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AHRQ-CDS CQL Testing Framework to allow CQL authors to more easily develop and run test cases for validating CQL-based CDS logic, regardless of how that CQL was developed (e.g., by hand, in the AT, etc). This is intended to be a developer-facing tool, run on the command-line; it has no server components.



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CQL Testing Framework


The CQL Testing Framework provides a simple mechanism for developing and maintaining automated test suites for FHIR-based CQL logic.

Current capabilities include:

  • Author test case data and expectations using YAML
  • Execute test cases against CQL logic using FHIR 1.0.2 (DSTU2) / FHIR 3.0.0 (STU3) / FHIR 4.0.0/4.0.1 (R4) model and VSAC value sets
  • Display diff rendering of actual vs. expected results for test failures
  • Run standalone or integrate CQL tests into existing Mocha test suites
  • Export test data as FHIR bundles for integration into a test server
  • Export test results as JSON for further investigation and debugging
  • Configure project to support custom layouts

Current limitations:

  • Only VSAC value sets are supported


For information about contributing to this project, please see CONTRIBUTING.

Using the CQL Testing Framework

Required Software

You must install Node.js to use the CQL Testing Framework. Node.js 12.x is confirmed to work, but other releases may also work.

You must also install cql-execution, a Node.js library for executing CQL expressions, in whatever project where you are using cql-testing. The reason for this requirement is to allow users of cql-testing to select the version of cql-execution that best suits their needs.

Integrating the CQL Testing Framework

The CQL Testing Framework is a Node.js module. You can integrate the CQL Testing Framework into a Node.js project by declaring a dependency on cql-testing in the package.json file. As noted above, you must also declare a dependency on whichever version of cql-execution which best suites your needs. See below for an example.

Typical Project Structure

The following is a typical file structure for a CQL project. This documentation will assume this structure, but other structures can be supported via configuration.

├── cql
│   ├── FHIRHelpers.cql
│   ├── FHIRHelpers.json
│   ├── MyCDSLogic.cql
│   └── MyCDSLogic.json
├── node_modules
│   └── ... // these contents are entirely managed by Node.js/NPM
├── package.json
└── test
    ├── cases
    │   ├── is-included.yaml
    │   ├── is-not-included.yaml
    │   └── another-test-case.yaml
    ├── cqlt.yaml
    ├── pm-test-gen.js
    └── test.js


Your CQL and ELM JSON files should reside somewhere in your project. The easiest configuration is to put them into a single cql folder, but other configurations are supported as well.

If your CQL logic uses any other CQL libraries, those must be provided as well. Again, it is easiest to put them in the same cql folder along side your own CQL, but this is not strictly necessary.

Each CQL file must have its corresponding ELM JSON file before tests can be run. If you use the CDS Authoring Tool, the downloaded zip package will already contain ELM JSON and so no further steps are needed in this case. If you only have the CQL source, you must translate it to ELM JSON using something like the CQL-to-ELM translator. The CQL Testing Framework includes a copy of this translator which is exposed as an npm executable command; for more information see below


This folder is managed by Node.js and the Node Package Manager (NPM). You do not need to create this folder, nor should you manually modify it. It will be created and updated using the npm commandline utility.


The package.json file contains the Node.js configuration data for your project. Most importantly, this defines the project's dependency on the CQL Testing Framework as well as the commands to execute the tests. This file is covered in more detail below.


The test folder contains the test cases and test configuration used by the CQL Testing Framework.


The test/cases folder contains the test cases defined in the YAML format. Descriptions of the YAML test case format are detailed further below.


The test/cqlt.yaml file contains configuration data used by the CQL Testing Framework. This configuration file is described in more detail below.


The test/pm-test-gen.js file is optional. If provided, it is used to generate Postman tests for CQL Hooks implementations. This file is described in more detail below.


The test/test.js file is a very simple "bootstrap" file used as an entry point for running the CQL tests using the Mocha test runner. It is covered in more detail below.

The package.json File

The snippet below is a minimal package.json file for integrating the CQL Testing Framework. If you have an existing package.json file, add the dependencies and test script as shown below; otherwise create a package.json at the root of your CQL project with the following contents (modifying the "name" and "version" values):

  "name": "my-cql-project",
  "version": "1.0.0",
  "scripts": {
    "test": "./node_modules/.bin/mocha --reporter spec --recursive"
  "devDependencies": {
    "mocha": "^5.2.0",
    "cql-testing": "^1.0.0",
    "cql-execution": "^1.3.7"

The cqlt.yaml File

The cqlt.yaml file provides important configuration data about where your CQL source is, where your test cases are, and other optional parameters. If you have multiple CQL libraries to test, you can either put unique cqlt.yaml files in different subfolders, or you can give them unique names, as long as they end with cqlt.yaml (for example, my-cds-cqlt.yaml and other-cds.cqlt.yaml).

The following configuration parameters are currently supported:

  • library:
    • name: The name of the CQL library to test (required, string)
    • version: The version of the CQL library to test (optional, string, default: latest version)'
    • paths: The path(s) at which the library and its dependencies can be found (optional, string array, default: cql)'
  • hook:
    • id: The hook id corresponding to this library; needed only for exporting Postman collections (optional)
    • pmTestGenSupport: The path to a Node module that supports Postman test generation (optional)
  • tests:
    • path: The file path containing the test case files (optional, string, default: tests)
  • options:
    • date: The execution date to use as "Now()" when CQL executes tests (optional, ISO 8601 formatted date string enclosed in double-quotes ("), default: now)
    • vsac:
      • apikey: The UMLS API Key to use when connecting to the VSAC (optional, string)
      • cache: The file path for the value set cache (optional, string, default: .vscache)
    • dumpFiles:
      • enabled: Indicates if test data and actual results should be dumped to files for debugging or testing; supports bundles, CQL Hooks requests, and Postman collections of CQL Hooks requests (optional, boolean, default: false)
      • path: The file path to dump files to, if enabled (optional, string, default: dump_files)

All file paths are relative to the location of the cqlt.yaml configuraton file unless the file path is absolute.

The following is an example cqlt.yaml file that corresponds with the file structure indicated above:

  name: My_CDS_Artifact
  paths: ../cql
  id: my-cds-hook
  pmTestGenSupport: pm-test-gen.js
  path: cases
  date: "2018-12-10T00:00:00.0Z"

The Postman Test Generator Support File

If the artifact under test is configured to run with the CQL Services CQL Hooks feature, the CQL Testing Framework can optionally generate corresponding collections and tests for the popular Postman API testing tool. As long as dumpFiles is enabled and a is configured, a Postman collection will be generated.

Since CQL Services allows CQL Hooks to be configured in many ways, additional support is needed to automatically create tests that will exercise the API and validate results. Developers can optionally add this support by creating a special Node module that exports one or more of the following function signatures:

  • function expectOK(testCase): returns boolean indicating if the HTTP response should be OK
  • function expectCards(testCase): returns boolean indicating if cards should be returned
  • function expectCardsContent(testCase): returns JSON object or array of JSON objects representing card content that should be returned

The following is a simple example of a pm-test-gen-support.js file:

function expectOK(testCase) {
  return true;

function expectCards(testCase) {
  if (testCase.expected != null) {
    return testCase.expected.Recommendation != null;

function expectCardsContent(testCase) {
  if (expectCards(testCase)) {
    return {
      summary: 'My CDS Hook Summary',
      indicator: 'info',
      detail: testCase.expected.Recommendation,
      source: {
        label: 'My CDS Source',
        url: ''

module.exports = { expectOK, expectCards, expectCardsContent };

The test/test.js File

Since the CQL Testing Framework leverages the Mocha testing library, it requires a test.js file as an entrypoint to the test suite. The following is a very simple test.js file:

const cqlt = require('cql-testing');
const path = require('path');


This assumes that the cqlt.yaml config file is in the same folder as the test.js file. If that's not the case, change test argument from path.join(__dirname) to the path where the cqlt.yaml file is.

The test/cases/*.yaml Files

CQL Testing Framework tests are written as files in the YAML format. See the full documentation for creating YAML test cases at

Running the CQL Tests

Setting Up to Run the Tests for the First Time

Installing Dependencies

After configuring your project for the CQL Testing Framework, you must download the CQL Testing Framework dependencies. This is done by opening a command prompt window, navigating to the folder containing your project, and running npm install.

$ cd /path/to/my/cql/project
$ npm install

This only needs to be done once. After this, your node_modules folder will be populated and all test runs will reference it for the necessary dependencies.

Translating CQL TO ELM

This step is only necessary if the ELM JSON representation is not already available (e.g., it was produced by the CDS Authoring Tool). The CQL Testing Framework includes scripts for running the CQL-to-ELM translator, however a requirement for using this functionality is that Java SE Development Kit 11 is installed on the system. The following page contains more information on installing Java. Once Java is installed, CQL can be translated to ELM by running the following command from the root directory of your project:

npx cql-to-elm /path/to/folder/with/cql

Downloading Value Sets

If your CQL uses value sets from the Value Set Authority Center (VSAC), then the first time you run the tests, they will need to download the value set definitions from VSAC. Downloading value sets from VSAC requires a VSAC account and an API key. You can find your API key in your UMLS profile and can configure your VSAC account by setting the options->vsac->apikey property in your cqlt.yaml file. If you prefer not to modify the config file, you may set the UMLS_API_KEY environment variable instead.

Once you've run the tests the first time and downloaded the value sets, they'll be stored in a VSAC cache folder (defaulted to /.vscache in the same folder as the cqlt.yaml file). After that, you do not need your VSAC credentials anymore since the CQL Testing Framework will just use the cache.

Running the Tests

At this point, running the tests is easy. Open a command prompt window, navigate to the CQL project folder, and run npm test.

$ cd /path/to/my/cql/project
$ npm test

If the tests succeed, you'll see a report indicating such:

CQLT Config: /path/to/my/cql/project/test/cqlt.yaml

    ✓ Meets Inclusion Criteria (40 y.o. male w/ Oxycodone)
    ✓ Doesn't Meet Incusion Criteria (40 y.o. male w/out Oxycodone)

  2 passing (26ms)

If they fail, you'll see a report indicating the failure along with the different actual and expected values:

CQLT Config: /path/to/my/cql/project/test/cqlt.yaml

    1) Meets Inclusion Criteria (40 y.o. male w/ Oxycodone)
    ✓ Doesn't Meet Incusion Criteria (40 y.o. male w/out Oxycodone)

  1 passing (26ms)
  1 failing

  1) My_CDS_Artifact_v1.0.0
       Meets Inclusion Criteria (40 y.o. male w/ Oxycodone)

      Summary=<[object Object]>
      + expected - actual

      -  "MeetsInclusionCriteria": true
      +  "MeetsInclusionCriteria": false

Generating FHIR Documentation

The and documentation files are generated using the FHIR specification definitions and the corresponding config.yaml files (in src/fhir/${version}/). Developers working on the CQL Testing Framework (i.e., developing the framework itself) can regenerate the documentation using the following command:

$ npm run doc


Copyright 2018-2023 Agency for Healthcare Research and Quality

Licensed under the Apache License, Version 2.0 (the "License"); you may not use this file except in compliance with the License. You may obtain a copy of the License at

Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an "AS IS" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License.


AHRQ-CDS CQL Testing Framework to allow CQL authors to more easily develop and run test cases for validating CQL-based CDS logic, regardless of how that CQL was developed (e.g., by hand, in the AT, etc). This is intended to be a developer-facing tool, run on the command-line; it has no server components.



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