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 5.0.0 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: Detailed Care Gap Guidance Response

Official URL: http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-guidanceresponse-detailedcaregap Version: 5.0.0
Standards status: Trial-use Active as of 2025-12-19 Maturity Level: 4 Computable Name: DetailedCareGapGuidanceResponse
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.25

Derived from the GuidanceResponse resource, the Detailed Care Gap Guidance Response profile supports the functionality of providing reason for guidance and detailed guidance to help address care gaps and close open gaps.

Mandatory Data Elements and Terminology

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

Each GuidanceResponse Must Have:

  1. module[x]: What guidance was requested
  2. status: success | data-requested | data-required | in-progress | failure | entered-in-error

More guidance can be found here.

Mandatory Data Elements and Terminology

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

Each must have:

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
.. GuidanceResponse 0..* GuidanceResponse The formal response to a guidance request
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... module[x] Σ 1..1 What guidance was requested
.... moduleUri uri
.... moduleCanonical canonical(Any)
.... moduleCodeableConcept CodeableConcept
... status ?!Σ 1..1 code success | data-requested | data-required | in-progress | failure | entered-in-error
Binding: GuidanceResponseStatus (required): The status of a guidance response.
... reasonCode 0..* CodeableConcept Why guidance is needed
Binding: Care Gap Reasons Value Set (preferred)
.... Slices for extension Content/Rules for all slices
..... extension:detail 0..1 (Complex) Which data element attribute is the cause of the care gap
URL: http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/reasonDetail

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
GuidanceResponse.status Base required GuidanceResponseStatus 📍4.0.1 FHIR Std.
GuidanceResponse.reasonCode Base preferred Care Gap Reasons Value Set 📦5.0.0 This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error GuidanceResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error GuidanceResponse If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error GuidanceResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error GuidanceResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice GuidanceResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. GuidanceResponse 0..* GuidanceResponse The formal response to a guidance request
... reasonCode 0..* CodeableConcept Why guidance is needed
Binding: Care Gap Reasons Value Set (preferred)
.... Slices for extension Content/Rules for all slices
..... extension:detail 0..1 (Complex) Which data element attribute is the cause of the care gap
URL: http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/reasonDetail
... dataRequirement
.... Slices for extension Content/Rules for all slices
..... extension:valueFilter 0..* (Complex) What values are expected
URL: http://hl7.org/fhir/StructureDefinition/cqf-valueFilter

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
GuidanceResponse.reasonCode Base preferred Care Gap Reasons Value Set 📦5.0.0 This IG
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. GuidanceResponse 0..* GuidanceResponse The formal response to a guidance request
... 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
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... requestIdentifier Σ 0..1 Identifier The identifier of the request associated with this response, if any
... identifier Σ 0..* Identifier Business identifier
... module[x] Σ 1..1 What guidance was requested
.... moduleUri uri
.... moduleCanonical canonical(Any)
.... moduleCodeableConcept CodeableConcept
... status ?!Σ 1..1 code success | data-requested | data-required | in-progress | failure | entered-in-error
Binding: GuidanceResponseStatus (required): The status of a guidance response.
... subject 0..1 Reference(Patient | Group) Patient the request was performed for
... encounter 0..1 Reference(Encounter) Encounter during which the response was returned
... occurrenceDateTime 0..1 dateTime When the guidance response was processed
... performer 0..1 Reference(Device) Device returning the guidance
... reasonCode 0..* CodeableConcept Why guidance is needed
Binding: Care Gap Reasons Value Set (preferred)
.... 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:detail 0..1 (Complex) Which data element attribute is the cause of the care gap
URL: http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/reasonDetail
.... coding Σ 0..* Coding Code defined by a terminology system
.... text Σ 0..1 string Plain text representation of the concept
... reasonReference 0..* Reference(Condition | Observation | DiagnosticReport | DocumentReference) Why guidance is needed
... note 0..* Annotation Additional notes about the response
... evaluationMessage 0..* Reference(OperationOutcome) Messages resulting from the evaluation of the artifact or artifacts
... outputParameters 0..1 Reference(Parameters) The output parameters of the evaluation, if any
... result 0..1 Reference(CarePlan | RequestGroup) Proposed actions, if any
... dataRequirement 0..* DataRequirement Additional required data
.... 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:valueFilter 0..* (Complex) What values are expected
URL: http://hl7.org/fhir/StructureDefinition/cqf-valueFilter
.... type Σ 1..1 code The type of the required data
Binding: FHIRAllTypes (required): A list of all the concrete types defined in this version of the FHIR specification - Abstract Types, Data Types and Resource Types.
.... profile Σ 0..* canonical(StructureDefinition) The profile of the required data
.... subject[x] Σ 0..1 E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Binding: SubjectType (extensible): The possible types of subjects for a data requirement (E.g., Patient, Practitioner, Organization, Location, etc.).
..... subjectCodeableConcept CodeableConcept
..... subjectReference Reference(Group)
.... mustSupport Σ 0..* string Indicates specific structure elements that are referenced by the knowledge module
.... codeFilter ΣC 0..* Element What codes are expected
Constraints: drq-1
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... path Σ 0..1 string A code-valued attribute to filter on
..... searchParam Σ 0..1 string A coded (token) parameter to search on
..... valueSet Σ 0..1 canonical(ValueSet) Valueset for the filter
..... code Σ 0..* Coding What code is expected
.... dateFilter ΣC 0..* Element What dates/date ranges are expected
Constraints: drq-2
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... path Σ 0..1 string A date-valued attribute to filter on
..... searchParam Σ 0..1 string A date valued parameter to search on
..... value[x] Σ 0..1 The value of the filter, as a Period, DateTime, or Duration value
...... valueDateTime dateTime
...... valuePeriod Period
...... valueDuration Duration
.... limit Σ 0..1 positiveInt Number of results
.... sort Σ 0..* Element Order of the results
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... path Σ 1..1 string The name of the attribute to perform the sort
..... direction Σ 1..1 code ascending | descending
Binding: SortDirection (required): The possible sort directions, ascending or descending.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
GuidanceResponse.language Base preferred Common Languages 📍4.0.1 FHIR Std.
GuidanceResponse.status Base required GuidanceResponseStatus 📍4.0.1 FHIR Std.
GuidanceResponse.reasonCode Base preferred Care Gap Reasons Value Set 📦5.0.0 This IG
GuidanceResponse.dataRequirement.​type Base required FHIRAllTypes 📍4.0.1 FHIR Std.
GuidanceResponse.dataRequirement.​subject[x] Base extensible Subject type 📍4.0.1 FHIR Std.
GuidanceResponse.dataRequirement.​sort.direction Base required SortDirection 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error GuidanceResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error GuidanceResponse If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error GuidanceResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error GuidanceResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice GuidanceResponse A resource should have narrative for robust management text.`div`.exists()
drq-1 error GuidanceResponse.dataRequirement.codeFilter Either a path or a searchParam must be provided, but not both path.exists() xor searchParam.exists()
drq-2 error GuidanceResponse.dataRequirement.dateFilter Either a path or a searchParam must be provided, but not both path.exists() xor searchParam.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. GuidanceResponse 0..* GuidanceResponse The formal response to a guidance request
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... module[x] Σ 1..1 What guidance was requested
.... moduleUri uri
.... moduleCanonical canonical(Any)
.... moduleCodeableConcept CodeableConcept
... status ?!Σ 1..1 code success | data-requested | data-required | in-progress | failure | entered-in-error
Binding: GuidanceResponseStatus (required): The status of a guidance response.
... reasonCode 0..* CodeableConcept Why guidance is needed
Binding: Care Gap Reasons Value Set (preferred)
.... Slices for extension Content/Rules for all slices
..... extension:detail 0..1 (Complex) Which data element attribute is the cause of the care gap
URL: http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/reasonDetail

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
GuidanceResponse.status Base required GuidanceResponseStatus 📍4.0.1 FHIR Std.
GuidanceResponse.reasonCode Base preferred Care Gap Reasons Value Set 📦5.0.0 This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error GuidanceResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error GuidanceResponse If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error GuidanceResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error GuidanceResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice GuidanceResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. GuidanceResponse 0..* GuidanceResponse The formal response to a guidance request
... reasonCode 0..* CodeableConcept Why guidance is needed
Binding: Care Gap Reasons Value Set (preferred)
.... Slices for extension Content/Rules for all slices
..... extension:detail 0..1 (Complex) Which data element attribute is the cause of the care gap
URL: http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/reasonDetail
... dataRequirement
.... Slices for extension Content/Rules for all slices
..... extension:valueFilter 0..* (Complex) What values are expected
URL: http://hl7.org/fhir/StructureDefinition/cqf-valueFilter

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
GuidanceResponse.reasonCode Base preferred Care Gap Reasons Value Set 📦5.0.0 This IG

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. GuidanceResponse 0..* GuidanceResponse The formal response to a guidance request
... 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
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... requestIdentifier Σ 0..1 Identifier The identifier of the request associated with this response, if any
... identifier Σ 0..* Identifier Business identifier
... module[x] Σ 1..1 What guidance was requested
.... moduleUri uri
.... moduleCanonical canonical(Any)
.... moduleCodeableConcept CodeableConcept
... status ?!Σ 1..1 code success | data-requested | data-required | in-progress | failure | entered-in-error
Binding: GuidanceResponseStatus (required): The status of a guidance response.
... subject 0..1 Reference(Patient | Group) Patient the request was performed for
... encounter 0..1 Reference(Encounter) Encounter during which the response was returned
... occurrenceDateTime 0..1 dateTime When the guidance response was processed
... performer 0..1 Reference(Device) Device returning the guidance
... reasonCode 0..* CodeableConcept Why guidance is needed
Binding: Care Gap Reasons Value Set (preferred)
.... 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:detail 0..1 (Complex) Which data element attribute is the cause of the care gap
URL: http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/reasonDetail
.... coding Σ 0..* Coding Code defined by a terminology system
.... text Σ 0..1 string Plain text representation of the concept
... reasonReference 0..* Reference(Condition | Observation | DiagnosticReport | DocumentReference) Why guidance is needed
... note 0..* Annotation Additional notes about the response
... evaluationMessage 0..* Reference(OperationOutcome) Messages resulting from the evaluation of the artifact or artifacts
... outputParameters 0..1 Reference(Parameters) The output parameters of the evaluation, if any
... result 0..1 Reference(CarePlan | RequestGroup) Proposed actions, if any
... dataRequirement 0..* DataRequirement Additional required data
.... 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:valueFilter 0..* (Complex) What values are expected
URL: http://hl7.org/fhir/StructureDefinition/cqf-valueFilter
.... type Σ 1..1 code The type of the required data
Binding: FHIRAllTypes (required): A list of all the concrete types defined in this version of the FHIR specification - Abstract Types, Data Types and Resource Types.
.... profile Σ 0..* canonical(StructureDefinition) The profile of the required data
.... subject[x] Σ 0..1 E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Binding: SubjectType (extensible): The possible types of subjects for a data requirement (E.g., Patient, Practitioner, Organization, Location, etc.).
..... subjectCodeableConcept CodeableConcept
..... subjectReference Reference(Group)
.... mustSupport Σ 0..* string Indicates specific structure elements that are referenced by the knowledge module
.... codeFilter ΣC 0..* Element What codes are expected
Constraints: drq-1
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... path Σ 0..1 string A code-valued attribute to filter on
..... searchParam Σ 0..1 string A coded (token) parameter to search on
..... valueSet Σ 0..1 canonical(ValueSet) Valueset for the filter
..... code Σ 0..* Coding What code is expected
.... dateFilter ΣC 0..* Element What dates/date ranges are expected
Constraints: drq-2
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... path Σ 0..1 string A date-valued attribute to filter on
..... searchParam Σ 0..1 string A date valued parameter to search on
..... value[x] Σ 0..1 The value of the filter, as a Period, DateTime, or Duration value
...... valueDateTime dateTime
...... valuePeriod Period
...... valueDuration Duration
.... limit Σ 0..1 positiveInt Number of results
.... sort Σ 0..* Element Order of the results
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... path Σ 1..1 string The name of the attribute to perform the sort
..... direction Σ 1..1 code ascending | descending
Binding: SortDirection (required): The possible sort directions, ascending or descending.

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
GuidanceResponse.language Base preferred Common Languages 📍4.0.1 FHIR Std.
GuidanceResponse.status Base required GuidanceResponseStatus 📍4.0.1 FHIR Std.
GuidanceResponse.reasonCode Base preferred Care Gap Reasons Value Set 📦5.0.0 This IG
GuidanceResponse.dataRequirement.​type Base required FHIRAllTypes 📍4.0.1 FHIR Std.
GuidanceResponse.dataRequirement.​subject[x] Base extensible Subject type 📍4.0.1 FHIR Std.
GuidanceResponse.dataRequirement.​sort.direction Base required SortDirection 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error GuidanceResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error GuidanceResponse If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error GuidanceResponse If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error GuidanceResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice GuidanceResponse A resource should have narrative for robust management text.`div`.exists()
drq-1 error GuidanceResponse.dataRequirement.codeFilter Either a path or a searchParam must be provided, but not both path.exists() xor searchParam.exists()
drq-2 error GuidanceResponse.dataRequirement.dateFilter Either a path or a searchParam must be provided, but not both path.exists() xor searchParam.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

 

Other representations of profile: CSV, Excel, Schematron