31.2.1Care Gaps
A gap in care refers to a discrepancy or gap in a patient's care that has been identified through analysis of their medical records, history, and current health status.
These gaps can include missing or incomplete information, unmet health needs, and opportunities for preventative care or intervention. Identifying and addressing care gaps can help improve the quality of care provided to patients, reduce healthcare costs, and ultimately lead to better health outcomes.
A Gaps in Care Report is designed to communicate actual or perceived gaps in care between systems, such as the payer’s system and provider’s EMR. The report provides opportunities for providers to provide missing care and/or to communicate care provision data to payers. The report may also provide information for upcoming care opportunities, prospective gaps.
The Gaps in Care Reporting uses the DEQM Individual MeasureReport Profile. This allows the Gaps in Care Reporting to use the same machinery as the Individual Reporting to calculate measures and represent the results of individual calculation.
31.2.1.1Implementation Guide
- Please refer to the Implementation Guide for more information.
31.2.2Operation
- Smile CDR implements the $care-gaps operation.
31.2.2.1Pre-Requisites
-
A Measure Bundle that can run an evaluate-measure operation is required before
$care-gapsoperation can be run. See Measure Evaluations for more information on evaluating quality measures. -
In order to use this operation, you need to start the DQM Module
-
example bundle for Colorectal Cancer Screenings
31.2.2.1.1Supported Measure Scoring Types
- Accepted Measure ScoringType: Must be Ratio or Proportion
| Scoring Method | Supported | Description |
|---|---|---|
| proportion | ✓ | Proportion Measures |
| ratio | ✓ | Ratio Measures |
| continuous-variable | Continuous Variable | |
| cohort | Cohort | |
| composite |
31.2.2.1.2Supported Measure Basis
| Measure Basis | Supported | Description |
|---|---|---|
| resource | Measures that have population counts that are qty of Resources that match criteria of expression. Example: qty of Encounter resources. | |
| boolean | ✓ | Measures that have population count that are of value true (boolean) for criteria of expression. Example: does patient have qualifying Encounter |
31.2.2.1.3Measure Behavior
- Group component specified 'Improvement Notation' and 'ScoringType' is prioritized over Measure level definitions to determine Measure report format.
- Multi-rate measures or Measures with multiple group components defined, that get evaluated by
$care-gapscould produce one 'Detected Issue' resource per group.
31.2.3Prospective Gap Status
As of 2024.11.R01, 'prospective-gap' status can evaluate for Measures that are set up to calculate "Date of Compliance" returned value within a MeasureReport.group.extension.
This conformant Measure resource would then be able to return an extension with the calculated DateTime Interval.
If no extension to calculate "Date of Compliance" is provided on the Measure.group, or no DateTime Interval is returned by the expression, then 'prospective-gap' can't be calculated.
31.2.3.1How Prospective Gap Calculates
The "Date of Compliance" Interval, Measure Report date, along with the Measure Report population results would determine if it is a 'prospective-gap'.
31.2.3.2Example Prospective Gap Request
GET http://localhost/fhir_request/Measure/$care-gaps?measureId=ColorectalCancerScreeningsFHIR&subject=Patient/numer-EXM130-Patient-1&status=prospective-gap&periodStart=2021-01-01&periodEnd=2023-12-31
- Response format would mirror example responses.
31.2.3.3Example Group Extension for Date of Compliance
Where the specified cql expression referenced would require a return of type Interval[DateTime,DateTime].
{
"extension": [ {
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-care-gap-date-of-compliance-expression",
"valueExpression": {
"language": "text/cql-identifier",
"expression": "date of compliance"
}
} ]
}
31.2.3.4Example Date Of Compliance Measure
{
"id": "MinimalProportionResourceBasisSingleGroupWithDOC",
"resourceType": "Measure",
"url": "http://example.com/Measure/MinimalProportionResourceBasisSingleGroupWithDOC",
"library": [
"http://example.com/Library/MinimalProportionResourceBasisSingleGroup"
],
"extension": [ {
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
"valueCode": "encounter"
}
],
"scoring": {
"coding": [
{
"system": "http://hl7.org/fhir/measure-scoring",
"code": "proportion"
}
]
},
"group": [
{
"extension": [ {
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-care-gap-date-of-compliance-expression",
"valueExpression": {
"language": "text/cql-identifier",
"expression": "date of compliance"
}
} ],
"population": [
{
"id": "initial-population",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "initial-population",
"display": "Initial Population"
}
]
},
"criteria": {
"language": "text/cql-identifier",
"expression": "Initial Population"
}
},
{
"id": "denominator",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator",
"display": "Denominator"
}
]
},
"criteria": {
"language": "text/cql-identifier",
"expression": "Denominator"
}
},
{
"id": "denominator-exclusion",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator-exclusion",
"display": "Denominator-Exclusion"
}
]
},
"criteria": {
"language": "text/cql-identifier",
"expression": "Denominator Exclusion"
}
},
{
"id": "denominator-exception",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator-exception",
"display": "Denominator-Exception"
}
]
},
"criteria": {
"language": "text/cql-identifier",
"expression": "Denominator Exception"
}
},
{
"id": "numerator-exclusion",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "numerator-exclusion",
"display": "Numerator-Exclusion"
}
]
},
"criteria": {
"language": "text/cql-identifier",
"expression": "Numerator Exclusion"
}
},
{
"id": "numerator",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "numerator",
"display": "Numerator"
}
]
},
"criteria": {
"language": "text/cql-identifier",
"expression": "Numerator"
}
}
]
}
]
}
31.2.4Parameters
| Parameter | Supported | Description |
|---|---|---|
| periodStart | ✓ | is still required, but the description is modified to reference the start date of the gaps through period. |
| periodEnd | ✓ | is still required, but the description is modified to reference the end of the gaps through period. |
| subject | ✓ | can now point to either a patient, practitioner, organization, or a group of patients. If empty value is passed in, all patients in system will be used. |
| status | ✓ | is required, it SHALL be a code from the gaps status value set, which indicates an 'open-gap', 'closed-gap', 'prospective-gap', and 'not-applicable'. For the Gaps in Care Report to return DetectedIssue results that match the passed in 'status' provided. |
| measureId | ✓ | is the id of a Measure resource that is on the server for which the gaps in care will be reported. The Client will need to check with the Server to know the identifiers used by the Server to uniquely identify measures. This parameter is one of the three options provided by this operation to specify one or more measures for which the Gaps in Care Report will be created. |
| measureIdentifier | ✓ | is the business identifier for a measure. This parameter is one of the three options provided by this operation to specify one or more measures for the which the Gaps in Care Report will be created. |
| measureUrl | ✓ | is the url of a measure. This parameter is one of the three options provided by this operation to specify one or more measures for the which the Gaps in Care Report will be created. |
| nonDocument | ✓ | defaults to 'false', if left empty, which returns standard 'document' bundle. If 'true', this will return summarized subject bundle with only detectedIssue & contained MeasureReport as evidence. |
31.2.5Example Request
- Look for open or closed gap
Also note that measurement period is subject to influence of timezone header value passed into FHIR request header, see headers with fhir requests.
31.2.5.1Document Request
GET http://localhost/fhir_request/Measure/$care-gaps?measureId=ColorectalCancerScreeningsFHIR&subject=Patient/numer-EXM130-Patient-1&status=open-gap&status=closed-gap&periodStart=2021-01-01&periodEnd=2023-12-31
31.2.5.2NonDocument Request
GET http://localhost/fhir_request/Measure/$care-gaps?measureId=ColorectalCancerScreeningsFHIR&subject=Patient/numer-EXM130-Patient-1&status=open-gap&status=closed-gap&periodStart=2021-01-01&periodEnd=2023-12-31&nonDocument=true
31.2.6Example 'Prospective Gap' Scenario
How $care-gaps status algorithm interprets a 'Measure Report' that results in prospective-gap status.
{
"resourceType": "MeasureReport",
"id": "a43392e2-9844-45dd-8df8-72d82d2d848e",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/indv-measurereport-deqm"
]
},
"status": "complete",
"type": "individual",
"measure": "http://example.com/Measure/MinimalProportionBooleanBasisSingleGroupWithDOC",
"subject": {
"reference": "Patient/male-2022"
},
"date": "2024-06-15T09:59:08-06:00",
"period": {
"start": "2024-01-01T00:00:00-07:00",
"end": "2024-12-31T00:00:00-07:00"
},
"group": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-care-gap-date-of-compliance-expression",
"valuePeriod": {
"start": "2024-01-01T00:00:00-07:00",
"end": "2024-12-31T00:00:00-07:00"
}
}
],
"population": [
{
"id": "initial-population",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "initial-population",
"display": "Initial Population"
}
]
},
"count": 1
},
{
"id": "denominator",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator",
"display": "Denominator"
}
]
},
"count": 1
},
{
"id": "numerator",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "numerator",
"display": "Numerator"
}
]
},
"count": 0
}
],
"measureScore": {
"value": 0.0
}
}
]
}
- [Date of Compliance] = [2024-01-01,2024-12-31]
- [Report Date] = [2024-06-15]
- [Measure Report Population: Denominator=1]
- [Measure Report Population: Numerator=0]
Explanation: Results of Denominator=1 and not Numerator=0 on a Measure Report. The patient is in an open-gap status, meaning they meet the criteria for the measure, but have not received appropriate care.
The Report Date is within or before the Date of Compliance interval, therefore there is opportunity to provide care within recommended window of time.
Result: prospective-gap.
31.2.7Example 'Open Gap' Scenario
How $care-gaps status algorithm interprets a 'Measure Report' that results in open-gap status.
{
"resourceType": "MeasureReport",
"id": "a43392e2-9844-45dd-8df8-72d82d2d848e",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/indv-measurereport-deqm"
]
},
"status": "complete",
"type": "individual",
"measure": "http://example.com/Measure/MinimalProportionBooleanBasisSingleGroupWithDOC",
"subject": {
"reference": "Patient/male-2022"
},
"date": "2025-06-15T09:59:08-06:00",
"period": {
"start": "2024-01-01T00:00:00-07:00",
"end": "2024-12-31T00:00:00-07:00"
},
"group": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-care-gap-date-of-compliance-expression",
"valuePeriod": {
"start": "2024-01-01T00:00:00-07:00",
"end": "2024-12-31T00:00:00-07:00"
}
}
],
"population": [
{
"id": "initial-population",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "initial-population",
"display": "Initial Population"
}
]
},
"count": 1
},
{
"id": "denominator",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator",
"display": "Denominator"
}
]
},
"count": 1
},
{
"id": "numerator",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "numerator",
"display": "Numerator"
}
]
},
"count": 0
}
],
"measureScore": {
"value": 0.0
}
}
]
}
- [Date of Compliance] = [2024-01-01,2024-12-31]
- [Report Date] = [2025-06-15]
- [Measure Report Population: Denominator=1]
- [Measure Report Population: Numerator=0]
Explanation: Results of Denominator=1 and not Numerator=0 on a Measure Report. The patient is in an open-gap status, meaning they meet the criteria for the measure, but have not received appropriate care.
The Report Date is after the Date of Compliance interval, therefore there is no opportunity to provide care within recommended window of time.
Result: open-gap.
31.2.8Example 'Closed Gap' Scenario
How $care-gaps status algorithm interprets a 'Measure Report' that results in closed-gap status.
{
"resourceType": "MeasureReport",
"id": "a43392e2-9844-45dd-8df8-72d82d2d848e",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/indv-measurereport-deqm"
]
},
"status": "complete",
"type": "individual",
"measure": "http://example.com/Measure/MinimalProportionBooleanBasisSingleGroupWithDOC",
"subject": {
"reference": "Patient/male-2022"
},
"date": "2025-06-15T09:59:08-06:00",
"period": {
"start": "2024-01-01T00:00:00-07:00",
"end": "2024-12-31T00:00:00-07:00"
},
"group": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-care-gap-date-of-compliance-expression",
"valuePeriod": {
"start": "2024-01-01T00:00:00-07:00",
"end": "2024-12-31T00:00:00-07:00"
}
}
],
"population": [
{
"id": "initial-population",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "initial-population",
"display": "Initial Population"
}
]
},
"count": 1
},
{
"id": "denominator",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator",
"display": "Denominator"
}
]
},
"count": 1
},
{
"id": "numerator",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "numerator",
"display": "Numerator"
}
]
},
"count": 1
}
],
"measureScore": {
"value": 1.0
}
}
]
}
- [Date of Compliance] = [2024-01-01,2024-12-31]
- [Report Date] = [2025-06-15]
- [Measure Report Population: Denominator=1]
- [Measure Report Population: Numerator=1]
Explanation: Results of Denominator=1 and not Numerator=1 on a Measure Report. The patient is in an closed-gap status, meaning they meet the criteria for the measure, and have received appropriate care.
Result: closed-gap.
31.2.9Example 'Not Applicable' Scenario
How $care-gaps status algorithm interprets a 'Measure Report' that results in not-applicable status.
{
"resourceType": "MeasureReport",
"id": "a43392e2-9844-45dd-8df8-72d82d2d848e",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/indv-measurereport-deqm"
]
},
"status": "complete",
"type": "individual",
"measure": "http://example.com/Measure/MinimalProportionBooleanBasisSingleGroupWithDOC",
"subject": {
"reference": "Patient/male-2022"
},
"date": "2024-06-15T09:59:08-06:00",
"period": {
"start": "2024-01-01T00:00:00-07:00",
"end": "2024-12-31T00:00:00-07:00"
},
"group": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-care-gap-date-of-compliance-expression",
"valuePeriod": {
"start": "2024-01-01T00:00:00-07:00",
"end": "2024-12-31T00:00:00-07:00"
}
}
],
"population": [
{
"id": "initial-population",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "initial-population",
"display": "Initial Population"
}
]
},
"count": 1
},
{
"id": "denominator",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator",
"display": "Denominator"
}
]
},
"count": 0
},
{
"id": "numerator",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "numerator",
"display": "Numerator"
}
]
},
"count": 0
}
],
"measureScore": {
"value": 0.0
}
}
]
}
- [Date of Compliance] = [2024-01-01,2024-12-31]
- [Report Date] = [2025-06-15]
- [Measure Report Population: Denominator=0]
- [Measure Report Population: Numerator=0]
Explanation: Results of Denominator=0 on a Measure Report. The patient is in an not-applicable status, meaning they do not meet the criteria for the measure, and are not relevant for recommended care.
Result: not-applicable.
31.2.10Example Response
31.2.10.0.1Detected Issue Resource
- The Resource that details the gap status for the measure per Patient. It also ties the Measure Report resource as evidence for the result.
{
"resourceType": "DetectedIssue",
"id": "19b18c06-ce51-4afa-a7d7-c8b65d522851",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-detectedissue-deqm"
]
},
"modifierExtension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-gapStatus",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-status",
"code": "closed-gap",
"display": "Closed Gap"
}
]
}
}
],
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:0a71da45-8fd2-4548-ada7-df0cf9691d63"
}
],
"status": "final",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "CAREGAP",
"display": "Care Gaps"
}
]
},
"patient": {
"reference": "Patient/numer-EXM130-Patient-1"
},
"evidence": [
{
"detail": [
{
"reference": "MeasureReport/146e4d91-607a-40d8-b3a3-70f3f5ed3f24"
}
]
}
]
}
31.2.10.0.2Document Response Body
- Contains a bundle of resources per queried patient, this example is for one measure and one patient, but the format would be repeated if multiple measures. The "Composition" just summarizes the contents within, The Organization resource used as reporter & author, and the evaluated resources used to generate the MeasureReport for the subject.
{
"resourceType": "Parameters",
"id": "care-gaps-report-d2e03d9a-43c8-445d-a3af-d0d1ecfcdb2c",
"parameter": [
{
"id": "subject-numer-EXM130-Patient-1",
"name": "return",
"resource": {
"resourceType": "Bundle",
"id": "f21c0731-9de5-4390-ad5d-4257bcba237f",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-bundle-deqm"
]
},
"identifier": {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:5419b676-bc8b-4af7-b976-25196d564151"
},
"type": "document",
"timestamp": "2024-03-05T02:29:22.931+00:00",
"entry": [
{
"fullUrl": "https://cdr-qa-cluster.alphora.com/fhir_request/Composition/5507c6a0-a3e3-415f-a0ed-bf77c70fbea3",
"resource": {
"resourceType": "Composition",
"id": "5507c6a0-a3e3-415f-a0ed-bf77c70fbea3",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-composition-deqm"
]
},
"identifier": {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:1bee456d-1ac5-42d9-a2e8-62312edd8aaa"
},
"status": "final",
"type": {
"coding": [
{
"system": "http://loinc.org",
"code": "96315-7",
"display": "Gaps in care report"
}
]
},
"subject": {
"reference": "Patient/numer-EXM130-Patient-1"
},
"date": "2024-03-05T02:29:21+00:00",
"author": [
{
"reference": "Organization/organization-group-1"
}
],
"title": "Care Gap Report for numer-EXM130-Patient-1",
"section": [
{
"id": "09ff0272-0c6b-4f0e-8d8a-c6d098d0b5a2",
"title": "Colorectal Cancer ScreeningFHIR",
"focus": {
"reference": "MeasureReport/61fb95cf-2707-40a3-b899-78a7580b54ce"
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>No detected issues.</p></div>"
},
"entry": [
{
"reference": "DetectedIssue/64cd6948-8d84-43c5-afb7-8e1de1ce76bd"
}
]
}
]
}
},
{
"fullUrl": "https://cdr-qa-cluster.alphora.com/fhir_request/MeasureReport/61fb95cf-2707-40a3-b899-78a7580b54ce",
"resource": {
"resourceType": "MeasureReport",
"id": "61fb95cf-2707-40a3-b899-78a7580b54ce",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/indv-measurereport-deqm"
]
},
"language": "en",
"contained": [
{
"resourceType": "Observation",
"id": "05cd8670-31c2-4afa-8a27-8a950268699d",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-measureInfo",
"extension": [
{
"url": "measure",
"valueCanonical": "http://ecqi.healthit.gov/ecqms/Measure/ColorectalCancerScreeningsFHIR"
}
]
}
],
"status": "final",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code": "supplemental-data"
}
]
},
"valueCodeableConcept": {
"coding": [
{
"code": "2028-9"
}
]
}
},
{
"resourceType": "Observation",
"id": "2e263cbd-efc5-4b26-a47d-0bfa7ed2f09c",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-measureInfo",
"extension": [
{
"url": "measure",
"valueCanonical": "http://ecqi.healthit.gov/ecqms/Measure/ColorectalCancerScreeningsFHIR"
}
]
}
],
"status": "final",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code": "supplemental-data"
}
]
},
"valueCodeableConcept": {
"coding": [
{
"code": "M"
}
]
}
},
{
"resourceType": "Observation",
"id": "a8cbc695-6b13-4aec-9db7-e4ddb7e6f229",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-measureInfo",
"extension": [
{
"url": "measure",
"valueCanonical": "http://ecqi.healthit.gov/ecqms/Measure/ColorectalCancerScreeningsFHIR"
}
]
}
],
"status": "final",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code": "supplemental-data"
}
]
},
"valueCodeableConcept": {
"coding": [
{
"code": "2135-2"
}
]
}
}
],
"extension": [
{
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.population.description",
"valueString": "Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer"
},
{
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalDataElement.reference",
"valueReference": {
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "8114BAD7-FAC8-4E22-91CB-33BC3DDB9986"
}
],
"reference": "#2e263cbd-efc5-4b26-a47d-0bfa7ed2f09c"
}
},
{
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalDataElement.reference",
"valueReference": {
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "9CB0299E-74B0-4425-8758-52D6FC0F979C"
}
],
"reference": "#a8cbc695-6b13-4aec-9db7-e4ddb7e6f229"
}
},
{
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalDataElement.reference",
"valueReference": {
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "5C3ACF2A-15D2-44A0-A83D-F4FCC3E2F27A"
}
],
"reference": "#05cd8670-31c2-4afa-8a27-8a950268699d"
}
}
],
"status": "complete",
"type": "individual",
"measure": "http://ecqi.healthit.gov/ecqms/Measure/ColorectalCancerScreeningsFHIR|0.0.003",
"subject": {
"reference": "Patient/numer-EXM130-Patient-1"
},
"date": "2024-03-05T02:29:22+00:00",
"reporter": {
"reference": "organization-group-1"
},
"period": {
"start": "2021-01-01T00:00:00+00:00",
"end": "2023-12-31T23:59:59+00:00"
},
"improvementNotation": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
"code": "increase"
}
]
},
"group": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-cqfm-denominator-membership",
"valueString": "1"
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-cqfm-numerator-membership",
"valueString": "1"
}
],
"population": [
{
"id": "178DA8D8-0694-4B88-8FFE-42CE671EEE35",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "initial-population",
"display": "Initial Population"
}
]
},
"count": 1
},
{
"id": "0AC3911A-2ADC-4DA4-BEBF-545FF8D6D819",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator",
"display": "Denominator"
}
]
},
"count": 1
},
{
"id": "67EABB9C-ADCF-4593-A8DA-35FF25DA594C",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator-exclusion",
"display": "Denominator Exclusion"
}
]
},
"count": 0
},
{
"id": "14B66980-07F4-4872-83AF-C425C379B971",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "numerator",
"display": "Numerator"
}
]
},
"count": 1
}
],
"measureScore": {
"value": 1.0
}
}
],
"evaluatedResource": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "178DA8D8-0694-4B88-8FFE-42CE671EEE35"
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "0AC3911A-2ADC-4DA4-BEBF-545FF8D6D819"
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "67EABB9C-ADCF-4593-A8DA-35FF25DA594C"
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "9CB0299E-74B0-4425-8758-52D6FC0F979C"
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "5C3ACF2A-15D2-44A0-A83D-F4FCC3E2F27A"
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "8114BAD7-FAC8-4E22-91CB-33BC3DDB9986"
}
],
"reference": "Patient/numer-EXM130-Patient-1"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "178DA8D8-0694-4B88-8FFE-42CE671EEE35"
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "0AC3911A-2ADC-4DA4-BEBF-545FF8D6D819"
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "67EABB9C-ADCF-4593-A8DA-35FF25DA594C"
}
],
"reference": "Encounter/numer-EXM130-Encounter-1"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "14B66980-07F4-4872-83AF-C425C379B971"
}
],
"reference": "Procedure/numer-EXM130-1"
}
]
}
},
{
"fullUrl": "https://cdr-qa-cluster.alphora.com/fhir_request/DetectedIssue/64cd6948-8d84-43c5-afb7-8e1de1ce76bd",
"resource": {
"resourceType": "DetectedIssue",
"id": "64cd6948-8d84-43c5-afb7-8e1de1ce76bd",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-detectedissue-deqm"
]
},
"modifierExtension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-gapStatus",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-status",
"code": "closed-gap",
"display": "Closed Gap"
}
]
}
}
],
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:e2696505-77cf-4e85-9c5d-d3b740cd8174"
}
],
"status": "final",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "CAREGAP",
"display": "Care Gaps"
}
]
},
"patient": {
"reference": "Patient/numer-EXM130-Patient-1"
},
"evidence": [
{
"detail": [
{
"reference": "MeasureReport/61fb95cf-2707-40a3-b899-78a7580b54ce"
}
]
}
]
}
},
{
"fullUrl": "https://cdr-qa-cluster.alphora.com/fhir_request/Organization/organization-group-1",
"resource": {
"resourceType": "Organization",
"id": "organization-group-1",
"meta": {
"versionId": "1",
"lastUpdated": "2024-03-04T15:38:56.843+00:00",
"source": "#LN6pEhFDHzMRJTrl"
},
"identifier": [
{
"use": "official",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "TAX",
"display": "Tax ID Number"
}
]
},
"value": "000014522"
}
],
"active": true,
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/organization-type",
"code": "pay"
}
],
"text": "Payer"
}
],
"name": "Group Organization",
"telecom": [
{
"system": "phone",
"value": "(+1) 555-555-5555"
},
{
"system": "email",
"value": "hq@acme.org"
}
],
"address": [
{
"line": [
"100 Insurance Avenue"
],
"city": "Amherst",
"state": "MA",
"postalCode": "01002",
"country": "USA"
}
]
}
},
{
"fullUrl": "https://cdr-qa-cluster.alphora.com/fhir_request/Organization/organization-group-1",
"resource": {
"resourceType": "Organization",
"id": "organization-group-1",
"meta": {
"versionId": "1",
"lastUpdated": "2024-03-04T15:38:56.843+00:00",
"source": "#LN6pEhFDHzMRJTrl"
},
"identifier": [
{
"use": "official",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "TAX",
"display": "Tax ID Number"
}
]
},
"value": "000014522"
}
],
"active": true,
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/organization-type",
"code": "pay"
}
],
"text": "Payer"
}
],
"name": "Group Organization",
"telecom": [
{
"system": "phone",
"value": "(+1) 555-555-5555"
},
{
"system": "email",
"value": "hq@acme.org"
}
],
"address": [
{
"line": [
"100 Insurance Avenue"
],
"city": "Amherst",
"state": "MA",
"postalCode": "01002",
"country": "USA"
}
]
}
},
{
"fullUrl": "https://cdr-qa-cluster.alphora.com/fhir_request/Patient/numer-EXM130-Patient-1",
"resource": {
"resourceType": "Patient",
"id": "numer-EXM130-Patient-1",
"meta": {
"versionId": "1",
"lastUpdated": "2024-03-04T15:39:05.393+00:00",
"source": "#jHv5rnS3TIf8vzxr",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
]
},
"extension": [
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
"extension": [
{
"url": "ombCategory",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2028-9",
"display": "Asian"
}
}
]
},
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
"extension": [
{
"url": "ombCategory",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2135-2",
"display": "Hispanic or Latino"
}
}
]
}
],
"identifier": [
{
"use": "usual",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MR",
"display": "Medical Record Number"
}
]
},
"system": "http://hospital.smarthealthit.org",
"value": "999999992"
}
],
"name": [
{
"family": "Blitz",
"given": [
"Don"
]
}
],
"gender": "male",
"birthDate": "1965-01-01",
"generalPractitioner": [
{
"reference": "Practitioner/practitioner-group-org-1"
}
]
}
},
{
"fullUrl": "https://cdr-qa-cluster.alphora.com/fhir_request/Encounter/numer-EXM130-Encounter-1",
"resource": {
"resourceType": "Encounter",
"id": "numer-EXM130-Encounter-1",
"meta": {
"versionId": "1",
"lastUpdated": "2024-03-04T15:39:05.393+00:00",
"source": "#jHv5rnS3TIf8vzxr",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"
]
},
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB",
"display": "ambulatory"
},
"type": [
{
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99201",
"display": "Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family."
}
]
}
],
"subject": {
"reference": "Patient/numer-EXM130-Patient-1"
},
"period": {
"start": "2023-05-30T00:00:00.0",
"end": "2023-05-31T00:00:00.0"
}
}
},
{
"fullUrl": "https://cdr-qa-cluster.alphora.com/fhir_request/Procedure/numer-EXM130-1",
"resource": {
"resourceType": "Procedure",
"id": "numer-EXM130-1",
"meta": {
"versionId": "1",
"lastUpdated": "2024-03-04T15:39:05.393+00:00",
"source": "#jHv5rnS3TIf8vzxr",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure"
]
},
"status": "completed",
"code": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "44388",
"display": "Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique"
}
]
},
"subject": {
"reference": "Patient/numer-EXM130-Patient-1"
},
"performedPeriod": {
"start": "2014-01-01T00:00:00-06:00",
"end": "2014-01-01T01:00:00-07:00"
}
}
}
]
}
}
]
}
31.2.10.0.3NonDocument Response Body
{
"resourceType": "Parameters",
"id": "care-gaps-report-d2e03d9a-43c8-445d-a3af-d0d1ecfcdb2c",
"parameter": [
{
"id": "subject-numer-EXM130-Patient-1",
"name": "return",
"resource": {
"resourceType": "Bundle",
"id": "f21c0731-9de5-4390-ad5d-4257bcba237f",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-bundle-deqm"
]
},
"identifier": {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:5419b676-bc8b-4af7-b976-25196d564151"
},
"type": "document",
"timestamp": "2024-03-05T02:29:22.931+00:00",
"entry": [
{
"fullUrl": "https://cdr-qa-cluster.alphora.com/fhir_request/DetectedIssue/64cd6948-8d84-43c5-afb7-8e1de1ce76bd",
"resource": {
"resourceType": "DetectedIssue",
"id": "64cd6948-8d84-43c5-afb7-8e1de1ce76bd",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-detectedissue-deqm"
]
},
"modifierExtension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-gapStatus",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-status",
"code": "closed-gap",
"display": "Closed Gap"
}
]
}
}
],
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:e2696505-77cf-4e85-9c5d-d3b740cd8174"
}
],
"status": "final",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "CAREGAP",
"display": "Care Gaps"
}
]
},
"patient": {
"reference": "Patient/numer-EXM130-Patient-1"
},
"evidence": [
{
"detail": [
{
"reference": "#MeasureReport/61fb95cf-2707-40a3-b899-78a7580b54ce"
}
]
}
],
"contained": [
{
"resourceType": "MeasureReport",
"id": "61fb95cf-2707-40a3-b899-78a7580b54ce",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/indv-measurereport-deqm"
]
},
"language": "en",
"contained": [
{
"resourceType": "Observation",
"id": "05cd8670-31c2-4afa-8a27-8a950268699d",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-measureInfo",
"extension": [
{
"url": "measure",
"valueCanonical": "http://ecqi.healthit.gov/ecqms/Measure/ColorectalCancerScreeningsFHIR"
}
]
}
],
"status": "final",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code": "supplemental-data"
}
]
},
"valueCodeableConcept": {
"coding": [
{
"code": "2028-9"
}
]
}
},
{
"resourceType": "Observation",
"id": "2e263cbd-efc5-4b26-a47d-0bfa7ed2f09c",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-measureInfo",
"extension": [
{
"url": "measure",
"valueCanonical": "http://ecqi.healthit.gov/ecqms/Measure/ColorectalCancerScreeningsFHIR"
}
]
}
],
"status": "final",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code": "supplemental-data"
}
]
},
"valueCodeableConcept": {
"coding": [
{
"code": "M"
}
]
}
},
{
"resourceType": "Observation",
"id": "a8cbc695-6b13-4aec-9db7-e4ddb7e6f229",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-measureInfo",
"extension": [
{
"url": "measure",
"valueCanonical": "http://ecqi.healthit.gov/ecqms/Measure/ColorectalCancerScreeningsFHIR"
}
]
}
],
"status": "final",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code": "supplemental-data"
}
]
},
"valueCodeableConcept": {
"coding": [
{
"code": "2135-2"
}
]
}
}
],
"extension": [
{
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.population.description",
"valueString": "Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer"
},
{
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalDataElement.reference",
"valueReference": {
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "8114BAD7-FAC8-4E22-91CB-33BC3DDB9986"
}
],
"reference": "#2e263cbd-efc5-4b26-a47d-0bfa7ed2f09c"
}
},
{
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalDataElement.reference",
"valueReference": {
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "9CB0299E-74B0-4425-8758-52D6FC0F979C"
}
],
"reference": "#a8cbc695-6b13-4aec-9db7-e4ddb7e6f229"
}
},
{
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalDataElement.reference",
"valueReference": {
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "5C3ACF2A-15D2-44A0-A83D-F4FCC3E2F27A"
}
],
"reference": "#05cd8670-31c2-4afa-8a27-8a950268699d"
}
}
],
"status": "complete",
"type": "individual",
"measure": "http://ecqi.healthit.gov/ecqms/Measure/ColorectalCancerScreeningsFHIR|0.0.003",
"subject": {
"reference": "Patient/numer-EXM130-Patient-1"
},
"date": "2024-03-05T02:29:22+00:00",
"reporter": {
"reference": "organization-group-1"
},
"period": {
"start": "2021-01-01T00:00:00+00:00",
"end": "2023-12-31T23:59:59+00:00"
},
"improvementNotation": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
"code": "increase"
}
]
},
"group": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-cqfm-denominator-membership",
"valueString": "1"
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-cqfm-numerator-membership",
"valueString": "1"
}
],
"population": [
{
"id": "178DA8D8-0694-4B88-8FFE-42CE671EEE35",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "initial-population",
"display": "Initial Population"
}
]
},
"count": 1
},
{
"id": "0AC3911A-2ADC-4DA4-BEBF-545FF8D6D819",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator",
"display": "Denominator"
}
]
},
"count": 1
},
{
"id": "67EABB9C-ADCF-4593-A8DA-35FF25DA594C",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator-exclusion",
"display": "Denominator Exclusion"
}
]
},
"count": 0
},
{
"id": "14B66980-07F4-4872-83AF-C425C379B971",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "numerator",
"display": "Numerator"
}
]
},
"count": 1
}
],
"measureScore": {
"value": 1.0
}
}
],
"evaluatedResource": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "178DA8D8-0694-4B88-8FFE-42CE671EEE35"
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "0AC3911A-2ADC-4DA4-BEBF-545FF8D6D819"
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "67EABB9C-ADCF-4593-A8DA-35FF25DA594C"
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "9CB0299E-74B0-4425-8758-52D6FC0F979C"
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "5C3ACF2A-15D2-44A0-A83D-F4FCC3E2F27A"
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "8114BAD7-FAC8-4E22-91CB-33BC3DDB9986"
}
],
"reference": "Patient/numer-EXM130-Patient-1"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "178DA8D8-0694-4B88-8FFE-42CE671EEE35"
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "0AC3911A-2ADC-4DA4-BEBF-545FF8D6D819"
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "67EABB9C-ADCF-4593-A8DA-35FF25DA594C"
}
],
"reference": "Encounter/numer-EXM130-Encounter-1"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-criteriaReference",
"valueString": "14B66980-07F4-4872-83AF-C425C379B971"
}
],
"reference": "Procedure/numer-EXM130-1"
}
]
}
]
}
}
]
}
}
]
}
31.2.11Example Resources
- You can test the same requests above by posting this measure bundle
31.2.12DQM Module Configurations
- This operation requires three configurations to be set for
care-gapsoperation in order to start the dQM module.
31.2.12.0.1Reporter Configuration
- An Organization resource reference that defines who is reporting the care-gap and will appear on Care-Gap response.
See here for Dqm Module Configuration Categories
31.2.12.0.2Reporter Author Configuration
- An Organization resource reference that defines who authored the care-gap report and will appear on Care-Gap response.
See here for Dqm Module Configuration Categories
31.2.12.0.3Multi-Threaded Care Gaps Configuration
- By default, this is set to true.
- This configuration allows CDR to parallelize care-gap requests to increase performance of the operation.
- This can be optimized by increasing the number of concurrent threads in the dqm module (dqm "advance properties") "number of Threads" property to align with the number of threads your CDR instance is deployed with (4 core deployment, number of threads = 4).
See here for Dqm Module Configuration Categories