Release 4 Snapshot 3: Connectathon 32 Base

This page is part of the Snapshot #3 for FHIR Specification (v4.0.1: R4 - Mixed Normative and STU ) in it's permanent home (it will always be available at this URL). The current version which supercedes this version is 5.0.0 R5 , released to support Connectathon 32 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

Example Measure/measure-exclusive-breastfeeding (Turtle)

FHIR Infrastructure
Clinical Quality Information Work Group Maturity Level : N/A Standards Status : Informative Compartments : Not linked to any defined compartments
7.13 Managing Push and Pull
  • Narrative The primary focus of FHIR is the exchange of healthcare data between systems. Whenever one system has information that another needs or wants, one question that automatically arises is whether the source system will push the data, or whether the destination system will pull the data. Push As new information becomes available, or whenever is deemed appropriate, the source system sends the information to the destination. It expects the destination system to maintain and index the information on receipt. The source system must trust the destination system to manage access/security appropriately Pull The source system maintains and indexes data. When the destination system wants or needs the information, it must retrieve it from the source system. Either the source or the destination (or both) manages access/security Note that it is possible to mix these modes by adding an interface repository into the mix. For example, to connect a push-based source with a pull-based destination, simply have the source push information to the repository, and the destination can pull data from it as required. If the source is pull-based, the interface repository can query it for new data on a regular basis, and when it finds any, it can pull it into the repository and/or push it to the destination. Which combination of push, pull and interface repositories is appropriate for any given context depends on a host of factors around deployment architecture, network and business topology, security policies, etc. However, it is often constrained by the capabilities of the various systems and the standards used in the exchange. The FHIR specification supports and enables both push and pull: REST : The REST API can be used in either fashion - this is discussed in more depth below
    • Messages : FHIR defines message events for both push and pull
  • Services : Services may be defined to support either model XML Documents : This question doesn't apply, because documents are bundles that are exchanged using either REST, messages, or services
    • 7.13.1
  • Push and Pull on a RESTful interface JSON
  • TTL

Raw Turtle Push: The source is a client, and when new data is available, it uses create , update , and transaction (+ also see Turtle/RDF Format Specification )

Exclusive Breastfeeding Measure 


@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

[a fhir:Measure;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "measure-exclusive-breastfeeding"]; # 
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table class=\"grid dict\"><tr><td><b>Id: </b></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\">Measure/measure-exclusive-breastfeeding</td></tr></table><p/><table class=\"grid dict\"><tr><td><b>Identifier: </b></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\"><b>value: </b><span>exclusive-breastfeeding-measure</span></td></tr></table><p/><table class=\"grid dict\"><tr><td><b>Title: </b></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\">Exclusive Breastfeeding Measure</td></tr></table><p/><table class=\"grid dict\"><tr><td><b>Status: </b></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\">active</td></tr></table><p/><table class=\"grid dict\"><tr><td><b>Description: </b></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\">Exclusive breastfeeding measure of outcomes for exclusive breastmilk feeding of newborns.</td></tr></table><p/><table class=\"grid dict\"><tr><td><b>Purpose: </b></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\">Exclusive breast milk feeding for the first 6 months of neonatal life can result in numerous long-term health benefits for both mother and newborn and is recommended by a number of national and international organizations. Evidence suggests that the prenatal and intrapartum period is critical for the success of exclusive (or any) breast feeding. Therefore, it is recommended that newborns are fed breast milk only from birth to discharge.</td></tr></table><p/><table class=\"grid dict\"><tr><td><b>Topic: </b></td></tr><tr><td style=\"padding-right: 25px;\"><span style=\"padding-left: 25px;\"><b>text: </b><span>Exclusive Breastfeeding</span><br/></span></td></tr></table><p/><table class=\"grid dict\"><tr><td><b>Library: </b></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\"><b>reference: </b><span>Library/library-exclusive-breastfeeding-cqm-logic</span></td></tr></table><p/><table class=\"grid dict\"><tr><td><b>Type: </b></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\">outcome</td></tr></table><p/><table class=\"grid dict\"><tr><td><b>Group:</b></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\"><b>Identifier:</b><br/><span style=\"padding-left: 25px;\"><b>value: </b><span>Population Group 1</span><br/></span></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\"><b>Population:</b><br/><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>type:</b><span>initial-population</span></p><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>Identifier:</b><br/><span style=\"padding-left: 25px;\"><b>value: </b><span>initial-population-1-identifier</span><br/></span></p><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>criteria: </b><span>InitialPopulation1</span></p></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\"><b>Population:</b><br/><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>type:</b><span>denominator</span></p><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>Identifier:</b><br/><span style=\"padding-left: 25px;\"><b>value: </b><span>denominator-1-identifier</span><br/></span></p><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>criteria: </b><span>Denominator1</span></p></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\"><b>Population:</b><br/><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>type:</b><span>denominator-exclusion</span></p><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>Identifier:</b><br/><span style=\"padding-left: 25px;\"><b>value: </b><span>denominator-exclusions-1-identifier</span><br/></span></p><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>criteria: </b><span>DenominatorExclusions1</span></p></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\"><b>Population:</b><br/><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>type:</b><span>numerator</span></p><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>Identifier:</b><br/><span style=\"padding-left: 25px;\"><b>value: </b><span>numerator-1-identifier</span><br/></span></p><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>criteria: </b><span>Numerator1</span></p></td></tr></table><table class=\"grid dict\"><tr><td><b>Group:</b></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\"><b>Identifier:</b><br/><span style=\"padding-left: 25px;\"><b>value: </b><span>Population Group 2</span><br/></span></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\"><b>Population:</b><br/><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>type:</b><span>initial-population</span></p><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>Identifier:</b><br/><span style=\"padding-left: 25px;\"><b>value: </b><span>initial-population-2-identifier</span><br/></span></p><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>criteria: </b><span>InitialPopulation2</span></p></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\"><b>Population:</b><br/><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>type:</b><span>denominator</span></p><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>Identifier:</b><br/><span style=\"padding-left: 25px;\"><b>value: </b><span>denominator-2-identifier</span><br/></span></p><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>criteria: </b><span>Denominator2</span></p></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\"><b>Population:</b><br/><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>type:</b><span>denominator-exclusion</span></p><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>Identifier:</b><br/><span style=\"padding-left: 25px;\"><b>value: </b><span>denominator-exclusions-2-identifier</span><br/></span></p><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>criteria: </b><span>DenominatorExclusions2</span></p></td></tr><tr><td style=\"padding-left: 25px; padding-right: 25px;\"><b>Population:</b><br/><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>type:</b><span>numerator</span></p><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>Identifier:</b><br/><span style=\"padding-left: 25px;\"><b>value: </b><span>numerator-2-identifier</span><br/></span></p><p style=\"margin-bottom: 5px; padding-left: 25px;\"><b>criteria: </b><span>Numerator2</span></p></td></tr></table></div>"
  ]; # 
  fhir:Measure.identifier [
     fhir:index 0;
     fhir:Identifier.use [ fhir:value "official" ];
     fhir:Identifier.value [ fhir:value "exclusive-breastfeeding-measure" ]
  ]; # 
  fhir:Measure.version [ fhir:value "5.0.0"]; # 
  fhir:Measure.title [ fhir:value "Exclusive Breastfeeding Measure"]; # 
  fhir:Measure.status [ fhir:value "active"]; # 
  fhir:Measure.date [ fhir:value "2015-03-08"^^xsd:date]; # 
  fhir:Measure.description [ fhir:value "Exclusive breastfeeding measure of outcomes for exclusive breastmilk feeding of newborns."]; # 
  fhir:Measure.purpose [ fhir:value "Measure of newborns who were fed breast milk only since birth"]; # 
  fhir:Measure.topic [
     fhir:index 0;
     fhir:CodeableConcept.text [ fhir:value "Exclusive Breastfeeding" ]
  ]; # 
  fhir:Measure.relatedArtifact [
     fhir:index 0;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.citation [ fhir:value "American Academy of Pediatrics. (2005). Section on Breastfeeding. Policy Statement:Breastfeeding and the Use of Human Milk. Pediatrics.115:496-506." ]
  ], [
     fhir:index 1;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.citation [ fhir:value "American College of Obstetricians and Gynecologists. (Feb. 2007). Committee on Obstetric Practice and Committee on Health Care for Underserved Women. Breastfeeding: Maternal and Infant Aspects. ACOG Committee Opinion 361." ]
  ], [
     fhir:index 2;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.citation [ fhir:value "California Department of Public Health. (2006). Genetic Disease Branch. California In-Hospital Breastfeeding as Indicated on the Newborn Screening Test Form, Statewide, County and Hospital of Occurrence: Available at: http://www.cdph.ca.gov/data/statistics/Pages/BreastfeedingStatistics.aspx." ]
  ], [
     fhir:index 3;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.citation [ fhir:value "Centers for Disease Control and Prevention. (Aug 3, 2007). Breastfeeding trends and updated national health objectives for exclusive breastfeeding--United States birth years 2000-2004. MMWR - Morbidity & Mortality Weekly Report. 56(30):760-3." ]
  ], [
     fhir:index 4;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.citation [ fhir:value "Centers for Disease Control and Prevention. (2014). Division of Nutrition, Physical Activity and Obesity. Breastfeeding Report Card. Available at: http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf" ]
  ], [
     fhir:index 5;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.citation [ fhir:value "Ip, S., Chung, M., Raman, G., et al. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: US Department of Health and Human Services. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf" ]
  ], [
     fhir:index 6;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.citation [ fhir:value "Kramer, M.S. & Kakuma, R. (2002).Optimal duration of exclusive breastfeeding. [107 refs] Cochrane Database of Systematic Reviews. (1):CD003517." ]
  ], [
     fhir:index 7;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.citation [ fhir:value "Petrova, A., Hegyi, T., & Mehta, R. (2007). Maternal race/ethnicity and one-month exclusive breastfeeding in association with the in-hospital feeding modality. Breastfeeding Medicine. 2(2):92-8." ]
  ], [
     fhir:index 8;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.citation [ fhir:value "Shealy, K.R., Li, R., Benton-Davis, S., & Grummer-Strawn, L.M. (2005).The CDC guide to breastfeeding interventions. Atlanta, GA: US Department of Health and Human Services, CDC. Available at: http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf." ]
  ], [
     fhir:index 9;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.citation [ fhir:value "Taveras, E.M., Li, R., Grummer-Strawn, L., Richardson, M., Marshall, R., Rego, V.H., Miroshnik, I., & Lieu, T.A. (2004). Opinions and practices of clinicians associated with continuation of exclusive breastfeeding. Pediatrics. 113(4):e283-90." ]
  ], [
     fhir:index 10;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.citation [ fhir:value "US Department of Health and Human Services. (2007). Healthy People 2010 Midcourse Review. Washington, DC: US Department of Health and Human Services. Available at: http://www.healthypeople.gov/2010/data/midcourse/?visit=1." ]
  ], [
     fhir:index 11;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.citation [ fhir:value "World Health Organization. (1991). Indicators for assessing breastfeeding practices. Geneva, Switzerland: World Health Organization. Available at: http://whqlibdoc.who.int/hq/1991/WHO_CDD_SER_91.14.pdf?ua=1." ]
  ], [
     fhir:index 12;
     fhir:RelatedArtifact.type [ fhir:value "predecessor" ];
     fhir:RelatedArtifact.resource [
       fhir:value "http://example.org/fhir/Measure/measure-predecessor-example";
       fhir:link <http://example.org/fhir/Measure/measure-predecessor-example>
     ]
  ], [
     fhir:index 13;
     fhir:RelatedArtifact.type [ fhir:value "derived-from" ];
     fhir:RelatedArtifact.resource [
       fhir:value "http://example.org/fhir/Measure/measure-predecessor-example";
       fhir:link <http://example.org/fhir/Measure/measure-predecessor-example>
     ]
  ]; # 
  fhir:Measure.library [
     fhir:value "http://example.org/fhir/Library/library-exclusive-breastfeeding-cqm-logic";
     fhir:index 0;
     fhir:link <http://example.org/fhir/Library/library-exclusive-breastfeeding-cqm-logic>
  ]; # 
  fhir:Measure.disclaimer [ fhir:value "These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty."]; # 
  fhir:Measure.scoring [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.code [ fhir:value "proportion" ]
     ]
  ]; # 
  fhir:Measure.type [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.code [ fhir:value "process" ]
     ]
  ]; # 
  fhir:Measure.rationale [ fhir:value "Exclusive breast milk feeding for the first 6 months of neonatal life has long been the expressed goal of World Health Organization (WHO), Department of Health and Human Services (DHHS), American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG). ACOG has recently reiterated its position (ACOG, 2007). A recent Cochrane review substantiates the benefits (Kramer et al., 2002). Much evidence has now focused on the prenatal and intrapartum period as critical for the success of exclusive (or any) BF (Centers for Disease Control and Prevention [CDC], 2007; Petrova et al., 2007; Shealy et al., 2005; Taveras et al., 2004). Exclusive breast milk feeding rate during birth hospital stay has been calculated by the California Department of Public Health for the last several years using newborn genetic disease testing data. Healthy People 2010 and the CDC have also been active in promoting this goal."]; # 
  fhir:Measure.clinicalRecommendationStatement [ fhir:value "Exclusive breast milk feeding for the first 6 months of neonatal life can result in numerous long-term health benefits for both mother and newborn and is recommended by a number of national and international organizations. Evidence suggests that the prenatal and intrapartum period is critical for the success of exclusive (or any) breast feeding. Therefore, it is recommended that newborns are fed breast milk only from birth to discharge."]; # 
  fhir:Measure.improvementNotation [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-improvement-notation" ];
       fhir:Coding.code [ fhir:value "increase" ]
     ]
  ]; # 
  fhir:Measure.term [
     fhir:index 0;
     fhir:Measure.term.definition [ fhir:value "Gestational age is calculated using the ACOG ReVITALize guidelines with Estimated Due Date (EDD) http://www.acog.org/about_acog/acog_departments/patient_safety_and_quality_improvement/~/media/departments/patient%20safety%20and%20quality%20improvement/201213issuesandrationale-gestationalageterm.pdf. The exam used needs to be the most recent exam associated with this pregnancy" ]
  ]; # 
  fhir:Measure.guidance [ fhir:value "A discharge to a designated cancer center or children's hospital should be captured as a discharge to an acute care facility. It is acceptable to calculate Gestational Age using the American College of Obstetricians and Gynecologists ReVITALize guidelines, which define Gestational Age as calculated using the best obstetrical Estimated Due Date (EDD) based on the formula: Gestational Age= (280-(EDD-Reference Date))/7 where Reference Date is the date on which you are trying to determine gestational age. For PC-05, Reference Date is the Birth Date. Note however that the calculation may yield a non-whole number and gestational age should be rounded off to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks."]; # 
  fhir:Measure.group [
     fhir:index 0;
     fhir:Element.id [ fhir:value "PopulationGroup1" ];
     fhir:Measure.group.population [
       fhir:index 0;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.code [ fhir:value "initial-population" ]
         ]
       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "InitialPopulation1" ]
       ]
     ], [
       fhir:index 1;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.code [ fhir:value "denominator" ]
         ]
       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Denominator1" ]
       ]
     ], [
       fhir:index 2;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.code [ fhir:value "denominator-exclusions" ]
         ]
       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "DenominatorExclusions1" ]
       ]
     ], [
       fhir:index 3;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.code [ fhir:value "numerator" ]
         ]
       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Numerator1" ]
       ]
     ]
  ], [
     fhir:index 1;
     fhir:Element.id [ fhir:value "PopulationGroup2" ];
     fhir:Measure.group.population [
       fhir:index 0;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.code [ fhir:value "initial-population" ]
         ]
       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "InitialPopulation2" ]
       ]
     ], [
       fhir:index 1;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.code [ fhir:value "denominator" ]
         ]
       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Denominator2" ]
       ]
     ], [
       fhir:index 2;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.code [ fhir:value "denominator-exclusion" ]
         ]
       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "DenominatorExclusions2" ]
       ]
     ], [
       fhir:index 3;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.code [ fhir:value "numerator" ]
         ]
       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Numerator2" ]
       ]
     ]
  ]] . # 

# - ontology header ------------------------------------------------------------

[a owl:Ontology;
  owl:imports fhir:fhir.ttl] .

# -------------------------------------------------------------------------------------

Usage note: every effort has been made to push data to the destination, which is a server Pull: The source is a server, and the destination is a client. When the client wants to use ensure that the data, it uses a combination of search examples are correct and read so the users can find the data useful, but they need Push/Pull: The source is a server, and the destination is a client. On are not a regular basis, the destination queries the server for its history , and replicates the changes in its own copy normative part of the database specification.