{
"description": "An example FHIR-based publishable measure",
"_filename": "example/Measure-EXMRatio-FHIR.json",
"package_name": "hl7.fhir.uv.cqm",
"date": "2025-08-13",
"group": [ {
"id": "group-1",
"extension": [ {
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.linkId",
"valueString": "primary"
} ],
"population": [ {
"id": "initial-population",
"code": {
"coding": [ {
"code": "initial-population",
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"display": "Initial Population"
} ]
},
"criteria": {
"language": "text/cql-identifier",
"expression": "Initial Population"
},
"extension": [ {
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
"valueString": "primary-exmratio-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"
},
"extension": [ {
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
"valueString": "primary-exmratio-numerator"
} ]
}, {
"id": "denominator",
"code": {
"coding": [ {
"code": "denominator",
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"display": "Denominator"
} ]
},
"criteria": {
"language": "text/cql-identifier",
"expression": "Denominator"
},
"extension": [ {
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
"valueString": "primary-exmratio-denominator"
} ]
}, {
"id": "denominator-observation",
"code": {
"coding": [ {
"code": "measure-observation",
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"display": "Measure Observation"
} ]
},
"criteria": {
"language": "text/cql-identifier",
"expression": "Denominator Observation"
},
"extension": [ {
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
"valueString": "primary-exmratio-denominator-observation"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
"valueString": "denominator"
}, {
"url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-aggregateMethod",
"valueCode": "sum"
} ]
}, {
"id": "numerator-observation",
"code": {
"coding": [ {
"code": "measure-observation",
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"display": "Measure Observation"
} ]
},
"criteria": {
"language": "text/cql-identifier",
"expression": "Numerator Observation"
},
"extension": [ {
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
"valueString": "primary-exmratio-numerator-observation"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
"valueString": "numerator"
}, {
"url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-aggregateMethod",
"valueCode": "sum"
} ]
} ]
} ],
"meta": {
"profile": [ "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-ratiomeasure", "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure", "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-cqlmeasure", "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure" ]
},
"publisher": "HL7 International / Clinical Quality Information",
"approvalDate": "2019-02-17",
"disclaimer": "Example disclaimer",
"jurisdiction": [ {
"coding": [ {
"code": "001",
"system": "http://unstats.un.org/unsd/methods/m49/m49.htm"
} ]
} ],
"purpose": "This measure has been developed to support improvement in clinical care.",
"name": "EXMRatioMeasure",
"useContext": [ {
"code": {
"code": "venue",
"system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
"display": "Clinical Venue"
},
"valueCodeableConcept": {
"coding": [ {
"code": "ec",
"system": "http://hl7.org/fhir/uv/cqm/CodeSystem/intended-venue-codes",
"display": "EC"
} ]
}
} ],
"copyright": "Example Copyright Statement",
"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 Ratio Measure",
"library": [ "http://hl7.org/fhir/uv/cqm/Library/EXMRatio" ],
"package_version": "2.0.0-ballot",
"author": [ {
"name": "Example Measure Content Developer"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis",
"valueCode": "Encounter"
}, {
"url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit",
"valueCodeableConcept": {
"coding": [ {
"code": "/1000.d",
"system": "http://unitsofmeasure.org"
} ]
}
}, {
"url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem",
"valueReference": {
"reference": "Device/software-system-example"
}
}, {
"url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
"valueCanonical": "#effective-data-requirements"
} ],
"contained": [ {
"dataRequirement": [ {
"type": "Encounter",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Encounter" ],
"codeFilter": [ {
"path": "type",
"valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
} ],
"mustSupport": [ "type", "status", "period" ]
}, {
"type": "Encounter",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Encounter" ],
"codeFilter": [ {
"path": "type",
"valueSet": "http://example.org/fhir/ValueSet/inpatient"
} ],
"mustSupport": [ "type", "period" ]
}, {
"type": "Observation",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Observation" ],
"codeFilter": [ {
"path": "code",
"valueSet": "http://example.org/fhir/ValueSet/fall"
} ],
"mustSupport": [ "code", "effective" ]
}, {
"type": "Patient",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ]
} ],
"name": "EffectiveDataRequirements",
"type": {
"coding": [ {
"code": "module-definition",
"system": "http://terminology.hl7.org/CodeSystem/library-type"
} ]
},
"resourceType": "Library",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMRatio"
}, {
"url": "name",
"valueString": "Qualifying Encounters"
}, {
"url": "statement",
"valueString": "define \"Qualifying Encounters\":\n [\"Encounter\": \"Inpatient\"]"
}, {
"url": "displaySequence",
"valueInteger": 0
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMRatio"
}, {
"url": "name",
"valueString": "Initial Population"
}, {
"url": "statement",
"valueString": "define \"Initial Population\":\n \"Qualifying Encounters\""
}, {
"url": "displaySequence",
"valueInteger": 1
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMRatio"
}, {
"url": "name",
"valueString": "Numerator"
}, {
"url": "statement",
"valueString": "define \"Numerator\":\n \"Initial Population\""
}, {
"url": "displaySequence",
"valueInteger": 2
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMRatio"
}, {
"url": "name",
"valueString": "Denominator"
}, {
"url": "statement",
"valueString": "define \"Denominator\":\n \"Initial Population\""
}, {
"url": "displaySequence",
"valueInteger": 3
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMRatio"
}, {
"url": "name",
"valueString": "Falls with Major Injury"
}, {
"url": "statement",
"valueString": "define \"Falls with Major Injury\":\n [\"Observation\": \"Fall\"]"
}, {
"url": "displaySequence",
"valueInteger": 4
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMRatio"
}, {
"url": "name",
"valueString": "Denominator Observation"
}, {
"url": "statement",
"valueString": "define function \"Denominator Observation\"(Encounter \"Encounter\"):\n duration in hours of Global.Hospitalization(Encounter) / 24"
}, {
"url": "displaySequence",
"valueInteger": 5
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "MATGlobalCommonFunctions"
}, {
"url": "name",
"valueString": "Hospitalization"
}, {
"url": "statement",
"valueString": "define function \"Hospitalization\"(TheEncounter FHIR.Encounter):\n\t( \"ED Visit\"(TheEncounter) ) X\n return\n if X is null then TheEncounter.period\n else Interval[start of FHIRHelpers.ToInterval(X.period), end of FHIRHelpers.ToInterval(TheEncounter.period)]"
}, {
"url": "displaySequence",
"valueInteger": 6
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "MATGlobalCommonFunctions"
}, {
"url": "name",
"valueString": "ED Visit"
}, {
"url": "statement",
"valueString": "define function \"ED Visit\"(TheEncounter FHIR.Encounter):\n singleton from (\n [Encounter: \"Emergency Department Visit\"] EDVisit\n where EDVisit.status = 'finished'\n and EDVisit.period ends 1 hour or less on or before start of FHIRHelpers.ToInterval(TheEncounter.period)\n )"
}, {
"url": "displaySequence",
"valueInteger": 7
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "FHIRHelpers"
}, {
"url": "name",
"valueString": "ToString"
}, {
"url": "statement",
"valueString": "define function ToString(value EncounterStatus): value.value"
}, {
"url": "displaySequence",
"valueInteger": 8
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "FHIRHelpers"
}, {
"url": "name",
"valueString": "ToInterval"
}, {
"url": "statement",
"valueString": "/*\n@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)\nvalue to a CQL DateTime Interval\n@comment: If the start value of the given period is unspecified, the starting\nboundary of the resulting interval will be open (meaning the start of the interval\nis unknown, as opposed to interpreted as the beginning of time).\n*/\ndefine function ToInterval(period FHIR.Period):\n if period is null then\n null\n else\n if period.\"start\" is null then\n Interval(period.\"start\".value, period.\"end\".value]\n else\n Interval[period.\"start\".value, period.\"end\".value]"
}, {
"url": "displaySequence",
"valueInteger": 9
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMRatio"
}, {
"url": "name",
"valueString": "Numerator Observation"
}, {
"url": "statement",
"valueString": "define function \"Numerator Observation\"(Encounter \"Encounter\"):\n Count(\n \"Falls with Major Injury\" Falls\n where Global.\"Normalize Interval\"(Falls.effective) during Encounter.period\n )"
}, {
"url": "displaySequence",
"valueInteger": 10
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "MATGlobalCommonFunctions"
}, {
"url": "name",
"valueString": "Normalize Interval"
}, {
"url": "statement",
"valueString": "/*\n*\n* CQFMeasures Common Logic\n*\n*/\n\ndefine function \"Normalize Interval\"(choice Choice, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>):\n case\n\t when choice is FHIR.dateTime then\n \tInterval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]\n\t\twhen choice is FHIR.Period then\n \t\tFHIRHelpers.ToInterval(choice as FHIR.Period)\n\t\twhen choice is FHIR.instant then\n\t\t\tInterval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]\n\t\twhen choice is FHIR.Age then\n\t\t Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),\n\t\t\t FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)\n\t\twhen choice is FHIR.Range then\n\t\t Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),\n\t\t\t FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)\n\t\twhen choice is FHIR.Timing then\n\t\t Message(null as Interval, true, '1', 'Error', 'Cannot compute a single interval from a Timing type')\n when choice is FHIR.string then\n Message(null as Interval, true, '1', 'Error', 'Cannot compute an interval from a String value')\n\t\telse\n\t\t\tnull as Interval\n\tend"
}, {
"url": "displaySequence",
"valueInteger": 11
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "FHIRHelpers"
}, {
"url": "name",
"valueString": "ToDateTime"
}, {
"url": "statement",
"valueString": "define function ToDateTime(value dateTime): value.value"
}, {
"url": "displaySequence",
"valueInteger": 12
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "FHIRHelpers"
}, {
"url": "name",
"valueString": "ToDateTime"
}, {
"url": "statement",
"valueString": "define function ToDateTime(value instant): value.value"
}, {
"url": "displaySequence",
"valueInteger": 13
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "FHIRHelpers"
}, {
"url": "name",
"valueString": "ToDate"
}, {
"url": "statement",
"valueString": "define function ToDate(value date): value.value"
}, {
"url": "displaySequence",
"valueInteger": 14
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "FHIRHelpers"
}, {
"url": "name",
"valueString": "ToQuantity"
}, {
"url": "statement",
"valueString": "/*\n@description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) \nvalue to a CQL Quantity\n@comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity\nhas a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`)\nan error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used.\n@seealso: ToCalendarUnit\n*/\ndefine function ToQuantity(quantity FHIR.Quantity):\n case\n when quantity is null then null\n when quantity.value is null then null\n when quantity.comparator is not null then\n Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')\n when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'\n or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then\n System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }\n else\n Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')\n end"
}, {
"url": "displaySequence",
"valueInteger": 15
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "FHIRHelpers"
}, {
"url": "name",
"valueString": "ToCalendarUnit"
}, {
"url": "statement",
"valueString": "/*\n@description: Converts a UCUM definite duration unit to a CQL calendar duration\nunit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities) \ntopic of the CQL specification.\n@comment: Note that for durations above days (or weeks), the conversion is understood to be approximate\n*/\ndefine function ToCalendarUnit(unit System.String):\n case unit\n when 'ms' then 'millisecond'\n when 's' then 'second'\n when 'min' then 'minute'\n when 'h' then 'hour'\n when 'd' then 'day'\n when 'wk' then 'week'\n when 'mo' then 'month'\n when 'a' then 'year'\n else unit\n end"
}, {
"url": "displaySequence",
"valueInteger": 16
} ]
} ],
"status": "active",
"id": "effective-data-requirements",
"relatedArtifact": [ {
"type": "depends-on",
"display": "FHIR model information",
"resource": "http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1"
}, {
"type": "depends-on",
"display": "Library Global",
"resource": "http://hl7.org/fhir/uv/cqm/Library/MATGlobalCommonFunctions|5.0.000"
}, {
"type": "depends-on",
"display": "Library FHIRHelpers",
"resource": "http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1"
}, {
"type": "depends-on",
"display": "Value set Inpatient",
"resource": "http://example.org/fhir/ValueSet/inpatient"
}, {
"type": "depends-on",
"display": "Value set Emergency Department Visit",
"resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
}, {
"type": "depends-on",
"display": "Value set Fall",
"resource": "http://example.org/fhir/ValueSet/fall"
} ],
"parameter": [ {
"max": "*",
"min": 0,
"use": "out",
"name": "Numerator",
"type": "Encounter"
}, {
"max": "*",
"min": 0,
"use": "out",
"name": "Denominator",
"type": "Encounter"
}, {
"max": "*",
"min": 0,
"use": "out",
"name": "Initial Population",
"type": "Encounter"
} ]
} ],
"usage": "Users of this measure should be aware of...",
"rationale": "The rationale of this measure is...",
"status": "active",
"id": "477abb2a-837c-4e4f-8f0b-8cd3ee7cc08f",
"kind": null,
"url": "http://example.org/fhir/measures/measure-ratio-exm",
"identifier": [ {
"value": "EXMRatio-FHIR",
"system": "http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm"
}, {
"value": "urn:oid:2.16.840.1.113883.4.642.40.61.29.10",
"system": "urn:ietf:rfc:3986"
} ],
"lastReviewDate": "2019-02-17",
"scoring": {
"coding": [ {
"code": "ratio",
"system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
"display": "Ratio"
} ]
},
"version": "2.0.0",
"contact": [ {
"telecom": [ {
"value": "http://www.hl7.org/Special/committees/cqi",
"system": "url"
} ]
} ],
"improvementNotation": {
"coding": [ {
"code": "decrease",
"system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
"display": "Decreased score indicates improvement"
} ]
},
"effectivePeriod": {
"end": "2018-12-31",
"start": "2018-01-01",
"extension": [ {
"url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-effectivePeriodAnchor",
"valueDateTime": "2018-01-01"
}, {
"url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-effectivePeriodDuration",
"valueDuration": {
"code": "a",
"value": 1,
"system": "http://unitsofmeasure.org"
}
} ]
}
}