-
Notifications
You must be signed in to change notification settings - Fork 0
Gaps in Care Expected Outputs
Matthew Gramigna edited this page Apr 15, 2022
·
2 revisions
The improvement notation of a FHIR Measure resources indicates whether or not higher quality is indicated by an increase or decrease in the measure score.
As seen in the specification, CMS122 is a "negative improvement" measure, which means that a lower measure score (i.e. less patients in the numerator) indicates better quality.
In the case of $care-gaps, we expect gaps to occur when data is present on the patient record rather than missing. In the case of CMS122, we expect gaps to occur in the following cases:
- The patient has a most recent HbA1c test whose value is
> 9% - The patient has a most recent HbA1c test which does not have a recorded value
- The patient has no record of HbA1c tests
http://localhost:3000/4_0_1/Measure/$care-gaps?periodStart=2019-01-01&periodEnd=2019-12-31&status=open-gap&measureId=DiabetesHemoglobinA1cHbA1cPoorControl9FHIR&subject=Patient/<your-patient-id>
Replace <your-patient-id> with the id of the FHIR Patient resource to calculate gaps for. For the sake of this guide, we assume the patient already meets the "Initial Population" and "Denominator" criteria for the measure.
Note that exact responses may not look like this right away, but getting to these is one of the goals of the Connectathon.
If the patient has an HbA1c test whose value is > 9% (this is the most common scenario), we expect the response to look as follows:
{
"resourceType": "Parameters",
"parameter": [
{
"name": "return",
"resource": {
"resourceType": "Bundle",
"type": "document",
"entry": [
{
"resource": {
"resourceType": "Composition",
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-doc-type",
"code": "gaps-doc",
"display": "Gaps in Care Report"
}
]
},
"author": [
{
"reference": "Patient/<your-patient-id>"
}
],
"subject": {
"reference": "Patient/<your-patient-id>"
},
"date": "2022-04-04T17:47:59.957Z",
"title": "Gaps in Care Report",
"status": "preliminary",
"section": [
{
"title": "http://ecqi.healthit.gov/ecqms/Measure/DiabetesHemoglobinA1cHbA1cPoorControl9FHIR",
"focus": {
"reference": "MeasureReport/94f59937-e945-45a0-8b42-0390ecc83516"
},
"entry": [
{
"reference": "DetectedIssue/532edca0-ac99-45d4-924b-dc80884f1242"
}
]
}
]
}
},
{ "resource": { <MeasureReport snipped for brevity> } },
{ "resource": { <Patient snipped for brevity> } },
{
"resource": {
"resourceType": "DetectedIssue",
"id": "532edca0-ac99-45d4-924b-dc80884f1242",
"status": "final",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/detectedissue-category",
"code": "care-gap",
"display": "Gap in Care Detected"
}
]
},
"evidence": [
{
"detail": [
{
"reference": "#b9cee92c-a73d-4176-8562-55b2e72e8261"
}
]
}
],
"contained": [
{
"resourceType": "GuidanceResponse",
"id": "b9cee92c-a73d-4176-8562-55b2e72e8261",
"dataRequirement": [
{
"type": "Observation",
"codeFilter": [
{
"path": "code",
"valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1013"
},
{
"path": "status",
"code": [
{
"code": "final",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "amended",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "corrected",
"system": "http://hl7.org/fhir/observation-status"
}
]
}
],
"dateFilter": [
{
"path": "effective",
"valuePeriod": {
"start": "<measurement-period-start>",
"end": "<measurement-period-end>"
}
}
],
"extension": [
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-valueFilter",
"extension": [
{
"url": "path",
"valueString": "value"
},
{
"url": "comparator",
"valueCode": "gt"
},
{
"url": "value",
"valueQuantity": {
"value": 9,
"unit": "%"
}
}
]
}
]
}
],
"reasonCode": [
{
"coding": [
{
"system": "CareGapReasonCodeSystem",
"code": "ValueOutOfRange",
"display": "Value is out of specified range",
"extension": [
{
"url": "ReasonDetail",
"extension": [
{
"url": "reference",
"valueReference": {
"reference": "Observation/<some-observation-id>"
}
},
{
"url": "path",
"valueString": "value"
}
]
}
]
}
]
}
],
"status": "data-required",
"moduleUri": "http://ecqi.healthit.gov/ecqms/Measure/DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
}
]
}
}
]
}
}
]
}If the patient has an HbA1c test without a recorded value, we expect the response to look as follows:
{
"resourceType": "Parameters",
"parameter": [
{
"name": "return",
"resource": {
"resourceType": "Bundle",
"type": "document",
"entry": [
{
"resource": {
"resourceType": "Composition",
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-doc-type",
"code": "gaps-doc",
"display": "Gaps in Care Report"
}
]
},
"author": [
{
"reference": "Patient/<your-patient-id>"
}
],
"subject": {
"reference": "Patient/<your-patient-id>"
},
"date": "2022-04-04T18:02:19.571Z",
"title": "Gaps in Care Report",
"status": "preliminary",
"section": [
{
"title": "http://ecqi.healthit.gov/ecqms/Measure/DiabetesHemoglobinA1cHbA1cPoorControl9FHIR",
"focus": {
"reference": "MeasureReport/106c6d5c-505d-407d-9d0b-52c7f6712cd8"
},
"entry": [
{
"reference": "DetectedIssue/34412aa6-3d05-4223-ae6f-3c692d8db351"
}
]
}
]
}
},
{ "resource": { <MeasureReport snipped for brevity> } },
{ "resource": { <Patient snipped for brevity> } },
{
"resource": {
"resourceType": "DetectedIssue",
"id": "34412aa6-3d05-4223-ae6f-3c692d8db351",
"status": "final",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/detectedissue-category",
"code": "care-gap",
"display": "Gap in Care Detected"
}
]
},
"evidence": [
{
"detail": [
{
"reference": "#f8ebec80-a924-4b2c-96d5-96ee3d28ef1e"
}
]
}
],
"contained": [
{
"resourceType": "GuidanceResponse",
"id": "f8ebec80-a924-4b2c-96d5-96ee3d28ef1e",
"dataRequirement": [
{
"type": "Observation",
"codeFilter": [
{
"path": "code",
"valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1013"
},
{
"path": "status",
"code": [
{
"code": "final",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "amended",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "corrected",
"system": "http://hl7.org/fhir/observation-status"
}
]
}
],
"dateFilter": [
{
"path": "effective",
"valuePeriod": {
"start": "<measurement-period-start>",
"end": "<measurement-period-end>"
}
}
],
"extension": [
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-valueFilter",
"extension": [
{
"url": "path",
"valueString": "value"
},
{
"url": "comparator",
"valueCode": "gt"
},
{
"url": "value",
"valueQuantity": {
"value": 9,
"unit": "%"
}
}
]
}
]
}
],
"reasonCode": [
{
"coding": [
{
"system": "CareGapReasonCodeSystem",
"code": "NotFound",
"display": "Data Element Not Found",
"extension": [
{
"url": "ReasonDetail",
"extension": [
{
"url": "reference",
"valueReference": {
"reference": "Observation/<some-observation-id>"
}
},
{
"url": "path",
"valueString": "value"
}
]
}
]
}
]
}
],
"status": "data-required",
"moduleUri": "http://ecqi.healthit.gov/ecqms/Measure/DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
}
]
}
}
]
}
}
]
}If the patient has no record of HbA1c the response should look as follows:
{
"resourceType": "Parameters",
"parameter": [
{
"name": "return",
"resource": {
"resourceType": "Bundle",
"type": "document",
"entry": [
{
"resource": {
"resourceType": "Composition",
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-doc-type",
"code": "gaps-doc",
"display": "Gaps in Care Report"
}
]
},
"author": [
{
"reference": "Patient/<your-patient-id>"
}
],
"subject": {
"reference": "Patient/<your-patient-id>"
},
"date": "2022-04-04T18:02:19.571Z",
"title": "Gaps in Care Report",
"status": "preliminary",
"section": [
{
"title": "http://ecqi.healthit.gov/ecqms/Measure/DiabetesHemoglobinA1cHbA1cPoorControl9FHIR",
"focus": {
"reference": "MeasureReport/106c6d5c-505d-407d-9d0b-52c7f6712cd8"
},
"entry": [
{
"reference": "DetectedIssue/34412aa6-3d05-4223-ae6f-3c692d8db351"
}
]
}
]
}
},
{ "resource": { <MeasureReport snipped for brevity> } },
{ "resource": { <Patient snipped for brevity> } },
{
"resource": {
"resourceType": "DetectedIssue",
"id": "34412aa6-3d05-4223-ae6f-3c692d8db351",
"status": "final",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/detectedissue-category",
"code": "care-gap",
"display": "Gap in Care Detected"
}
]
},
"evidence": [
{
"detail": [
{
"reference": "#f8ebec80-a924-4b2c-96d5-96ee3d28ef1e"
}
]
}
],
"contained": [
{
"resourceType": "GuidanceResponse",
"id": "f8ebec80-a924-4b2c-96d5-96ee3d28ef1e",
"dataRequirement": [
{
"type": "Observation",
"codeFilter": [
{
"path": "code",
"valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1013"
},
{
"path": "status",
"code": [
{
"code": "final",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "amended",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "corrected",
"system": "http://hl7.org/fhir/observation-status"
}
]
}
],
"dateFilter": [
{
"path": "effective",
"valuePeriod": {
"start": "<measurement-period-start>",
"end": "<measurement-period-end>"
}
}
],
"extension": [
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-valueFilter",
"extension": [
{
"url": "path",
"valueString": "value"
},
{
"url": "comparator",
"valueCode": "gt"
},
{
"url": "value",
"valueQuantity": {
"value": 9,
"unit": "%"
}
}
]
}
]
}
],
"reasonCode": [
{
"coding": [
{
"system": "CareGapReasonCodeSystem",
"code": "NotFound",
"display": "Data Element Not Found"
}
]
}
],
"status": "data-required",
"moduleUri": "http://ecqi.healthit.gov/ecqms/Measure/DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
}
]
}
}
]
}
}
]
}