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Back to overview of RI Inferences
Quality Measure corresponds to a MIPS ("merit based payment incentive") result.
As described in the standards, a specific concept in the document, such as an incidental pulmonary nodule, triggers a MIPS measure.
The result can be performanceMet, performanceNotMet, denominatorException, or notEligible.
For example, if there's an incidental pulmonary nodule, the text should contain a follow-up recommendation for the result to be performanceMet.
If the required text isn't present but there's an explanation (for example, the patient has unexplained fever), the result is denominatorException.
If the follow-up recommendation is missing without a valid explanation, the result is performanceNotMet.
Finally, notEligible applies if the code was configured to make a mips result for a specific trigger (for example, incidental pulmonary nodule) but the trigger wasn't in the text.
It's determined by option "measureTypes" in "QualityMeasureOptions" (see the model configuration) for which triggers a MIPS result will be searched. The possible values of array measureTypes can be found in the description of this option in the model configuration, or under "QualityMeasureType" in the OpenAPI specification.
- Field "kind" has value
qualityMeasure. - Field
qualityMeasureDenominatorhas the MIPS kind, for example "INCIDENTAL PULMONARY NODULE". - Field
complianceTypehas either valuenotEligible,performanceNotMet,performanceMet, ordenominatorException. - Field
qualityCriteriacontains strings that correspond to document substrings supporting resultperformanceMetordenominatorException. Even for resultperformanceNotMetit might contain strings, but not enough to support resultperformanceMetordenominatorException. These strings are normalized, so in most cases they aren't exactly the same as substrings from the document.
All fields are mandatory, exceptqualityCriteria.
Example of a quality measure (without extensions):
{
"kind": "qualityMeasure",
"qualityMeasureDenominator": "INCIDENTAL PULMONARY NODULE",
"complianceType": "performanceMet",
"qualityCriteria": [
"FOLLOW-UP RECOMMENDATION"
]
}
The following table contains the possible values for qualityMeasureDenominator, each with a URL that provides an explanation of the value:
Examples Request/Response JSON:
{
"jobData" : {
"configuration" : {
"inferenceOptions" : {
"followupRecommendationOptions" : {
"includeRecommendationsWithNoSpecifiedModality" : false,
"includeRecommendationsInReferences" : false,
"provideFocusedSentenceEvidence" : true
},
"findingOptions" : {
"provideFocusedSentenceEvidence" : true
},
"QualityMeasureOptions" : {
"measureTypes" : [ "mips364", "mips360", "mips436" ]
}
},
"inferenceTypes" : ["qualityMeasure"],
"locale" : "en-US",
"verbose" : false,
"includeEvidence" : false
},
"patients" : [ {
"id" : "11111",
"details" : {
"sex" : "female",
"birthDate" : "1939-05-25",
"clinicalInfo" : [ {
"resourceType" : "Observation",
"status" : "unknown",
"code" : {
"coding" : [ {
"system" : "http://www.nlm.nih.gov/research/umls",
"code" : "C0018802",
"display" : "MalignantNeoplasms"
} ]
},
"valueBoolean" : "true"
} ]
},
"encounters" : [ {
"id" : "encounterid1",
"period" : {
"start" : "2014-2-20T00:00:00",
"end" : "2014-2-20T00:00:00"
},
"class" : "inpatient"
} ],
"patientDocuments" : [ {
"type" : "note",
"clinicalType" : "radiologyReport",
"id" : "docid1",
"language" : "en",
"authors" : [ {
"id" : "authorid1",
"name" : "authorname1"
} ],
"specialtyType" : "radiology",
"createdAt" : "2014-2-20T00:00:00",
"administrativeMetadata" : {
"orderedProcedures" : [ {
"code" : {
"coding" : [ {
"system" : "http://loinc.org",
"code" : "CTCHWO",
"display" : "CT CHEST WO CONTRAST "
} ]
},
"description" : "CT CHEST WO CONTRAST "
} ],
"encounterId" : "encounterid1"
},
"content" : {
"sourceType" : "inline",
"value" : "\n\n\n\r\n\nEXAM: CT CHEST WO CONTRAST\n\nINDICATION: abnormal lung findings. History of emphysema.\n\nTECHNIQUE: Helical CT images through the chest, without contrast. This exam was performed using one or more of the following dose reduction techniques: Automated exposure control, adjustment of the mA and/or kV according to patient size, and/or use of iterative reconstruction technique. \n\nCOMPARISON: Chest CT dated 6/21/2022.\n\nNumber of previous CT examinations or cardiac nuclear medicine (myocardial perfusion) examinations performed in the preceding 12-months: 2\n\nFINDINGS: \n\nHeart size is normal. No pericardial effusion. Thoracic aorta as well as pulmonary arteries are normal in caliber. There are dense coronary artery calcifications. No enlarged axillary, mediastinal, or hilar lymph nodes by CT size criteria. Central airways are widely patent. No bronchial wall thickening. No pneumothorax, pleural effusion or pulmonary edema. The previously identified posterior right upper lobe nodules are no longer seen. However, there are multiple new small pulmonary nodules. An 8 mm nodule in the right upper lobe, image #15 series 4. New posterior right upper lobe nodule measuring 6 mm, image #28 series 4. New 1.2 cm pulmonary nodule, right upper lobe, image #33 series 4. New 4 mm pulmonary nodule left upper lobe, image #22 series 4. New 8 mm pulmonary nodule in the left upper lobe adjacent to the fissure, image #42 series 4. A few new tiny 2 to 3 mm pulmonary nodules are also noted in the left lower lobe. As before there is a background of severe emphysema. No evidence of pneumonia.\n\nLimited evaluation of the upper abdomen shows no concerning abnormality.\n\nReview of bone windows shows no aggressive appearing osseous lesions.\n\n\nIMPRESSION:\n\n1. Previously identified small pulmonary nodules in the right upper lobe have resolved, but there are multiple new small nodules scattered throughout both lungs. Recommend short-term follow-up with noncontrast chest CT in 3 months as per current Current guidelines (2017 Fleischner Society).\n2. Severe emphysema.\n\nFindings communicated to Dr. Jane Smith.\n\n\r\n"
}
} ]
} ]
}
}
{
"result": {
"patientResults": [
{
"patientId": "11111",
"inferences": [
{
"kind": "qualityMeasure",
"qualityMeasureDenominator": "INCIDENTAL PULMONARY NODULE",
"complianceType": "performanceMet",
"qualityCriteria": [
"APPROPRIATE FOLLOW-UP RECOMMENDATION"
]
},
{
"kind": "qualityMeasure",
"qualityMeasureDenominator": "HIGH DOSE RADIATION IMAGING",
"complianceType": "performanceMet",
"qualityCriteria": [
"DOCUMENTED COUNT"
]
},
{
"kind": "qualityMeasure",
"qualityMeasureDenominator": "DOSE LOWERING TECHNIQUE",
"complianceType": "performanceMet",
"qualityCriteria": [
"AUTOMATED EXPOSURE CONTROL",
"MA OR KV ADJUSTMENT",
"ITERATIVE RECONSTRUCTION"
]
}
]
}
],
"modelVersion": "2025-03-17"
},
"id": "fca112",
"createdAt": "2025-04-30T11:25:58Z",
"expiresAt": "2025-05-01T11:25:58Z",
"updatedAt": "2025-04-30T11:26:10Z",
"status": "succeeded"
}