Da Vinci Risk Adjustment Implementation Guide
2.1.0 - STU 2.1

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 2.1.0 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

## Resource Profile: Risk Adjustment Coding Gap MeasureReport with Remark

Official URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-measurereport-with-remark | Version: 2.1.0
Standards status: Trial-use | Maturity Level: 2 | Computable Name: RiskAdjustmentCodingGapMeasureReport
Other Identifiers: OID:2.16.840.1.113883.4.642.40.29.42.19
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

This profile represents a risk adjustment coding gap report with condition categories and at least one of the condition category has one or more condition category remark(s).

Usages:

- Use this Profile: Risk Adjustment MeasureReport With Remark Bundle

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MeasureReport | C | 0..* | RiskAdjustmentCodingGapMeasureReport | A risk adjustment coding gap report with ccRemark present. Constraints: mrp-1, mrp-2
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:measurereport-category | S | 1..1 | (Complex) | What category is this measure report URL: http://hl7.org/fhir/StructureDefinition/measurereport-category
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/measurereport-category"
value[x] |  | 1..1 | CodeableConcept | Value of extension Binding: MeasureReportCategory (extensible)
coding | Σ | 1..1 | Coding | Code defined by a terminology system
code | Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: ra
extension:clinicalDataCollectionDeadline | S | 0..1 | date | This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
extension:contextId | S | 0..* | id | context id URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-contextId
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | complete | pending | error Binding: MeasureReportStatus (required): The status of the measure report.
type | S Σ C | 1..1 | code | The type code is fixed to 'individual' for a risk adjustment coding gap report Binding: MeasureReportType (required): The type of the measure report. Fixed Value: individual
measure | S Σ | 1..1 | canonical(Risk Adjustment Model Measure) | This references a measure that represents a risk adjustment model, such as CMS-HCC V24, CMS-HCC V28.
subject | S Σ | 1..1 | Reference(US Core Patient Profile(7.0.0)) | What individual(s) the report is for
date | S Σ | 1..1 | dateTime | When the report was generated
reporter | S Σ | 1..1 | Reference(US Core Organization Profile(7.0.0)) | Organization that generated the MeasureReport
period | S Σ C | 1..1 | Period | Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. Constraints: ra-1
start | S Σ C | 1..1 | dateTime | Starting time with inclusive boundary
end | S Σ C | 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 | S C | 1..* | BackboneElement | A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
id | S | 1..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:ccType | S | 1..1 | CodeableConcept | Condition Category type: historic|suspected|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Condition Category Type (extensible)
extension:dxCode | S | 0..* | CodeableConcept | diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: USCoreConditionCodes (7.0.0) (preferred)
extension:evidenceStatus | S | 0..1 | CodeableConcept | This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|invalid-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Evidence Status (extensible)
extension:evidenceStatusDate | S | 0..1 | date | When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
extension:hierarchicalStatus | S | 0..1 | CodeableConcept | How hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Hierarchical Status (extensible)
extension:confidenceScale | S | 0..1 | CodeableConcept | Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: RA Confidence Scale (extensible)
extension:ccRemark | S C | 0..* | (Complex) | Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark Constraints: ra-2
extension:qualifyingDxCode | S | 0..* | string, CodeableConcept | Qualifying dx code(s) URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-qualifyingDxCode
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S Σ | 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 is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap.
Slices for extension |  |  |  | Content/Rules for all slices
extension: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

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MeasureReport.extension:measurereport-category.​value[x] | Base | extensible | Measure Report Category VS | 📍5.2.0 | FHIR Extensions Pack v5.2
MeasureReport.status | Base | required | MeasureReportStatus | 📍4.0.1 | FHIR Std.
MeasureReport.type | Base | required | MeasureReportType | 📍4.0.1 | FHIR Std.
MeasureReport.improvementNotation | Base | required | MeasureImprovementNotation | 📍4.0.1 | FHIR Std.
MeasureReport.group.​code | Base | example | Sample CMS Hierarchical Condition Category | 📦2.1.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
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`
ra-2 | error | MeasureReport.group.extension:ccRemark | A remark shall include an author, an authorOrganization, or an authorSoftware | `extension.where(url = 'author').exists() or extension.where(url = 'authorOrganization').exists() or extension.where(url = 'authorSoftware').exists()`

This structure is derived from RiskAdjustmentCodingGapMeasureReport

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MeasureReport |  | 0..* | RiskAdjustmentCodingGapMeasureReport | A risk adjustment coding gap report with ccRemark present.
group |  | 1..* | BackboneElement | A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MeasureReport | C | 0..* | RiskAdjustmentCodingGapMeasureReport | A risk adjustment coding gap report with ccRemark present. Constraints: mrp-1, mrp-2
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 Bindings | Purpose
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
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:measurereport-category | S | 1..1 | (Complex) | What category is this measure report URL: http://hl7.org/fhir/StructureDefinition/measurereport-category
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/measurereport-category"
value[x] |  | 1..1 | CodeableConcept | Value of extension Binding: MeasureReportCategory (extensible)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 1..1 | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 0..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: ra
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
extension:clinicalDataCollectionDeadline | S | 0..1 | date | This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
extension:contextId | S | 0..* | id | context id URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-contextId
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Additional identifier for the MeasureReport
status | ?!S Σ | 1..1 | code | complete | pending | error Binding: MeasureReportStatus (required): The status of the measure report.
type | S Σ C | 1..1 | code | The type code is fixed to 'individual' for a risk adjustment coding gap report Binding: MeasureReportType (required): The type of the measure report. Fixed Value: individual
measure | S Σ | 1..1 | canonical(Risk Adjustment Model Measure) | This references a measure that represents a risk adjustment model, such as CMS-HCC V24, CMS-HCC V28.
subject | S Σ | 1..1 | Reference(US Core Patient Profile(7.0.0)) | What individual(s) the report is for
date | S Σ | 1..1 | dateTime | When the report was generated
reporter | S Σ | 1..1 | Reference(US Core Organization Profile(7.0.0)) | Organization that generated the MeasureReport
period | S Σ C | 1..1 | Period | Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. Constraints: ra-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
start | S Σ C | 1..1 | dateTime | Starting time with inclusive boundary
end | S Σ C | 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 | S C | 1..* | BackboneElement | A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
id | S | 1..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:ccType | S | 1..1 | CodeableConcept | Condition Category type: historic|suspected|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Condition Category Type (extensible)
extension:dxCode | S | 0..* | CodeableConcept | diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: USCoreConditionCodes (7.0.0) (preferred)
extension:evidenceStatus | S | 0..1 | CodeableConcept | This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|invalid-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Evidence Status (extensible)
extension:evidenceStatusDate | S | 0..1 | date | When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
extension:hierarchicalStatus | S | 0..1 | CodeableConcept | How hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Hierarchical Status (extensible)
extension:confidenceScale | S | 0..1 | CodeableConcept | Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: RA Confidence Scale (extensible)
extension:ccRemark | S C | 0..* | (Complex) | Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark Constraints: ra-2
extension:qualifyingDxCode | S | 0..* | string, CodeableConcept | Qualifying dx code(s) URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-qualifyingDxCode
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S Σ | 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..1 | 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 is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap.
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:groupReference | S | 0..* | string | This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
reference | Σ C | 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

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MeasureReport.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
MeasureReport.extension:measurereport-category.​value[x] | Base | extensible | Measure Report Category VS | 📍5.2.0 | FHIR Extensions Pack v5.2
MeasureReport.status | Base | required | MeasureReportStatus | 📍4.0.1 | FHIR Std.
MeasureReport.type | Base | required | MeasureReportType | 📍4.0.1 | FHIR Std.
MeasureReport.improvementNotation | Base | required | MeasureImprovementNotation | 📍4.0.1 | FHIR Std.
MeasureReport.group.​code | Base | example | Sample CMS Hierarchical Condition Category | 📦2.1.0 | This IG
MeasureReport.group.​population.code | Base | extensible | MeasurePopulationType | 📍4.0.1 | FHIR Std.
MeasureReport.group.​stratifier.stratum.population.​code | Base | extensible | MeasurePopulationType | 📍4.0.1 | FHIR Std.
MeasureReport.evaluatedResource.​type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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`
ra-2 | error | MeasureReport.group.extension:ccRemark | A remark shall include an author, an authorOrganization, or an authorSoftware | `extension.where(url = 'author').exists() or extension.where(url = 'authorOrganization').exists() or extension.where(url = 'authorSoftware').exists()`

This structure is derived from RiskAdjustmentCodingGapMeasureReport

Summary

Mandatory: 1 element

Maturity: 2

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MeasureReport | C | 0..* | RiskAdjustmentCodingGapMeasureReport | A risk adjustment coding gap report with ccRemark present. Constraints: mrp-1, mrp-2
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:measurereport-category | S | 1..1 | (Complex) | What category is this measure report URL: http://hl7.org/fhir/StructureDefinition/measurereport-category
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/measurereport-category"
value[x] |  | 1..1 | CodeableConcept | Value of extension Binding: MeasureReportCategory (extensible)
coding | Σ | 1..1 | Coding | Code defined by a terminology system
code | Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: ra
extension:clinicalDataCollectionDeadline | S | 0..1 | date | This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
extension:contextId | S | 0..* | id | context id URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-contextId
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 1..1 | code | complete | pending | error Binding: MeasureReportStatus (required): The status of the measure report.
type | S Σ C | 1..1 | code | The type code is fixed to 'individual' for a risk adjustment coding gap report Binding: MeasureReportType (required): The type of the measure report. Fixed Value: individual
measure | S Σ | 1..1 | canonical(Risk Adjustment Model Measure) | This references a measure that represents a risk adjustment model, such as CMS-HCC V24, CMS-HCC V28.
subject | S Σ | 1..1 | Reference(US Core Patient Profile(7.0.0)) | What individual(s) the report is for
date | S Σ | 1..1 | dateTime | When the report was generated
reporter | S Σ | 1..1 | Reference(US Core Organization Profile(7.0.0)) | Organization that generated the MeasureReport
period | S Σ C | 1..1 | Period | Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. Constraints: ra-1
start | S Σ C | 1..1 | dateTime | Starting time with inclusive boundary
end | S Σ C | 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 | S C | 1..* | BackboneElement | A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
id | S | 1..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:ccType | S | 1..1 | CodeableConcept | Condition Category type: historic|suspected|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Condition Category Type (extensible)
extension:dxCode | S | 0..* | CodeableConcept | diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: USCoreConditionCodes (7.0.0) (preferred)
extension:evidenceStatus | S | 0..1 | CodeableConcept | This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|invalid-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Evidence Status (extensible)
extension:evidenceStatusDate | S | 0..1 | date | When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
extension:hierarchicalStatus | S | 0..1 | CodeableConcept | How hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Hierarchical Status (extensible)
extension:confidenceScale | S | 0..1 | CodeableConcept | Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: RA Confidence Scale (extensible)
extension:ccRemark | S C | 0..* | (Complex) | Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark Constraints: ra-2
extension:qualifyingDxCode | S | 0..* | string, CodeableConcept | Qualifying dx code(s) URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-qualifyingDxCode
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S Σ | 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 is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap.
Slices for extension |  |  |  | Content/Rules for all slices
extension: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

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MeasureReport.extension:measurereport-category.​value[x] | Base | extensible | Measure Report Category VS | 📍5.2.0 | FHIR Extensions Pack v5.2
MeasureReport.status | Base | required | MeasureReportStatus | 📍4.0.1 | FHIR Std.
MeasureReport.type | Base | required | MeasureReportType | 📍4.0.1 | FHIR Std.
MeasureReport.improvementNotation | Base | required | MeasureImprovementNotation | 📍4.0.1 | FHIR Std.
MeasureReport.group.​code | Base | example | Sample CMS Hierarchical Condition Category | 📦2.1.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
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`
ra-2 | error | MeasureReport.group.extension:ccRemark | A remark shall include an author, an authorOrganization, or an authorSoftware | `extension.where(url = 'author').exists() or extension.where(url = 'authorOrganization').exists() or extension.where(url = 'authorSoftware').exists()`

Differential View

This structure is derived from RiskAdjustmentCodingGapMeasureReport

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MeasureReport |  | 0..* | RiskAdjustmentCodingGapMeasureReport | A risk adjustment coding gap report with ccRemark present.
group |  | 1..* | BackboneElement | A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
MeasureReport | C | 0..* | RiskAdjustmentCodingGapMeasureReport | A risk adjustment coding gap report with ccRemark present. Constraints: mrp-1, mrp-2
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 Bindings | Purpose
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
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:measurereport-category | S | 1..1 | (Complex) | What category is this measure report URL: http://hl7.org/fhir/StructureDefinition/measurereport-category
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/measurereport-category"
value[x] |  | 1..1 | CodeableConcept | Value of extension Binding: MeasureReportCategory (extensible)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 1..1 | Coding | Code defined by a terminology system
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
system | Σ | 0..1 | uri | Identity of the terminology system
version | Σ | 0..1 | string | Version of the system - if relevant
code | Σ | 1..1 | code | Symbol in syntax defined by the system Fixed Value: ra
display | Σ | 0..1 | string | Representation defined by the system
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user
text | Σ | 0..1 | string | Plain text representation of the concept
extension:clinicalDataCollectionDeadline | S | 0..1 | date | This is the deadline by which the providers must have all claims data to the payers to count for risk adjustment for a clinical evaluation period. This date is set by the Payer and applies to the early-bird date if incentive were offered. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline
extension:contextId | S | 0..* | id | context id URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-contextId
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Additional identifier for the MeasureReport
status | ?!S Σ | 1..1 | code | complete | pending | error Binding: MeasureReportStatus (required): The status of the measure report.
type | S Σ C | 1..1 | code | The type code is fixed to 'individual' for a risk adjustment coding gap report Binding: MeasureReportType (required): The type of the measure report. Fixed Value: individual
measure | S Σ | 1..1 | canonical(Risk Adjustment Model Measure) | This references a measure that represents a risk adjustment model, such as CMS-HCC V24, CMS-HCC V28.
subject | S Σ | 1..1 | Reference(US Core Patient Profile(7.0.0)) | What individual(s) the report is for
date | S Σ | 1..1 | dateTime | When the report was generated
reporter | S Σ | 1..1 | Reference(US Core Organization Profile(7.0.0)) | Organization that generated the MeasureReport
period | S Σ C | 1..1 | Period | Clinical evaluation period during which risk adjusting encounters could be conducted and documented with expectations of submission for risk adjustment purposes. Constraints: ra-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
start | S Σ C | 1..1 | dateTime | Starting time with inclusive boundary
end | S Σ C | 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 | S C | 1..* | BackboneElement | A group contains information for a Condition Category. If a patient/member has multiple Condition Categories, there will be multiple group(s) and each group represents a Condition Category.
id | S | 1..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:ccType | S | 1..1 | CodeableConcept | Condition Category type: historic|suspected|net-new URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType Binding: Condition Category Type (extensible)
extension:dxCode | S | 0..* | CodeableConcept | diagnosis code: if ccType historic or net-new, this is documented condition; if ccType is suspected, this is inferred/suspected condition. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-dxCode Binding: USCoreConditionCodes (7.0.0) (preferred)
extension:evidenceStatus | S | 0..1 | CodeableConcept | This is evidence status of a Condition Category (CC) coding gap: open-gap|closed-gap|invalid-gap|pending. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus Binding: Evidence Status (extensible)
extension:evidenceStatusDate | S | 0..1 | date | When the evidence status was changed to either closed-gap, open-gap, or pending URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate
extension:hierarchicalStatus | S | 0..1 | CodeableConcept | How hiearchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded: applied-superseded|applied-not-superseded|not-applied|not-applicable URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus Binding: Hierarchical Status (extensible)
extension:confidenceScale | S | 0..1 | CodeableConcept | Confidence scale for a coding gap URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale Binding: RA Confidence Scale (extensible)
extension:ccRemark | S C | 0..* | (Complex) | Remark added to a Condition Category URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccRemark Constraints: ra-2
extension:qualifyingDxCode | S | 0..* | string, CodeableConcept | Qualifying dx code(s) URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-qualifyingDxCode
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S Σ | 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..1 | 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 is any data a clinician would need to independently arrive at the clinical inference that a Condition Category (CC) listed on a Risk Adjustment Coding Gap Report could be present for a patient. Risk adjusted evaluated resources may include practitioners, encounters, diagnoses, medications, labs, or any other clinical evidence that the suspecting algorithm may have used as supporting evidence to infer the presence of a Condition Category (CC) gap.
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:groupReference | S | 0..* | string | This references the MeasureReport.group.id. URL: http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference
reference | Σ C | 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

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
MeasureReport.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
MeasureReport.extension:measurereport-category.​value[x] | Base | extensible | Measure Report Category VS | 📍5.2.0 | FHIR Extensions Pack v5.2
MeasureReport.status | Base | required | MeasureReportStatus | 📍4.0.1 | FHIR Std.
MeasureReport.type | Base | required | MeasureReportType | 📍4.0.1 | FHIR Std.
MeasureReport.improvementNotation | Base | required | MeasureImprovementNotation | 📍4.0.1 | FHIR Std.
MeasureReport.group.​code | Base | example | Sample CMS Hierarchical Condition Category | 📦2.1.0 | This IG
MeasureReport.group.​population.code | Base | extensible | MeasurePopulationType | 📍4.0.1 | FHIR Std.
MeasureReport.group.​stratifier.stratum.population.​code | Base | extensible | MeasurePopulationType | 📍4.0.1 | FHIR Std.
MeasureReport.evaluatedResource.​type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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`
ra-2 | error | MeasureReport.group.extension:ccRemark | A remark shall include an author, an authorOrganization, or an authorSoftware | `extension.where(url = 'author').exists() or extension.where(url = 'authorOrganization').exists() or extension.where(url = 'authorSoftware').exists()`

This structure is derived from RiskAdjustmentCodingGapMeasureReport

Summary

Mandatory: 1 element

Maturity: 2

Other representations of profile: CSV, Excel, Schematron