Ld 20260204 group measure scoring from def to report

cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/measure/common/GroupDef.java

@@ -1,5 +1,6 @@
 package org.opencds.cqf.fhir.cr.measure.common;
 
+import ca.uhn.fhir.rest.server.exceptions.InternalErrorException;
 import jakarta.annotation.Nullable;
 import java.util.Collections;
 import java.util.List;
@@ -13,7 +14,10 @@ public class GroupDef {
     private final ConceptDef code;
     private final List<StratifierDef> stratifiers;
     private final List<PopulationDef> populations;
+
+    @Nullable
     private final MeasureScoring measureScoring;
+
     private final boolean isGroupImpNotation;
     private final CodeDef populationBasis;
     private final CodeDef improvementNotation;
@@ -28,7 +32,7 @@ public GroupDef(
             ConceptDef code,
             List<StratifierDef> stratifiers,
             List<PopulationDef> populations,
-            MeasureScoring measureScoring,
+            @Nullable MeasureScoring measureScoring,
             boolean isGroupImprovementNotation,
             CodeDef improvementNotation,
             CodeDef populationBasis) {
@@ -149,6 +153,17 @@ private Map<MeasurePopulationType, List<PopulationDef>> index(List<PopulationDef
         return populations.stream().collect(Collectors.groupingBy(PopulationDef::type));
     }
 
+    public boolean hasMeasureScoring() {
+        return this.measureScoring != null;
+    }
+
+    /**
+     * This method should only be called from production code that builds a MeasureReport group,
+     * setting the scoring extension on that group.
+     *
+     * @return MeasureScoring associated directly with the group, if it exists at all.
+     */
+    @Nullable
     public MeasureScoring measureScoring() {
         return this.measureScoring;
     }
@@ -204,13 +219,27 @@ public Double getScore() {
         return this.score;
     }
 
-    public void setScoreAndAdaptToImprovementNotation(Double originalScore) {
-        if ((MeasureScoring.RATIO == measureScoring && hasPopulationType(MeasurePopulationType.MEASUREOBSERVATION))
-                || MeasureScoring.PROPORTION == measureScoring) {
+    public void setScoreAndAdaptToImprovementNotation(Double originalScore, MeasureScoring measureOrGroupScoring) {
+        if ((MeasureScoring.RATIO == measureOrGroupScoring
+                        && hasPopulationType(MeasurePopulationType.MEASUREOBSERVATION))
+                || MeasureScoring.PROPORTION == measureOrGroupScoring) {
             this.score = MeasureScoreCalculator.scoreGroupAccordingToIncreaseImprovementNotation(
                     originalScore, isIncreaseImprovementNotation());
         } else {
             this.score = originalScore;
         }
     }
+
+    public MeasureScoring getMeasureOrGroupScoring(MeasureDef measureDef) {
+        if (measureDef.hasMeasureScoring()) {
+            return measureDef.measureScoring();
+        }
+
+        if (hasMeasureScoring()) {
+            return measureScoring();
+        }
+
+        throw new InternalErrorException("Must have scoring either at the measure or group level for measure URL: %s"
+                .formatted(measureDef.url()));
+    }
 }

cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/measure/common/MeasureDef.java

@@ -15,18 +15,30 @@ public class MeasureDef {
     private final String url;
 
     private final String version;
+
+    @Nullable
+    private final MeasureScoring measureScoring;
+
     private final List<GroupDef> groups;
     private final List<SdeDef> sdes;
     private final List<String> errors;
 
     public static MeasureDef fromIdAndUrl(IIdType idType, @Nullable String url) {
-        return new MeasureDef(idType, url, null, List.of(), List.of());
+        return new MeasureDef(idType, url, null, null, List.of(), List.of());
     }
 
-    public MeasureDef(IIdType idType, @Nullable String url, String version, List<GroupDef> groups, List<SdeDef> sdes) {
+    public MeasureDef(
+            IIdType idType,
+            @Nullable String url,
+            String version,
+            @Nullable MeasureScoring measureScoring,
+            List<GroupDef> groups,
+            List<SdeDef> sdes) {
+
         this.idType = idType;
         this.url = url;
         this.version = version;
+        this.measureScoring = measureScoring;
         this.groups = groups;
         this.sdes = sdes;
 
@@ -53,6 +65,15 @@ public String version() {
         return this.version;
     }
 
+    public boolean hasMeasureScoring() {
+        return this.measureScoring != null;
+    }
+
+    @Nullable
+    public MeasureScoring measureScoring() {
+        return this.measureScoring;
+    }
+
     public List<SdeDef> sdes() {
         return this.sdes;
     }
@@ -93,6 +114,7 @@ public String toString() {
                 .add("idType='" + idType.getValueAsString() + "'")
                 .add("url='" + url + "'")
                 .add("version='" + version + "'")
+                .add("measureScoring='" + measureScoring + "'")
                 .add("groups=" + groups.size())
                 .add("sdes=" + sdes.size())
                 .add("errors=" + errors)

cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/measure/common/MeasureEvaluator.java

@@ -220,6 +220,7 @@ protected void validateRatioContinuousVariable(GroupDef groupDef) {
     }
 
     protected void evaluateProportion(
+            MeasureScoring measureOrGroupScoring,
             GroupDef groupDef,
             String subjectType,
             String subjectId,
@@ -228,7 +229,7 @@ protected void evaluateProportion(
             boolean applyScoring) {
         // check populations
         R4MeasureScoringTypePopulations.validateScoringTypePopulations(
-                groupDef.populations().stream().map(PopulationDef::type).toList(), groupDef.measureScoring());
+                groupDef.populations().stream().map(PopulationDef::type).toList(), measureOrGroupScoring);
 
         PopulationDef initialPopulation = groupDef.getSingle(INITIALPOPULATION);
         PopulationDef numerator = groupDef.getSingle(NUMERATOR);
@@ -624,10 +625,18 @@ protected void evaluateGroup(
 
         evaluateStratifiers(subjectId, groupDef.stratifiers(), evaluationResult, groupDef);
 
-        var scoring = groupDef.measureScoring();
-        switch (scoring) {
+        final MeasureScoring measureOrGroupScoring = groupDef.getMeasureOrGroupScoring(measureDef);
+
+        switch (measureOrGroupScoring) {
             case PROPORTION, RATIO:
-                evaluateProportion(groupDef, subjectType, subjectId, reportType, evaluationResult, applyScoring);
+                evaluateProportion(
+                        measureOrGroupScoring,
+                        groupDef,
+                        subjectType,
+                        subjectId,
+                        reportType,
+                        evaluationResult,
+                        applyScoring);
                 break;
             case CONTINUOUSVARIABLE:
                 evaluateContinuousVariable(

cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/measure/common/MeasureReportDefScorer.java

@@ -90,29 +90,27 @@ public class MeasureReportDefScorer {
     public void score(String measureUrl, MeasureDef measureDef) {
         // Def-first iteration: iterate over MeasureDef.groups()
         for (GroupDef groupDef : measureDef.groups()) {
-            scoreGroup(measureUrl, groupDef);
+            scoreGroup(measureDef, groupDef);
         }
     }
 
-    /**
-     * Score a single group including all its stratifiers - MUTATES GroupDef and StratumDef objects.
-     *
-     * @param measureUrl the measure URL for error reporting
-     * @param groupDef the group definition to score (will be mutated with setScore())
-     */
-    public void scoreGroup(String measureUrl, GroupDef groupDef) {
-        MeasureScoring measureScoring = checkMissingScoringType(measureUrl, groupDef.measureScoring());
+    public void scoreGroup(MeasureDef measureDef, GroupDef groupDef) {
+
+        var measureUrl = measureDef.url();
+        var measureOrGroupScoring = groupDef.getMeasureOrGroupScoring(measureDef);
+
+        checkMissingScoringType(measureUrl, measureOrGroupScoring);
 
         // Calculate group-level score
-        Double groupScore = calculateGroupScore(measureUrl, groupDef, measureScoring);
+        Double groupScore = calculateGroupScore(measureUrl, groupDef, measureOrGroupScoring);
 
         // MUTATE: Set score on GroupDef
-        groupDef.setScoreAndAdaptToImprovementNotation(groupScore);
+        groupDef.setScoreAndAdaptToImprovementNotation(groupScore, measureOrGroupScoring);
 
         // Score all stratifiers using Def-first iteration
         // Modified from R4MeasureReportScorer to iterate over Def classes instead of FHIR components
         for (StratifierDef stratifierDef : groupDef.stratifiers()) {
-            scoreStratifier(measureUrl, groupDef, stratifierDef, measureScoring);
+            scoreStratifier(measureUrl, groupDef, stratifierDef, measureOrGroupScoring);
         }
     }
 
@@ -121,8 +119,7 @@ public void scoreGroup(String measureUrl, GroupDef groupDef) {
      */
     private Double calculateGroupScore(String measureUrl, GroupDef groupDef, MeasureScoring measureScoring) {
         switch (measureScoring) {
-            case PROPORTION:
-            case RATIO:
+            case PROPORTION, RATIO:
                 // Special case: RATIO with separate numerator/denominator observations
                 if (measureScoring == MeasureScoring.RATIO
                         && groupDef.hasPopulationType(MeasurePopulationType.MEASUREOBSERVATION)) {
@@ -263,12 +260,11 @@ private Double getStratumScoreOrNull(
             String measureUrl, GroupDef groupDef, StratumDef stratumDef, MeasureScoring measureScoring) {
 
         switch (measureScoring) {
-            case PROPORTION:
-            case RATIO:
+            case PROPORTION, RATIO:
                 // Check for special RATIO continuous variable case
                 if (measureScoring.equals(MeasureScoring.RATIO)
                         && groupDef.hasPopulationType(MeasurePopulationType.MEASUREOBSERVATION)) {
-                    return scoreRatioMeasureObservationStratum(measureUrl, stratumDef);
+                    return scoreRatioMeasureObservationStratum(stratumDef);
                 } else {
                     return scoreProportionRatioStratum(groupDef, stratumDef);
                 }
@@ -286,12 +282,11 @@ private Double getStratumScoreOrNull(
      * Handles continuous variable ratio scoring where numerator and denominator have separate observations.
      * Uses pre-computed cache to eliminate redundant lookups during scoring.
      *
-     * @param measureUrl the measure URL for error reporting
      * @param stratumDef the stratum definition
      * @return the calculated score or null
      */
     @Nullable
-    private Double scoreRatioMeasureObservationStratum(String measureUrl, StratumDef stratumDef) {
+    private Double scoreRatioMeasureObservationStratum(StratumDef stratumDef) {
 
         if (stratumDef == null) {
             return null;
@@ -311,8 +306,7 @@ private Double scoreRatioMeasureObservationStratum(String measureUrl, StratumDef
         PopulationDef numPopDef = stratumPopulationDefNum.populationDef();
         PopulationDef denPopDef = stratumPopulationDefDen.populationDef();
 
-        return scoreRatioContVariableStratum(
-                measureUrl, stratumPopulationDefNum, stratumPopulationDefDen, numPopDef, denPopDef);
+        return scoreRatioContVariableStratum(stratumPopulationDefNum, stratumPopulationDefDen, numPopDef, denPopDef);
     }
 
     /**
@@ -372,15 +366,13 @@ private Double scoreContinuousVariableStratum(String measureUrl, GroupDef groupD
      * Score ratio continuous variable for a stratum.
      * Copied from R4MeasureReportScorer#scoreRatioContVariableStratum.
      *
-     * @param measureUrl the measure URL for error reporting
      * @param measureObsNumStratum stratum population for numerator measure observation
      * @param measureObsDenStratum stratum population for denominator measure observation
      * @param numPopDef numerator population definition
      * @param denPopDef denominator population definition
      * @return the ratio score or null
      */
     private Double scoreRatioContVariableStratum(
-            String measureUrl,
             StratumPopulationDef measureObsNumStratum,
             StratumPopulationDef measureObsDenStratum,
             PopulationDef numPopDef,
@@ -502,7 +494,7 @@ private static Collection<Object> getResultsForStratum(
                 .filter(entry -> stratumSubjectsUnqualified.contains(entry.getKey()))
                 .map(Map.Entry::getValue)
                 .flatMap(Collection::stream)
-                .collect(Collectors.toList());
+                .toList();
     }
 
     /**
@@ -561,7 +553,7 @@ private static Collection<Object> getResultsForStratumByResourceIds(
                     }
                     return false;
                 })
-                .collect(Collectors.toList());
+                .toList();
     }
 
     /**
@@ -601,21 +593,19 @@ private static QuantityDef calculateContinuousVariableAggregateQuantity(
     }
 
     private static void setAggregateResultIfPopNonNull(@Nullable PopulationDef populationDef, QuantityDef quantityDef) {
-        Optional.ofNullable(populationDef).ifPresent(nonNullPopulationDef -> {
-            nonNullPopulationDef.setAggregationResult(quantityDef);
-        });
+        Optional.ofNullable(populationDef)
+                .ifPresent(nonNullPopulationDef -> nonNullPopulationDef.setAggregationResult(quantityDef));
     }
 
     /**
      * Validate scoring type is present.
      * Reused from BaseMeasureReportScorer pattern.
      */
-    protected MeasureScoring checkMissingScoringType(String measureUrl, MeasureScoring measureScoring) {
+    private void checkMissingScoringType(String measureUrl, MeasureScoring measureScoring) {
         if (measureScoring == null) {
             throw new InvalidRequestException(
                     "Measure does not have a scoring methodology defined. Add a \"scoring\" property to the measure definition or the group definition for measure: "
                             + measureUrl);
         }
-        return measureScoring;
     }
 }

cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/measure/dstu3/Dstu3MeasureDefBuilder.java

@@ -5,6 +5,7 @@
 import static org.opencds.cqf.fhir.cr.measure.constant.MeasureReportConstants.IMPROVEMENT_NOTATION_SYSTEM_INCREASE;
 
 import ca.uhn.fhir.rest.server.exceptions.InvalidRequestException;
+import jakarta.annotation.Nullable;
 import java.util.ArrayList;
 import java.util.HashSet;
 import java.util.List;
@@ -53,7 +54,8 @@ public MeasureDef build(Measure measure) {
         }
 
         // scoring
-        MeasureScoring measureScoring =
+        @Nullable
+        final MeasureScoring measureScoring =
                 MeasureScoring.fromCode(measure.getScoring().getCodingFirstRep().getCode());
         // populationBasis
         var measureBasis = getMeasureBasis(measure);
@@ -115,7 +117,8 @@ public MeasureDef build(Measure measure) {
             groups.add(groupDef);
         }
 
-        return new MeasureDef(measure.getIdElement(), measure.getUrl(), measure.getVersion(), groups, sdes);
+        return new MeasureDef(
+                measure.getIdElement(), measure.getUrl(), measure.getVersion(), measureScoring, groups, sdes);
     }
 
     private ConceptDef conceptToConceptDef(CodeableConcept codeable) {

cqf-fhir-cr/src/main/java/org/opencds/cqf/fhir/cr/measure/r4/R4MeasureDefBuilder.java

@@ -57,7 +57,7 @@ public MeasureDef build(Measure measure) {
         checkId(measure);
 
         // scoring
-        var measureScoring = R4MeasureUtils.getMeasureScoring(measure);
+        @Nullable final MeasureScoring measureScoring = R4MeasureUtils.getMeasureScoring(measure);
         // populationBasis
         var measureBasis = getMeasureBasis(measure);
         // improvement Notation
@@ -73,18 +73,30 @@ public MeasureDef build(Measure measure) {
 
         return new MeasureDef(
                 // We don't need either the version of the "Measure" qualifier here
-                measure.getIdElement(), measure.getUrl(), measure.getVersion(), groups, getSdeDefs(measure));
+                measure.getIdElement(),
+                measure.getUrl(),
+                measure.getVersion(),
+                measureScoring,
+                groups,
+                getSdeDefs(measure));
     }
 
     private GroupDef buildGroupDef(
             Measure measure,
             MeasureGroupComponent group,
-            MeasureScoring measureScoring,
+            @Nullable MeasureScoring measureScoring,
             CodeDef measureImpNotation,
             CodeDef measureBasis) {
 
         // group Measure Scoring
         var groupScoring = getGroupMeasureScoring(measure, group);
+
+        if (measureScoring != null && groupScoring != null) {
+            throw new InvalidRequestException(
+                    "Scoring should be at the measure level or the group level, but not both for measure: %s"
+                            .formatted(measure.getUrl()));
+        }
+
         // populationBasis
         var groupBasis = getGroupPopulationBasis(group);
         // improvement Notation
@@ -114,7 +126,7 @@ private GroupDef buildGroupDef(
                 conceptToConceptDef(group.getCode()),
                 stratifiers,
                 mergePopulations(populationsWithCriteriaReference, optPopulationDefDateOfCompliance.orElse(null)),
-                R4MeasureUtils.computeScoring(measure.getUrl(), measureScoring, groupScoring),
+                groupScoring,
                 hasGroupImpNotation,
                 getImprovementNotation(measureImpNotation, groupImpNotation),
                 populationBasisDef);