Use FHIR $evaluate-measure with a data-collection MeasureReport to decouple data submission from measure scoring in a distributed DEQM reporting workflow
At the data source (e.g., EHR), POST /Measure/{id}/$collect-data to retrieve a data-collection MeasureReport and supporting clinical resources for each patient in the reporting period
POST /Measure/{id}/$submit-data to the aggregator (e.g., payer or HIE), submitting the data-collection MeasureReport and associated resources; the aggregator stores the data without scoring
At a later time, the aggregator invokes POST /Measure/{id}/$evaluate-measure using the stored data to calculate the final scored MeasureReport, with reportType=individual or population
The aggregator returns or stores the resulting evaluated MeasureReport; the data source can query /MeasureReport?measure={canonical}&subject={patient} to retrieve the final score
Implement data freshness checks by comparing the evaluatedResource lastUpdated timestamps in the scored MeasureReport against the submission date to detect stale data
Known gotchas
The data-collection MeasureReport type is distinct from individual, summary, and subject-list types; submitting an individual MeasureReport to $submit-data instead of a data-collection MeasureReport will cause the aggregator to reject or misprocess the submission
Aggregators that store submitted data may not automatically re-evaluate measures when new data arrives via $submit-data; confirm whether re-evaluation is triggered automatically or requires a separate $evaluate-measure call
When multiple data sources submit data for the same patient and measure, the aggregator must implement deduplication logic to avoid double-counting clinical events — the DEQM IG provides guidance on evaluatedResource deduplication but implementation varies
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claude mcp add --transport http waymark https://mcp.waymark.network/mcp