{
  "description": "An example FHIR-based measure",
  "_filename": "example/Measure-EXMLogic-FHIR.json",
  "package_name": "hl7.fhir.us.cqfmeasures",
  "date": "2022-02-22",
  "group": [ {
    "id": "group-1",
    "code": {
      "coding": [ {
        "display": "group-1"
      } ]
    },
    "population": [ {
      "id": "initial-population-1",
      "code": {
        "coding": [ {
          "code": "initial-population",
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "display": "Initial Population"
        } ]
      },
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Initial Population"
      }
    }, {
      "id": "numerator",
      "code": {
        "coding": [ {
          "code": "numerator",
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "display": "Numerator"
        } ]
      },
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Numerator"
      }
    }, {
      "id": "denominator",
      "code": {
        "coding": [ {
          "code": "denominator",
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "display": "Denominator"
        } ]
      },
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Denominator"
      }
    } ],
    "stratifier": [ {
      "id": "stratifier-1",
      "code": {
        "text": "Stratifier 1"
      },
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Stratifier 1"
      },
      "extension": [ {
        "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
        "valueCodeableConcept": {
          "text": "initial-population",
          "coding": [ {
            "system": "http://terminology.hl7.org/CodeSystem/measure-population"
          } ]
        }
      } ]
    }, {
      "id": "stratifier-2",
      "code": {
        "text": "Stratifier 2"
      },
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Stratifier 2"
      },
      "extension": [ {
        "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
        "valueCodeableConcept": {
          "text": "initial-population",
          "coding": [ {
            "system": "http://terminology.hl7.org/CodeSystem/measure-population"
          } ]
        }
      } ]
    }, {
      "id": "stratifier-3",
      "code": {
        "text": "Stratifier 3"
      },
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Stratifier 3"
      },
      "extension": [ {
        "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
        "valueCodeableConcept": {
          "text": "initial-population",
          "coding": [ {
            "system": "http://terminology.hl7.org/CodeSystem/measure-population"
          } ]
        }
      } ]
    }, {
      "id": "stratifier-4",
      "code": {
        "text": "Stratifier 4"
      },
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Stratifier 4"
      },
      "extension": [ {
        "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
        "valueCodeableConcept": {
          "text": "initial-population",
          "coding": [ {
            "system": "http://terminology.hl7.org/CodeSystem/measure-population"
          } ]
        }
      } ]
    } ]
  } ],
  "meta": {
    "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm", "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm", "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm" ]
  },
  "publisher": "Clinical Quality Information WG",
  "approvalDate": "2019-02-17",
  "disclaimer": "Example disclaimer",
  "jurisdiction": [ {
    "coding": [ {
      "code": "US",
      "system": "urn:iso:std:iso:3166"
    } ]
  } ],
  "purpose": "The purpose of this measure is to show how all the elements of a FHIR-based quality measure are represented.",
  "name": "MeasureEXM",
  "_definition": [ {
    "extension": [ {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-definitionTerm",
      "extension": [ {
        "url": "term",
        "valueString": "Term"
      }, {
        "url": "definition",
        "valueMarkdown": "A term used in the measure that bears clearly definition to communicate the measure intent"
      } ]
    } ]
  } ],
  "useContext": [ {
    "code": {
      "code": "program",
      "system": "http://terminology.hl7.org/CodeSystem/usage-context-type"
    },
    "valueCodeableConcept": {
      "text": "eligible-provider"
    }
  } ],
  "copyright": "Example Copyright Statement",
  "guidance": "Additional guidance provided to help communicate the intent of the measure",
  "type": "[{:coding [{:system \\\"http://terminology.hl7.org/CodeSystem/measure-type\\\", :code \\\"process\\\"}]}]",
  "experimental": "true",
  "topic": [ {
    "text": "Health Quality Measure Document",
    "coding": [ {
      "code": "57024-2",
      "system": "http://loinc.org"
    } ]
  } ],
  "resourceType": "Measure",
  "title": "EXM Measure",
  "supplementalData": [ {
    "id": "sde-ethnicity",
    "usage": [ {
      "coding": [ {
        "code": "supplemental-data",
        "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage"
      } ]
    } ],
    "criteria": {
      "language": "text/cql-identifier",
      "expression": "SDE Ethnicity"
    }
  }, {
    "id": "sde-race",
    "usage": [ {
      "coding": [ {
        "code": "supplemental-data",
        "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage"
      } ]
    } ],
    "criteria": {
      "language": "text/cql-identifier",
      "expression": "SDE Race"
    }
  }, {
    "id": "sde-payer",
    "usage": [ {
      "coding": [ {
        "code": "supplemental-data",
        "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage"
      } ]
    } ],
    "criteria": {
      "language": "text/cql-identifier",
      "expression": "SDE Payer"
    }
  }, {
    "id": "sde-sex",
    "usage": [ {
      "coding": [ {
        "code": "supplemental-data",
        "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage"
      } ]
    } ],
    "criteria": {
      "language": "text/cql-identifier",
      "expression": "SDE Sex"
    }
  } ],
  "library": [ "http://hl7.org/fhir/us/cqfmeasures/Library/EXMLogic-FHIR" ],
  "package_version": "4.0.0",
  "author": [ {
    "name": "Example Measure Content Developer"
  } ],
  "extension": [ {
    "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-artifactComment",
    "extension": [ {
      "url": "type",
      "valueCode": "documentation"
    }, {
      "url": "text",
      "valueMarkdown": "This illustrates an example comment"
    } ]
  }, {
    "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
    "valueCode": "Encounter"
  }, {
    "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem",
    "valueReference": {
      "reference": "Device/software-system-example"
    }
  }, {
    "id": "effective-data-requirements",
    "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
    "valueReference": {
      "reference": "#effective-data-requirements"
    }
  } ],
  "contained": [ {
    "dataRequirement": [ {
      "type": "Patient",
      "profile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ],
      "extension": [ {
        "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-fhirQueryPattern",
        "valueString": "Patient?_id={{context.patientId}}"
      } ]
    }, {
      "type": "Patient",
      "profile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ],
      "extension": [ {
        "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-fhirQueryPattern",
        "valueString": "Patient?_id={{context.patientId}}"
      }, {
        "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-valueFilter",
        "extension": [ {
          "url": "path",
          "valueString": "url"
        }, {
          "url": "comparator",
          "valueCode": "eq"
        }, {
          "url": "value",
          "valueString": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity"
        } ]
      } ],
      "mustSupport": [ "url", "extension", "value" ]
    }, {
      "type": "Patient",
      "profile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ],
      "extension": [ {
        "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-fhirQueryPattern",
        "valueString": "Patient?_id={{context.patientId}}"
      } ],
      "codeFilter": [ {
        "code": [ {
          "code": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
          "system": "urn:ietf:rfc:3986"
        } ],
        "path": "url"
      } ],
      "mustSupport": [ "url", "extension", "value" ]
    }, {
      "type": "Encounter",
      "profile": [ "http://hl7.org/fhir/StructureDefinition/Encounter" ],
      "extension": [ {
        "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-fhirQueryPattern",
        "valueString": "Encounter?subject=Patient/{{context.patientId}}"
      }, {
        "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-isSelective",
        "valueBoolean": true
      } ],
      "dateFilter": [ {
        "path": "period",
        "valuePeriod": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/cqf-expression",
            "valueExpression": {
              "language": "text/cql-identifier",
              "expression": "Measurement Period"
            }
          } ]
        }
      } ],
      "mustSupport": [ "period" ]
    }, {
      "type": "Coverage",
      "profile": [ "http://hl7.org/fhir/StructureDefinition/Coverage" ],
      "extension": [ {
        "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-fhirQueryPattern",
        "valueString": "Coverage?policy-holder=Patient/{{context.patientId}}&type:in=http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
      } ],
      "codeFilter": [ {
        "path": "type",
        "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
      } ],
      "mustSupport": [ "type", "period" ]
    } ],
    "name": "EffectiveDataRequirements",
    "type": {
      "coding": [ {
        "code": "module-definition",
        "system": "http://terminology.hl7.org/CodeSystem/library-type"
      } ]
    },
    "resourceType": "Library",
    "extension": [ {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
      "valueCoding": {
        "code": "billing",
        "system": "http://terminology.hl7.org/CodeSystem/diagnosis-role",
        "display": "Billing"
      }
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMLogic-FHIR"
      }, {
        "url": "name",
        "valueString": "SDE Sex"
      }, {
        "url": "statement",
        "valueString": "define \"SDE Sex\":\n  case\n    when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }\n    when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }\n    else null\n  end"
      }, {
        "url": "displaySequence",
        "valueInteger": 0
      } ]
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMLogic-FHIR"
      }, {
        "url": "name",
        "valueString": "Inpatient Encounter"
      }, {
        "url": "statement",
        "valueString" : "define \"Inpatient Encounter\":\n  [\"Encounter\"] Encounter\n    where LengthInDays(Encounter.period) <= 120\n      and Encounter.period ends during \"Measurement Period\""
      }, {
        "url": "displaySequence",
        "valueInteger": 1
      } ]
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMLogic-FHIR"
      }, {
        "url": "name",
        "valueString": "Stratifier 3"
      }, {
        "url": "statement",
        "valueString" : "define \"Stratifier 3\":\n  \"Inpatient Encounter\" Encounter\n    where PrincipalDiagnosis(Encounter) is null"
      }, {
        "url": "displaySequence",
        "valueInteger": 2
      } ]
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMLogic"
      }, {
        "url": "name",
        "valueString": "Stratifier 4"
      }, {
        "url": "statement",
        "valueString" : "define \"Stratifier 4\":\n  \"Inpatient Encounter\" Encounter\n    where PrincipalDiagnosis(Encounter) is null"
      }, {
        "url": "displaySequence",
        "valueInteger": 3
      } ]
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMLogic-FHIR"
      }, {
        "url": "name",
        "valueString": "SDE Payer"
      }, {
        "url": "statement",
        "valueString": "define \"SDE Payer\":\n    [Coverage: type in \"Payer\"] Payer\n      return {\n        code: Payer.type,\n        period: Payer.period\n      }"
      }, {
        "url": "displaySequence",
        "valueInteger": 4
      } ]
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMLogic"
      }, {
        "url": "name",
        "valueString": "Initial Population"
      }, {
        "url": "statement",
        "valueString" : "define \"Initial Population\":\n  \"Inpatient Encounter\" Encounter"
      }, {
        "url": "displaySequence",
        "valueInteger": 5
      } ]
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMLogic-FHIR"
      }, {
        "url": "name",
        "valueString": "SDE Ethnicity"
      }, {
        "url": "statement",
        "valueString": "define \"SDE Ethnicity\":\n  (flatten (\n    Patient.extension Extension\n      where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity'\n        return Extension.extension\n  )) E\n    where E.url = 'ombCategory'\n      or E.url = 'detailed'\n    return E.value as Coding"
      }, {
        "url": "displaySequence",
        "valueInteger": 6
      } ]
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMLogic"
      }, {
        "url": "name",
        "valueString": "SDE Race"
      }, {
        "url": "statement",
        "valueString": "define \"SDE Race\":\n  (flatten (\n    Patient.extension Extension\n      where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race'\n        return Extension.extension\n  )) E\n    where E.url = 'ombCategory'\n      or E.url = 'detailed'\n    return E.value as Coding"
      }, {
        "url": "displaySequence",
        "valueInteger": 7
      } ]
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMLogic-FHIR"
      }, {
        "url": "name",
        "valueString": "Stratifier 1"
      }, {
        "url": "statement",
        "valueString" : "define \"Stratifier 1\":\n  \"Inpatient Encounter\" Encounter\n    where not (PrincipalDiagnosis(Encounter).code in \"Psychiatric/Mental Health Patient\")"
      }, {
        "url": "displaySequence",
        "valueInteger": 8
      } ]
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMLogic-FHIR"
      }, {
        "url": "name",
        "valueString": "Stratifier 2"
      }, {
        "url": "statement",
        "valueString" : "define \"Stratifier 2\":\n  \"Inpatient Encounter\" Encounter\n    where PrincipalDiagnosis(Encounter).code in \"Psychiatric/Mental Health Patient\""
      }, {
        "url": "displaySequence",
        "valueInteger": 9
      } ]
    } ],
    "status": "active",
    "id": "effective-data-requirements",
    "relatedArtifact": [ {
      "type": "depends-on",
      "display": "Library FHIRHelpers",
      "resource": "http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1"
    }, {
      "type": "depends-on",
      "display": "Code system Diagnosis Role",
      "resource": "http://terminology.hl7.org/CodeSystem/diagnosis-role"
    }, {
      "type": "depends-on",
      "display": "Value set Payer",
      "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
    }, {
      "type": "depends-on",
      "display": "Value set Psychiatric/Mental Health Patient",
      "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.299"
    } ],
    "parameter": [ {
      "max": "1",
      "min": 0,
      "use": "in",
      "name": "Measurement Period",
      "type": "Period"
    }, {
      "max": "1",
      "min": 0,
      "use": "out",
      "name": "SDE Sex",
      "type": "Coding"
    }, {
      "max": "*",
      "min": 0,
      "use": "out",
      "name": "Stratifier 3",
      "type": "Encounter"
    }, {
      "max": "*",
      "min": 0,
      "use": "out",
      "name": "Stratifier 4",
      "type": "Encounter"
    }, {
      "max": "*",
      "min": 0,
      "use": "out",
      "name": "SDE Payer",
      "type": "Resource"
    }, {
      "max": "*",
      "min": 0,
      "use": "out",
      "name": "Initial Population",
      "type": "Encounter"
    }, {
      "max": "*",
      "min": 0,
      "use": "out",
      "name": "SDE Ethnicity",
      "type": "Coding"
    }, {
      "max": "*",
      "min": 0,
      "use": "out",
      "name": "SDE Race",
      "type": "Coding"
    }, {
      "max": "*",
      "min": 0,
      "use": "out",
      "name": "Stratifier 1",
      "type": "Encounter"
    }, {
      "max": "*",
      "min": 0,
      "use": "out",
      "name": "Stratifier 2",
      "type": "Encounter"
    } ]
  } ],
  "usage": "Users of this measure should be aware that this is intentionally simplified to show specific aspects of a measure.",
  "rationale": "Rationale for this measure is...",
  "status": "active",
  "id": "09832e55-d096-4f83-a8fe-c753592433b0",
  "kind": null,
  "url": "http://hl7.org/fhir/us/cqfmeasures/Measure/EXMLogic-FHIR",
  "identifier": [ {
    "value": "EXM",
    "system": "http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm"
  } ],
  "lastReviewDate": "2019-02-17",
  "riskAdjustment": "Risk adjustment for this measure is performed by...",
  "scoring": {
    "coding": [ {
      "code": "proportion",
      "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
      "display": "Proportion"
    } ]
  },
  "version": "2.0.0",
  "contact": [ {
    "telecom": [ {
      "value": "http://www.hl7.org/Special/committees/cqi",
      "system": "url"
    } ]
  } ],
  "improvementNotation": {
    "coding": [ {
      "code": "increase",
      "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
      "display": "Increased score indicates improvement"
    } ]
  },
  "rateAggregation": "Rate aggregation for this measure is performed by...",
  "effectivePeriod": {
    "end": "2018-12-31",
    "start": "2018-01-01",
    "extension": [ {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectivePeriodAnchor",
      "valueDateTime": "2018-01-01"
    }, {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectivePeriodDuration",
      "valueDuration": {
        "code": "a",
        "value": 1,
        "system": "http://unitsofmeasure.org"
      }
    } ]
  },
  "clinicalRecommendationStatement": "The clinical recommendation statement for this measure is..."
}