Clinical Quality Framework is an effort to “identify, develop, and harmonize standards that promote integration and reuse between Clinical Decision Support (CDS) and Clinical Quality Measurement (CQM)” (see http://wiki.hl7.org/index.php?title=Clinical_Quality_Framework). The framework defines a large breadth of use cases, requirements, and tools. CQF-Ruler, a project by the Database Consulting Group, is an open source project that has several CQF tools in the form of API endpoints. The Logica Sandbox Manager has implemented the CQF-Ruler project into our STU3 FHIR server for all users to try out.

Endpoints

In these examples, I’ll be using a sandbox I called cqfruler.

If you want to try these endpoints on your own sandbox, I have provided a Bundle resource which contains all of the FHIR resources needed. You can download this bundle (cqf-example-resources.json) and upload it to your Sandbox via a POST method similar to this:

POST https://api-v5-stu3.logicahealth.org/cqfruler/data

$submit-data

This endpoint allows users to submit FHIR data to a “payer”. The operation requires a Parameter resource that contains a list of resources you’d like to submit (see http://build.fhir.org/ig/Healthedata1/DaVinci/OperationDefinition-submit-data.html).

POST https://api-v5-stu3.logicahealth.org/cqfruler/open/Measure/measure-mrp/$submit-data
--- REQUEST BODY ---
[use content in submit-data-parameter-resource.json]

The server will return a "transaction-response" bundle showing whether the resources were successfully created in the server.

$evaluate-measure

This endpoint “calculate[s] the measure for the given patient, or all patients if no patient is supplied” (see https://www.hl7.org/fhir/measure-operations.html). In this example we provide a patient, as well as a period which the api uses to limit its evaluation.

https://api-v5-stu3.logicahealth.org/cqfruler/open/Measure/measure-asf/$evaluate-measure?periodStart=2003-01-01&periodEnd=2003-12-31&patient=Patient/Patient-6529

The server will return a MeasureReport resource summarizing the evaluation.

$care-gaps

This endpoint is used to “determine gaps-in-care based on the results of quality measures” (see http://build.fhir.org/operation-measure-care-gaps.html). This example uses the same parameters as above but includes a “topic” parameter which is used to determine which measures are included in the report.

GET https://api-v5-stu3.logicahealth.org/cqfruler/open/Measure/$care-gaps?periodStart=1997-01-01&periodEnd=1997-12-31&patient=Patient/Patient-6523&topic=Preventive%20Care%20and%20Screening

The server will return a bundle summarizing the results of each measure found.

$apply

This endpoint “applies” either an ActivityDefinition or PlanDefinition resource to a given context. The context is given in the parameters of the url call. In these examples, only patient is used although others are available (see https://www.hl7.org/fhir/activitydefinition-operations.html and https://www.hl7.org/fhir/plandefinition-operations.html).

GET https://api-v5-stu3.logicahealth.org/cqfruler/open/ActivityDefinition/ad-apply-example/$apply?patient=Patient-12214

The server will return the applicable resource which is defined in the ActivityDefinition. The above example returns a ProcedureRequest.

GET https://api-v5-stu3.logicahealth.org/cqfruler/open/PlanDefinition/apply-example/$apply?patient=Patient-12214

The server will return a CarePlan resource.

$data-requirements

This endpoint “aggregates and returns the parameters and data requirements for a resource and all its dependencies as a single module definition” (see https://www.hl7.org/fhir/library-operations.html).

GET https://api-v5-stu3.logicahealth.org/cqfruler/open/Measure/measure-asf/$data-requirements?periodStart=2018-07-06&periodEnd=2018-09-06

The server will return a Library resource that “contains all the parameter definitions and data requirements of the target resource and any libraries referenced by it.”

Currently, Logica is running servers that are utilizing old versions of the HAPI FHIR software. We will be upgrading all of the sandboxes running on these servers to the newest version of HAPI. To do so, the following will occur to the affected sandboxes:

1. The registered app information will not change; however, launch scenarios and personas will be deleted.

2. The data on the FHIR server (patients, practitioners, observations, etc.) will be deleted and repopulated with the default sample patients dataset.

3. All sandboxes that have had no activity over the last year will be deleted.

If you need to keep your data (launch scenarios, personas, and/or FHIR data), please contact us at support@logicahealth.org and we will help you. The upgrade will occur on November 15, 2018 so please contact us before then.

As part of the upgrade, any apps that directly use a FHIR server’s URL will need to change that URL to the newest version. Here’s a conversion table you can use to do so:

All affected sandboxes are currently displaying a notice in Sandbox Manager like this:

This sandbox will undergo extensive changes on 11/15/2018. Please see this announcement for details.

If your sandbox does not have this banner, then it will not be affected by the upgrade.

Thanks.

UPDATE:

We are still working at completing this process although we are well on our way. Thank you for your patience.

UPDATE:

All sandboxes have been updated. Thank you all for your patience.

We are excited to announce that you can now launch your SMART apps in your Logica Sandbox instance using app link cards in the CDS-Hooks Sandbox!

Complete Flow

Please see CDS Hooks Integration for details.  

Setting It Up

To set up this scenario,

1. either create a new, or use an existing Logica Sandbox instance,
2. create, host, and register your SMART app,
   1. make sure your SMART app can launch successfully from your Logica Sandbox instance
3. create and host your CDS services

Launching Your App

Referring to CDS Hooks Integration, your app link cards will now be functional!  To see this, 

1. click on the link in your app link card in the CDS Hooks sandbox,
2. as shown in the diagram above, your app will be launched using your Logica sandbox instance as the issuer (iss=My Sandbox),
3. your app will complete the SMART launch flow, discovering the auth server, requesting authorization, and finally receiving an access token to your Logica Sandbox!