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Clinical Quality Framework Measure Content

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fhir cql clinical-quality-measurement clinical-quality-improvement

cqf-measures's Introduction

CQF Measures

This implementation guide describes an approach to representing electronic Clinical Quality Measures (eCQMs) using the FHIR Clinical Reasoning Module and Clinical Quality Language (CQL) in the U.S. Realm. However, this Implementation Guide can be usable for multiple use cases across domains, and much of the content is likely to be usable outside the U.S. Realm.

Commits to this repository will automatically trigger a new build of the IG, which will then be published to the following location:

http://build.fhir.org/ig/HL7/cqf-measures

Build log is available here: http://ig-build.fhir.org.s3-website-us-east-1.amazonaws.com/logs/HL7/cqf-measures

Full debugging information is available here: http://build.fhir.org/ig/HL7/cqf-measures/debug.tgz

Local Build

To initially build locally, clone the repository and run the following commands in order below in the root command:

_updatePublisher[.bat | .sh] - Process retrieves the current version of the IG publisher and stores it within the input-cache folder. The IG publisher is updated on a regular basis but this process does not have to be executed for every instance of the publication process.
_genonce[.bat | .sh] - This initiates the publication process. Launching the .bat file (Windows) or .sh file (Unix/Mac) will launch HL7's IGPublisher program and build/publish the IG one time.

Dependencies

Before the instructions in the above "Local Build" section will work, you need to install several primary dependencies.

Java

Go to http://www.oracle.com/technetwork/java/javase/downloads/ and download the latest (version 8 or higher) JDK for your platform, and install it.

Ruby

Jekyll requires Ruby version 2.1 or greater. Depending on your operating system, you may already have Ruby bundled with it. Otherwise, or if you need a newer version, go to https://www.ruby-lang.org/en/downloads/ for directions.

Jekyll

Go to https://jekyllrb.com and follow the instructions there, for example gem install jekyll bundler. The end result of this should be that the binary "jekyll" is now in your path.

cqf-measures's People

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lmichlsen okeefm rsamples mparenzan zoedalley mdnazmulkarim abdullah-git1 mholck mzuhl echicoine-icf awatson1978 pmechineniesac alexanderkiel jreyno77 roderickd bryantaustin13 p9g dand9959 rkorytkowski

cqf-measures's Issues

FHIR Valueset URLs

In CQL examples, lines of CQL like
valueset "Encounter Inpatient": 'urn:oid:2.16.840.1.113883.3.666.5.307'
should become
valueset "Encounter Inpatient": 'https://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307/$expand'

Feedback on COL measure

```
 Add to
```

// added FecalOccultResult.status in {'final', 'amended', 'corrected'}
// commented out the provenance.recorded statement - let's ignore provenance for now...
define "Fecal Occult Blood Test Performed":
               [Observation: "Fecal Occult Blood Test (FOBT)"] FecalOccultResult
                              where FecalOccultResult.status in {'final', 'amended', 'corrected'}
                                             and FecalOccultResult.value is not null
                                             // and FecalOccultResult.FHIR.provenance.recorded during "Measurement Period"

This preliminary status:

// added FecalOccultResult.status in {'final', 'amended', 'corrected'}
// commented out the provenance.recorded statement - let's ignore provenance for now...
define "Fecal Occult Blood Test Performed":
               [Observation: "Fecal Occult Blood Test (FOBT)"] FecalOccultResult
                              where FecalOccultResult.status in {'final', 'amended', 'corrected',’preliminary’}
                                             and FecalOccultResult.value is not null
                                             // and FecalOccultResult.FHIR.provenance.recorded during "Measurement Period"

 With the last line commented out, how do you get timing?  We also noticed same on FITDNA.

 We don’t think the status on the procedure is correct, we think it should be “completed” not “active”

Malignant Neoplasm definition should not require clinical status of "Active"

The Malignant Neoplasm definition is looking for a Condition with a clinical status of "Active", but it doesn't have to be active now, it just has to have been active prior to the measurement period.

We should remove the clinical status = 'active' restriction.

packaging-tests-cases definition suggestion from Zulip

https://chat.fhir.org/#narrow/stream/406765-cds/topic/QM.3A.20test.20package/near/421519402

René Spronk
12:43 PM
https://build.fhir.org/ig/HL7/cqf-measures/packaging.html#packaging-test-cases defines a Test bundle to (mandatory) have a MeasureReport as a kind of assertion as to what the outcome of the Measure evaluation should be. This seems a kludgy way of doing things - wouldn't it be better to use TestScript - this has the advantage that we'd be using a standard FHIR mechanism for testing, and that it would also allow for the definition of assertions when testing Libraries.

 On below, we are wondering why the visit status is commented out – for CQL on FHIR created from QDM.

define "Qualifying Encounters":
    ([Encounter: "Office Visit"] visit
                 union [Encounter."Annual Wellness Visit"]
                 union [Encounter."Preventive Care Services - Established Office Visit, 18 and Up"]
                 union [Encounter."Preventive Care Services-Initial Office Visit, 18 and Up"]
                 union [Encounter."Home Healthcare Services"] ) ValidEncounter
                   where ValidEncounter.relevantPeriod during "Measurement Period"
                                // and visit.status = 'finished'
                                             Think above should be ValidEncounter.status

 We also noticed that same file is calling what appears to be the library for QDM at the top

// changed to use STU3 FHIR model
using FHIR version '3.0.0'
 
include Adult_Outpatient_Encounters version '1.1.000' called AdultOutpatientEncounters
include MATGlobalCommonFunctions version '2.0.000' called Global
include Hospice version '1.0.000' called Hospice
// added FHIRHelpers conversion Library
include FHIRHelpers version '3.0.0' called FHIRHelpers

 Should this be “Display” instead of “Code” – since it has the description? Would that change the fhirpath?

define "Hospice.Has Hospice":
               exists (Encounter."Encounter Inpatient"] DischargeHospice
                              where ( DischargeHospice.hospitalization.dischargeDisposition as Code ~ "Discharge to home for hospice care (procedure)"
                                                            or DischargeHospice.hospitalization.dischargeDisposition as Code ~ "Discharge to healthcare facility for hospice care (procedure)"

```
 Should these be colons?
```

define "Qualifying Encounters":
    [Encounter: "Office Visit"] visit
                 union [Encounter."Annual Wellness Visit"]
                 union [Encounter."Preventive Care Services - Established Office Visit, 18 and Up"]
                 union [Encounter."Preventive Care Services-Initial Office Visit, 18 and Up"]
                 union [Encounter."Home Healthcare Services"] ) ValidEncounter
                   where ValidEncounter.relevantPeriod during "Measurement Period"
                                // and visit.status = 'finished'

define "Hospice.Has Hospice":
               exists (Encounter."Encounter Inpatient"] DischargeHospice
                              where ( DischargeHospice.hospitalization.dischargeDisposition as Code ~ "Discharge to home for hospice care (procedure)"
                                                            or DischargeHospice.hospitalization.dischargeDisposition as Code ~ "Discharge to healthcare facility for hospice care (procedure)"
                              )
                                             and DischargeHospice.period ends during "Measurement Period"
)
               or exists ( task."Hospice care ambulatory"] HospiceOrder
                                             where HospiceOrder.AuthoredOn during "Measurement Period"
               )
               or exists ( task."Hospice care ambulatory"] HospicePerformed
                                             where HospicePerformed.period overlaps "Measurement Period"

use of criteriaReference extension for continuous variable measures

The text here isn't clear on how to use the criteriaReference extension: https://build.fhir.org/ig/HL7/cqf-measures/measure-conformance.html#continuous-variable-measure

The Measure snippet 3-18 refers to an identifier section which isn't valid and isn't in the linked example resource.