Hello CQI WG Members,

The DEQM changes listed below have been applied and are available for early review in the current CI build:  HL7.FHIR.US.DAVINCI-DEQM\Home - FHIR v4.0.1

Issue Type	Key	Summary	Resolution Description	Creator
Change Request	FHIR-40110	Issues with invariant deqm-5	Update the wording of deqm-5 to "If the scoring, at either the root level or the group level, is other than composite then the group.population cardinality is >=1" The expression in the invariant should be fixed to the following: _((extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').value.coding.code in ('composite')).not()_ _and_ _extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').value.coding.code.exists())_ _or_ _((group.extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').value.coding.code in ('composite')).not()_ _and_ _group.extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').value.coding.code.exists()) implies group.population.exists()_ 53. MeasureReport.group.population |Invariants|*Defined on this element* {*}deqm-5{*}: ensure that cardinality is >= 1 if the scoring is other than composite (: %resource.extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').exists().not() and group.extension.('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').exists and group.extension.('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').valueCodeableConcept.coding.code in ('proportion' \| 'ratio' \| 'continuous-variable' \| 'cohort') implies group.population.exists())|	Yan Heras
Technical Correction	FHIR-40789	Wrong groupImprovementNotation extension description	Correct the extension description as suggested.  description of this groupImprovementNotation extension should read "Indicates whether improvement in the measure group is noted by an increase or decrease in the measure score." On the Individual and Summary MeasureReport profile add short definitions to the scoring and groupImprovementNotation elements under group element scoring should have short description  measure, including proportion, ratio, continuous-variable, and cohort groupImprovementNotation should have short description of Increase | Decrease	Yan Heras
Change Request	FHIR-39901	Add Bulk Submit Data Operation to Data Exchange Narrative	In section 2.2.3 Submit Data, add the paragraph below after the existing introductory paragraph ending in "[...] These update methods are described in detail below." Alternatively, data may be submitted in bulk with the [$bulk-submit-data|http://hl7.org/fhir/us/davinci-deqm/2023Jan/OperationDefinition-bulk-submit-data.html] operation. This supports both synchronous and asynchronous messaging as described in the operation definition.	Weiyu Zhang
Change Request	FHIR-40797	MeasureReport.date could be misleading	Change short description of the measureReport.date to  "When the report was generated.  Note: The language in R5 was changed to calculated.  We are clarifying that intent." DEQM individual profile currently describes .date as "When the report as calculated", update to "When the report was generated.  Note: The language in R5 was changed to calculated.  We are clarifying that intent." DEQM summary profile currently describes .date as "When the report was generated", add "Note: The language in R5 was changed to calculated.  We are clarifying that intent." Add a new date extension using a base canonical for MeasureReport.group for the calculation of the scores.  This would have a short description of "The date the score was calculated".  This is in the intro page for the extension "This applies to the date this metric was actually calculated. If your measure calculation draws on stored calculations and there are multiple calculation dates, this extension would not apply, as in the example of a composite measure where the individual measures were calculated on different dates.  This would only cover the case where there is only one calculation date."  Extension Name calculatedDate with a Cardinality 0..1, Type of dateTime. Use this extension in the DEQM profile until we can get this extension added to the Extension IG. We will add this extension to the base specification for R6 once it is available in the Extension IG.  Tracker: https://jira.hl7.org/browse/FHIR-41018	Cody Danielshak
Change Request	FHIR-40115	The Reporting Program Reference extension needs explanation	Change the name of the extension reportingProgram, and allow it to be a choice of canonical reference to a Quality program, or CodeableConcept bound to the reporting program example value set. reportingProgram 0..1 canonical(Library\{CQFMQualityProgram}) | CodeableConcept - A reference to the Quality Program being reported, or a code from the Reporting Program value set indicating which quality program is being reported. 2 new input parameters should be added to the _$deqm.evaluate-measure:_ * program | 0..1 canonical | | The quality program being reported via canonical reference (Library\{CQFMQualityProgram}) * programCode | 0..1 CodeableConcept | Quality Programs[Extensible] | The quality program being reported via code from the Reporting Program Value Set " Also add language to indicate can only use one or the other for the two input parameters.	Yan Heras
Change Request	FHIR-40031	Support reporting multiple facilities	The actual use case is to support identifying the locations from which reported data was gathered. It really doesn't have anything to do with the reporter, so suggest modeling as an extension: measurereport-location 0..* Reference(Location) A location from which reported data was gathered, both individual and summary measure report When including the extension in profile definitions, further constrain the reference to location to be a QI-Core Location.	Bryn Rhodes
Change Request	FHIR-40666	add new URL to $deqm.evaluate-measure	Add the following to $deqm.evaluate-measure URL: [base]/Measure/[id]/$deqm.evaluate-measure	Matthew Tiller
Change Request	FHIR-40112	Data Exchange MeasureReport profile intro notes	The DEQM Data Exchange MeasureReport profile intro notes should be updated to add the reporter.group to the list of "Each MeasureReport should have (Must Support):"	Yan Heras
Change Request	FHIR-40113	short description of Criteria Reference Extension	Update description to match the definition.	Yan Heras
Change Request	FHIR-40114	Remove Population Reference Extension	Mark the extension (http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-populationReference) as deprecated in the list in section 4.2 Use standards status extension in structureDefinintion to mark it as deprecated	Yan Heras
Technical Correction	FHIR-35776	Cut and paste error in diagram		Brent Zenobia
Change Request	FHIR-39980	When do you use the Group Improvement Notation over the MeasureReport Improvement Notation	There are invariants (deqm-2 and deqm-4) on Individual and Summary MeasureReport profiles to ensure a MeasureReport can either have improvement notation at the root or at the group level.  Agreed to add language to the DEQM Group Improvement Notation Extension profile introduction notes to clarify.  Also need to make sure to look at other extensions to include the same clarifications.	Linda Michaelsen
Change Request	FHIR-40190	Clarity on whether this IG should be used for payers to communicate care gaps to providers/HC orgs	Yes, there is a strong use case for exchange from payer to provider. The two use cases described in the Guidance introduction section are examples. For instance, the Guidance section says “The first interaction is when a Producer, such as a practitioner, or owner of data needs to exchange that data with a Consumer of that data, such as a payer, a registry or public health.” In this sentence, practitioner is just an example of Producer, payer could also serve as a Producer. Will update the General Guidance - Introduction section to make it clear that it is bi-directional, there is a use case from payer to provider.	Julia Skapik
Change Request	FHIR-40111	Individual and Summary MeasureReport profile intro notes	The Mandatory Data Elements and Terminology sections on both these two profile pages should be updated to reflect the updates made. Use a script if available to automate creation of the list. Update both the MUST and SHOULD lists.	Yan Heras

 Please provide feedback via HL7 Jira, referencing the original change where applicable.

 A full list of changes considered for this update cycle can be viewed here.  

 Thanks!

ICF Standards Team

Note: This notification is for early review only, a full review cycle will be conducted prior to approval for publication.

Jen Seeman |Project Manager |Jennifer.Seeman@icf.com +1.515.971.6734 mobile  icf.com | LinkedIn