Quality Measure Implementation Guide
2.0.0-ballot - STU 2 Ballot 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 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: EXM Measure (Experimental)

Official URL: http://hl7.org/fhir/uv/cqm/Measure/EXMLogic-FHIR Version: 2.0.0
Standards status: Informative Active as of 2025-08-13 Computable Name: MeasureEXM
Other Identifiers: http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm#EXM, OID:2.16.840.1.113883.4.642.40.61.29.9

Usage: Clinical Venue: EC

Copyright/Legal: Example Copyright Statement

An example FHIR-based measure

Metadata
Title EXM Measure
Version 2.0.0
Identifier EXM
Identifier urn:oid:2.16.840.1.113883.4.642.40.61.29.9
Effective Period 2018-01-01 + 1 year(s)
Approval Date 2019-02-17
Last Review Date 2019-02-17
Experimental true
Use Context Clinical Venue = EC
Jurisdiction 001 from http://unstats.un.org/unsd/methods/m49/m49.htm
Topic Health Quality Measure Document
Steward (Publisher) HL7 International / Clinical Quality Information
Developer Example Measure Content Developer
Description

An example FHIR-based measure
Purpose

This measure has been developed to support improvement in clinical care.
Copyright

Example Copyright Statement
Disclaimer

Example disclaimer
Measure Basis Encounter
Measure Scoring Continuous Variable
Measure Scoring Precision 2
Improvement Notation Increased score indicates improvement
Measure Type process from http://terminology.hl7.org/CodeSystem/measure-type
Risk Adjustment Risk adjustment for this measure is performed by...
Rate Aggregation Rate aggregation for this measure is performed by...
Rationale

The purpose of this measure is to show how all the elements of a FHIR-based quality measure are represented.
Clinical Recommendation Statement

The clinical recommendation statement for this measure is...
Guidance (Usage) Users of this measure should be aware that this is intentionally simplified to show specific aspects of a measure.
Measure Group (Rate) (ID: primary)
Stratifier ID: stratifier-1
Code: Stratifier 1
Stratifier ID: stratifier-2
Code: Stratifier 2
Stratifier ID: stratifier-3
Code: Stratifier 3
Stratifier ID: stratifier-4
Code: Stratifier 4
Supplemental Data Elements
Supplemental Data Element ID: sde-ethnicity
Usage Code: Supplemental Data
Description: No description provided
Logic Definition: SDE Ethnicity
Supplemental Data Element ID: sde-race
Usage Code: Supplemental Data
Description: No description provided
Logic Definition: SDE Race
Supplemental Data Element ID: sde-payer
Usage Code: Supplemental Data
Description: No description provided
Logic Definition: SDE Payer
Supplemental Data Element ID: sde-sex
Usage Code: Supplemental Data
Description: No description provided
Logic Definition: SDE Sex
Measure Logic
Primary Library Example Logic Library
Contents Population Criteria
Logic Definitions
Terminology
Dependencies
Data Requirements
Parameters
Population Criteria
Measure Group (Rate) (ID: primary)
Stratifier 
define "Stratifier 1" :
  "Inpatient Encounter" Encounter
    where not (PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient")
Definition
Stratifier 
define "Stratifier 2" :
  "Inpatient Encounter" Encounter
    where PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient"
Definition
Stratifier 
define "Stratifier 3" :
  "Inpatient Encounter" Encounter
    where PrincipalDiagnosis(Encounter) is null
Definition
Stratifier 
define "Stratifier 4" :
  "Inpatient Encounter" Encounter
    where PrincipalDiagnosis(Encounter) is null
Definition
Logic Definitions
Logic Definition Library Name: EXMLogic 
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
Logic Definition Library Name: EXMLogic 
define "Inpatient Encounter" :
  ["Encounter"] Encounter
    where LengthInDays(Encounter.period) <= 120
      and Encounter.period ends during "Measurement Period"
Logic Definition Library Name: EXMLogic 
define "Stratifier 3" :
  "Inpatient Encounter" Encounter
    where PrincipalDiagnosis(Encounter) is null
Logic Definition Library Name: EXMLogic 
define "Stratifier 4" :
  "Inpatient Encounter" Encounter
    where PrincipalDiagnosis(Encounter) is null
Logic Definition Library Name: EXMLogic 
define "SDE Payer":
    [Coverage: type in "Payer"] Payer
      return {
        code: Payer.type,
        period: Payer.period
      }
Logic Definition Library Name: EXMLogic 
define "Initial Population" :
  "Inpatient Encounter" Encounter
Logic Definition Library Name: EXMLogic 
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
Logic Definition Library Name: EXMLogic 
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
Logic Definition Library Name: EXMLogic 
define "Measure Population" :
  "Initial Population"
Logic Definition Library Name: EXMLogic 
define "Stratifier 1" :
  "Inpatient Encounter" Encounter
    where not (PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient")
Logic Definition Library Name: EXMLogic 
define "Stratifier 2" :
  "Inpatient Encounter" Encounter
    where PrincipalDiagnosis(Encounter).code in "Psychiatric/Mental Health Patient"
Logic Definition Library Name: EXMLogic 
define function "LengthInDays"(Value Interval<DateTime>):
	difference in days between start of Value and end of Value
Logic Definition Library Name: EXMLogic 
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: EXMLogic 
define function "GetId"(uri String):
	Last(Split(uri, '/'))
Logic Definition Library Name: EXMLogic 
define function "Measure Observation" (Encounter "Encounter" ) :
  duration in minutes of "Related ED Visit"(Encounter).period
Logic Definition Library Name: EXMLogic 
//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 )
Logic Definition Library Name: FHIRHelpers 
define function ToString(value AdministrativeGender): value.value
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 uri): value.value
Logic Definition Library Name: FHIRHelpers 
define function ToString(value EncounterStatus): value.value
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 Payer
Resource: Payer Type
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
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 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
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: 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
Parameters
Name Use Card. Type Documentation
Measurement Period In 0..1 Period
SDE Sex Out 0..1 Coding
Stratifier 3 Out 0..* Encounter
Stratifier 4 Out 0..* Encounter
SDE Payer Out 0..* Resource
Initial Population Out 0..* Encounter
SDE Ethnicity Out 0..* Coding
SDE Race Out 0..* Coding
Measure Population Out 0..* Encounter
Stratifier 1 Out 0..* Encounter
Stratifier 2 Out 0..* Encounter
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