JMIR medical informatics · 2026
Implementing Taiwan National Health Insurance Quality Indicators as Clinical Quality Language on Fast Healthcare Interoperability Resources: Development and Feasibility Study.
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Chen Meng-Chi, Pei Yu-Cheng, Lin Kun-Ju, Lin Shao-Chi, Chen Yueh-Peng, Lin Yu-Chun
Аннотация
BACKGROUND: Clinical Quality Language (CQL) and Fast Healthcare Interoperability Resources (FHIR) support executable electronic clinical quality measures. Translating national claims-based indicators into CQL remains challenging because terminology, exclusions, and data semantics require adaptation. To our knowledge, Taiwan National Health Insurance (NHI) medical-center indicators have not previously been represented as an executable CQL library.
OBJECTIVE: This study aimed to develop CQL libraries derived from 39 Taiwan NHI medical-center quality indicator codes and evaluate technical executability and computational consistency using synthetic data and real-world cross-institution medication records.
METHODS: We implemented 39 CQL libraries across 6 principal FHIR R4 clinical resources using 21 data elements, with documented adaptations where official requirements could not be represented. Compiled Expression Logical Model was executed against author-defined synthetic fixtures. In a retrospective 2-campus study, a separately coded Python implementation and the CQL pipeline computed aggregate numerators and denominators for 20 indicators from the same deidentified records, represented as a long table and FHIR resources, respectively.
RESULTS: All 39 CQL libraries compiled and executed against the predefined synthetic fixtures, and their outputs matched the author-defined expected results (39/39 libraries; 136/136 early-refill grace-period control groups). The real-world dataset included 88 patients (Taipei: n=65; Linkou: n=23), 1597 medication records, and 630 visits from January 1 to June 2, 2026. Across the 20 medication-based indicators, the 2 pipelines produced identical aggregate numerators and denominators (20/20), and 7 of the 8 cross-institution drug-class overlap indicators had nonzero numerators. All 2317 FHIR resources passed base FHIR R4 structural validation, and Anatomical Therapeutic Chemical mapping coverage was 98.3% (1570/1597 records).
CONCLUSIONS: The implemented NHI-derived indicator logic was executable and computationally consistent across synthetic testing and aggregate real-world comparisons. These findings do not establish complete fidelity to official NHI specifications. Further evaluation requires expert semantic review, patient-level testing, and execution across independent CQL/FHIR environments.
OBJECTIVE: This study aimed to develop CQL libraries derived from 39 Taiwan NHI medical-center quality indicator codes and evaluate technical executability and computational consistency using synthetic data and real-world cross-institution medication records.
METHODS: We implemented 39 CQL libraries across 6 principal FHIR R4 clinical resources using 21 data elements, with documented adaptations where official requirements could not be represented. Compiled Expression Logical Model was executed against author-defined synthetic fixtures. In a retrospective 2-campus study, a separately coded Python implementation and the CQL pipeline computed aggregate numerators and denominators for 20 indicators from the same deidentified records, represented as a long table and FHIR resources, respectively.
RESULTS: All 39 CQL libraries compiled and executed against the predefined synthetic fixtures, and their outputs matched the author-defined expected results (39/39 libraries; 136/136 early-refill grace-period control groups). The real-world dataset included 88 patients (Taipei: n=65; Linkou: n=23), 1597 medication records, and 630 visits from January 1 to June 2, 2026. Across the 20 medication-based indicators, the 2 pipelines produced identical aggregate numerators and denominators (20/20), and 7 of the 8 cross-institution drug-class overlap indicators had nonzero numerators. All 2317 FHIR resources passed base FHIR R4 structural validation, and Anatomical Therapeutic Chemical mapping coverage was 98.3% (1570/1597 records).
CONCLUSIONS: The implemented NHI-derived indicator logic was executable and computationally consistent across synthetic testing and aggregate real-world comparisons. These findings do not establish complete fidelity to official NHI specifications. Further evaluation requires expert semantic review, patient-level testing, and execution across independent CQL/FHIR environments.