31.1.1Table of Contents

• Clinical Reasoning Operations
• CQL Module
• CQL Evaluate Operation
  • CQL Evaluate Operation Parameters
  • CQL Operation Examples
    • Loaded Library, Expression
    • Inline CQL Expression
• Library Evaluate Operation
  • Library Evaluate Operation Parameters
  • Evaluate Whole Library Resource with Subject
  • Evaluate Library Resource Expression with Subject
• Usage

31.1.2Introduction

Clinical Quality Language (CQL) is a high-level, domain-specific language focused on clinical quality and targeted at measure and decision support artifact authors. Smile CDR has an embedded CQL engine allowing the evaluation of clinical knowledge artifacts that use CQL to describe their logic.

A more detailed description of CQL is available at the CQL Specification Implementation Guide

The FHIR Clinical Reasoning module defines a set of resources, profiles, operations, etc. that can be used to work with clinical knowledge within FHIR. Smile CDR provides implementation for some of those operations, described in more detail below.

31.1.2.1CQL Implementation Guides

• CQL Evaluation Operation IG
• Library Evaluation Operation IG
• CQL IG

31.1.2.2Clinical Reasoning Operations

Smile CDR provides implementations of operations using CQL in DSTU3 and R4:

• Quality Measure Evaluations
• Care Gaps
• PlanDefinition Operations
• Questionnaire Operations

31.1.3CQL Module

CQL module is used to configure CQL options that control how the CQL is executed and how the errors are reported during expression evaluation.

This module is to capture and set the CQL options to be used by other components or modules.

Following are the modules identified to be dependent on CQL properties module.

• DQM
• Prior Auth DTR

NOTE: The values set for the cql properties are applied for all the dependent modules. See Module for specific configuration options.

31.1.4CQL Evaluate Operation

• This operation is defined to support evaluating CQL expressions directly via an operation
• Start DQM Module in order to activate operation in CDR

31.1.4.1CQL Evaluate Operation Parameters

31.1.4.2CQL Operation Examples

Examples of using the $cql operation

POST https://localhost/fhir_request/$cql?subject=Patient/numer-EXM130-Patient-1

{
  "resourceType": "Parameters",
  "parameter":[
      {
        "name": "expression",
        "valueString": "ColorectalCancerScreeningsFHIR.Numerator"
      },
      {
        "name": "library",
        "resource": {
                "resourceType": "Parameters",
                "parameter": [
                    {
                        "name": "name",
                    "valueString": "ColorectalCancerScreeningsFHIR"
                    },
                    {
                    "name": "url",
                    "valueCanonical": "https://localhost/fhir_request/Library/ColorectalCancerScreeningsFHIR|0.0.003"
                    }
                ]
        }
      }
  ]       
}

{
    "resourceType": "Parameters",
    "parameter": [
        {
            "name": "return",
            "valueBoolean": false
        }
    ]
}

GET https://localhost/fhir_request/$cql?expression=Interval[Today() - 2 years, Today())

{
    "resourceType": "Parameters",
    "parameter": [
        {
            "name": "return",
            "valuePeriod": {
                "start": "2022-03-05T00:00:00+00:00",
                "end": "2024-03-04T00:00:00+00:00"
            }
        }
    ]
}

31.1.5Library Evaluate Operation

• This operation is defined to support evaluating the contents of a library directly via an operation
• Start DQM Module in order to activate operation in CDR

31.1.5.1Library Evaluate Operation Parameters

31.1.5.2Evaluate Whole Library Resource with Subject

• Request

GET https://localhost/fhir_request/Library/ColorectalCancerScreeningsFHIR/$evaluate?subject=Patient/numer-EXM130-Patient-1

• Response

{
   "resourceType": "Parameters",
   "parameter": [
      {
         "name": "Denominator",
         "valueBoolean": false
      },
      {
         "name": "Denominator Exclusions"
      },
      {
         "name": "Initial Population",
         "valueBoolean": false
      },
      {
         "name": "Numerator",
         "valueBoolean": false
      },
      {
         "name": "Patient",
         "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"
               }
            ]
         }
      },
      {
         "name": "SDE Ethnicity",
         "valueCoding": {
            "system": "urn:oid:2.16.840.1.113883.6.238",
            "code": "2135-2",
            "display": "Hispanic or Latino"
         }
      },
      {
         "name": "SDE Race",
         "valueCoding": {
            "system": "urn:oid:2.16.840.1.113883.6.238",
            "code": "2028-9",
            "display": "Asian"
         }
      },
      {
         "name": "SDE Sex",
         "valueCoding": {
            "system": "http://hl7.org/fhir/v3/AdministrativeGender",
            "code": "M",
            "display": "Male"
         }
      }
   ]
}

31.1.5.3Evaluate Library Resource Expression with Subject

• Request

GET https://localhost/fhir_request/Library/ColorectalCancerScreeningsFHIR/$evaluate?subject=Patient/numer-EXM130-Patient-1&expression=Numerator

• Response

{
    "resourceType": "Parameters",
    "parameter": [
        {
            "name": "Numerator",
            "valueBoolean": false
        }
    ]
}

31.1.6Usage

• CQL Module should be enabled on the admin page of SmileCDR. Once it is enabled after selecting the required values for the properties that needs to be applied to the other modules, the configurations are needed to be saved and the module need to be restarted.