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WorkWell Measure Catalog

WorkWell Measure Studio implements the Total Worker Health (TWH) model: OSHA occupational safety compliance and clinical quality / wellness measures managed in a single platform. The TWH instance seeds all three categories on startup.

Catalog summary

Category Count Status CQL
OSHA occupational safety — fully evaluated 4 Active Full CQL, runnable
OSHA occupational safety — catalog only 3 Draft / Approved / Deprecated Partial or no CQL
HEDIS wellness — fully evaluated 4 Active Full CQL, runnable
CMS eCQM — fully evaluated 2 Active Full CQL, runnable (CMS125v14, CMS122v14)
CMS eCQM catalog (2026 performance period) 47 Draft Catalog entry only — CQL authoring pending
Total 60

Outcome buckets (all measures): COMPLIANT, DUE_SOON, OVERDUE, MISSING_DATA, EXCLUDED.

Category 1 — OSHA Occupational Safety (Full CQL)

These four measures have complete CQL libraries, are seeded as Active, and run against the synthetic employee dataset.

1.1 Annual Audiogram Completed

Define logic

  • Program eligibility: In Hearing Conservation Program
  • Exemption: Has Active Waiver
  • Recency: Most Recent Audiogram Date
  • Aging metric: Days Since Last Audiogram

Outcome mapping

  • EXCLUDED when Has Active Waiver = true
  • MISSING_DATA when enrolled, not waived, no exam date
  • OVERDUE when enrolled, not waived, days since exam > 365
  • DUE_SOON when enrolled, not waived, days in (336..365)
  • COMPLIANT when enrolled, not waived, days <= 335

1.2 HAZWOPER Annual Medical Surveillance

Define logic

  • Program eligibility: In HAZWOPER Program
  • Exemption: Has Medical Exemption
  • Recency: Most Recent Surveillance Exam Date
  • Aging metric: Days Since Last Exam

Outcome mapping

  • EXCLUDED when Has Medical Exemption = true
  • MISSING_DATA when in program, not exempt, no exam date
  • OVERDUE when in program, not exempt, days since exam > 365
  • DUE_SOON when in program, not exempt, days in (335..365]
  • COMPLIANT when in program, not exempt, days <= 335

1.3 Annual TB Screening

Define logic

  • Program eligibility: In TB Screening Program
  • Exemption: Has Medical Exemption
  • Recency: Most Recent TB Screen Date
  • Aging metric: Days Since Last TB Screen

Outcome mapping

  • EXCLUDED when Has Medical Exemption = true
  • MISSING_DATA when eligible, not exempt, no TB screen date
  • OVERDUE when eligible, not exempt, days since last screen > 365
  • DUE_SOON when eligible, not exempt, days in (330..365]
  • COMPLIANT when eligible, not exempt, days <= 330

1.4 Flu Vaccine This Season

Define logic

  • Program eligibility: Clinical Facing Employee
  • Exemption: Has Valid Exemption
  • Season completion: Flu Vaccine This Season

Outcome mapping

  • EXCLUDED when Has Valid Exemption = true
  • COMPLIANT when eligible, not exempt, vaccinated this season
  • MISSING_DATA when eligible, not exempt, not vaccinated this season
  • OVERDUE is hard-coded false in current CQL

Category 2 — OSHA Occupational Safety (Catalog Only)

These three measures are seeded for catalog richness and demonstrate the full measure lifecycle (Draft → Approved → Deprecated). They have no runnable CQL evaluation.

Name Policy Ref Status Tags
Respirator Fit Test OSHA 29 CFR 1910.134 Draft v0.9 surveillance, respiratory, osha
Hepatitis B Vaccination Series OSHA 29 CFR 1910.1030 Approved v2.0 vaccine, bbp, osha
Lead Medical Surveillance OSHA 29 CFR 1910.1025 Deprecated v1.1 surveillance, lead, osha

Category 3 — HEDIS Wellness (Full CQL)

Four employer wellness / HEDIS-style measures with complete CQL and active evaluation. These represent the wellness side of TWH — chronic disease management and preventive health screening programs run by occupational health departments.

3.1 Hypertension BP Screening

  • Policy reference: HEDIS BPC / JPMC Wellness Rewards
  • CQL file: backend/src/main/resources/measures/hypertension.cql
  • Tags: wellness, hypertension, cardiovascular
  • Compliance window: 365 days (DueSoon 336–365)

3.2 Diabetes HbA1c Monitoring

  • Policy reference: HEDIS HBD / JPMC Wellness Rewards
  • CQL file: backend/src/main/resources/measures/diabetes_hba1c.cql
  • Tags: wellness, diabetes, hba1c
  • Compliance window: 180 days biannual (DueSoon 161–180)

3.3 BMI Screening & Counseling

  • Policy reference: HEDIS WCC / Cigna Healthcare Wellness
  • CQL file: backend/src/main/resources/measures/obesity_bmi.cql
  • Tags: wellness, bmi, obesity
  • Compliance window: 365 days annual

3.4 Cholesterol LDL Screening

  • Policy reference: HEDIS CBP / JPMC Wellness Rewards
  • CQL file: backend/src/main/resources/measures/cholesterol_ldl.cql
  • Tags: wellness, cholesterol, cardiovascular
  • Compliance window: 365 days annual

All four wellness measures use the same outcome pattern:

  • EXCLUDED when Has Medical Exemption = true
  • MISSING_DATA when enrolled, not exempt, no qualifying lab/screening date
  • OVERDUE when enrolled, not exempt, days since last event > compliance window
  • DUE_SOON when enrolled, not exempt, days approaching window end
  • COMPLIANT when enrolled, not exempt, days within window

Category 3b — CMS eCQM (Full CQL)

Two CMS eCQM measures promoted from Draft catalog to Active with full CQL evaluation:

3b.1 Breast Cancer Screening (CMS125v14 / MIPS 112)

  • Policy reference: CMS125v14
  • CQL file: backend/src/main/resources/measures/cms125.cql
  • Tags: ecqm, cms, cancer-screening, preventive
  • Compliance window: 27 months (820 days — mammogram within the measurement period or 26 months prior)

Outcome mapping:

  • EXCLUDED when bilateral mastectomy or documented clinical exclusion
  • MISSING_DATA when enrolled, not excluded, no mammogram date found
  • OVERDUE when enrolled, not excluded, days since last mammogram > 820
  • DUE_SOON when enrolled, not excluded, days in (790..820]
  • COMPLIANT when enrolled, not excluded, days <= 790

3b.2 Diabetes: HbA1c Poor Control (CMS122v14 / MIPS 1)

  • Policy reference: CMS122v14
  • CQL file: backend/src/main/resources/measures/cms122.cql
  • Tags: ecqm, cms, diabetes
  • Value-based (numeric): outcome is driven by HbA1c lab value, not recency

Outcome mapping:

  • EXCLUDED when documented clinical exclusion
  • MISSING_DATA when diabetes diagnosis, not excluded, no recent HbA1c result
  • OVERDUE when diabetes diagnosis, not excluded, HbA1c value > 9% (poor control — intervention needed)
  • COMPLIANT when diabetes diagnosis, not excluded, HbA1c value ≤ 9% (adequate control)
  • DUE_SOON — not applicable (hard-coded false; control status drives outcome, not recency)

Category 4 — CMS eCQM Catalog (2026 Performance Period)

47 official CMS electronic Clinical Quality Measures seeded as Draft v1.0 catalog entries (CMS125v14 and CMS122v14 are now Active with full CQL — see Category 3b). The policy_ref field stores the CMS eCQM ID (e.g., CMS128v14). The spec_json stores cmsEcqmId and mipsQualityId for downstream tooling. CQL authoring for the remaining catalog entries is future work.

The measures page renders CMS IDs as blue mono badges to distinguish them from OSHA CFR citations and HEDIS references.

Two new measures added in 2026 vs 2025: CMS146v14 (Appropriate Testing for Pharyngitis) and CMS154v14 (Appropriate Treatment for URI) in the new Respiratory / Antimicrobial Stewardship domain; CMS1173v1 (Diagnostic Delay of VTE) added to Cardiovascular; CMS1154v1 (Screening for Abnormal Glucose Metabolism) added to Diabetes. CMS249v7 (DXA Scans) retired from 2026 eligible clinician list.

Domain breakdown

Domain Measures
Mental Health / Behavioral CMS2v15, CMS128v14, CMS136v15, CMS137v14, CMS149v14, CMS159v14, CMS177v14
Cardiovascular CMS22v14, CMS90v15, CMS135v14, CMS144v14, CMS145v14, CMS165v14, CMS347v9, CMS1173v1
Diabetes CMS122v14, CMS131v14, CMS142v14, CMS951v4, CMS1154v1
Cancer Screening / Preventive CMS69v14, CMS124v14, CMS125v14, CMS130v14, CMS138v14, CMS139v14, CMS153v14, CMS155v14
Respiratory / Antimicrobial Stewardship CMS146v14, CMS154v14
Pediatric / Immunization CMS74v15, CMS75v14, CMS117v14
HIV / Infectious Disease CMS314v3, CMS349v8, CMS1157v2, CMS1188v3
Oncology CMS129v15, CMS157v14, CMS645v9, CMS646v6
Ophthalmology CMS133v14, CMS143v14
Functional Status / Orthopedic CMS56v14
Medication Safety CMS68v15, CMS156v14
Care Coordination CMS50v14
Urology CMS771v7
Radiology / Patient Safety CMS1056v3

Full list with MIPS Quality IDs is embedded in MeasureService.CMS_ECQM_CATALOG and visible in the measures catalog at /measures.

Canonical Status Source

For all runnable measures, the canonical stored status is the value of CQL define Outcome Status.

Persistence path:

  1. CQL engine evaluates all defines.
  2. Outcome Status string is read from expression results.
  3. Status is persisted in outcomes.status.
  4. Full define-level results are persisted in outcomes.evidence_json.expressionResults.

Evidence Traceability

Each outcome evidence payload includes:

  • Key eligibility/exemption/recency defines for the measure.
  • Computed day-difference define where applicable.
  • Outcome Status define result.
  • why_flagged derived fields for the UI (last exam date, compliance window, days overdue, waiver status).

Implementation Notes

  • All 8 active CQL measures now use inline code-filter expressions on both the qualifying event (Procedure or Immunization) and the enrollment/exemption Conditions, matching the system/code stamped by SyntheticFhirBundleBuilder. This replaces the earlier exists([Condition]) / Count([Condition]) > 1 pattern that was semantically correct but not code-scoped. True ValueSet token expansion (resolving urn:workwell:vs:* OIDs via the VSAC or a local expansion service) is a known evaluator limitation of the in-memory CQF path; the inline-code pattern is the stable workaround until a resolver is wired.
  • All four HEDIS wellness measures are seeded via ensureInstanceSeeds() when WORKWELL_INSTANCE=ecqm or twh.
  • All 49 CMS eCQM catalog entries (2026 performance period) are seeded via ensureCmsEcqmCatalogSeed() for the same instance values. They are Draft-only and do not participate in CQL evaluation runs until CQL is authored and compiled. On re-seed, existing measures are looked up by CMS ID prefix (LIKE 'CMSNNNv%') and updated in-place so version bumps (e.g., v13→v14) do not create duplicate DB rows.