535 measure evaluation should respect improvement notation specified on group

cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/measure/common/GroupDef.java

@@ -11,15 +11,25 @@ public class GroupDef {
     private final ConceptDef code;
     private final List<StratifierDef> stratifiers;
     private final List<PopulationDef> populations;
+    private final MeasureScoring measureScoring;
+    private final boolean isPositiveImprovementNotation;
 
     private final Map<MeasurePopulationType, List<PopulationDef>> populationIndex;
 
-    public GroupDef(String id, ConceptDef code, List<StratifierDef> stratifiers, List<PopulationDef> populations) {
+    public GroupDef(
+            String id,
+            ConceptDef code,
+            List<StratifierDef> stratifiers,
+            List<PopulationDef> populations,
+            MeasureScoring measureScoring,
+            boolean isPositiveImprovementNotation) {
         this.id = id;
         this.code = code;
         this.stratifiers = stratifiers;
         this.populations = populations;
         this.populationIndex = index(populations);
+        this.measureScoring = measureScoring;
+        this.isPositiveImprovementNotation = isPositiveImprovementNotation;
     }
 
     public String id() {
@@ -58,4 +68,12 @@ public List<PopulationDef> get(MeasurePopulationType type) {
     private Map<MeasurePopulationType, List<PopulationDef>> index(List<PopulationDef> populations) {
         return populations.stream().collect(Collectors.groupingBy(PopulationDef::type));
     }
+
+    public MeasureScoring measureScoring() {
+        return this.measureScoring;
+    }
+
+    public boolean isPositiveImprovementNotation() {
+        return this.isPositiveImprovementNotation;
+    }
 }

cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/measure/common/MeasureDef.java

@@ -1,7 +1,6 @@
 package org.opencds.cqf.fhir.cr.measure.common;
 
 import java.util.List;
-import java.util.Map;
 import org.opencds.cqf.cql.engine.runtime.Interval;
 
 public class MeasureDef {
@@ -10,26 +9,20 @@ public class MeasureDef {
     private final String url;
     private final String version;
     private Interval defaultMeasurementPeriod;
-    private final Map<GroupDef, MeasureScoring> scoring;
     private final List<GroupDef> groups;
     private final List<SdeDef> sdes;
     private final boolean isBooleanBasis;
+    private final boolean useMeasureImpNotation;
 
     public MeasureDef(
-            String id,
-            String url,
-            String version,
-            Map<GroupDef, MeasureScoring> scoring,
-            List<GroupDef> groups,
-            List<SdeDef> sdes,
-            boolean isBooleanBasis) {
+            String id, String url, String version, List<GroupDef> groups, List<SdeDef> sdes, boolean isBooleanBasis) {
         this.id = id;
         this.url = url;
         this.version = version;
         this.groups = groups;
         this.sdes = sdes;
-        this.scoring = scoring;
         this.isBooleanBasis = isBooleanBasis;
+        this.useMeasureImpNotation = groupDefAllSameImpNotation(groups);
     }
 
     public String id() {
@@ -56,11 +49,16 @@ public List<GroupDef> groups() {
         return this.groups;
     }
 
-    public Map<GroupDef, MeasureScoring> scoring() {
-        return this.scoring;
-    }
-
     public boolean isBooleanBasis() {
         return this.isBooleanBasis;
     }
+
+    public boolean useMeasureImpNotation() {
+        return this.useMeasureImpNotation;
+    }
+
+    public boolean groupDefAllSameImpNotation(List<GroupDef> groupDefs) {
+        // if single rate, then always true
+        return groupDefs.stream().allMatch(GroupDef::isPositiveImprovementNotation);
+    }
 }

cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/measure/common/MeasureEvaluator.java

@@ -451,13 +451,12 @@ protected void evaluateProportion(
             throw new NullPointerException("`" + INITIALPOPULATION.getDisplay() + "`, `" + NUMERATOR.getDisplay()
                     + "`, `" + DENOMINATOR.getDisplay()
                     + "` are required Population Definitions for Measure Scoring Type: "
-                    + measureDef.scoring().get(groupDef).toCode());
+                    + groupDef.measureScoring().toCode());
         }
         // Ratio Populations Check
-        if (measureDef.scoring().get(groupDef).toCode().equals("ratio") && denominatorException != null) {
-            throw new IllegalArgumentException(
-                    "`" + DENOMINATOREXCEPTION.getDisplay() + "` are not permitted " + "for MeasureScoring type: "
-                            + measureDef.scoring().get(groupDef).toCode());
+        if (groupDef.measureScoring().toCode().equals("ratio") && denominatorException != null) {
+            throw new IllegalArgumentException("`" + DENOMINATOREXCEPTION.getDisplay() + "` are not permitted "
+                    + "for MeasureScoring type: " + groupDef.measureScoring().toCode());
         }
 
         initialPopulation = evaluatePopulationMembership(subjectType, subjectId, initialPopulation, evaluationResult);
@@ -548,7 +547,7 @@ protected void evaluateContinuousVariable(
             throw new NullPointerException(
                     "`" + INITIALPOPULATION.getDisplay() + "` & `" + MEASUREPOPULATION.getDisplay()
                             + "` are required Population Definitions for Measure Scoring Type: "
-                            + measureDef.scoring().get(groupDef).toCode());
+                            + groupDef.measureScoring().toCode());
         }
 
         initialPopulation = evaluatePopulationMembership(subjectType, subjectId, initialPopulation, evaluationResult);
@@ -597,7 +596,7 @@ protected void evaluateCohort(
         if (initialPopulation == null) {
             throw new NullPointerException("`" + INITIALPOPULATION.getDisplay()
                     + "` is a required Population Definition for Measure Scoring Type: "
-                    + measureDef.scoring().get(groupDef).toCode());
+                    + groupDef.measureScoring().toCode());
         }
         // Evaluate Population
         evaluatePopulationMembership(subjectType, subjectId, initialPopulation, evaluationResult);
@@ -613,7 +612,7 @@ protected void evaluateGroup(
             EvaluationResult evaluationResult) {
         evaluateStratifiers(subjectId, groupDef.stratifiers(), evaluationResult);
 
-        var scoring = measureDef.scoring().get(groupDef);
+        var scoring = groupDef.measureScoring();
         switch (scoring) {
             case PROPORTION:
             case RATIO:

cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/measure/common/MeasureReportScorer.java

@@ -1,7 +1,5 @@
 package org.opencds.cqf.fhir.cr.measure.common;
 
-import java.util.Map;
-
 public interface MeasureReportScorer<MeasureReportT> {
-    public void score(Map<GroupDef, MeasureScoring> measureScoring, MeasureReportT measureReport);
+    public void score(MeasureDef measureDef, MeasureReportT measureReport);
 }

cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/measure/constant/MeasureReportConstants.java

@@ -8,6 +8,10 @@
 public class MeasureReportConstants {
     private MeasureReportConstants() {}
 
+    public static final String IMPROVEMENT_NOTATION_SYSTEM_INCREASE = "increase";
+    public static final String IMPROVEMENT_NOTATION_SYSTEM_INCREASE_DISPLAY = "Increase";
+    public static final String IMPROVEMENT_NOTATION_SYSTEM_DECREASE = "decrease";
+    public static final String IMPROVEMENT_NOTATION_SYSTEM_DECREASE_DISPLAY = "Decrease";
     public static final String MEASUREREPORT_IMPROVEMENT_NOTATION_SYSTEM =
             "http://terminology.hl7.org/CodeSystem/measure-improvement-notation";
 

cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/measure/dstu3/Dstu3MeasureDefBuilder.java

@@ -2,12 +2,12 @@
 
 import static org.opencds.cqf.fhir.cr.measure.common.MeasurePopulationType.TOTALDENOMINATOR;
 import static org.opencds.cqf.fhir.cr.measure.common.MeasurePopulationType.TOTALNUMERATOR;
+import static org.opencds.cqf.fhir.cr.measure.constant.MeasureReportConstants.IMPROVEMENT_NOTATION_SYSTEM_INCREASE;
+import static org.opencds.cqf.fhir.cr.measure.constant.MeasureReportConstants.MEASUREREPORT_IMPROVEMENT_NOTATION_EXTENSION;
 
 import java.util.ArrayList;
 import java.util.Collections;
-import java.util.HashMap;
 import java.util.List;
-import java.util.Map;
 import org.apache.commons.lang3.StringUtils;
 import org.hl7.fhir.dstu3.model.CodeableConcept;
 import org.hl7.fhir.dstu3.model.Coding;
@@ -56,11 +56,11 @@ public MeasureDef build(Measure measure) {
         if (!measure.getGroup().isEmpty() && groupMeasureScoringCode == null) {
             throw new IllegalArgumentException("MeasureScoring must be specified on Measure");
         }
+        var measureLevelImpNotation = measureIsIncreaseImprovementNotation(measure);
         List<GroupDef> groups = new ArrayList<>();
-        Map<GroupDef, MeasureScoring> groupMeasureScoring = new HashMap<>();
         for (MeasureGroupComponent group : measure.getGroup()) {
-            // Ids are not required on groups in dstu3
-            // checkId(group);
+            // group improvement notation
+            var groupIsIncreaseImprovementNotation = groupIsIncreaseImprovementNotation(measureLevelImpNotation, group);
 
             // Populations
             List<PopulationDef> populations = new ArrayList<>();
@@ -101,9 +101,11 @@ public MeasureDef build(Measure measure) {
                     group.getId(),
                     null, // No code on group in dstu3
                     stratifiers,
-                    populations);
+                    populations,
+                    groupMeasureScoringCode,
+                    groupIsIncreaseImprovementNotation);
             groups.add(groupDef);
-            groupMeasureScoring.put(groupDef, groupMeasureScoringCode);
+            // groupMeasureScoring.put(groupDef, groupMeasureScoringCode);
         }
         // define basis of measure
         Dstu3MeasureBasisDef measureBasisDef = new Dstu3MeasureBasisDef();
@@ -112,7 +114,6 @@ public MeasureDef build(Measure measure) {
                 measure.getId(),
                 measure.getUrl(),
                 measure.getVersion(),
-                groupMeasureScoring,
                 groups,
                 sdes,
                 measureBasisDef.isBooleanBasis(measure));
@@ -165,4 +166,27 @@ private void checkId(Resource r) {
     private MeasureScoring getMeasureScoring(Measure measure) {
         return MeasureScoring.fromCode(measure.getScoring().getCodingFirstRep().getCode());
     }
+
+    private boolean isIncreaseImprovementNotation(String improvementNotationValue) {
+        return improvementNotationValue.equals(IMPROVEMENT_NOTATION_SYSTEM_INCREASE);
+    }
+
+    public boolean measureIsIncreaseImprovementNotation(Measure measure) {
+        if (measure.hasImprovementNotation()) {
+            return isIncreaseImprovementNotation(measure.getImprovementNotation());
+        } else {
+            // default ImprovementNotation behavior
+            return true;
+        }
+    }
+
+    public boolean groupIsIncreaseImprovementNotation(
+            boolean measureImprovementNotationIsPositive, MeasureGroupComponent group) {
+        var improvementNotationExt = group.getExtensionByUrl(MEASUREREPORT_IMPROVEMENT_NOTATION_EXTENSION);
+        if (improvementNotationExt != null) {
+            return isIncreaseImprovementNotation(
+                    improvementNotationExt.getValue().toString());
+        }
+        return measureImprovementNotationIsPositive;
+    }
 }

cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/measure/dstu3/Dstu3MeasureReportBuilder.java

@@ -94,7 +94,7 @@ public MeasureReport build(
         buildGroups(measure, measureDef);
         processSdes(measure, measureDef, subjectIds);
 
-        this.measureReportScorer.score(measureDef.scoring(), this.report);
+        this.measureReportScorer.score(measureDef, this.report);
 
         // Only add evaluated resources to individual reports
         if (measureReportType == MeasureReportType.INDIVIDUAL) {

cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/measure/dstu3/Dstu3MeasureReportScorer.java

@@ -1,6 +1,5 @@
 package org.opencds.cqf.fhir.cr.measure.dstu3;
 
-import java.util.Map;
 import java.util.Optional;
 import org.hl7.fhir.dstu3.model.MeasureReport;
 import org.hl7.fhir.dstu3.model.MeasureReport.MeasureReportGroupComponent;
@@ -9,27 +8,33 @@
 import org.hl7.fhir.dstu3.model.MeasureReport.StratifierGroupComponent;
 import org.hl7.fhir.dstu3.model.MeasureReport.StratifierGroupPopulationComponent;
 import org.opencds.cqf.fhir.cr.measure.common.BaseMeasureReportScorer;
-import org.opencds.cqf.fhir.cr.measure.common.GroupDef;
+import org.opencds.cqf.fhir.cr.measure.common.MeasureDef;
 import org.opencds.cqf.fhir.cr.measure.common.MeasurePopulationType;
 import org.opencds.cqf.fhir.cr.measure.common.MeasureScoring;
 
 public class Dstu3MeasureReportScorer extends BaseMeasureReportScorer<MeasureReport> {
 
     @Override
-    public void score(Map<GroupDef, MeasureScoring> measureScoring, MeasureReport measureReport) {
+    public void score(MeasureDef measureDef, MeasureReport measureReport) {
+        // Measure Def Check
+        if (measureDef == null) {
+            throw new IllegalArgumentException("MeasureDef is required in order to score a Measure.");
+        }
         // No groups, nothing to score
         if (measureReport.getGroup().isEmpty()) {
             return;
         }
+        // Dstu3 doesn't have scoring on group level, extract first assigned groupDef measureScore
+        MeasureScoring measureScoring = measureDef.groups().get(0).measureScoring();
 
-        if (measureScoring == null || measureScoring.isEmpty()) {
+        // validate scoring
+        if (measureScoring == null) {
             throw new IllegalArgumentException(
                     "Measure does not have a scoring methodology defined. Add a \"scoring\" property to the measure definition or the group definition.");
         }
 
-        var scoring = measureScoring.values().iterator().next();
         for (MeasureReportGroupComponent mrgc : measureReport.getGroup()) {
-            scoreGroup(scoring, mrgc);
+            scoreGroup(measureScoring, mrgc);
         }
     }
 

cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/measure/r4/R4CareGapStatusEvaluator.java

@@ -1,13 +1,16 @@
 package org.opencds.cqf.fhir.cr.measure.r4;
 
 import static org.opencds.cqf.fhir.cr.measure.constant.MeasureConstants.CQFM_CARE_GAP_DATE_OF_COMPLIANCE_EXT_URL;
+import static org.opencds.cqf.fhir.cr.measure.constant.MeasureReportConstants.IMPROVEMENT_NOTATION_SYSTEM_INCREASE;
+import static org.opencds.cqf.fhir.cr.measure.constant.MeasureReportConstants.MEASUREREPORT_IMPROVEMENT_NOTATION_EXTENSION;
 import static org.opencds.cqf.fhir.cr.measure.constant.MeasureReportConstants.MEASUREREPORT_IMPROVEMENT_NOTATION_SYSTEM;
 import static org.opencds.cqf.fhir.cr.measure.constant.MeasureReportConstants.MEASUREREPORT_MEASURE_POPULATION_SYSTEM;
 
 import java.util.HashMap;
 import java.util.Map;
 import org.apache.commons.lang3.tuple.MutablePair;
 import org.apache.commons.lang3.tuple.Pair;
+import org.hl7.fhir.r4.model.CodeableConcept;
 import org.hl7.fhir.r4.model.DateTimeType;
 import org.hl7.fhir.r4.model.Measure;
 import org.hl7.fhir.r4.model.MeasureReport;
@@ -83,13 +86,12 @@ private CareGapsStatusCode getGapStatus(
         // default improvementNotation
         boolean isPositive = true;
 
-        // TODO: look for group specified 'improvement notation', if missing, then look on measure
-        /*if (groupHasImprovementNotation(measureReportGroup)) {
+        // look for group specified 'improvement notation', if missing, then look on measure
+        if (groupHasImprovementNotation(measureReportGroup)) {
             isPositive = groupImprovementNotationIsPositive(measureReportGroup);
-        } else if (measure.hasImprovementNotation()) {*/
-        if (measure.hasImprovementNotation()) {
-            isPositive =
-                    measure.getImprovementNotation().hasCoding(MEASUREREPORT_IMPROVEMENT_NOTATION_SYSTEM, "increase");
+        } else if (measure.hasImprovementNotation()) {
+            isPositive = measure.getImprovementNotation()
+                    .hasCoding(MEASUREREPORT_IMPROVEMENT_NOTATION_SYSTEM, IMPROVEMENT_NOTATION_SYSTEM_INCREASE);
         }
 
         if (Boolean.FALSE.equals(inDenominator.getValue())) {
@@ -134,8 +136,7 @@ private Period getDateOfComplianceExt(MeasureReportGroupComponent measureReportG
         return (Period) extValue;
     }
 
-    /*
-    // TODO implement Measure Group Level improvement notation extension
+    // Measure Group Level improvement notation extension
     private boolean groupHasImprovementNotation(MeasureReportGroupComponent groupComponent) {
         return groupComponent.getExtensionByUrl(MEASUREREPORT_IMPROVEMENT_NOTATION_EXTENSION) != null;
     }
@@ -144,6 +145,6 @@ private boolean groupImprovementNotationIsPositive(MeasureReportGroupComponent g
         var code = (CodeableConcept) groupComponent
                 .getExtensionByUrl(MEASUREREPORT_IMPROVEMENT_NOTATION_EXTENSION)
                 .getValue();
-        return code.hasCoding(MEASUREREPORT_IMPROVEMENT_NOTATION_SYSTEM, "increase");
-    }*/
+        return code.hasCoding(MEASUREREPORT_IMPROVEMENT_NOTATION_SYSTEM, IMPROVEMENT_NOTATION_SYSTEM_INCREASE);
+    }
 }