Da Vinci Risk Adjustment Implementation Guide
2.0.0-preview - STU2
Da Vinci Risk Adjustment Implementation Guide
2.0.0-preview - STU2
Da Vinci Risk Adjustment Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 2.0.0-preview built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-ra/ and changes regularly. See the Directory of published versions
| Official URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-datax-measurereport | Version: 2.0.0-preview | |||
| Active as of 2024-04-18 | Computable Name: RiskAdjustmentDataExchangeMeasureReport | |||
Copyright/Legal: Used by permission of HL7 International - Clinical Quality Information Work Group, all rights reserved Creative Commons License |
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This profile is based on the MeasureReport. It is used for Provider to submit data such as clinical evaluation evidence to Payer.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from MeasureReport
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  MeasureReport |
0..* | MeasureReport | This is a risk adjustment data exchange MeasureReport. | |
  payerCodingGapReportId |
S | 0..1 | id | Payer generated coding gap report id URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-payerCodingGapReportId |
| software |
S | 0..* | Reference(CRMI Software System Device) | Extension URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem |
| vendor |
S | 0..1 | Reference(US Core Organization Profile) | Vendor information URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-reportingVendor |
 status |
S | 1..1 | code | complete | pending | error |
 type |
S | 1..1 | code | The type code is fixed to 'data-collection' for a risk adjustment data exchange measure report Fixed Value: data-collection |
| measure |
S | 1..1 | canonical(Risk Adjustment Model Measure) | This references a measure that represents a risk adjustment model, such as CMS-HCC V24. |
 subject |
S | 1..1 | Reference(US Core Patient Profile) | What individual(s) the report is for |
| date |
S | 1..1 | dateTime | When the report was generated |
| reporter |
S | 1..1 | Reference(US Core Organization Profile) | Organization that generated the MeasureReport |
  period |
SC | 1..1 | Period | Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD ) |
 start |
S | 1..1 | dateTime | Starting time with inclusive boundary |
 end |
S | 1..1 | dateTime | End time with inclusive boundary, if not ongoing |
| group |
S | 0..* | BackboneElement | Condition Category |
| id |
S | 1..1 | string | Unique id for inter-element referencing |
| code |
S | 0..1 | CodeableConcept | Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example) |
 evaluatedResource |
S | 0..* | Reference(Resource) | An evaluated resource in a risk adjusstment data exchange MeasureReport is any data Provider submits to Payer as clinical evaluation evidence, such as a Consolidated Clinical Document Architecture (C-CDA) document, enounters, and diagnoses. |
 groupReference |
S | 0..* | string | This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| MeasureReport.group.code | example | SampleCMSHCChttp://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshccfrom this IG |
| Id | Grade | Path(s) | Details | Requirements |
| ra-1 | error | MeasureReport.period | Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9 |
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| MeasureReport |
C | 0..* | MeasureReport | This is a risk adjustment data exchange MeasureReport. mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components |
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
| payerCodingGapReportId |
S | 0..1 | id | Payer generated coding gap report id URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-payerCodingGapReportId |
| software |
S | 0..* | Reference(CRMI Software System Device) | Extension URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem |
| vendor |
S | 0..1 | Reference(US Core Organization Profile) | Vendor information URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-reportingVendor |
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored |
| status |
?!SΣ | 1..1 | code | complete | pending | error Binding: MeasureReportStatus (required): The status of the measure report. |
| type |
SΣC | 1..1 | code | The type code is fixed to 'data-collection' for a risk adjustment data exchange measure report Binding: MeasureReportType (required): The type of the measure report. Fixed Value: data-collection |
| measure |
SΣ | 1..1 | canonical(Risk Adjustment Model Measure) | This references a measure that represents a risk adjustment model, such as CMS-HCC V24. |
| subject |
SΣ | 1..1 | Reference(US Core Patient Profile) | What individual(s) the report is for |
| date |
SΣ | 1..1 | dateTime | When the report was generated |
| reporter |
SΣ | 1..1 | Reference(US Core Organization Profile) | Organization that generated the MeasureReport |
| period |
SΣC | 1..1 | Period | Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD ) |
| start |
SΣC | 1..1 | dateTime | Starting time with inclusive boundary |
| end |
SΣC | 1..1 | dateTime | End time with inclusive boundary, if not ongoing |
| improvementNotation |
?!Σ | 0..1 | CodeableConcept | increase | decrease Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue. |
| group |
SC | 0..* | BackboneElement | Condition Category |
| id |
S | 1..1 | string | Unique id for inter-element referencing |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code |
SΣ | 0..1 | CodeableConcept | Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example) |
| evaluatedResource |
S | 0..* | Reference(Resource) | An evaluated resource in a risk adjusstment data exchange MeasureReport is any data Provider submits to Payer as clinical evaluation evidence, such as a Consolidated Clinical Document Architecture (C-CDA) document, enounters, and diagnoses. |
| groupReference |
S | 0..* | string | This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference |
| Documentation for this format | ||||
| Path | Conformance | ValueSet / Code | URI |
| MeasureReport.status | required | MeasureReportStatushttp://hl7.org/fhir/ValueSet/measure-report-status|4.0.1from the FHIR Standard | |
| MeasureReport.type | required | Fixed Value: data-collectionhttp://hl7.org/fhir/ValueSet/measure-report-type|4.0.1from the FHIR Standard | |
| MeasureReport.improvementNotation | required | MeasureImprovementNotationhttp://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1from the FHIR Standard | |
| MeasureReport.group.code | example | SampleCMSHCChttp://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshccfrom this IG |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | MeasureReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | MeasureReport | 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 | MeasureReport | 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 | MeasureReport | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | MeasureReport | 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() | |
| mrp-1 | error | MeasureReport | Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not() | |
| mrp-2 | error | MeasureReport | Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists()) | |
| ra-1 | error | MeasureReport.period | Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9 |
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| MeasureReport |
C | 0..* | MeasureReport | This is a risk adjustment data exchange MeasureReport. mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components | ||||
| 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.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
 Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| payerCodingGapReportId |
S | 0..1 | id | Payer generated coding gap report id URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-payerCodingGapReportId | ||||
| software |
S | 0..* | Reference(CRMI Software System Device) | Extension URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem | ||||
| vendor |
S | 0..1 | Reference(US Core Organization Profile) | Vendor information URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-reportingVendor | ||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
Σ | 0..* | Identifier | Additional identifier for the MeasureReport | ||||
| status |
?!SΣ | 1..1 | code | complete | pending | error Binding: MeasureReportStatus (required): The status of the measure report. | ||||
| type |
SΣC | 1..1 | code | The type code is fixed to 'data-collection' for a risk adjustment data exchange measure report Binding: MeasureReportType (required): The type of the measure report. Fixed Value: data-collection | ||||
| measure |
SΣ | 1..1 | canonical(Risk Adjustment Model Measure) | This references a measure that represents a risk adjustment model, such as CMS-HCC V24. | ||||
| subject |
SΣ | 1..1 | Reference(US Core Patient Profile) | What individual(s) the report is for | ||||
| date |
SΣ | 1..1 | dateTime | When the report was generated | ||||
| reporter |
SΣ | 1..1 | Reference(US Core Organization Profile) | Organization that generated the MeasureReport | ||||
| period |
SΣC | 1..1 | Period | Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD ) | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| start |
SΣC | 1..1 | dateTime | Starting time with inclusive boundary | ||||
| end |
SΣC | 1..1 | dateTime | End time with inclusive boundary, if not ongoing | ||||
| improvementNotation |
?!Σ | 0..1 | CodeableConcept | increase | decrease Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue. | ||||
| group |
SC | 0..* | BackboneElement | Condition Category | ||||
| id |
S | 1..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 |
SΣ | 0..1 | CodeableConcept | Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example) | ||||
| population |
0..* | BackboneElement | The populations in the group | |||||
| 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 |
Σ | 0..1 | CodeableConcept | initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Binding: MeasurePopulationType (extensible): The type of population (e.g. initial, numerator, denominator, etc.). | ||||
| count |
0..1 | integer | Size of the population | |||||
| subjectResults |
0..1 | Reference(List) | For subject-list reports, the subject results in this population | |||||
| measureScore |
Σ | 0..1 | Quantity | What score this group achieved | ||||
| stratifier |
0..* | BackboneElement | Stratification results | |||||
| 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 | What stratifier of the group | |||||
| stratum |
0..* | BackboneElement | Stratum results, one for each unique value, or set of values, in the stratifier, or stratifier components | |||||
| 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 | ||||
| value |
0..1 | CodeableConcept | The stratum value, e.g. male | |||||
| component |
0..* | BackboneElement | Stratifier component values | |||||
| 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 |
1..1 | CodeableConcept | What stratifier component of the group | |||||
| value |
1..1 | CodeableConcept | The stratum component value, e.g. male | |||||
| population |
0..* | BackboneElement | Population results in this stratum | |||||
| 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..1 | CodeableConcept | initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Binding: MeasurePopulationType (extensible): The type of population (e.g. initial, numerator, denominator, etc.). | |||||
| count |
0..1 | integer | Size of the population | |||||
| subjectResults |
0..1 | Reference(List) | For subject-list reports, the subject results in this population | |||||
| measureScore |
0..1 | Quantity | What score this stratum achieved | |||||
| evaluatedResource |
S | 0..* | Reference(Resource) | An evaluated resource in a risk adjusstment data exchange MeasureReport is any data Provider submits to Payer as clinical evaluation evidence, such as a Consolidated Clinical Document Architecture (C-CDA) document, enounters, and diagnoses. | ||||
| 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 | |||||
| groupReference |
S | 0..* | string | This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference | ||||
| 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 | ||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet / Code | URI | |||
| MeasureReport.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard | ||||
| MeasureReport.status | required | MeasureReportStatushttp://hl7.org/fhir/ValueSet/measure-report-status|4.0.1from the FHIR Standard | ||||
| MeasureReport.type | required | Fixed Value: data-collectionhttp://hl7.org/fhir/ValueSet/measure-report-type|4.0.1from the FHIR Standard | ||||
| MeasureReport.improvementNotation | required | MeasureImprovementNotationhttp://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1from the FHIR Standard | ||||
| MeasureReport.group.code | example | SampleCMSHCChttp://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshccfrom this IG | ||||
| MeasureReport.group.population.code | extensible | MeasurePopulationTypehttp://hl7.org/fhir/ValueSet/measure-populationfrom the FHIR Standard | ||||
| MeasureReport.group.stratifier.stratum.population.code | extensible | MeasurePopulationTypehttp://hl7.org/fhir/ValueSet/measure-populationfrom the FHIR Standard | ||||
| MeasureReport.evaluatedResource.type | extensible | ResourceTypehttp://hl7.org/fhir/ValueSet/resource-typesfrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | MeasureReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | MeasureReport | 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 | MeasureReport | 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 | MeasureReport | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | MeasureReport | 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() | |
| mrp-1 | error | MeasureReport | Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not() | |
| mrp-2 | error | MeasureReport | Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists()) | |
| ra-1 | error | MeasureReport.period | Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9 |
This structure is derived from MeasureReport
Summary
Mandatory: 6 elements(1 nested mandatory element)
Must-Support: 17 elements
Fixed: 1 element
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Differential View
This structure is derived from MeasureReport
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| MeasureReport |
0..* | MeasureReport | This is a risk adjustment data exchange MeasureReport. | |
| payerCodingGapReportId |
S | 0..1 | id | Payer generated coding gap report id URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-payerCodingGapReportId |
| software |
S | 0..* | Reference(CRMI Software System Device) | Extension URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem |
| vendor |
S | 0..1 | Reference(US Core Organization Profile) | Vendor information URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-reportingVendor |
| status |
S | 1..1 | code | complete | pending | error |
| type |
S | 1..1 | code | The type code is fixed to 'data-collection' for a risk adjustment data exchange measure report Fixed Value: data-collection |
| measure |
S | 1..1 | canonical(Risk Adjustment Model Measure) | This references a measure that represents a risk adjustment model, such as CMS-HCC V24. |
| subject |
S | 1..1 | Reference(US Core Patient Profile) | What individual(s) the report is for |
| date |
S | 1..1 | dateTime | When the report was generated |
| reporter |
S | 1..1 | Reference(US Core Organization Profile) | Organization that generated the MeasureReport |
| period |
SC | 1..1 | Period | Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD ) |
| start |
S | 1..1 | dateTime | Starting time with inclusive boundary |
| end |
S | 1..1 | dateTime | End time with inclusive boundary, if not ongoing |
| group |
S | 0..* | BackboneElement | Condition Category |
| id |
S | 1..1 | string | Unique id for inter-element referencing |
| code |
S | 0..1 | CodeableConcept | Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example) |
| evaluatedResource |
S | 0..* | Reference(Resource) | An evaluated resource in a risk adjusstment data exchange MeasureReport is any data Provider submits to Payer as clinical evaluation evidence, such as a Consolidated Clinical Document Architecture (C-CDA) document, enounters, and diagnoses. |
| groupReference |
S | 0..* | string | This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| MeasureReport.group.code | example | SampleCMSHCChttp://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshccfrom this IG |
| Id | Grade | Path(s) | Details | Requirements |
| ra-1 | error | MeasureReport.period | Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9 |
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| MeasureReport |
C | 0..* | MeasureReport | This is a risk adjustment data exchange MeasureReport. mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components |
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
| payerCodingGapReportId |
S | 0..1 | id | Payer generated coding gap report id URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-payerCodingGapReportId |
| software |
S | 0..* | Reference(CRMI Software System Device) | Extension URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem |
| vendor |
S | 0..1 | Reference(US Core Organization Profile) | Vendor information URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-reportingVendor |
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored |
| status |
?!SΣ | 1..1 | code | complete | pending | error Binding: MeasureReportStatus (required): The status of the measure report. |
| type |
SΣC | 1..1 | code | The type code is fixed to 'data-collection' for a risk adjustment data exchange measure report Binding: MeasureReportType (required): The type of the measure report. Fixed Value: data-collection |
| measure |
SΣ | 1..1 | canonical(Risk Adjustment Model Measure) | This references a measure that represents a risk adjustment model, such as CMS-HCC V24. |
| subject |
SΣ | 1..1 | Reference(US Core Patient Profile) | What individual(s) the report is for |
| date |
SΣ | 1..1 | dateTime | When the report was generated |
| reporter |
SΣ | 1..1 | Reference(US Core Organization Profile) | Organization that generated the MeasureReport |
| period |
SΣC | 1..1 | Period | Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD ) |
| start |
SΣC | 1..1 | dateTime | Starting time with inclusive boundary |
| end |
SΣC | 1..1 | dateTime | End time with inclusive boundary, if not ongoing |
| improvementNotation |
?!Σ | 0..1 | CodeableConcept | increase | decrease Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue. |
| group |
SC | 0..* | BackboneElement | Condition Category |
| id |
S | 1..1 | string | Unique id for inter-element referencing |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code |
SΣ | 0..1 | CodeableConcept | Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example) |
| evaluatedResource |
S | 0..* | Reference(Resource) | An evaluated resource in a risk adjusstment data exchange MeasureReport is any data Provider submits to Payer as clinical evaluation evidence, such as a Consolidated Clinical Document Architecture (C-CDA) document, enounters, and diagnoses. |
| groupReference |
S | 0..* | string | This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference |
| Documentation for this format | ||||
| Path | Conformance | ValueSet / Code | URI |
| MeasureReport.status | required | MeasureReportStatushttp://hl7.org/fhir/ValueSet/measure-report-status|4.0.1from the FHIR Standard | |
| MeasureReport.type | required | Fixed Value: data-collectionhttp://hl7.org/fhir/ValueSet/measure-report-type|4.0.1from the FHIR Standard | |
| MeasureReport.improvementNotation | required | MeasureImprovementNotationhttp://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1from the FHIR Standard | |
| MeasureReport.group.code | example | SampleCMSHCChttp://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshccfrom this IG |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | MeasureReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | MeasureReport | 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 | MeasureReport | 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 | MeasureReport | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | MeasureReport | 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() | |
| mrp-1 | error | MeasureReport | Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not() | |
| mrp-2 | error | MeasureReport | Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists()) | |
| ra-1 | error | MeasureReport.period | Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9 |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| MeasureReport |
C | 0..* | MeasureReport | This is a risk adjustment data exchange MeasureReport. mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components | ||||
| 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.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| payerCodingGapReportId |
S | 0..1 | id | Payer generated coding gap report id URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-payerCodingGapReportId | ||||
| software |
S | 0..* | Reference(CRMI Software System Device) | Extension URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem | ||||
| vendor |
S | 0..1 | Reference(US Core Organization Profile) | Vendor information URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-reportingVendor | ||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
Σ | 0..* | Identifier | Additional identifier for the MeasureReport | ||||
| status |
?!SΣ | 1..1 | code | complete | pending | error Binding: MeasureReportStatus (required): The status of the measure report. | ||||
| type |
SΣC | 1..1 | code | The type code is fixed to 'data-collection' for a risk adjustment data exchange measure report Binding: MeasureReportType (required): The type of the measure report. Fixed Value: data-collection | ||||
| measure |
SΣ | 1..1 | canonical(Risk Adjustment Model Measure) | This references a measure that represents a risk adjustment model, such as CMS-HCC V24. | ||||
| subject |
SΣ | 1..1 | Reference(US Core Patient Profile) | What individual(s) the report is for | ||||
| date |
SΣ | 1..1 | dateTime | When the report was generated | ||||
| reporter |
SΣ | 1..1 | Reference(US Core Organization Profile) | Organization that generated the MeasureReport | ||||
| period |
SΣC | 1..1 | Period | Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. ra-1: Date precision SHALL be at least to day ( YYYY-MM-DD ) | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| start |
SΣC | 1..1 | dateTime | Starting time with inclusive boundary | ||||
| end |
SΣC | 1..1 | dateTime | End time with inclusive boundary, if not ongoing | ||||
| improvementNotation |
?!Σ | 0..1 | CodeableConcept | increase | decrease Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue. | ||||
| group |
SC | 0..* | BackboneElement | Condition Category | ||||
| id |
S | 1..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 |
SΣ | 0..1 | CodeableConcept | Condition Category (CC) code for a Risk Adjustment Model Binding: Sample CMS Hierarchical Condition Category (example) | ||||
| population |
0..* | BackboneElement | The populations in the group | |||||
| 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 |
Σ | 0..1 | CodeableConcept | initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Binding: MeasurePopulationType (extensible): The type of population (e.g. initial, numerator, denominator, etc.). | ||||
| count |
0..1 | integer | Size of the population | |||||
| subjectResults |
0..1 | Reference(List) | For subject-list reports, the subject results in this population | |||||
| measureScore |
Σ | 0..1 | Quantity | What score this group achieved | ||||
| stratifier |
0..* | BackboneElement | Stratification results | |||||
| 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 | What stratifier of the group | |||||
| stratum |
0..* | BackboneElement | Stratum results, one for each unique value, or set of values, in the stratifier, or stratifier components | |||||
| 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 | ||||
| value |
0..1 | CodeableConcept | The stratum value, e.g. male | |||||
| component |
0..* | BackboneElement | Stratifier component values | |||||
| 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 |
1..1 | CodeableConcept | What stratifier component of the group | |||||
| value |
1..1 | CodeableConcept | The stratum component value, e.g. male | |||||
| population |
0..* | BackboneElement | Population results in this stratum | |||||
| 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..1 | CodeableConcept | initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Binding: MeasurePopulationType (extensible): The type of population (e.g. initial, numerator, denominator, etc.). | |||||
| count |
0..1 | integer | Size of the population | |||||
| subjectResults |
0..1 | Reference(List) | For subject-list reports, the subject results in this population | |||||
| measureScore |
0..1 | Quantity | What score this stratum achieved | |||||
| evaluatedResource |
S | 0..* | Reference(Resource) | An evaluated resource in a risk adjusstment data exchange MeasureReport is any data Provider submits to Payer as clinical evaluation evidence, such as a Consolidated Clinical Document Architecture (C-CDA) document, enounters, and diagnoses. | ||||
| 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 | |||||
| groupReference |
S | 0..* | string | This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference | ||||
| 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 | ||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet / Code | URI | |||
| MeasureReport.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard | ||||
| MeasureReport.status | required | MeasureReportStatushttp://hl7.org/fhir/ValueSet/measure-report-status|4.0.1from the FHIR Standard | ||||
| MeasureReport.type | required | Fixed Value: data-collectionhttp://hl7.org/fhir/ValueSet/measure-report-type|4.0.1from the FHIR Standard | ||||
| MeasureReport.improvementNotation | required | MeasureImprovementNotationhttp://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1from the FHIR Standard | ||||
| MeasureReport.group.code | example | SampleCMSHCChttp://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshccfrom this IG | ||||
| MeasureReport.group.population.code | extensible | MeasurePopulationTypehttp://hl7.org/fhir/ValueSet/measure-populationfrom the FHIR Standard | ||||
| MeasureReport.group.stratifier.stratum.population.code | extensible | MeasurePopulationTypehttp://hl7.org/fhir/ValueSet/measure-populationfrom the FHIR Standard | ||||
| MeasureReport.evaluatedResource.type | extensible | ResourceTypehttp://hl7.org/fhir/ValueSet/resource-typesfrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | MeasureReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | MeasureReport | 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 | MeasureReport | 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 | MeasureReport | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | MeasureReport | 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() | |
| mrp-1 | error | MeasureReport | Measure Reports used for data collection SHALL NOT communicate group and score information : (type != 'data-collection') or group.exists().not() | |
| mrp-2 | error | MeasureReport | Stratifiers SHALL be either a single criteria or a set of criteria components : group.stratifier.stratum.all(value.exists() xor component.exists()) | |
| ra-1 | error | MeasureReport.period | Date precision SHALL be at least to day ( YYYY-MM-DD ) : start.toString().length()>9 and end.toString().length()>9 |
This structure is derived from MeasureReport
Summary
Mandatory: 6 elements(1 nested mandatory element)
Must-Support: 17 elements
Fixed: 1 element
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Other representations of profile: CSV, Excel, Schematron
IG © 2021+ HL7 International / Clinical Quality Information. Package hl7.fhir.us.davinci-ra#2.0.0-preview based on FHIR 4.0.1. Generated 2024-04-18
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