This change request to enable the ability to support evaluating a measure by provider requires updates to both the DEQM IG for the $submit-data operation and the specification in FHIR Core for the $evaluate-measure operation.

In order to support associating the provider with the data submitted through the $submit-data operation, the IG should state that optionally the X-Provenance header should be submitted as part of the request.  The "agent" field on the Provenance object should be filled in according to who is submitting the data.  If an EHR or other third party is submitting data on behalf of a Provider, then the "agent.who" field should be filled in with an Organization reference to the Organization that is submitting the data.  The "agent.onBehalfOf" field is a reference to the actual Provider that the data being submitted is for.  If a Provider is submitting data for themselves, then only the "agent.who" field will be filled in.

This usage relies on the server supporting the use of the X-Provenance header and correctly filling in the target field on the resulting Provenance resource with references to all of the resources in the Bundle being inserted with the $submit-data operation.

The $evaluate-measure operation will be extended by adding an optional parameter called "provider".  Provider is an Organization Reference to the Provider the user wants to evaluate a Measure for.  A server should support this by performing a Provenance search on the "agent.onBehalfOf" field for the Provider and also performing a Provenance search on the "agent.who" field where "agent.onBehalfOf" is null.  Once all relevant Provenance Resources are found, all Patient resources that are targets of the Provenance Resources are aggregated and used in the Measure evaluation.