Prototype results

The prototype runs today. All figures below come from published test data, or from counts on a live export with no patient data shown.

On the published test decks

Engine	Measures	Result
fqm-execution	CMS122, CMS125, CMS130	All 185 published test cases reproduced, with every patch disclosed
HAPI FHIR Clinical Reasoning 8.12	CMS122, CMS125, CMS165	56 differences across 189 cases, none unexplained — all trace to one remaining engine defect

On the 121 cases both engines ran, fqm-execution matches all 121 with patches disclosed.

Throughput is about 0.2 seconds per patient on HAPI against a loaded deck.

Two engine defects, both silent — one already fixed upstream

The harness isolated two engine defects. Neither produced an error; both returned a plausible MeasureReport. Finding them, and confirming when they are fixed, is what the harness is for.

1. Unit conversion — fixed upstream. Converting a quantity returned null when the source unit was a CQL calendar duration. That nulled every days-supply calculation in the shared medication library and failed 17 medication-dependent exclusions across three test decks. It is fixed in CQL 5.2.0 and ships in HAPI FHIR 8.12. Our 15 October 2026 run confirmed the fix with no patch of our own: CMS122 55 of 55, CMS125 64 of 66.
2. Measurement-period precision — open. The measurement period is built at second precision, so resources dated in the period’s final second compare as null. On CMS165 this removes 54 of 68 patients from the initial population. All 56 remaining differences on HAPI 8.12 trace to this defect.

Reporting defects upstream

Defects found by the harness are written up for the engine maintainers with a minimal reproducing test case. A finding is only useful to the ecosystem once the people who can fix it have it.

On a live eClinicalWorks export

The breast cancer screening measure (CMS125) on a real eClinicalWorks bulk export:

Run	Initial population	Denominator	Denominator exclusions	Numerator	Performance rate
Expected — eCQM control, QRDA I export	427	427	0	291	68.15%
Actual — published measure on the FHIR export	21	21	0	0	0.0%, with no error and no warning
With the dQMGrid adapter layer	430	430	2	292	68.22%

Performance rate = Numerator ÷ (Denominator − Denominator exclusions). The re-mapped result is within 0.07 points of the eCQM result; the rates are very close, not a patient-by-patient match.

The production calculator used for this comparison is itself validated against a Cypress-certified QRDA Category I path. On a live athenahealth practice the screened rate agreed at 87%, against the QRDA control at 84%. This is the validation chain described in Validating FHIR results.

Explore this run in the live run report.

Limits, stated

• Whether a retrieve should match a resource that declares no profile is an engine setting the measure community has not settled. The calculator conforms the data rather than change the setting.
• No rule has yet been clinically signed.
• The retrieve tracer, fault-injected test decks and bias report are designed but not yet built.
• Every run to date is ambulatory.