FHIR IG Statistics: Measure/publishable-example

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Narrative

Note: links and images are rebased to the (stated) source

define "Antenatal care contact":
  ["Encounter": type in BCx."Antenatal care contact"]

define "First antenatal care contact":
  BaseData."Antenatal care contact" C
    where C.reasonCode in Cx."First Antenatal Care Contact Choices"

/*
  @dataElement: ANC.B6.DE17 Gestational age
  @activity: ANC.B6 Profile
  @description: Gestational age in weeks and/or days depending on the source of gestational age
*/
define "Gestational age":
  WC.MostRecent(
  [Observation: Cx."Gestational age"] O
    where O.status in { 'final', 'amended', 'corrected' }
      and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
      and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
  ).value as FHIR.Quantity

/*
Numerator: Number of pregnant women who had their first ANC contact before 12 weeks (facility level)
Numerator Computation: Count of women whose gestational age <= 12 weeks at the time of first contact
*/
define Numerator:
  exists (
    "First antenatal care contact" C
      where C.period starts during "Measurement Period"
        and ContactData."Gestational age" <= 12 weeks
  )

/*
By Patient Age as of the start of the Measurement Period
Age (10-14, 15-19, 20+)
*/
define "By Age":
  case
    when AgeInYearsAt(start of "Measurement Period") in Interval[10, 14] then "P10Y--P14Y"
    when AgeInYearsAt(start of "Measurement Period") in Interval[15, 19] then "P15Y--P19Y"
    when AgeInYearsAt(start of "Measurement Period") >= 20 then "P20Y--P9999Y"
    else null
  end

/*
Disaggregation: Age (10-14, 15-19, 20+)
*/
define "Age Stratifier":
  Stratifiers."By Age"

/*
Denominator: Total number of antenatal clients with a first contact
Denominator Computation: Count of all women who had first contact within the last reporting period
*/
define Denominator:
  exists (
    "First antenatal care contact" C
      where C.period starts during "Measurement Period"
  )

/*
By Patient Education Level (none, don't know, primary, secondary, higher)
*/
define "By Education Level":
  Patient.extension E
    where E.url = 'http://fhir.org/guides/who/anc-cds/StructureDefinition/educationlevel'
    return E.value as CodeableConcept

/*
Disaggregation: Education Level (none, don't know, primary, secondary, higher)
*/
define "Education Level Stratifier":
  Stratifiers."By Education Level"

/*
define "Pregnant":
  "Pregnancy" is not null
    or "Pregnancy status" in BCx."Pregnancy status - pregnant"

define "Pregnancy status":
  FHIRHelpers.ToConcept(
    Last(
      [Observation: BCx."Pregnancy status"] O
        where O.status = 'final'
        sort by FHIRHelpers.ToDateTime(effective as FHIR.dateTime)
    ).value
  )
*/
define "Antenatal care case":
  ["EpisodeOfCare": type in BCx."Antenatal care case"]

/*
Initial population: Antenatal clients
*/
define "Initial Population":
  exists (BaseData."Antenatal care case")

Source

{
  "resourceType": "Measure",
  "id": "publishable-example",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-publishablemeasure"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "contained": [
    {
      "resourceType": "Library",
      "id": "effective-data-requirements",
      "extension": [
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://example.org/CodeSystem/iso-8601-derived-periods",
            "code": "P10Y--P14Y",
            "display": "10-14 years"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://example.org/CodeSystem/iso-8601-derived-periods",
            "code": "P15Y--P19Y",
            "display": "15-19 years"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://example.org/CodeSystem/iso-8601-derived-periods",
            "code": "P20Y--P9999Y",
            "display": "20+ years"
          }
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ANCBaseDataElements"
            },
            {
              "url": "name",
              "valueString": "Antenatal care contact"
            },
            {
              "url": "statement",
              "valueString": "define \"Antenatal care contact\":\n  [\"Encounter\": type in BCx.\"Antenatal care contact\"]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 0
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ANCIND01"
            },
            {
              "url": "name",
              "valueString": "First antenatal care contact"
            },
            {
              "url": "statement",
              "valueString": "define \"First antenatal care contact\":\n  BaseData.\"Antenatal care contact\" C\n    where C.reasonCode in Cx.\"First Antenatal Care Contact Choices\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 1
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ANCContactDataElements"
            },
            {
              "url": "name",
              "valueString": "Gestational age"
            },
            {
              "url": "statement",
              "valueString": "/*\n  @dataElement: ANC.B6.DE17 Gestational age\n  @activity: ANC.B6 Profile\n  @description: Gestational age in weeks and/or days depending on the source of gestational age\n*/\ndefine \"Gestational age\":\n  WC.MostRecent(\n  [Observation: Cx.\"Gestational age\"] O\n    where O.status in { 'final', 'amended', 'corrected' }\n      and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false\n      and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))\n  ).value as FHIR.Quantity"
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ANCIND01"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "/*\nNumerator: Number of pregnant women who had their first ANC contact before 12 weeks (facility level)\nNumerator Computation: Count of women whose gestational age <= 12 weeks at the time of first contact\n*/\ndefine Numerator:\n  exists (\n    \"First antenatal care contact\" C\n      where C.period starts during \"Measurement Period\"\n        and ContactData.\"Gestational age\" <= 12 weeks\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ANCStratifiers"
            },
            {
              "url": "name",
              "valueString": "By Age"
            },
            {
              "url": "statement",
              "valueString": "/*\nBy Patient Age as of the start of the Measurement Period\nAge (10-14, 15-19, 20+)\n*/\ndefine \"By Age\":\n  case\n    when AgeInYearsAt(start of \"Measurement Period\") in Interval[10, 14] then \"P10Y--P14Y\"\n    when AgeInYearsAt(start of \"Measurement Period\") in Interval[15, 19] then \"P15Y--P19Y\"\n    when AgeInYearsAt(start of \"Measurement Period\") >= 20 then \"P20Y--P9999Y\"\n    else null\n  end"
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ANCIND01"
            },
            {
              "url": "name",
              "valueString": "Age Stratifier"
            },
            {
              "url": "statement",
              "valueString": "/*\nDisaggregation: Age (10-14, 15-19, 20+)\n*/\ndefine \"Age Stratifier\":\n  Stratifiers.\"By Age\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ANCIND01"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "/*\nDenominator: Total number of antenatal clients with a first contact\nDenominator Computation: Count of all women who had first contact within the last reporting period\n*/\ndefine Denominator:\n  exists (\n    \"First antenatal care contact\" C\n      where C.period starts during \"Measurement Period\"\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ANCStratifiers"
            },
            {
              "url": "name",
              "valueString": "By Education Level"
            },
            {
              "url": "statement",
              "valueString": "/*\nBy Patient Education Level (none, don't know, primary, secondary, higher)\n*/\ndefine \"By Education Level\":\n  Patient.extension E\n    where E.url = 'http://fhir.org/guides/who/anc-cds/StructureDefinition/educationlevel'\n    return E.value as CodeableConcept"
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ANCIND01"
            },
            {
              "url": "name",
              "valueString": "Education Level Stratifier"
            },
            {
              "url": "statement",
              "valueString": "/*\nDisaggregation: Education Level (none, don't know, primary, secondary, higher)\n*/\ndefine \"Education Level Stratifier\":\n  Stratifiers.\"By Education Level\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ANCBaseDataElements"
            },
            {
              "url": "name",
              "valueString": "Antenatal care case"
            },
            {
              "url": "statement",
              "valueString": "/*\ndefine \"Pregnant\":\n  \"Pregnancy\" is not null\n    or \"Pregnancy status\" in BCx.\"Pregnancy status - pregnant\"\n\ndefine \"Pregnancy status\":\n  FHIRHelpers.ToConcept(\n    Last(\n      [Observation: BCx.\"Pregnancy status\"] O\n        where O.status = 'final'\n        sort by FHIRHelpers.ToDateTime(effective as FHIR.dateTime)\n    ).value\n  )\n*/\ndefine \"Antenatal care case\":\n  [\"EpisodeOfCare\": type in BCx.\"Antenatal care case\"]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ANCIND01"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "/*\nInitial population: Antenatal clients\n*/\ndefine \"Initial Population\":\n  exists (BaseData.\"Antenatal care case\")"
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        }
      ],
      "status": "active",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/library-type",
            "code": "module-definition"
          }
        ]
      },
      "relatedArtifact": [
        {
          "type": "depends-on",
          "display": "Library ANCCohort",
          "resource": "http://hl7.org/fhir/uv/crmi/Library/ANCCohort"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1"
        },
        {
          "type": "depends-on",
          "display": "Example Code system ISO-8601-Derived Periods",
          "resource": "http://example.org/CodeSystem/iso-8601-derived-periods"
        },
        {
          "type": "depends-on",
          "display": "Value set Antenatal care contact",
          "resource": "http://fhir.org/guides/who/anc-cds/ValueSet/antenatal-care-contact"
        },
        {
          "type": "depends-on",
          "display": "Value set First Antenatal Care Contact Choices",
          "resource": "http://fhir.org/guides/who/anc-cds/ValueSet/anc-b5-de2"
        },
        {
          "type": "depends-on",
          "display": "Value set Gestational age",
          "resource": "http://fhir.org/guides/who/anc-cds/ValueSet/anc-b6-de17"
        },
        {
          "type": "depends-on",
          "display": "Value set Antenatal care case",
          "resource": "http://fhir.org/guides/who/anc-cds/ValueSet/antenatal-care-case"
        }
      ],
      "parameter": [
        {
          "name": "Measurement Period",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "Period"
        },
        {
          "name": "encounter",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "string"
        },
        {
          "name": "Numerator",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "Age Stratifier",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Coding"
        },
        {
          "name": "Denominator",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "Education Level Stratifier",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "CodeableConcept"
        },
        {
          "name": "Initial Population",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        }
      ],
      "dataRequirement": [
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/cqf-isSelective",
              "valueBoolean": true
            }
          ],
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "reasonCode",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://fhir.org/guides/who/anc-cds/ValueSet/antenatal-care-contact"
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/cqf-isSelective",
              "valueBoolean": true
            }
          ],
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Observation"
          ],
          "mustSupport": [
            "code",
            "status",
            "encounter",
            "encounter.reference"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://fhir.org/guides/who/anc-cds/ValueSet/anc-b6-de17"
            }
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Patient"
          ],
          "mustSupport": [
            "url",
            "value"
          ]
        },
        {
          "type": "EpisodeOfCare",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/EpisodeOfCare"
          ],
          "mustSupport": [
            "type"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://fhir.org/guides/who/anc-cds/ValueSet/antenatal-care-case"
            }
          ]
        }
      ]
    }
  ],
  "extension": [
    {
      "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem",
      "valueReference": {
        "reference": "Device/cqf-tooling"
      }
    },
    {
      "id": "effective-data-requirements",
      "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
      "valueCanonical": "#effective-data-requirements"
    }
  ],
  "url": "http://hl7.org/fhir/uv/crmi/Measure/publishable-example",
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:oid:2.16.840.1.113883.4.642.40.38.29.1"
    }
  ],
  "version": "2.0.0-cibuild",
  "name": "ANCIND01Publishable",
  "title": "ANC.IND.01 Percentage of pregnant women with first ANC contact in the first trimester (Publishable Example)",
  "status": "draft",
  "experimental": true,
  "date": "2023-03-13T22:32:10-06:00",
  "publisher": "HL7 International / Clinical Decision Support",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/dss"
        }
      ]
    }
  ],
  "description": "Percentage of pregnant women with first ANC contact in the first trimester (before 12 weeks of gestation)",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
          "code": "001",
          "display": "World"
        }
      ]
    }
  ],
  "relatedArtifact": [
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-isPrimaryCitation",
          "valueBoolean": true
        }
      ],
      "type": "citation",
      "citation": "WHO, UN Women, UNFPA. Health care for women subjected to intimate partner violence or sexual violence – a clinical handbook. Geneva: World Health Organization; 2014",
      "url": "https://apps.who.int/iris/bitstream/handle/10665/136101/WHO_RHR_14.26_eng.pdf",
      "document": {
        "url": "https://apps.who.int/iris/bitstream/handle/10665/136101/WHO_RHR_14.26_eng.pdf"
      }
    }
  ],
  "library": [
    "http://hl7.org/fhir/uv/crmi/Library/ANCCohort"
  ],
  "scoring": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
        "code": "proportion"
      }
    ]
  },
  "type": [
    {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/measure-type",
          "code": "process"
        }
      ]
    }
  ],
  "improvementNotation": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
        "code": "increase"
      }
    ]
  },
  "group": [
    {
      "id": "group-1",
      "population": [
        {
          "id": "initial-population",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population"
              }
            ]
          },
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "denominator",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator"
              }
            ]
          },
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator"
          }
        },
        {
          "id": "numerator",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator"
              }
            ]
          },
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        }
      ],
      "stratifier": [
        {
          "id": "by-age",
          "code": {
            "text": "Age"
          },
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Age Stratifier"
          }
        },
        {
          "id": "by-education-level",
          "code": {
            "text": "Education Level"
          },
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Education Level Stratifier"
          }
        }
      ]
    }
  ]
}