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Data Exchange for Quality Measures

Owning work group name

Clinical Quality Information

Committee Approval Date:

Updated proposal approved on 2020-06-12

Contributing or Reviewing Work Groups

FHIR Development Project Insight ID


Scope of coverage

This IG is specific to the US Realm exchange of data for quality measures and gaps in care across all healthcare disciplines. Its purpose is inpatient; outpatient; and primary, secondary and tertiary care settings. The content is developed by stakeholders including clinical care provider, EHR vendor, and payor representatives.

IG Purpose

As the US Healthcare system transitions from a fee-for-service payment model to a value-based-care (VBC) model, the authoring, collection and reporting of quality measures is essential to this new model. Currently, disparate methods, both propriety and non-proprietary, are used to collect, aggregate and report quality measures data. This implementation guide leverages the interoperability of FHIR to create a framework for the timely and standardized method for exchanging this data. By shortening the feedback loop of quality measures data, the framework can support activities such as closing gaps in care. Main IG will address the general framework for data exchange of quality measures. The framework will be exemplified in the specific use case of 30-Day Medication Reconciliation Post-Discharge, for which the guide will implementation details including profiles and operations.

Content location

Proposed IG realm and code


Maintenance Plan

This specification will be maintained by the CQI work group once the Da Vinci project has completed initial development.

Short Description

Provides a mechanism for healthcare providers and data aggregators to exchange quality measure information using subscription, query, and push methods in support of quality reporting and improvement, including gaps in care.

Long Description

The Data Exchange for Quality Measures Implementation Guide (IG) will provide guidance to implementers who wish to request and report clinical and administrative data using FHIR resources and operations in support of quality measure reporting, including gaps in care. The main IG will detail the base and profiled FHIR resources and operations which provides a framework to enable the Exchange of Quality Measure Data between Data "Aggregators" (organizations that want to evaluate quality measures) and Providers (organizations that deliver care to patients). This guide describes three methods of exchanging data quality and the specific use case of 30-Day Medication Reconciliation Post-Discharge will demonstrate how one of these methods can be implemented to exchange the MRP measure data. This IG will span both FHIR STU3 and R4 with additional guidance for backward compatibility with STU3. A future release of this guide will include all the R4 artifacts when then US Core and QI Core profiles and the DEQM Profiles derived from them have been defined.

Involved parties

This implementation guide has been developed by U.S. EHR and Payor organizations as part of the Da Vinci project.

Expected implementations

Pilot reference implementation and testing at multiple connectathons since 2018. Several EHR and Payor organizations have implemented this implementation guide and are expected to continue with their implementation .

Content sources

Requirements are drawn from payor and provider organizations as part of the Da Vinci initiative. Additional guidance come from quality measure authors.

Example Scenarios

This IG outlines three methods for the data exchange: subscription, query/request, and push. In each case below, the [id] is the profile for a specific measure.

  • In the subscription method, an aggregator system subscribes to a specific measure on a provider system. When measure data is generated on the provider system, the provider system will notify the aggregator via the subscription callback, and the aggregator will then query the provider system using the query/request method.
  • In the query/request method, an aggregator system will invoke the Measure/[id]/$collect-data operation and passes parameters for the query. The provider system returns an operation response with the applicable FHIR resources.
  • In the push method, after measure data is generated, the provider system performs a POST Measure/[id]/$submit-data operation to send data to an aggregator system.

IG Relationships

This implementation guide will be based on FHIR STU 3 and R4. The FHIR R4-based IG will be derived from US Core .


The initial balloting of the IG was in the 2018 September Ballot Cycle

The STU2 for FHIR R4 was balloted in the 2020 February Ballot Cycle.

Intended to ballot in the 2020 September Ballot Cycle for the gaps in care content.

When IG Proposal Is Complete

When you have completed your proposal, please send an email to

FMG Notes

Approved 2018-07-11

Updated IG Proposal was approved on: 2020-06-24