 1..* BackboneElement Supporting evidence
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code 0..* CodeableConcept Manifestation
Binding: ManifestationAndSymptomCodes (example): Codes that describes the types of evidence for a detected issue.
.... detail S 1..1 Reference(DEQM Individual MeasureReport Profile | DEQM Detailed Care Gap Guidance Response) This references either a DEQM Individual MeasureReport or a Detailed Care Gap Guidance Response resource.
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... extension:criteriaReference S 0..1 string Criteria reference
URL: http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference
..... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
..... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
..... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
..... display Σ 0..1 string Text alternative for the resource
... detail 0..1 string Description and context
... reference 0..1 uri Authority for issue
... mitigation 0..* BackboneElement Step taken to address
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... action 1..1 CodeableConcept What mitigation?
Binding: DetectedIssueMitigationAction (preferred): Codes describing steps taken to resolve the issue or other circumstances that mitigate the risk associated with the issue; e.g. 'added concurrent therapy', 'prior therapy documented', etc.
.... date 0..1 dateTime Date committed
.... author 0..1 Reference(Practitioner | PractitionerRole) Who is committing?

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DetectedIssue.language Base preferred Common Languages 📍4.0.1 FHIR Std.
DetectedIssue.status Base required ObservationStatus 📍4.0.1 FHIR Std.
DetectedIssue.code Base preferred Detected Issue Category 📍4.0.1 FHIR Std.
DetectedIssue.severity Base required DetectedIssueSeverity 📍4.0.1 FHIR Std.
DetectedIssue.evidence.​code Base example Manifestation and Symptom Codes 📍4.0.1 FHIR Std.
DetectedIssue.evidence.​detail.type Base extensible ResourceType 📍4.0.1 FHIR Std.
DetectedIssue.mitigation.​action Base preferred Detected Issue Mitigation Action 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression

 

Other representations of profile: CSV, Excel, Schematron