CMS FHIR Quality Measure Development IG
1.0.0-cibuild - CI Build
CMS FHIR Quality Measure Development IG
1.0.0-cibuild - CI Build
CMS FHIR Quality Measure Development IG, published by Centers for Medicare & Medicaid Services (CMS). This guide is not an authorized publication; it is the continuous build for version 1.0.0-cibuild built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/cms-qmd/ and changes regularly. See the Directory of published versions
QI-Core defines a variety of profiles for representing and accessing patient’s observations. These include vital signs, laboratory data, imaging, clinical findings, device measurements, clinical assessments, pregnancy and smoking status and more.
When using QI-Core to access profiled resources, the result of the retrieve will only include resources that conform to that profile. This means that the retrieve is effectively a filter by conformance, meaning that the expression does not need to provide filters for values that are fixed by the profile definition. When retrieving Respiratory rate, for example, this means that the expression does not need to test that the code of the Observation is the LOINC code for respiratory rate (9279-1), the retrieve will only result in observations that already have that code:
CQL:
// Respiratory rate - 9279-1
// @profile: [https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-respiratory-rate.html](https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-respiratory-rate.html)
define "Respiratory Rate":
[USCoreRespiratoryRateProfile] RR
where RR.status in { 'final', 'amended', 'corrected' }
As a rule of thumb, if a profile definition defines a fixed value constraint for an element, then the expression does not need to use that element.
CQL:
// Heart rate - 8867-4
// @profile: [https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-heart-rate.html](https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-heart-rate.html)
define "Heart Rate":
[USCoreHeartRateProfile] HR
where HR.status in { 'final', 'amended', 'corrected' }
// Body temperature - 8310-5
// @profile: [https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-body-temperature.html](https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-body-temperature.html)
define "Body Temperature":
[USCoreBodyTemperatureProfile] BodyTemp
where BodyTemp.status in { 'final', 'amended', 'corrected' }
// Body height - 8302-2
// @profile: [https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-body-height.html](https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-body-height.html)
define "Body Height":
[USCoreBodyHeightProfile] BodyHt
where BodyHt.status in { 'final', 'amended', 'corrected' }
// Head circumference - 9843-4
// @profile: [https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-head-occipital-frontal-circumference-percentile.html](https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-head-occipital-frontal-circumference-percentile.html)
define "Head Circumference":
[USCoreHeadCircumferenceProfile] HeadSize
where HeadSize.status in { 'final', 'amended', 'corrected' }
// Body weight - 29463-7
// @profile: [https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-body-weight.html](https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-body-weight.html)
define "Body Weight":
[USCoreBodyWeightProfile] BodyWt
where BodyWt.status in { 'final', 'amended', 'corrected' }
// Body mass index - 39156-5
// @profile: [https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-bmi.html](https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-bmi.html)
define "Body Mass Index":
[USCoreBMIProfile] BMI
where BMI.status in { 'final', 'amended', 'corrected' }
// Blood pressure systolic and diastolic - 85354-9
// Systolic blood pressure - 8480-6
// Diastolic blood pressure - 8462-4
// @profile: [https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-blood-pressure.html](https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-blood-pressure.html)
define "Blood Pressure Less Than 140 Over 90":
[USCoreBloodPressureProfile] BP
where BP.status in { 'final', 'amended', 'corrected' }
and BP.systolic.value < 140 'mm[Hg]'
and BP.diastolic.value < 90 'mm[Hg]'
// USCore Pediatric BMI for Age - 59576-9
// @profile: [https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-pediatric-bmi-for-age.html](https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-pediatric-bmi-for-age.html)
define "Pediatric BMI For Age":
[USCorePediatricBMIforAgeObservationProfile] PedsBMI
where PedsBMI.status in { 'final', 'amended', 'corrected' }
// USCore Pediatric Weight for Height - 77606-2
// @profile: [https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-pediatric-weight-for-height.html](https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-pediatric-weight-for-height.html)
define "Pediatric Weight For Height":
[USCorePediatricWeightForHeightObservationProfile] PedsWtForHt
where PedsWtForHt.status in { 'final', 'amended', 'corrected' }
// USCore Pulse Oximetry - 59408-5
// @profile: [https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-pulse-oximetry.html](https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-pulse-oximetry.html)
define "Pulse Oximetry":
[USCorePulseOximetryProfile] Pulse
where Pulse.status in { 'final', 'amended', 'corrected' }
Note that Oxygen Saturation is now part of the pulse oximetry profile.
QI-Core 6.0.0 allows for the presence of pregnancy to be represented in multiple profile resources. The US Core profile Pregnancy Status allows for the representation of pregnancy as an Observation. Pregnancy may also be represented as a Condition using the ConditionEncounterDiagnosis or ConditionProblemsHealthConcerns profiles.
To determine whether an individual is pregnant, measure authors should consider these four representations:
CQL:
valueset "Pregnancy Condition Codes": 'TBD'
valueset "Pregnancy Test Codes": 'TBD'
codesystem "SNOMEDCT": 'http://snomed.info/sct'
code "Pregnant": '77386006' from "SNOMEDCT" display 'Pregnant (finding)'
code "Positive": 'positive' from "Interpretation Codes"
define "Positive Pregnancy Observation":
[USCoreObservationPregnancyStatusProfile] PregnancyStatus
where PregnancyStatus.status = 'final'
and PregnancyStatus.value ~ "Pregnant"
and PregnancyStatus.effective.toInterval() during day of "Measurement Period"
define "Positive Pregnancy Test Result":
[LaboratoryResultObservation: "Pregnancy Test Codes"] PregnancyTest
where PregnancyTest.status = 'final'
and PregnancyTest.value ~ "Positive"
and PregnancyTest.effective.toInterval() during day of "Measurement Period"
define "Pregnancy Encounter Diagnosis":
[ConditionEncounterDiagnosis] EncounterDiagnosis
with "Encounters" Encounter
such that EncounterDiagnosis.encounter.references(Encounter)
where EncounterDiagnosis.code in "Pregnancy Condition Codes"
define "Pregnancy Condition":
[ConditionProblemsHealthConcerns] Condition
where Condition.code in "Pregnancy Condition Codes"
and Condition.clinicalStatus ~ "active"
and Condition.verificationStatus ~ "confirmed"
and Condition.prevalenceInterval() starts during day of "Measurement Period"
define "Is Pregnant":
exists "Positive Pregnancy Observation"
or exists "Positive Pregnancy Test"
or exists "Pregnancy Condition"
or exists "Pregnancy Encounter Diagnosis"
Note that the examples above assume the existence of a ValueSet “Pregnancy Condition Codes” which contain codes representing conditions associated with pregnancy.
The “Pregnancy Encounter Diagnosis” logic assumes the presences of an “Encounters” expression that filters encounters and their associated diagnoses-according the measures’ intent and measurement period.
If a use case requires evaluation of a prevalence period (onset and/or abatement), then the logic must rely on the ConditionProblemsHealthConcerns or ConditionEncounterDiagnosis profiles. This is because onset and/or abatement information is available only within the Condition resource and cannot be derived from observation -based pregnancy representations.
The Pregnancy Intentprofile defines minimum expectations for the Observation resource to support recording, searching, and retrieving information about a “patient’s intent to become pregnant” within the next year.
The Smoking Status profile defines the minimum expectations for the Observation resource to record, search, and retrieve a patient’s smoking status. The profile specifies the required core elements, extensions, vocabularies, and value sets that SHALL be present, and constrains how those elements must be used.
QI-Core includes the USCore Smoking Status profile:
CQL:
// USCore Smoking Status
// @profile: [https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-smokingstatus.html](https://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-smokingstatus.html)
define "Smoking Status":
[USCoreSmokingStatusProfile] SmokingStatus
where SmokingStatus.status in { 'final', 'amended', 'corrected' }
QI-Core uses the US Core Laboratory Result Observation Profile which defines the minimum expectations for using the Observation resource to record, search, and retrieve laboratory test results for a patient.
Laboratory results in QI-Core use the LaboratoryResultObservation profile. By default, Laboratory results in QI-Core are characterized by the code element.
CQL:
define "Laboratory Result Observation":
[LaboratoryResultObservation] LabResult
where LabResult.status in { 'final', 'amended', 'corrected' }
Category is fixed to laboratory.
Clinical test results (including imaging results) in QI-Core use ObservationClinicalResult Profile which defines the minimum expectations for using the Observation resource to record and search non-laboratory clinical test results, such as imaging findings or procedure-based observations (e.g., the size of a polyp seen during colonoscopy).
CQL:
define "Observation Clinical Result":
[ObservationClinicalResult] ClinicalResult
where ClinicalResult.status in { 'final', 'amended', 'corrected' }
NOTE: Observations associated with imaging are expected to represent specific measurements obtained from imaging. See the Imaging Procedures discussion for more information.
The QI-Core Observation Screening Assessment Profile, derived from the US Core version, supports representing individual survey responses, multi-question panels, and multi-select (“check all that apply”) answers.
New from 4.1.1 Surveys and assessments in QI-Core use the ObservationScreeningAssessment profile. By default, survey observations in QI-Core are characterized by the code element.
CQL:
define "Observation Assessment":
[ObservationScreeningAssessment] Assessment
where Assessment.status in { 'final', 'amended', 'corrected' }
Category is fixed to survey.
QI-Core defines a Simple Observation profile for use when accessing observations that are not covered by the specific profiles defined in FHIR and US Core. Observations in QI-Core are characterized by the code element, which is typically filtered to a particular value set:
CQL:
define "Pap Test With Results":
[SimpleObservation: "Pap Test"] PapTest
where PapTest.value is not null
and PapTest.status in { 'final', 'amended', 'corrected', 'preliminary' }
NOTE: As with the other observation profiles, the status of a QI-Core Observation must be considered to ensure that the results of the expression will match measure intent. This typically means that the status element will be used in the expression as in the prior example.
QI-Core defines an ObservationCancelled profile originally intended to support identifying observations that were not performed for a particular reason. However, feedback from implementers and HL7 standards experts indicates that an observation not performed for a reason does not exist since no observations occurred. Therefore, there is no such concept of an observation cancelled. However, a user can reject a proposal to perform an observation. To express such a rejection in QI-Core, use QI-Core TaskRejected with focus = ServiceRequested where the requested service is the intended observation represented as a code or a value set.
CQL:
define "Pap Test Rejected For Reason":
[ServiceRequest: "Pap Test"] PapTestRequest
with [TaskRejected: code "Fulfill"] Rejection
such that Rejection.focus.references(PapTestRequest)
and Rejection.statusReason in "Patient Declined"
where PapTestRequest.status = "Active"
QI-Core defines an ObservationNonPatient profile for evaluating resource use and availability rather than focusing on patients:
CQL:
define "Hemodialysis Machine Availability":
[ObservationNonPatient: "Hemodialysis"] Hemo
where Hemo.subject.getDevice().type ~ "Device Hemodialysis machine, device (physical object)"
and Hemo.value ~ "Equipment available"
define fluent function "getDevice"(reference QICore.Reference):
singleton from (
[Device] Device
where reference.references(Device)
)