FHIR Measure Evaluator

About the tool

Use this tool to evaluate CQL-based clinical quality measures against test patient data. The tool outputs a FHIR MeasureReport resource with the calculated measure score.

Demo

Measure logic (CQL)

library TestLibrary version '1.0'

using FHIR version '4.0.1'

include FHIRHelpers version '4.0.1' called FHIRHelpers

codesystem "LOINC": 'http://loinc.org'
codesystem "SNOMEDCT": 'http://snomed.info/sct'

code "Mammography": '24604-1' from "LOINC" display 'MG Breast Diagnostic Limited Views'
code "Unilateral Mastectomy Right": '429400009' from "SNOMEDCT" display 'Mastectomy of right breast (procedure)'
code "Unilateral Mastectomy Left": '428571003' from "SNOMEDCT" display 'Mastectomy of left breast (procedure)'
code "Bilateral Mastectomy": '27865001' from "SNOMEDCT" display 'Bilateral mastectomy (procedure)'

parameter "Measurement Period" Interval<DateTime>

context Patient

define "Initial Population":
  Patient.gender = 'female' and AgeInYearsAt(start of "Measurement Period") between 51 and 74

define "Denominator":
  "Initial Population"

define "Denominator Exclusion":
  (exists "Right Mastectomy Procedure" and exists "Left Mastectomy Procedure") or exists "Bilateral Mastectomy Procedure"

define "Numerator":
  exists ( [DiagnosticReport: "Mammography"] Mammogram )

define "Right Mastectomy Procedure":
  [Procedure: "Unilateral Mastectomy Right"] UnilateralMastectomyRightPerformed

define "Left Mastectomy Procedure":
  [Procedure: "Unilateral Mastectomy Left"] UnilateralMastectomyLeftPerformed

define "Bilateral Mastectomy Procedure":
  [Procedure: "Bilateral Mastectomy"] BilateralMastectomyPerformed1
library TestLibrary version '1.0'
2

3
using FHIR version '4.0.1'
4

5
include FHIRHelpers version '4.0.1' called FHIRHelpers
6

7
codesystem "LOINC": 'http://loinc.org'
8
codesystem "SNOMEDCT": 'http://snomed.info/sct'
9

10
code "Mammography": '24604-1' from "LOINC" display 'MG Breast Diagnostic Limited Views'
11
code "Unilateral Mastectomy Right": '429400009' from "SNOMEDCT" display 'Mastectomy of right breast (procedure)'
12
code "Unilateral Mastectomy Left": '428571003' from "SNOMEDCT" display 'Mastectomy of left breast (procedure)'
13
code "Bilateral Mastectomy": '27865001' from "SNOMEDCT" display 'Bilateral mastectomy (procedure)'
14

15
parameter "Measurement Period" Interval<DateTime>
16

17
context Patient
18

19
define "Initial Population":
20
  Patient.gender = 'female' and AgeInYearsAt(start of "Measurement Period") between 51 and 74
21

22
define "Denominator":
23
  "Initial Population"
24

25
define "Denominator Exclusion":
26
  (exists "Right Mastectomy Procedure" and exists "Left Mastectomy Procedure") or exists "Bilateral Mastectomy Procedure"
27

28
define "Numerator":
29
  exists ( [DiagnosticReport: "Mammography"] Mammogram )
30

31
define "Right Mastectomy Procedure":
32
  [Procedure: "Unilateral Mastectomy Right"] UnilateralMastectomyRightPerformed
33

34
define "Left Mastectomy Procedure":
35
  [Procedure: "Unilateral Mastectomy Left"] UnilateralMastectomyLeftPerformed
36

37
define "Bilateral Mastectomy Procedure":
38
  [Procedure: "Bilateral Mastectomy"] BilateralMastectomyPerformed

The CQL code of the measure.

Test FHIR resources (FSH instances)

Alias: $loinc = http://loinc.org

Instance: June
InstanceOf: Patient
* name.family = "Dunn"
* name.given = "June"
* gender = #female
* birthDate = "1965-01-01"

Instance: Karen
InstanceOf: Patient
* name.family = "McCarren"
* name.given = "Karen"
* gender = #female
* birthDate = "1965-01-01"

Instance: Donald
InstanceOf: Patient
* name.family = "Duck"
* name.given = "Donald"
* gender = #male
* birthDate = "1975-01-01"

Instance: JunesMammogram
InstanceOf: DiagnosticReport
* code = $loinc#24604-1 "MG Breast Diagnostic Limited Views"
* subject = Reference(Patient/June)1
Alias: $loinc = http://loinc.org
2

3
Instance: June
4
InstanceOf: Patient
5
* name.family = "Dunn"
6
* name.given = "June"
7
* gender = #female
8
* birthDate = "1965-01-01"
9

10
Instance: Karen
11
InstanceOf: Patient
12
* name.family = "McCarren"
13
* name.given = "Karen"
14
* gender = #female
15
* birthDate = "1965-01-01"
16

17
Instance: Donald
18
InstanceOf: Patient
19
* name.family = "Duck"
20
* name.given = "Donald"
21
* gender = #male
22
* birthDate = "1975-01-01"
23

24
Instance: JunesMammogram
25
InstanceOf: DiagnosticReport
26
* code = $loinc#24604-1 "MG Breast Diagnostic Limited Views"
27
* subject = Reference(Patient/June)

The FHIR resources (FSH instances) to be used for evaluating the measure.

Reporting (measurement) period start

Reporting (measurement) period end

Result

Press Evaluate measure to see the result.

What are quality measurement and reporting?

Quality measurement and reporting are essential components of/prerequisites for healthcare quality improvement. They help in assessing the performance of healthcare providers and organizations, and in identifying areas for improvement.

What are dQMs and eCQMs?

When clinical quality measures are translated into executable logic and become digital quality measures (dQMs), they can be programmatically and reproducibly evaluated against patient data at scale. This is why dQMs play a very important role in healthcare quality reporting and improvement.

eCQMs (electronic clinical quality measures) are a type of dQMs that only use the data from EHRs for measure evaluation.

What is CQL?

CQL (Clinical Quality Language) is an HL7 standard for capturing computable clinical logic. As a domain-specific language, it is commonly used to author/express the logic for eCQMs.

Motivation

I initially started playing with FHIR clinical reasoning (namely, the CQF Clinical Reasoning on FHIR for Java project) to learn how to do FHIR/CQL-based measure evaluation in code. Later on, I built this tool which wraps around the CQF library and exposes the measure evaluation functionality using a simple and interactive web UI.

I hope you find this tool useful, whether you want to quickly test your measure logic or need to troubleshoot measure evaluation issues. If you're only getting started with FHIR Measures, this tool can also help you understand how measures are evaluated and what the output of the evaluation looks like.

How does it work?

The tool accepts the following inputs:

the logic for the measure in CQL,
a set of patients and their associated data in FSH (FHIR Shorthand) format,
reporting period (measurement period) start and end dates.

Try out various patient sets and reporting periods to observe how the measure results change.