{
"description": "An example FHIR-based measure",
"_filename": "example/Measure-EXMLogic-FHIR.json",
"package_name": "hl7.fhir.uv.cqm",
"date": "2025-08-13",
"group": [ {
"id": "group-1",
"code": {
"coding": [ {
"code": "group",
"system": "http://example.org/group",
"display": "group-1"
} ]
},
"extension": [ {
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.linkId",
"valueString": "primary"
} ],
"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"
},
"extension": [ {
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
"valueString": "primary-exmlogic-initial-population"
} ]
}, {
"id": "measure-population",
"code": {
"coding": [ {
"code": "measure-population",
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"display": "Measure Population"
} ]
},
"criteria": {
"language": "text/cql-identifier",
"expression": "Measure Population"
},
"extension": [ {
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
"valueString": "primary-exmlogic-measure-population"
} ]
}, {
"id": "measure-observation",
"code": {
"coding": [ {
"code": "measure-observation",
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"display": "Measure Observation"
} ]
},
"criteria": {
"language": "text/cql-identifier",
"expression": "Measure Observation"
},
"extension": [ {
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
"valueString": "primary-exmlogic-measure-observation"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
"valueString": "measure-population"
}, {
"url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-aggregateMethod",
"valueCode": "median"
} ]
} ],
"stratifier": [ {
"id": "stratifier-1",
"code": {
"text": "Stratifier 1"
},
"criteria": {
"language": "text/cql-identifier",
"expression": "Stratification 1"
},
"extension": [ {
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.linkId",
"valueString": "primary-exmlogic-stratification-1"
}, {
"url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-appliesTo",
"valueCodeableConcept": {
"text": "initial-population",
"coding": [ {
"code": "initial-population",
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"display": "Initial Population"
} ]
}
} ]
}, {
"id": "stratifier-2",
"code": {
"text": "Stratifier 2"
},
"criteria": {
"language": "text/cql-identifier",
"expression": "Stratification 2"
},
"extension": [ {
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.linkId",
"valueString": "primary-exmlogic-stratification-2"
}, {
"url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-appliesTo",
"valueCodeableConcept": {
"text": "initial-population",
"coding": [ {
"code": "initial-population",
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"display": "Initial Population"
} ]
}
} ]
}, {
"id": "stratifier-3",
"code": {
"text": "Stratifier 3"
},
"criteria": {
"language": "text/cql-identifier",
"expression": "Stratification 3"
},
"extension": [ {
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.linkId",
"valueString": "primary-exmlogic-stratification-3"
}, {
"url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-appliesTo",
"valueCodeableConcept": {
"text": "initial-population",
"coding": [ {
"code": "initial-population",
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"display": "Initial Population"
} ]
}
} ]
} ]
} ],
"meta": {
"profile": [ "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-cvmeasure|2.0.0", "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure|2.0.0", "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-executablemeasure|2.0.0", "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-cqlmeasure|2.0.0", "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-elmmeasure|2.0.0", "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure|2.0.0" ]
},
"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": "MeasureEXM",
"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",
"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",
"library": [ "http://hl7.org/fhir/uv/cqm/Library/EXMLogic|2.0.0" ],
"package_version": "2.0.0",
"author": [ {
"name": "Example Measure Content Developer"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-artifactComment",
"extension": [ {
"url": "type",
"valueCode": "documentation"
}, {
"url": "text",
"valueMarkdown": "This illustrates an example comment"
} ]
}, {
"url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis",
"valueCode": "Encounter"
}, {
"url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem",
"valueReference": {
"reference": "Device/software-system-example"
}
}, {
"url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringPrecision",
"valuePositiveInt": 2
}, {
"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|4.0.1" ],
"mustSupport": [ "period", "type" ]
}, {
"type": "Encounter",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Encounter|4.0.1" ],
"codeFilter": [ {
"path": "type",
"valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292|20210611"
} ],
"mustSupport": [ "type", "status", "period" ]
}, {
"type": "Claim",
"profile": [ "http://hl7.org/fhir/StructureDefinition/Claim|4.0.1" ],
"mustSupport": [ "status", "use", "item" ]
} ],
"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-directReferenceCode",
"valueCoding": {
"code": "principal",
"system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"display": "Principal Diagnosis"
}
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMLogic"
}, {
"url": "name",
"valueString": "Inpatient Encounter"
}, {
"url": "statement",
"valueString" : "define \"Inpatient Encounter\":\n [\"Encounter\"] Encounter\n where Encounter.period.lengthInDays() <= 120\n and Encounter.period ends during \"Measurement Period\""
}, {
"url": "displaySequence",
"valueInteger": 0
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMLogic"
}, {
"url": "name",
"valueString": "Stratification 3"
}, {
"url": "statement",
"valueString" : "define \"Stratification 3\":\n \"Inpatient Encounter\" Encounter\n where Encounter.principalDiagnosis().diagnosis is null"
}, {
"url": "displaySequence",
"valueInteger": 1
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMLogic"
}, {
"url": "name",
"valueString": "Stratification 2"
}, {
"url": "statement",
"valueString" : "define \"Stratification 2\":\n \"Inpatient Encounter\" Encounter\n where Encounter.principalDiagnosis().diagnosis in \"Psychiatric/Mental Health Patient\""
}, {
"url": "displaySequence",
"valueInteger": 2
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMLogic"
}, {
"url": "name",
"valueString": "Stratification 1"
}, {
"url": "statement",
"valueString" : "define \"Stratification 1\":\n \"Inpatient Encounter\" Encounter\n where not (Encounter.principalDiagnosis().diagnosis in \"Psychiatric/Mental Health Patient\")"
}, {
"url": "displaySequence",
"valueInteger": 3
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMLogic"
}, {
"url": "name",
"valueString": "Initial Population"
}, {
"url": "statement",
"valueString" : "define \"Initial Population\" :\n \"Inpatient Encounter\" Encounter\n with [\"Encounter\": \"Emergency Department Visit\"] ED\n such that ED.status = 'finished'\n and ED.period ends 1 hour or less before start of Encounter.period"
}, {
"url": "displaySequence",
"valueInteger": 4
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMLogic"
}, {
"url": "name",
"valueString": "Measure Population"
}, {
"url": "statement",
"valueString" : "define \"Measure Population\":\n \"Initial Population\""
}, {
"url": "displaySequence",
"valueInteger": 5
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMCommon"
}, {
"url": "name",
"valueString": "lengthInDays"
}, {
"url": "statement",
"valueString": "define fluent function lengthInDays(Value Interval ):\n difference in days between start of Value and end of Value"
}, {
"url": "displaySequence",
"valueInteger": 6
} ]
}, {
"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": 7
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMCommon"
}, {
"url": "name",
"valueString": "principalDiagnosis"
}, {
"url": "statement",
"valueString": "define fluent function principalDiagnosis(encounter Encounter):\n singleton from (\n (encounter.claimDiagnosis()) CD\n where CD.type.includesCode(\"Principal Diagnosis\")\n )"
}, {
"url": "displaySequence",
"valueInteger": 8
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMCommon"
}, {
"url": "name",
"valueString": "claimDiagnosis"
}, {
"url": "statement",
"valueString": "define fluent function claimDiagnosis(encounter Encounter):\n encounter E\n let \n claim: ([Claim] C where C.status = 'active' and C.use = 'claim' and exists (C.item I where I.encounter.references(E))),\n claimItem: (claim.item I where I.encounter.references(E))\n return claim.diagnosis D where D.sequence in claimItem.diagnosisSequence"
}, {
"url": "displaySequence",
"valueInteger": 9
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "FHIRHelpers"
}, {
"url": "name",
"valueString": "ToString"
}, {
"url": "statement",
"valueString": "define function ToString(value ClaimStatus): value.value"
}, {
"url": "displaySequence",
"valueInteger": 10
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "FHIRHelpers"
}, {
"url": "name",
"valueString": "ToString"
}, {
"url": "statement",
"valueString": "define function ToString(value Use): value.value"
}, {
"url": "displaySequence",
"valueInteger": 11
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "FHIRCommon"
}, {
"url": "name",
"valueString": "references"
}, {
"url": "statement",
"valueString": "/*\n@description: Returns true if any of the given references are to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(references List, resource FHIR.Resource):\n exists (references R where R.references(resource))"
}, {
"url": "displaySequence",
"valueInteger": 12
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "FHIRCommon"
}, {
"url": "name",
"valueString": "references"
}, {
"url": "statement",
"valueString": "/*\n@description: Returns true if the given reference is to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(reference FHIR.Reference, resource FHIR.Resource):\n resource.id = Last(Split(reference.reference, '/'))"
}, {
"url": "displaySequence",
"valueInteger": 13
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "FHIRHelpers"
}, {
"url": "name",
"valueString": "ToString"
}, {
"url": "statement",
"valueString": "define function ToString(value string): value.value"
}, {
"url": "displaySequence",
"valueInteger": 14
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "FHIRCommon"
}, {
"url": "name",
"valueString": "includesCode"
}, {
"url": "statement",
"valueString": "/*\n@description: Returns true if the given code is in the given codeList\n@comment: Returns true if the `code` is equivalent to any of the codes in the given `codeList`, false otherwise.\n*/\ndefine fluent function includesCode(codeList List, code Concept):\n exists (codeList C where C ~ code)"
}, {
"url": "displaySequence",
"valueInteger": 15
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "FHIRHelpers"
}, {
"url": "name",
"valueString": "ToConcept"
}, {
"url": "statement",
"valueString": "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n if concept is null then\n null\n else\n System.Concept {\n codes: concept.coding C return ToCode(C),\n display: concept.text.value\n }"
}, {
"url": "displaySequence",
"valueInteger": 16
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "FHIRHelpers"
}, {
"url": "name",
"valueString": "ToCode"
}, {
"url": "statement",
"valueString": "/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n if coding is null then\n null\n else\n System.Code {\n code: coding.code.value,\n system: coding.system.value,\n version: coding.version.value,\n display: coding.display.value\n }"
}, {
"url": "displaySequence",
"valueInteger": 17
} ]
}, {
"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": 18
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMLogic"
}, {
"url": "name",
"valueString": "Measure Observation"
}, {
"url": "statement",
"valueString": "define function \"Measure Observation\"(Encounter \"Encounter\") :\n duration in minutes of \"Related ED Visit\"(Encounter).period"
}, {
"url": "displaySequence",
"valueInteger": 19
} ]
}, {
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
"extension": [ {
"url": "libraryName",
"valueString": "EXMLogic"
}, {
"url": "name",
"valueString": "Related ED Visit"
}, {
"url": "statement",
"valueString" : "//Measure Observation\ndefine function \"Related ED Visit\"(Encounter \"Encounter\") :\n Last([\"Encounter\": \"Emergency Department Visit\"] ED\n where ED.status = 'finished'\n and ED.period ends 1 hour or less before start of Encounter.period\n sort by start of period )"
}, {
"url": "displaySequence",
"valueInteger": 20
} ]
} ],
"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 EXMCommon",
"resource": "http://hl7.org/fhir/uv/cqm/Library/EXMCommon|2.0.0"
}, {
"type": "depends-on",
"display": "Library FHIRHelpers",
"resource": "http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1"
}, {
"type": "depends-on",
"display": "Library FHIRCommon",
"resource": "http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0"
}, {
"type": "depends-on",
"display": "Code system Diagnosis Type",
"resource": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype|1.0.1"
}, {
"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|20170816"
}, {
"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|20210611"
} ],
"parameter": [ {
"max": "1",
"min": 0,
"use": "in",
"name": "Measurement Period",
"type": "Period"
}, {
"max": "*",
"min": 0,
"use": "out",
"name": "Stratification 3",
"type": "Encounter"
}, {
"max": "*",
"min": 0,
"use": "out",
"name": "Stratification 2",
"type": "Encounter"
}, {
"max": "*",
"min": 0,
"use": "out",
"name": "Stratification 1",
"type": "Encounter"
}, {
"max": "*",
"min": 0,
"use": "out",
"name": "Initial Population",
"type": "Encounter"
}, {
"max": "*",
"min": 0,
"use": "out",
"name": "Measure Population",
"type": "Encounter"
} ]
} ],
"usage": "Users of this measure should be aware that this is intentionally simplified to show specific aspects of a measure.",
"rationale": "The purpose of this measure is to show how all the elements of a FHIR-based quality measure are represented.",
"status": "active",
"id": "b9f23be9-704d-4942-bb85-3e0000acdca8",
"kind": null,
"url": "http://hl7.org/fhir/uv/cqm/Measure/EXMLogic-FHIR",
"identifier": [ {
"value": "EXM",
"system": "http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm"
}, {
"value": "urn:oid:2.16.840.1.113883.4.642.40.61.29.9",
"system": "urn:ietf:rfc:3986"
} ],
"lastReviewDate": "2019-02-17",
"riskAdjustment": "Risk adjustment for this measure is performed by...",
"scoring": {
"coding": [ {
"code": "continuous-variable",
"system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
"display": "Continuous Variable"
} ]
},
"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/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"
}
} ]
},
"clinicalRecommendationStatement": "The clinical recommendation statement for this measure is..."
}