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  1. FHIR Specification Feedback
  2. FHIR-42889

Remove QI-Core specific Must Support flags

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US QI Core (FHIR)
    • 6.0.0-ballot
    • Clinical Quality Information
    • QI-Core Profiles
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      Change landing page section 1.11 to 

      "QI-Core derives from US Core and so the requirements on “MustSupport” defined in US Core must be respected.

      QI-Core flags elements that the quality improvement community has identified as significant to express the full intent of measures and CDS artifacts or those that are used in established measures or CDS support services. Implementers are only required to support these additional elements when they are used in the measures or CDS artifacts implemented on or otherwise supported by the system. Since not all artifacts use each of these additional elements, QI-Core does not use the “MustSupport” flag to indicate these elements. Instead, “(QI-Core)” is prepended to the element’s short description found in the Description & Constraints column of the Key Elements Table, and the computable QI-Core Key Element Extension is added to each element definition. This approach is inspired by the way that US Core communicates USCDI requirements and allows IGs that extend QI-Core, such as those representing data requirements for specific measures or supporting CDS, to avoid inheriting requirements for those QI-Core-flagged elements that they do not use.

      Quality improvement artifacts communicate the elements they reference using the DataRequirement structure in FHIR. This structure allows the base resource type and profile to be specified, as well as a mustSupport element that indicates which elements of the resource and profile are reference by the logic. Implementers can use this information directly from the effective data requirements to determine which elements must be provided in order to achieve a successful evaluation of the artifact. In addition, repositories and publishers may make use of this information to define artifact-specific profiles using the effective data requirements provided by the artifact."

       

      Change the language explaining the QI-Core extension to "This extension is only used in the QI-Core Implementation Guide’s Profile StructureDefinition elements. It flags elements that the the quality improvement community has identified as significant to express the full intent of measures or decision support artifacts. See the MustSupport Flag section in this IG for more information."

      Add (QI-Core) in place of the QI-Core MS flags, and retain the US Core driven USCDI flags. Assure that the non-MS USCDI elements from US Core also appear in the QI-Core Differential and Key Element Tables with a QI-Core extension as well.

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      Change landing page section 1.11 to  "QI-Core derives from US Core and so the requirements on “MustSupport” defined in US Core  must be respected. QI-Core flags elements that the quality improvement community has identified as significant to express the full intent of measures and CDS artifacts or those that are used in established measures or CDS support services. Implementers are only required to support these additional elements when they are used in the measures or CDS artifacts implemented on or otherwise supported by the system. Since not all artifacts use each of these additional elements, QI-Core does not use the “MustSupport” flag to indicate these elements. Instead, “(QI-Core)” is prepended to the element’s short description found in the Description & Constraints column of the Key Elements Table, and the computable QI-Core Key Element Extension is added to each element definition. This approach is inspired by the way that US Core communicates USCDI requirements and allows IGs that extend QI-Core, such as those representing data requirements for specific measures or supporting CDS, to avoid inheriting requirements for those QI-Core-flagged elements that they do not use. Quality improvement artifacts communicate the elements they reference using the DataRequirement structure in FHIR. This structure allows the base resource type and profile to be specified, as well as a mustSupport element that indicates which elements of the resource and profile are reference by the logic. Implementers can use this information directly from the effective data requirements to determine which elements must be provided in order to achieve a successful evaluation of the artifact. In addition, repositories and publishers may make use of this information to define artifact-specific profiles using the effective data requirements provided by the artifact."   Change the language explaining the QI-Core extension to " This extension is only used in the QI-Core Implementation Guide’s Profile StructureDefinition elements. It flags elements that the the quality improvement community has identified as significant to express the full intent of measures or decision support artifacts. See the MustSupport Flag section in this IG for more information." Add (QI-Core) in place of the QI-Core MS flags, and retain the US Core driven USCDI flags. Assure that the non-MS USCDI elements from US Core also appear in the QI-Core Differential and Key Element Tables with a QI-Core extension as well.
    • Floyd Eisenberg/Karl Naden:28-0-0
    • Enhancement
    • Compatible, substantive

    Description

      In QI-Core 6.0 we took the approach of identifying common elements using in existing measure artifacts and allowing measure developers to select other snapshot elements as needed, expecting users of such elements to evaluate feasibility and likelihood of retrieving such information.  Further, the QI-Core specific Must Support flag was intended to be an indication to measure implementers that support for all tagged elements provide assurance that any given eCQM could be implemented.  However, individual measures, and measure sets may only use a subset of QI-Core Must Support elements. A measure set content IG should be able to indicate only the elements used in the measures in the set, and not include QI-Core Must Support elements not used by the measures in the set.   Therefore, it is clearer to remove QI-Core specific Must Support flags.  However, to indicate the concept that QI-Core-only significant elements in the Differential Table and Key Elements table may be expected in an eCQM or dQM, replace the MS flag with indication at the beginning of the definition of "(QI-Core)" similar to the way US Core adds such indication for (USCDI).  Thus, the Differential and Key Elements Table content does not change, only the tag MS changes to (QI-Core).  Element inherited directly from US Core will retain their MS flags.  The result is that eCQM Measure Set content IGs built on QI-Core will not need to retrieve (QI-Core) elements unless the measures specifically use them in the CQL.

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        2. QI Core no-MS Prototype Comparison Picture.png
          QI Core no-MS Prototype Comparison Picture.png
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          People

            jen_seeman Jennifer Seeman
            feisenberg Floyd Eisenberg
            Karl Naden
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            Dates

              Created:
              Updated:
              Resolved: