Quality Measure Implementation Guide
1.0.0 - STU 1 International flag

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

Library: Example Executable Library (Experimental)

Official URL: http://hl7.org/fhir/uv/cqm/Library/EXMExecutableLibrary Version: 2.0.0
Standards status: Informative Computable Name: EXMExecutableLibrary
Other Identifiers: http://example.org/fhir/cqi/ecqm/Library/Identifier#EXMExecutableLibrary (use: official, ), OID:2.16.840.1.113883.4.642.40.61.28.16

This library is used as an example in the FHIR Quality Measure Implementation Guide

Metadata
Title Example Executable Library
Version 2.0.0
Identifier EXMExecutableLibrary
Identifier urn:oid:2.16.840.1.113883.4.642.40.61.28.16
Approval Date 2019-08-03
Last Review Date 2019-08-03
Experimental true
Jurisdiction Global (Whole world)
Steward (Publisher) HL7 International / Clinical Quality Information
Description

This library is used as an example in the FHIR Quality Measure Implementation Guide

Type Logic Library
Parameter Name: Measurement Period
Use: In
Min Cardinality: 0
Max Cardinality: 1
Type: Period
Parameter Name: Patient
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: Patient
Parameter Name: Inpatient Encounter
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Encounter
Parameter Name: Initial Population
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Encounter
Parameter Name: Measure Population
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Encounter
Parameter Name: Stratifier 1
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Encounter
Parameter Name: Stratifier 2
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Encounter
Parameter Name: Stratifier 3
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Encounter
Parameter Name: Stratifier 4
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Encounter
Parameter Name: SDE Ethnicity
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Coding
Parameter Name: SDE Payer
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Resource
Parameter Name: SDE Race
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Coding
Parameter Name: SDE Sex
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: Coding
Data Requirement Type: Patient
Profile(s): Patient
Must Support Elements: url, extension, value
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type, status, period, use, rank, rank.value, condition, condition.reference
Code Filter(s):
Path: type
ValueSet: Emergency Department Visit
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: period, use, rank, rank.value, condition, condition.reference
Data Requirement Type: Condition
Profile(s): Condition
Must Support Elements: id
Code Filter(s):
Path: id
Data Requirement Type: Coverage
Profile(s): Coverage
Must Support Elements: type, period
Code Filter(s):
Path: type
ValueSet: Payer Type
Library Content
CQL Content
/*
This example is purely for illustration purposes to show how all the elements of a
FHIR-based quality measure are represented. It is intentionally simplified to show
specific aspects of a measure, and is not intended as an example of a clinically
meaningful measure.

NOTE: This is the same library as EXMLogic, being used to illustrate the different flavors of profiles:
* Computable: Focusing on computable/design-time aspects
* Executable: Focusing on run-time aspects
* Publishable: Focusing on knowledge management aspects
*/
library EXMExecutableLibrary version '2.0.0'

using FHIR version '4.0.1'

include hl7.fhir.uv.cql.FHIRHelpers version '4.0.1' called FHIRHelpers

codesystem "Diagnosis Role": 'http://terminology.hl7.org/CodeSystem/diagnosis-role'

valueset "Emergency Department Visit" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292'
valueset "Psychiatric/Mental Health Patient" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.299'
valueset "Hospital Settings" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.126'

valueset "ONC Administrative Sex": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1'
valueset "Race": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.836'
valueset "Ethnicity": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.837'
valueset "Payer": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591'

code "Billing": 'billing' from "Diagnosis Role" display 'Billing'

parameter "Measurement Period" Interval<DateTime>

context Patient

define "Initial Population" :
  "Inpatient Encounter" Encounter

define "Measure Population" :
  "Initial Population"

define function "Measure Observation" (Encounter "Encounter" ) :
  duration in minutes of "Related ED Visit"(Encounter).period

define "Stratifier 1" :
  "Inpatient Encounter" Encounter
    where not (PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient")

define "Stratifier 2" :
  "Inpatient Encounter" Encounter
    where PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient"

define "Stratifier 3" :
  "Inpatient Encounter" Encounter
    where PrincipalDiagnosis(Encounter) is null

define "Stratifier 4" :
  "Inpatient Encounter" Encounter
    where PrincipalDiagnosis(Encounter) is null

define "Inpatient Encounter" :
  ["Encounter"] Encounter
    where LengthInDays(Encounter.period) <= 120
      and Encounter.period ends during "Measurement Period"

define function "PrincipalDiagnosis"(Encounter Encounter):
	(singleton from (Encounter.diagnosis D where D.use ~ ToConcept("Billing") and D.rank.value = 1)) PD
		return singleton from ([Condition: id in "GetId"(PD.condition.reference)])

define function "LengthInDays"(Value Interval<DateTime>):
	difference in days between start of Value and end of Value

define function "GetId"(uri String):
	Last(Split(uri, '/'))

//Measure Observation
define function "Related ED Visit" (Encounter "Encounter" ) :
  Last(["Encounter" : "Emergency Department Visit"] ED
    where ED.status = 'finished'
      and ED.period ends 1 hour or less before start of Encounter.period
    sort by start of period )

define "SDE Ethnicity":
  (flatten (
    Patient.extension Extension
      where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity'
        return Extension.extension
  )) E
    where E.url = 'ombCategory'
      or E.url = 'detailed'
    return E.value as Coding

define "SDE Payer":
    [Coverage: type in "Payer"] Payer
      return {
        code: Payer.type,
        period: Payer.period
      }

define "SDE Race":
  (flatten (
    Patient.extension Extension
      where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race'
        return Extension.extension
  )) E
    where E.url = 'ombCategory'
      or E.url = 'detailed'
    return E.value as Coding

define "SDE Sex":
  case
    when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }
    when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }
    else null
  end
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