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Name

Flags

Card.

Type

Description & Constraints

Notescqf-ruler RI Status

 Composition

TU


DomainResource

A set of resources composed into a single coherent clinical statement with clinical attestation

Elements defined in Ancestors: idmetaimplicitRuleslanguagetextcontainedextensionmodifierExtension



 identifier

Σ

0..1

Identifier

Version-independent identifier for the Composition



 status

?!Σ

1..1

code

preliminary | final | amended | entered-in-error

CompositionStatus (Required)




 type

Σ

1..1

CodeableConcept

Kind of composition (LOINC if possible)

FHIR Document Type Codes (Preferred)

For the September ballot, will define a FHIR code system with 

"system": "http://hl7.org/fhir/us/davinci-deqm/CodeSystem/deqm-document-type",

"code": "care-gap-report"

Will request a LOINC code in the meantime


 category

Σ

0..*

CodeableConcept

Categorization of Composition Document Class Value Set (Example)



 subject

Σ

0..1

1..1

Reference(Any)

Who and/or what the composition is about

Constrain to Reference (QI-Core Patient) only

 encounter

Σ

0..1

Reference(Encounter)

Context of the Composition



 date

Σ

1..1

dateTime

Composition editing time

The time the Care Gaps Report was run. 

(missing from the RI returned bundle)


 author

Σ

1..*

Reference(Practitioner | PractitionerRole | 

Device | Patient | RelatedPerson | Organization)

Who and/or what authored the composition

(missing from the RI returned bundle)

6/4: device (e.g., system generates the report)

organization (Producer that generates the report)


 title

Σ

1..1

string

Human Readable name/title

E.g., "Care Gap Report"

 confidentiality

Σ

0..1

code

As defined by affinity domain V3 Value SetConfidentialityClassification (Required)



 attester


0..*

BackboneElement

Attests to accuracy of composition



    mode


1..1

code

personal | professional | legal | official

CompositionAttestationMode (Required)



    time


0..1

dateTime

When the composition was attested



    party


0..1

Reference(Patient | RelatedPerson | 

Practitioner | PractitionerRole | Organization)

Who attested the composition



 custodian

Σ

0..1

Reference(Organization)

Organization which maintains the composition

Producers have the obligations to either keep the care gaps report for future reference or have the capability to reproduce (exact time stamps as it was originally generated) for auditing purpose.

In an ideal FHIR environment, you would be able to use version histories to recreate a snapshot at a point in time when the report was generated, but not sure how it runs and will be challenging in real world..

From providers perspective, archiving things, because memberships could change. Cannot necessarily re-generate the exact same report at the time it was originally created. 

Keeping the custodian is useful to support the use cases, but not making it required in the spec. Since different states may have different regulations. E.g., CA has a stricter regulation. 


 relatesTo


0..*

BackboneElement

Relationships to other compositions/documents



    code


1..1

code

replaces | transforms | signs | appends DocumentRelationshipType (Required)



    target[x]


1..1


Target of the relationship



 event

Σ

0..*

BackboneElement

The clinical service(s) being documented



     code

Σ

0..*

CodeableConcept

Code(s) that apply to the event being documented v3 Code System ActCode (Example)



     period

Σ

0..1

Period

The period covered by the documentation



     detail

Σ

0..*

Reference(Any)

The event(s) being documented



 section

I

0..*

1..*

BackboneElement

Composition is broken into sections

+ Rule: A section must contain at least one of text, entries, or sub-sections

+ Rule: A section can only have an emptyReason if it is empty

Must contain at least one section, each section corresponds to a measure

      title


0..1

string

Label for section (e.g. for ToC)

The would be the measure name (referenced in focus)

      code


0..1

CodeableConcept

Classification of section (recommended)

Document Section Codes (Example)



      author


0..*

Reference(Practitioner | PractitionerRole | Device 

Patient | RelatedPerson | Organization)

Who and/or what authored the section



      focus


0..1

1..1

Reference(Any)

Who/what the section is about, when it is not about the subject of composition

Constrain to Reference (DEQM Gaps Individual MeasureReport) only

http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-indv-measurereport-deqm

      text

I

0..1

Narrative

Text summary of the section, for human interpretation



      mode


0..1

code

working | snapshot | changes ListMode (Required)



      orderedBy


0..1

CodeableConcept

Order of section entries List Order Codes (Preferred)



      entry

I

0..*

Reference(Any)

A reference to data that supports this section

Constrain this to Reference (Gaps in Care DetectedIssue) 

The entry is optional. Will only return DetectedIssue when there is an open gap. 


     emptyReason

I

0..1

CodeableConcept

Why the section is empty List Empty Reasons (Preferred)



     section

I

0..*

see section

Nested Section



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