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  1. FHIR Specification Feedback
  2. FHIR-33150

$evaluateMeasure reportType and subject params unclear

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • FHIR Core (FHIR)
    • R4
    • Clinical Quality Information
    • Measure
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      In the Measure, we are concerned with specifying the definition of the subject of the measure, that can be a "type" (i.e. this measure operates on Patients or Locations, or Practitioner, etc), or it can be a reference to a Group, but that must be a definitional Group, not an actual Group. In the Measure definition context, we never specify "instance" level data.

      In the MeasureReport (and the $evaluate-measure operation), we are concerned with specifying the actual subject of the calculation (i.e. instance-level data), so for the MeasureReport, a Group reference must be an actual Group, and in $evaluate-measure, the subject, if it's a Group, must be an actual Group.

      So two clarifications:

      1) Change the Reference(Group) to include that it must be a Definitional Group (https://build.fhir.org/groupdefinition.html) On the subject[x] element, add a comment that:

      If the subject is specified as a reference to a Group, it must be a definitional group.

      2) Change the $evaluateMeasure reportType and subject parameters to:

      reportType: If not specified, a default value of subject will be used if the subject parameter is supplied and is not a Group, otherwise, population will be used.

      subject: Add: The subject must be an instance of a type that is consistent with the subjectType of the Measure being evaluated (e.g. Patient, Practitioner, Location...) If the subject is a Group, it must be an actual Group, not a definitional one. https://build.fhir.org/groupdefinition.html

       

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      In the Measure, we are concerned with specifying the definition of the subject of the measure, that can be a "type" (i.e. this measure operates on Patients or Locations, or Practitioner, etc), or it can be a reference to a Group, but that must be a definitional Group, not an actual Group. In the Measure definition context, we never specify "instance" level data. In the MeasureReport (and the $evaluate-measure operation), we are concerned with specifying the actual subject of the calculation (i.e. instance-level data), so for the MeasureReport, a Group reference must be an actual Group, and in $evaluate-measure, the subject, if it's a Group, must be an actual Group. So two clarifications: 1) Change the Reference(Group) to include that it must be a Definitional Group ( https://build.fhir.org/groupdefinition.html) On the subject [x] element, add a comment that: If the subject is specified as a reference to a Group, it must be a definitional group. 2) Change the $evaluateMeasure reportType and subject parameters to: reportType: If not specified, a default value of subject will be used if the subject parameter is supplied and is not a Group, otherwise, population will be used. subject: Add: The subject must be an instance of a type that is consistent with the subjectType of the Measure being evaluated (e.g. Patient, Practitioner, Location...) If the subject is a Group, it must be an actual Group, not a definitional one. https://build.fhir.org/groupdefinition.html  
    • Bryn Rhodes/Ben Hamlin: 23-0-0
    • Clarification
    • Non-substantive

    Description

      The $evaluateMeasure page has the following:

      reportType 0..1 code     The type of measure report: subject, subject-list, or population. If not specified, a default value of subject will be used if the subject parameter is supplied, otherwise, population will be used

      This implies that if you specify reportType at all, population will be used. What happens if I specify reportType=subject-list. 

      Also

      subject 0..1 string
      (reference)      		     Subject for which the measure will be calculated. If not specified, the measure will be calculated for all subjects that meet the requirements of the measure. If specified, the measure will only be calculated for the referenced subject(s)

      This does not specify what kind of resources you are allowed to reference. The definition for the Measure resource has this for subject:

       subject[x]   0..1   E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
      Subject type (Extensible)
       subjectCodeableConcept     CodeableConcept  
       subjectReference     Reference([Group https://build.fhir.org/group.html])

       

      So it would seem like the only valid reference would be to a Group resource, but based on the definition for the reportType parameter it seems like Patient is also allowed. So can we update the definition of the subject parameter to say only references to Patient and Group resources are allowed? Also, we should then update subjectReference in the Measure definition to be Reference(Patient | Group). 

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            rgeimer Rick Geimer
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