Updated cql docs (#3175)
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Measure / CQL Components
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H2
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<br/>
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(Resource Tables, Cache Tables)
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BaseServlet
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Operation Providers ($evaluate-measure)
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CQL Evaluator
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CQL Evaluator
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FHIR Resource Daos
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(Resource
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CRUD + Searches)
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FHIR Resource Daos...
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System Dao
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Terminology Service
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<br/>
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(Hierarchical Code Searches, Expansion)
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Terminology Service...
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Lucene
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CQL Engine
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CQL Translator
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CQL Translator
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JPA
|
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<br/>
|
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TerminologyProvider
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JPA
|
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<br/>
|
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FhirRetrieve
|
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<br/>
|
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Provider
|
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JPA...
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LibraryContent
|
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<br/>
|
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Provider
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||||
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LibraryContent...
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<div style="box-sizing: border-box; font-size: 0; text-align: center; ">
|
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<div style="display: inline-block; font-size: 12px; font-family: Helvetica; color: #000000; line-height: 1.2; pointer-events: all; white-space: normal; word-wrap: normal; ">
|
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HAPI
|
||||
<br/>
|
||||
ELM
|
||||
<br/>
|
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Cache
|
||||
</div>
|
||||
</div>
|
||||
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|
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HAPI...
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<switch>
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<div style="box-sizing: border-box; font-size: 0; text-align: center; ">
|
||||
<div style="display: inline-block; font-size: 11px; font-family: Helvetica; color: #000000; line-height: 1.2; pointer-events: all; background-color: #ffffff; white-space: nowrap; ">
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REST API
|
||||
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|
||||
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|
||||
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<switch>
|
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<div style="box-sizing: border-box; font-size: 0; text-align: center; ">
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|
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HAPI
|
||||
<br/>
|
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FhirDal
|
||||
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|
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</div>
|
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|
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HAPI...
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HAPI Data Access Layer
|
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|
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<switch>
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|
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<div style="display: inline-block; font-size: 12px; font-family: Helvetica; color: #000000; line-height: 1.2; pointer-events: all; white-space: normal; word-wrap: normal; ">
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HAPI CQL Interface Implementations
|
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|
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|
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|
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<div style="box-sizing: border-box; font-size: 0; text-align: center; ">
|
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<div style="display: inline-block; font-size: 12px; font-family: Helvetica; color: #000000; line-height: 1.2; pointer-events: all; white-space: normal; word-wrap: normal; ">
|
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Server
|
||||
</div>
|
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|
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|
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<switch>
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<div xmlns="http://www.w3.org/1999/xhtml" style="display: flex; align-items: unsafe center; justify-content: unsafe flex-start; width: 178px; height: 1px; padding-top: 230px; margin-left: 602px;">
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<div style="box-sizing: border-box; font-size: 0; text-align: left; ">
|
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<div style="display: inline-block; font-size: 12px; font-family: Helvetica; color: #000000; line-height: 1.2; pointer-events: all; white-space: normal; word-wrap: normal; ">
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CQL Interfaces
|
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|
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<div style="box-sizing: border-box; font-size: 0; text-align: left; ">
|
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<div style="display: inline-block; font-size: 12px; font-family: Helvetica; color: #000000; line-height: 1.2; pointer-events: all; white-space: normal; word-wrap: normal; ">
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Core CQL modules
|
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<div style="box-sizing: border-box; font-size: 0; text-align: left; ">
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||||
<div style="display: inline-block; font-size: 12px; font-family: Helvetica; color: #000000; line-height: 1.2; pointer-events: all; white-space: normal; word-wrap: normal; ">
|
||||
FHIR Operation Implementations
|
||||
</div>
|
||||
</div>
|
||||
</div>
|
||||
</foreignObject>
|
||||
<text x="602" y="149" fill="#000000" font-family="Helvetica" font-size="12px">
|
||||
FHIR Operation Implemen...
|
||||
</text>
|
||||
</switch>
|
||||
</g>
|
||||
<rect x="220" y="420" width="820" height="80" fill="#ffffff" stroke="#000000" stroke-width="2" pointer-events="all"/>
|
||||
<g transform="translate(-0.5 -0.5)scale(2)">
|
||||
<switch>
|
||||
<foreignObject style="overflow: visible; text-align: left;" pointer-events="none" width="100%" height="100%" requiredFeatures="http://www.w3.org/TR/SVG11/feature#Extensibility">
|
||||
<div xmlns="http://www.w3.org/1999/xhtml" style="display: flex; align-items: unsafe center; justify-content: unsafe center; width: 408px; height: 1px; padding-top: 230px; margin-left: 111px;">
|
||||
<div style="box-sizing: border-box; font-size: 0; text-align: center; ">
|
||||
<div style="display: inline-block; font-size: 12px; font-family: Helvetica; color: #000000; line-height: 1.2; pointer-events: all; white-space: normal; word-wrap: normal; ">
|
||||
CQL Interfaces
|
||||
</div>
|
||||
</div>
|
||||
</div>
|
||||
</foreignObject>
|
||||
<text x="315" y="234" fill="#000000" font-family="Helvetica" font-size="12px" text-anchor="middle">
|
||||
CQL Interfaces
|
||||
</text>
|
||||
</switch>
|
||||
</g>
|
||||
</g>
|
||||
<switch>
|
||||
<g requiredFeatures="http://www.w3.org/TR/SVG11/feature#Extensibility"/>
|
||||
<a transform="translate(0,-5)" xlink:href="https://www.diagrams.net/doc/faq/svg-export-text-problems" target="_blank">
|
||||
<text text-anchor="middle" font-size="10px" x="50%" y="100%">
|
||||
Viewer does not support full SVG 1.1
|
||||
</text>
|
||||
</a>
|
||||
</switch>
|
||||
</svg>
|
||||
|
After Width: | Height: | Size: 43 KiB |
|
|
@ -0,0 +1,43 @@
|
|||
@startuml measure_evaluation_sequence
|
||||
!include styling.puml
|
||||
title Measure $evaluate-measure
|
||||
|
||||
actor User as User
|
||||
participant OperationProvider as "HAPI Measure Operation Provider"
|
||||
participant CQLEngine as "CQL Engine"
|
||||
participant HAPI as "HAPI CQL Adapters"
|
||||
participant JPA as "HAPI JPA / Terminology Providers"
|
||||
|
||||
User -> OperationProvider: invoke $evaluate-measure
|
||||
OperationProvider -> JPA: read Measure
|
||||
JPA --> OperationProvider: return Measure
|
||||
OperationProvider -> JPA: read Libraries
|
||||
JPA --> OperationProvider: return Libraries
|
||||
OperationProvider -> OperationProvider: convert FHIR Libraries to ELM libraries
|
||||
OperationProvider-> CQLEngine **: create with ELM Libraries
|
||||
|
||||
OperationProvider -> JPA: get Subjects
|
||||
JPA --> OperationProvider: return Subjects
|
||||
loop each Subject
|
||||
OperationProvider -> CQLEngine: set current Subject context
|
||||
loop each SDE/Population
|
||||
OperationProvider -> CQLEngine: evaluate SDE/Population criteria
|
||||
CQLEngine -> CQLEngine: evaluate Definition
|
||||
alt terminology required
|
||||
CQLEngine -> HAPI: retrieve terminology
|
||||
HAPI -> JPA: request terminology
|
||||
JPA --> HAPI: return terminology
|
||||
HAPI --> CQLEngine: return terminology
|
||||
end
|
||||
CQLEngine -> HAPI: retrieve data
|
||||
HAPI -> JPA: request data
|
||||
JPA --> HAPI: return data
|
||||
HAPI --> CQLEngine: return data
|
||||
CQLEngine --> OperationProvider: return SDE/Population criteria result
|
||||
end
|
||||
end
|
||||
OperationProvider -> CQLEngine !!: destroy
|
||||
OperationProvider -> OperationProvider: build MeasureReport
|
||||
OperationProvider -> OperationProvider: score MeasureReport
|
||||
OperationProvider -> User: return MeasureReport
|
||||
@enduml
|
||||
|
|
@ -0,0 +1,126 @@
|
|||
@startuml styling
|
||||
|
||||
'These are Alphora colors, they need
|
||||
' to be updated to reflect the HAPI style guide
|
||||
!$white = "#fff"
|
||||
|
||||
!$greylt000 = "#F4F6F5"
|
||||
!$greylt100 = "#DDE3E0"
|
||||
!$greylt200 = "#C7D1CC"
|
||||
!$greylt300 = "#B0BFB8"
|
||||
!$grey = $greylt000
|
||||
|
||||
!$greydk000 = "#404F47"
|
||||
!$greydk100 = "#2E3833"
|
||||
!$greydk200 = "#1C221F"
|
||||
!$greydk250 = "#121614"
|
||||
!$greydk300 = "#090B0A"
|
||||
!$black = $greydk300
|
||||
|
||||
!$blue000 = "#4B7DD2"
|
||||
!$blue100 = "#3064BF"
|
||||
!$blue200 = "#2956A3"
|
||||
!$blue300 = "#214583"
|
||||
!$blue = $blue100
|
||||
|
||||
!$purple000 = "#645FAB"
|
||||
!$purple100 = "#524D93"
|
||||
!$purple200 = "#433F78"
|
||||
!$purple300 = "#34315E"
|
||||
!$purple = $purple100
|
||||
|
||||
!$green000 = "#568A67"
|
||||
!$green100 = "#477154"
|
||||
!$green200 = "#375841"
|
||||
!$green300 = "#273F2F"
|
||||
!$green = $green100
|
||||
|
||||
!$yellow000 = "#FBB337"
|
||||
!$yellow100 = "#FAA40F"
|
||||
!$yellow200 = "#DC8D04"
|
||||
!$yellow300 = "#B47304"
|
||||
!$yellow = $yellow100
|
||||
|
||||
!$red000 = "#FF6633"
|
||||
!$red100 = "#FF4000"
|
||||
!$red200 = "#E03800"
|
||||
!$red300 = "#B82E00"
|
||||
!$red = $red100
|
||||
|
||||
skinparam {
|
||||
defaultFontName Source Sans Pro
|
||||
|
||||
TitleFontStyle bold
|
||||
|
||||
BackgroundColor $white
|
||||
Shadowing false
|
||||
|
||||
ArrowColor $greydk000
|
||||
ArrowFontColor $black
|
||||
ArrowFontSize 12
|
||||
ArrowFont Open Sans
|
||||
|
||||
DelayFontColor $black
|
||||
DelayFontSize 12
|
||||
|
||||
ActorBorderColor $black
|
||||
ActorBackgroundColor $white
|
||||
ActorFontColor $black
|
||||
ActorFontSize 14
|
||||
ActorFontStyle bold
|
||||
|
||||
ParticipantBorderColor $black
|
||||
ParticipantBackgroundColor $yellow
|
||||
ParticipantFontColor $black
|
||||
ParticipantFontSize 14
|
||||
ParticipantFontStyle bold
|
||||
|
||||
DatabaseBorderColor $black
|
||||
DatabaseBackgroundColor $yellow
|
||||
DatabaseFontColor $black
|
||||
DatabaseFontSize 14
|
||||
DatabaseFontStyle bold
|
||||
|
||||
}
|
||||
|
||||
|
||||
skinparam Sequence {
|
||||
MessageAlign center
|
||||
|
||||
LifeLineBorderColor $black
|
||||
' loop, alt, ref
|
||||
GroupBodyBackgroundColor $white
|
||||
GroupBackgroundColor $blue
|
||||
GroupHeaderFontColor $white
|
||||
GroupHeaderFontSize 12
|
||||
GroupFontSize 12
|
||||
|
||||
BoxBackgroundColor $greylt000
|
||||
BoxBorderColor $black
|
||||
BoxFontColor $black
|
||||
BoxFontSize 12
|
||||
|
||||
|
||||
ReferenceBorderColor $black
|
||||
ReferenceFontColor $black
|
||||
ReferenceFontSize 12
|
||||
ReferenceHeaderBackgroundColor $blue
|
||||
|
||||
DividerBackgroundColor $blue
|
||||
DividerBorderColor $black
|
||||
DividerFontColor $white
|
||||
DividerFontSize 12
|
||||
}
|
||||
|
||||
skinparam Note {
|
||||
BackgroundColor $green
|
||||
BorderColor $black
|
||||
FontColor $white
|
||||
FontStyle bold
|
||||
FontSize 12
|
||||
Font Open Sans
|
||||
}
|
||||
|
||||
hide footbox
|
||||
|
||||
@enduml
|
||||
|
|
@ -25,14 +25,19 @@ There are two Spring beans available that add CQL processing to HAPI. You can en
|
|||
* `ca.uhn.fhir.cql.config.CqlDstu3Config`
|
||||
* `ca.uhn.fhir.cql.config.CqlR4Config`
|
||||
|
||||
## Operations
|
||||
## Clinical Reasoning Operations
|
||||
|
||||
HAPI provides implementations for some Measure operations for DSTU3 and R4
|
||||
HAPI provides implementations for some operations in DSTU3 and R4:
|
||||
|
||||
### $evaluate-measure
|
||||
[Measure Operations](cql_measure)
|
||||
|
||||
The [$evaluate-measure](http://hl7.org/fhir/measure-operation-evaluate-measure.html) operation allows the evaluation of a clinical quality measure. This operation is invoked on an instance of a Measure resource:
|
||||
## Roadmap
|
||||
|
||||
`http://base/Measure/measureId/$evaluate-measure?subject=124&periodStart=2014-01&periodend=2014-03`
|
||||
Further development of the CQL capabilities in HAPI is planned:
|
||||
|
||||
The Measure will be evaluated, including any CQL that is referenced. The CQL evaluation requires that all the supporting knowledge artifacts for a given Measure be loaded on the HAPI server, including `Libaries` and `ValueSets`.
|
||||
* Additional features and performance enhancements for Measure evaluation
|
||||
* Additional FHIR Clinical Reasoning Module operations:
|
||||
* Library $evaluate
|
||||
* PlanDefinition $apply
|
||||
* Support for the CPG IG Operations
|
||||
* $cql
|
||||
|
|
|
|||
|
|
@ -0,0 +1,406 @@
|
|||
# Measures
|
||||
|
||||
## Introduction
|
||||
|
||||
The FHIR Clinical Reasoning Module defines the [Measure resource](https://www.hl7.org/fhir/measure.html) and several [associated operations](https://www.hl7.org/fhir/measure-operations.html). The Measure Resource represents a structured, computable definition of a health-related measure such as a clinical quality measure, public health indicator, or population analytics measure. These Measures can then be used for reporting, analytics, and data-exchange purposes.
|
||||
|
||||
Electronic Clinical Quality Measures (eCQMs) in FHIR are represented as a FHIR Measure resource containing metadata and terminology, a population criteria section, and at least one FHIR Library resource containing a data criteria section as well as the logic used to define the population criteria. The population criteria section typically contains initial population criteria, denominator criteria, and numerator criteria sub-components, among others. This is elaborated upon in greater detail in the [CQF Measures IG](http://hl7.org/fhir/us/cqfmeasures). An example of an eCQM as defined in FHIR looks like:
|
||||
|
||||
```json
|
||||
{
|
||||
"resourceType" : "Measure",
|
||||
"library" : [
|
||||
"http://hl7.org/fhir/us/cqfmeasures/Library/EXMLogic"
|
||||
],
|
||||
"group" : [
|
||||
{
|
||||
"population" : [
|
||||
{
|
||||
"code" : {
|
||||
"coding" : [
|
||||
{
|
||||
"code" : "initial-population"
|
||||
}
|
||||
]
|
||||
},
|
||||
"criteria" : {
|
||||
"language" : "text/cql.identifier",
|
||||
"expression" : "Initial Population"
|
||||
}
|
||||
},
|
||||
{
|
||||
"code" : {
|
||||
"coding" : [
|
||||
{
|
||||
"code" : "numerator"
|
||||
}
|
||||
]
|
||||
},
|
||||
"criteria" : {
|
||||
"language" : "text/cql.identifier",
|
||||
"expression" : "Numerator"
|
||||
}
|
||||
},
|
||||
{
|
||||
"code" : {
|
||||
"coding" : [
|
||||
{
|
||||
"code" : "denominator"
|
||||
}
|
||||
]
|
||||
},
|
||||
"criteria" : {
|
||||
"language" : "text/cql.identifier",
|
||||
"expression" : "Denominator"
|
||||
}
|
||||
}
|
||||
]
|
||||
}
|
||||
]
|
||||
}
|
||||
|
||||
```
|
||||
|
||||
Measures are then scored according the whether a subjects (or subjects) are members of the various populations.
|
||||
|
||||
For example, a Measure for Breast Cancer screening might define an Initial Population (via CQL expressions) of "all women", a Denominator of "women over 35", and a Numerator of "women over 35 who have had breast cancer screenings in the past year". If the Measure is evaluated against a population of 100 women, 50 are over 35, and of those 25 have had breast cancer screenings in the past year, the final score would be 50%<sup>1</sup> (total number in numerator / total number in the denominator).
|
||||
|
||||
1. There are several methods for scoring Measures, this is meant only as an example.
|
||||
|
||||
## Operations
|
||||
|
||||
HAPI implements the [$evaluate-measure](https://www.hl7.org/fhir/operation-measure-evaluate-measure.html) operation. Support for additional operations is planned.
|
||||
|
||||
## Evaluate Measure
|
||||
|
||||
The `$evaluate-measure` operation is used to execute a Measure as specified by the relevant FHIR Resources against a subject or set of subjects. This implementation currently focuses primarily on supporting the narrower evaluation requirements defined by the [CQF Measures IG](http://hl7.org/fhir/us/cqfmeasures). Some support for extensions defined by other IGs is included as well, and the implementation aims to support a wider range of functionality in the future.
|
||||
|
||||
### Example Measure
|
||||
|
||||
Several example Measures are available in the [ecqm-content-r4](https://github.com/cqframework/ecqm-content-r4) IG. Full Bundles with all the required supporting resources are available [here](https://github.com/cqframework/ecqm-content-r4/tree/master/bundles/measure). You can download a Bundle and load it on your server as a transaction:
|
||||
|
||||
```bash
|
||||
POST http://your-server-base/fhir BreastCancerScreeningFHIR-bundle.json
|
||||
```
|
||||
|
||||
These Bundles also include example Patient clinical data so once posted Measure evaluation can be invoked with:
|
||||
|
||||
```bash
|
||||
GET http://your-server-base/fhir/Measure/BreastCancerScreeningFHIR/$evaluate-measure?periodStart=2019-01-01&periodEnd=2019-12-31&subject=numerator&reportType=subject
|
||||
```
|
||||
|
||||
### Measure Features
|
||||
|
||||
The FHIR Measure specification defines several different types of Measures and various parameters for controlling the Measure evaluation. This section describes the features supported by HAPI.
|
||||
|
||||
#### Reporting Period
|
||||
|
||||
The `periodStart` and `periodEnd` parameters are used to control the Reporting Period for which a report is generated. This corresponds to `Measurement Period` defined in the CQL logic, as defined by the conformance requirements in the CQF Measures IG. Both `periodStart` and `periodEnd` must be used or neither must be used.
|
||||
|
||||
If neither are used the default reporting period specified in the CQL logic is used, as shown here
|
||||
|
||||
```cql
|
||||
parameter "Measurement Period" Interval<DateTime>
|
||||
default Interval[@2019-01-01T00:00:00.0, @2020-01-01T00:00:00.0)
|
||||
```
|
||||
|
||||
If neither are used and there is no default reporting period in the CQL logic an error is thrown.
|
||||
|
||||
A request using `periodStart` and `periodEnd` looks like:
|
||||
|
||||
```bash
|
||||
GET fhir/Measure/<MeasureId>/$evaluate-measure?periodStart=2019-01-01&periodEnd=2019-12-31
|
||||
```
|
||||
|
||||
`periodStart` and `periodEnd` support Dates (YYYY, YYYY-MM, or YYYY-MM-DD) and DateTimes (YYYY-MM-DDThh:mm:ss+zz:zz)
|
||||
|
||||
#### Report Types
|
||||
|
||||
Measure report types determine what data is returned from the evaluation. This is controlled with the `reportType` parameter on the $evaluate-measure Operation
|
||||
|
||||
| Report Type | Supported | Description |
|
||||
| ------------ | :----------------: | -------------------------------------------------------------------------------------------------------------- |
|
||||
| subject | :white_check_mark: | Measure report for a single subject (e.g. one patient). Includes additional detail, such as evaluatedResources |
|
||||
| subject-list | :white_check_mark: | Measure report including the list of subjects in each population (e.g. all the patients in the "numerator") |
|
||||
| population | :white_check_mark: | Summary measure report for a population |
|
||||
|
||||
NOTE: There's an open issue on the FHIR specification to align these names to the MeasureReportType value set.
|
||||
|
||||
A request using `reportType` looks like:
|
||||
|
||||
```bash
|
||||
GET fhir/Measure/<MeasureId>/$evaluate-measure?reportType=subject-list
|
||||
```
|
||||
|
||||
#### Subject Types
|
||||
|
||||
The subject of a measure evaluation is controlled with the `subject` (R4+) and `patient` (DSTU3) operation parameters. Currently the only subject type supported by HAPI is Patient. This means that all Measure evaluation and reporting happens with respect to a Patient or set of Patient resources.
|
||||
|
||||
| Subject Type | Supported | Description |
|
||||
| ----------------- | :------------------: | ----------------- |
|
||||
| Patient | :white_check_mark: | A Patient |
|
||||
| Practitioner | :white_large_square: | A Practitioner |
|
||||
| Organization | :white_large_square: | An Organization |
|
||||
| Location | :white_large_square: | A Location |
|
||||
| Device | :white_large_square: | A Device |
|
||||
| Group<sup>1</sup> | :white_large_square: | A set of subjects |
|
||||
|
||||
1. See next section
|
||||
|
||||
A request using `subject` looks like:
|
||||
|
||||
```bash
|
||||
GET fhir/Measure/<MeasureId>/$evaluate-measure?subject=Patient/123
|
||||
```
|
||||
|
||||
##### Selecting a set of Patients
|
||||
|
||||
The set of Patients used for Measure evaluation is controlled with the `subject` (R4+) or `patient` (DSTU3), and `practitioner` parameters. The two parameters are mutually exclusive.
|
||||
|
||||
| Parameter | Supported | Description |
|
||||
| ----------------------------------------------------- | :------------------: | ----------------------------------------------------------------------- |
|
||||
| Not specified | :white_check_mark: | All Patients on the server |
|
||||
| `subject=XXX` or `subject=Patient/XXX` | :white_check_mark: | A single Patient |
|
||||
| `practitioner=XXX` or `practitioner=Practitioner/XXX` | :white_check_mark: | All Patients whose `generalPractitioner` is the referenced Practitioner |
|
||||
| `subject=Group/XXX`<sup>1</sup> | :white_large_square: | A Group containing subjects |
|
||||
| `subject=XXX` AND `practitioner=XXX` | :x: | Not a valid combination |
|
||||
|
||||
1. Referencing a Group of Patients as the subject is defined in the ATR IG and is on the roadmap. This will allow much more control over which Patients are included in the evaluated set.
|
||||
|
||||
A request using `practitioner` looks like:
|
||||
|
||||
```bash
|
||||
GET fhir/Measure/<MeasureId>/$evaluate-measure?practitioner=Practitioner/XYZ
|
||||
```
|
||||
|
||||
#### ReportType, Subject, Practitioner Matrix
|
||||
|
||||
The following table shows the combinations of the `subject` (or `patient`), `practitioner` and `reportType` parameters that are valid
|
||||
|
||||
| | subject reportType | subject-list reportType | population reportType |
|
||||
| ---------------- | :----------------: | :-------------------------------: | :-------------------------------: |
|
||||
| subject parameter | :white_check_mark: | :white_check_mark: <sup>1,2</sup> | :white_check_mark: <sup>1,2</sup> |
|
||||
| practitioner parameter | :x:<sup>3</sup> | :white_check_mark: | :white_check_mark: |
|
||||
|
||||
1. Including the subject parameter restricts the Measure evaluation to a single Patient. Omit the `subject` (or `patient`) parameter to get report for multiple Patients. The subject-list and population report types have less detail than a subject report.
|
||||
2. A Group `subject` with a subject-list or population `reportType` will be a valid combination once Group support is implemented.
|
||||
3. A practitioner have may zero, one, or many patients so a practitioner report always assumes a set.
|
||||
|
||||
#### Scoring Methods
|
||||
|
||||
The Measure scoring method determines how a Measure score is calculated. It is set with the [scoring](https://www.hl7.org/fhir/measure-definitions.html#Measure.scoring) element on the Measure resource.
|
||||
|
||||
The HAPI implementation conforms to the requirements defined by the CQF Measures IG. A more detailed description of each scoring method is linked in the table below.
|
||||
|
||||
| Scoring Method | Supported | Description |
|
||||
| ------------------- | :------------------: | ---------------------------------------------------------------------------------------------------------------------- |
|
||||
| proportion | :white_check_mark: | [Proportion Measures](https://build.fhir.org/ig/HL7/cqf-measures/measure-conformance.html#proportion-measures) |
|
||||
| ratio | :white_check_mark: | [Ratio Measures](https://build.fhir.org/ig/HL7/cqf-measures/measure-conformance.html#ratio-measures) |
|
||||
| continuous-variable | :white_check_mark: | [Continuous Variable](https://build.fhir.org/ig/HL7/cqf-measures/measure-conformance.html#continuous-variable-measure) |
|
||||
| cohort | :white_check_mark:* | [Cohort](https://build.fhir.org/ig/HL7/cqf-measures/measure-conformance.html#cohort-definitions) |
|
||||
| composite | :white_large_square: | See below |
|
||||
|
||||
* The cohort Measure scoring support is partial. The HAPI implementation does not yet return the required Measure observations
|
||||
|
||||
An example Measure resource with `scoring` defined looks like:
|
||||
|
||||
```json
|
||||
{
|
||||
"resourceType": "Measure",
|
||||
"scoring": {
|
||||
"coding": [ {
|
||||
"system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
|
||||
"code": "proportion",
|
||||
"display": "Proportion"
|
||||
} ]
|
||||
}
|
||||
}
|
||||
```
|
||||
|
||||
##### Composite Scoring
|
||||
|
||||
A composite Measure is scored by combining and/or aggregating the results of other Measures. The [compositeScoring](https://www.hl7.org/fhir/measure-definitions.html#Measure.compositeScoring) element is used to control how composite Measures are scored. HAPI does not currently support any composite scoring method.
|
||||
|
||||
| Composite Scoring Method | Supported | Description |
|
||||
| ------------------------ | :------------------: | ---------------------------------------------------------------------------------------------- |
|
||||
| opportunity | :white_large_square: | Combines Numerators and Denominators for each component Measure |
|
||||
| all-or-nothing | :white_large_square: | Includes individuals that are in the numerator for all component Measures |
|
||||
| linear | :white_large_square: | Gives an individual score based on the number of numerators in which they appear |
|
||||
| weighted | :white_large_square: | Gives an individual a cored based on a weighted factor for each numerator in which they appear |
|
||||
|
||||
#### Populations
|
||||
|
||||
The HAPI implementation uses the populations defined by the CQF Measures IG for each scoring type. A matrix of the supported populations is shown in the [Criteria Names](https://build.fhir.org/ig/HL7/cqf-measures/measure-conformance.html#criteria-names) section of the CQF Measures IG.
|
||||
|
||||
#### Population Criteria
|
||||
|
||||
The logical criteria used for determining each Measure population is defined by the [Measure.group.population.criteria element](). The Measure specification allows population criteria to be defined using FHIR Path, CQL, or other languages as appropriate. The HAPI implementation currently only supports using CQL. The relationship between a Measure Population and CQL is illustrated in the [Population Criteria](https://build.fhir.org/ig/HL7/cqf-measures/measure-conformance.html#population-criteria) section of the CQF Measures IG.
|
||||
|
||||
An example Measure resource with a population criteria referencing a CQL identifier looks like:
|
||||
|
||||
```json
|
||||
{
|
||||
"resourceType": "Measure",
|
||||
"group": [ {
|
||||
"population": [ {
|
||||
"code": {
|
||||
"coding": [ {
|
||||
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
|
||||
"code": "initial-population",
|
||||
"display": "Initial Population"
|
||||
} ]
|
||||
},
|
||||
"criteria": {
|
||||
"language": "text/cql.identifier",
|
||||
"expression": "Initial Population"
|
||||
}
|
||||
}]
|
||||
}]
|
||||
}
|
||||
```
|
||||
|
||||
##### Criteria Expression Type
|
||||
|
||||
| Expression Type | Supported |
|
||||
| --------------- | :------------------: |
|
||||
| CQL | :white_check_mark: |
|
||||
| FHIR Path | :white_large_square: |
|
||||
|
||||
#### Supplemental Data Elements
|
||||
|
||||
Supplemental Data Elements are used to report additional information about the subjects that may not be included in the in the Population criteria definitions. For example, it may be of interest to report the gender of all subjects for informational purposes. Supplemental data elements are defined by the [Measure.supplementalData](http://www.hl7.org/fhir/measure-definitions.html#Measure.supplementalData) element, and are reported as Observations in the evaluatedResources of the MeasureReport.
|
||||
|
||||
Supplemental Data Elements can be specified as either CQL definitions or FHIR Path expressions.
|
||||
|
||||
| Expression Type | Supported |
|
||||
| --------------- | :------------------: |
|
||||
| CQL | :white_check_mark: |
|
||||
| FHIR Path | :white_large_square: |
|
||||
|
||||
An example Measure resource with some supplemental data elements set looks like:
|
||||
|
||||
```json
|
||||
{
|
||||
"resourceType": "Measure",
|
||||
"supplementalData": [ {
|
||||
"code": {
|
||||
"text": "sde-ethnicity"
|
||||
},
|
||||
"criteria": {
|
||||
"language": "text/cql.identifier",
|
||||
"expression": "SDE Ethnicity"
|
||||
}
|
||||
}]
|
||||
}
|
||||
```
|
||||
|
||||
#### Stratifiers
|
||||
|
||||
Stratifiers are used divide Measure populations into segments of interest. For example, it may be of interest to compare the Measure score between different age groups or genders. Each stratum within a stratification is scored the same way as the overall population. Stratifiers are defined using the [Measure.group.stratifier](http://hl7.org/fhir/R4/measure-definitions.html#Measure.group.stratifier) element.
|
||||
|
||||
HAPI does not implement stratifier support but it's on the roadmap.
|
||||
|
||||
An example Measure resource with a stratifier set looks like:
|
||||
|
||||
```json
|
||||
{
|
||||
"resourceType": "Measure",
|
||||
"group": [ {
|
||||
"stratifier": [ {
|
||||
"code": {
|
||||
"text": "Stratum 1"
|
||||
},
|
||||
"criteria": {
|
||||
"language": "text/cql.identifier",
|
||||
"expression": "Stratification 1"
|
||||
}
|
||||
}]
|
||||
}]
|
||||
}
|
||||
```
|
||||
|
||||
##### Stratifier Expression Support
|
||||
|
||||
As with Populations and Supplemental Data Elements the criteria used for Stratification may be defined with CQL or FHIR Path.
|
||||
|
||||
| Expression Type | Supported |
|
||||
| --------------- | :------------------: |
|
||||
| CQL | :white_large_square: |
|
||||
| FHIR Path | :white_large_square: |
|
||||
|
||||
##### Stratifier Component Support
|
||||
|
||||
The Measure specification also supports multi-dimensional stratification, for cases where more than one data element is needed.
|
||||
|
||||
| Stratifier Type | Supported |
|
||||
| ---------------- | :------------------: |
|
||||
| Single Component | :white_large_square: |
|
||||
| Multi Component | :white_large_square: |
|
||||
|
||||
#### Evaluated Resources
|
||||
|
||||
A FHIR MeasureReport permits referencing the Resources used when evaluating in the [MeasureReport.evaluatedResource](https://www.hl7.org/fhir/measurereport-definitions.html#MeasureReport.evaluatedResource) element. HAPI includes these resources when generating `subject` reports for a single Patient. Evaluated resources for `population` or `subject-list` reports are not included. For large populations this could quickly become an extremely large number of resources.
|
||||
|
||||
The evaluated resources will not include every resource on the HAPI server for a given subject. Rather, it includes only the resources that were retrieved from the server by the CQL logic that was evaluated. This corresponds to the data-requirements for a given Measure. As an example, consider the following CQL:
|
||||
|
||||
```cql
|
||||
valueset "Example Value Set" : 'http://fhir.org/example-value-set'
|
||||
|
||||
define "Example Observations":
|
||||
[Observation : "Example Value Set"]
|
||||
```
|
||||
|
||||
That CQL will only select Observation Resources that have a code in the "Example Value Set". Those Observations will be reported in the Evaluated Resources while any others will not.
|
||||
|
||||
#### Last Received On
|
||||
|
||||
The `lastReceivedOn` parameter is the date the Measure was evaluated and reported. It is used to limit the number of resources reported in the Measure report for individual reports. It is currently not supported by HAPI.
|
||||
|
||||
#### Extensions
|
||||
|
||||
A number of extensions to Measure evaluation defined by various IGs are supported. They are described briefly in the table below.
|
||||
|
||||
| Extension | Description |
|
||||
| --------- | ----------- |
|
||||
| http://hl7.org/fhir/us/cqframework/cqfmeasures/StructureDefinition/cqfm-productLine | Used to evaluate different product lines (e.g. Medicare, Private, etc.) |
|
||||
| http://hl7.org/fhir/StructureDefinition/cqf-measureInfo | Used to demark a Measure Observation |
|
||||
| http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference | Used to specify the population that triggered a particular `evaluatedResource`|
|
||||
|
||||
There's not currently a way to configure which extensions are enabled. All supported extensions are always enabled.
|
||||
|
||||
## Architecture
|
||||
|
||||
Below are a few diagrams that show the overall architecture of Measure evaluation and how it fits into the HAPI FHIR Server.
|
||||
|
||||
### Component Diagram
|
||||
|
||||
This is a simplified component diagram of the Measure evaluation architecture
|
||||
|
||||
|
||||
|
||||
### Sequence Chart
|
||||
|
||||
This sequence chart approximates the Measure evaluation logic implemented by HAPI.
|
||||
|
||||
|
||||
|
||||
## FAQs
|
||||
|
||||
Q: I get an error saying HAPI can't locate my library, and I've verified it's on the server.
|
||||
|
||||
A: HAPI follows the [Library conformance requirements](https://build.fhir.org/ig/HL7/cqf-measures/measure-conformance.html#conformance-requirement-3-1) defined by the CQF Measures IG, meaning the Library must have a `logic-library` type, the name and versions of the FHIR Library and CQL Library must match, and the url of the Library must end in the name of the Library.
|
||||
|
||||
FHIR Libraries generated from CQL via the IG Publisher follow these requirements automatically.
|
||||
|
||||
Q: Does HAPI support partitions for evaluation?
|
||||
|
||||
A: Yes, though the Measure and associated Resources must be in the same partition as the clinical data being used.
|
||||
|
||||
## Roadmap
|
||||
|
||||
* Complete cohort implementation
|
||||
* Support for stratifiers
|
||||
* Support for Group subjects
|
||||
* Support for FHIRPath expressions in Stratifiers, Supplemental Data Elements, and Population Criteria
|
||||
* $data-requirements, $collect-data, $submit-data, and $care-gaps operations
|
||||
* Support for more extensions defined in the CQF Measures, CPG, and ATR IGs
|
||||
Loading…
Reference in New Issue