Quality Measure Implementation Guide
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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 2.0.0-ballot 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

Measure: EXM55 - Median Emergency Department Visit Duration (Experimental)

Official URL: http://hl7.org/fhir/uv/cqm/Measure/EXM55-FHIR Version: 5.0.0
Standards status: Informative Active as of 2025-08-13 Computable Name: EXM55
Other Identifiers: http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm#55 (use: official, ), OID:2.16.840.1.113883.4.642.40.61.29.8

Usage: Clinical Venue: EH

This example illustrates a continuous variable measure represented as a FHIR eCQM

Metadata
Title EXM55 - Median Emergency Department Visit Duration
Version 5.0.0
Identifier 55
Identifier urn:oid:2.16.840.1.113883.4.642.40.61.29.8
Effective Period 2018-01-01 through 2018-12-31
Approval Date 2019-03-08
Last Review Date 2019-03-08
Experimental true
Use Context Clinical Venue = EH
Jurisdiction 001 from http://unstats.un.org/unsd/methods/m49/m49.htm
Topic Health Quality Measure Document
Steward (Publisher) HL7 International / Clinical Quality Information
Description

This example illustrates a continuous variable measure represented as a FHIR eCQM
Measure Basis Encounter
Measure Scoring Continuous Variable
Improvement Notation Decreased score indicates improvement
Measure Type process from http://terminology.hl7.org/CodeSystem/measure-type
Measure Group (Rate) (ID: primary)
Stratifier Code: Stratification 1
Stratifier Code: Stratification 2
Stratifier Code: Stratification 3
Measure Logic
Primary Library EXM55 - Median Emergency Department Visit Duration Library (Example Continuous Variable Measure Library)
Contents Population Criteria
Logic Definitions
Terminology
Dependencies
Data Requirements
Parameters
Population Criteria
Measure Group (Rate) (ID: primary)
Stratifier 
define "Stratification 1" :
  "Inpatient Encounter" Encounter
    where not (PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient")
Definition
Stratifier 
define "Stratification 2" :
  "Inpatient Encounter" Encounter
    where PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient"
Definition
Stratifier 
define "Stratification 3" :
  "Inpatient Encounter" Encounter
    where PrincipalDiagnosis(Encounter) is null
Definition
Logic Definitions
Logic Definition Library Name: FHIRHelpers 
/*
@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
value to a CQL DateTime Interval
@comment: If the start value of the given period is unspecified, the starting
boundary of the resulting interval will be open (meaning the start of the interval
is unknown, as opposed to interpreted as the beginning of time).
*/
define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period."start" is null then
            Interval(period."start".value, period."end".value]
        else
            Interval[period."start".value, period."end".value]
Logic Definition Library Name: FHIRHelpers 
/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }
Logic Definition Library Name: FHIRHelpers 
/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }
Logic Definition Library Name: FHIRHelpers 
define function ToString(value string): value.value
Logic Definition Library Name: FHIRHelpers 
define function ToString(value EncounterStatus): value.value
Logic Definition Library Name: EXM55 
define "Inpatient Encounter" :
  ["Encounter"] Encounter
    where LengthInDays(Encounter.period) <= 120
      and Encounter.period ends during "Measurement Period"
Logic Definition Library Name: EXM55 
define "Stratification 3" :
  "Inpatient Encounter" Encounter
    where PrincipalDiagnosis(Encounter) is null
Logic Definition Library Name: EXM55 
define "Stratification 2" :
  "Inpatient Encounter" Encounter
    where PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient"
Logic Definition Library Name: EXM55 
define "Measure Population Exclusion" :
  "Inpatient Encounter" Encounter
    with ["Encounter" : "Emergency Department Visit"] ED
      such that ED.period ends 1 hour or less before start of Encounter.period
        and ED.status = 'finished'
        and ED.hospitalization.admitSource in "Hospital Settings"
Logic Definition Library Name: EXM55 
define "Stratification 1" :
  "Inpatient Encounter" Encounter
    where not (PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient")
Logic Definition Library Name: EXM55 
define "Initial Population" :
  "Inpatient Encounter" Encounter
    with ["Encounter" : "Emergency Department Visit"] ED
     such that ED.status = 'finished'
       and ED.period ends 1 hour or less before start of Encounter.period
Logic Definition Library Name: EXM55 
define "Measure Population" :
  "Initial Population"
Logic Definition Library Name: EXM55 
define function "LengthInDays"(Value Interval<DateTime>):
	difference in days between start of Value and end of Value
Logic Definition Library Name: EXM55 
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)])
Logic Definition Library Name: EXM55 
define function "GetId"(uri String):
	Last(Split(uri, '/'))
Logic Definition Library Name: EXM55 
define function "Measure Observation" (Encounter "Encounter" ) :
  duration in minutes of "Related ED Visit"(Encounter).period
Logic Definition Library Name: EXM55 
//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 )
Terminology
Code System Description: Code system Diagnosis Role
Resource: Diagnosis Role
Canonical URL: http://terminology.hl7.org/CodeSystem/diagnosis-role
Value Set Description: Value set Psychiatric/Mental Health Patient
Resource: Psychiatric/Mental Health Diagnosis
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.299
Value Set Description: Value set Emergency Department Visit
Resource: Emergency Department Visit
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292
Value Set Description: Value set Hospital Settings
Resource: Hospital Settings
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.126
Direct Reference Code Display: Billing
Code: billing
System: http://terminology.hl7.org/CodeSystem/diagnosis-role
Dependencies
Dependency Description: FHIR model information
Resource: http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1
Canonical URL: http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1
Dependency Description: Library FHIRHelpers
Resource: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1
Canonical URL: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1
Data Requirements
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: period, use, rank, rank.value, condition, condition.reference
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type, period, status, hospitalization, hospitalization.admitSource, use, rank, rank.value, condition, condition.reference
Code Filter(s):
Path: type
ValueSet: Emergency Department Visit
Data Requirement Type: Condition
Profile(s): Condition
Must Support Elements: id
Code Filter(s):
Path: id
Parameters
Name Use Card. Type Documentation
Measurement Period In 0..1 Period
Stratification 3 Out 0..* Encounter
Stratification 2 Out 0..* Encounter
Measure Population Exclusion Out 0..* Encounter
Stratification 1 Out 0..* Encounter
Initial Population Out 0..* Encounter
Measure Population Out 0..* Encounter
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