feat: VSAC value sets integration — CMS-versioned code lists, measure strata, evaluator seam#1
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…ent Phase 5 session)
…dge seed)
Copies 1,545 value sets / 225,261 codes / 72 measures / 1,597 measure-value-sets
from parthenon app.vsac_* to medgnosis phm_edw.vsac_* via \copy TO STDOUT | FROM STDIN.
Seeds the measure_value_set bridge (44 of 45 CMS measures; CMS249v6 has no VSAC entry).
EDW joinability confirmed:
conditions (SNOMEDCT): 89 distinct codes
medications (RXNORM): 228 distinct codes
observations (LOINC): 43 distinct codes in sampled 5k rows (full scan
blocked by 1B-row table; no index on observation_code)
Source-consistency: OID 2.16.840.1.113883.3.464.1003.103.12.1001 (Diabetes)
medgnosis count = 774, parthenon count = 774. Exact match.
Pure Wilson score interval (wilsonCI) for binomial proportions — preferred over normal approximation for the small panels Medgnosis serves; bounds are always clamped to [0, 1]. 5 Vitest tests, all passing; tsc clean.
Implements vsacService.ts with listValueSets, getValueSetCodes, getMeasureValueSets, and resolveMeasureCodes over phm_edw.vsac_* tables and the measure_value_set bridge. Uses inline NULL-coalescing for optional filters to avoid nested sql`` fragments. EDW_CODE_SYSTEM maps domains to verified VSAC code systems (condition/procedure = SNOMEDCT, not ICD-10/CPT). TDD: 7/7 tests pass. Live DB: CMS122v12 resolves 2,704 SNOMEDCT codes across 26 value sets.
… /:oid/codes) Co-Authored-By: Claude Sonnet 4.6 <noreply@anthropic.com>
…n 051)
- Migration 051: creates phm_star.fact_measure_strata (SERIAL PK, measure_key,
date_key_period, dimension, stratum, denominator, numerator, excluded, created_at)
with idx_fms_measure index. Rebuilt atomically with fact_measure_result.
- measureCalculatorV2: single-pass GROUPING SETS produces 'all' + 'age_band' +
'gender' strata in one subquery scan (no extra round-trip). TRUNCATE of both
tables inside the same transaction — strata and results never diverge.
Statement timeout raised 30s → 60s to accommodate the added strata INSERT.
- getMeasureSummary: adds ci_lower/ci_upper fields (Wilson 95% CI, percent ×1 decimal)
via wilsonCI(). Returns null for measures with zero eligible patients.
Refresh timings (26967 fact rows, live DB):
First run: { rowCount: 26967, durationMs: 1596 }
Steady-state: { rowCount: 26967, durationMs: 231 }
Verification: dimensions=age_band,all,gender | violations=0 | mismatches=0
…terface Introduces MeasureEvaluator interface with sql (current) and cql (stub) implementations. Call sites in the BullMQ worker and admin routes now resolve the engine via getMeasureEvaluator() instead of calling refreshMeasureResults() directly. Engine selected by MEASURE_EVALUATOR env var (default: sql). 5 new unit tests, full suite 121/121 green, tsc clean.
Matches the referential policy of sibling star fact tables (ON DELETE RESTRICT). Applied to the live dev DB via equivalent ALTER TABLE since 051 was already recorded in _migrations there; fresh environments get it from the CREATE TABLE.
… review)
- resolveMeasureCodes header now warns it unions ALL population roles
(~82% of CMS122 SNOMEDCT codes are exclusion-family) — must not drive
population finding until the bridge carries population_role
- EDW_CODE_SYSTEM comment clarifies values are VSAC labels, not EDW
code_system column values ('SNOMED'/'ICD-10') — translate before joining
- load-vsac.sh verification now asserts source==destination counts and
exits non-zero on mismatch (was echo-only, could ship wrong data green)
This was referenced Jun 13, 2026
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Summary
phm_edw.vsac_*reference tables (migration 050), with ameasure_value_setbridge auto-mapping 44 of 45 local CMS measures to value-set OIDs by base CMS number (only CMS249 has no VSAC entry; version drift v12↔v14 recorded explicitly)packages/db/scripts/load-vsac.sh(psql\copypipes,--reloadguard, built-in count verification) — already run against the dev DB; row counts verified exact against sourcevsacService(resolveMeasureCodesis the workhorse for the Phase 2 population finder) + read-only transparency endpoints:GET /value-sets,/value-sets/measure/:code,/value-sets/:oid/codesphm_star.fact_measure_strata: headline + age band + gender, rebuilt atomically withfact_measure_result), Wilson 95% CIs on summary and newGET /measures/:id/strata, eCQM exclusion accounting regression-gated (excluded ∉ denominator ∧ ∉ numerator — verified 0 violations live)MeasureEvaluatorseam (MEASURE_EVALUATOR=sql|cql) so a future CQL/cqf-ruler engine drops in with no caller change; worker + admin refresh paths now go through itNotes for merge
pg_dump --data-onlyof the fourphm_edw.vsac_*tables from a loaded environmentcondition/procedureare SNOMED CT,medicationRxNorm,observationLOINC — the upstream handoff's ICD-10/CPT routing was corrected inEDW_CODE_SYSTEMdocs/superpowers/specs/2026-06-12-parthenon-ecqm-handoff.md; plan:docs/superpowers/plans/2026-06-12-vsac-value-sets-integration.mdTest plan
tsc --noEmitcleanexclusion_flag AND (denominator_flag OR numerator_flag)GET /measures/136/stratareturns all three dimensions with rates + CIs./packages/db/scripts/load-vsac.shin any environment that hasn't loaded VSAC yet🤖 Generated with Claude Code