Quality Measure Implementation Guide (STU3 Ballot)
2.1.0 - ballot

Quality Measure Implementation Guide (STU3 Ballot), published by Clinical Quality Information WG. This is not an authorized publication; it is the continuous build for version 2.1.0). This version is based on the current content of https://github.com/HL7/cqf-measures/ and changes regularly. See the Directory of published versions

Example Measure: Venous Thromboembolism Prophylaxis

Id: measure-vte-1-FHIR
Url: http://hl7.org/fhir/us/cqfmeasures/Measure/measure-vte-1-FHIR
Version: 8.2.000
Identifier:

value: 108

Identifier:

value: 0371

Name: VTE_1_FHIR
Title: Venous Thromboembolism Prophylaxis
Status: active
Experimental: true
Scoring:

system: http://terminology.hl7.org/CodeSystem/measure-scoring

code: proportion

display: Proportion

Improvement Notation:

system: http://terminology.hl7.org/CodeSystem/measure-improvement-notation

code: increase

display: Increased score indicates improvement

Type:

system: http://terminology.hl7.org/CodeSystem/measure-type

code: process

Date: 2021-04-03
Publisher: Clinical Quality Information WG
Description: This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission
Parameters:
nameuseminmaxtype
Admission Without VTE or Obstetrical Conditions out 0 * Encounter
Denominator out 0 * Encounter
Denominator Exclusion out 0 * Any
Encounter Less Than 2 Days out 0 * Encounter
Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions out 0 * Encounter
Encounter With ICU Location Stay 1 Day or More out 0 * Encounter
Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission out 0 * Encounter
Encounter With Intervention Comfort Measures on Day of or Day After Procedure out 0 * Encounter
Encounter With Low Risk for VTE or Anticoagulant Administered out 0 * Encounter
Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure out 0 * Encounter
Encounter With No VTE Prophylaxis Due to Medical Reason out 0 * Encounter
Encounter With No VTE Prophylaxis Due to Patient Refusal out 0 * Encounter
Encounter With Principal Diagnosis of Mental Disorder or Stroke out 0 * Encounter
Encounter With Principal Procedure of SCIP VTE Selected Surgery out 0 * Any
Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE out 0 * Encounter
Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery out 0 * Encounter
Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure out 0 * Encounter
Initial Population out 0 * Encounter
Inpatient Encounter out 0 * Encounter
Intervention Comfort Measures out 0 * Any
Is In Low Risk for VTE or On Anticoagulant out 0 * Observation
Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission out 0 * Encounter
Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure out 0 * Encounter
Measurement Period in 0 1 Period
No VTE Prophylaxis Device Applied or Ordered out 0 * Any
No VTE Prophylaxis Device Due to Medical Reason From Day of Start of Hospitalization To Day After Admission out 0 * Encounter
No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure out 0 * Encounter
No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission out 0 * Encounter
No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure out 0 * Encounter
No VTE Prophylaxis Medication Administered or Ordered out 0 * Any
No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission out 0 * Encounter
No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure out 0 * Encounter
No VTE Prophylaxis Medication or Device Due to Patient Refusal out 0 * Any
Numerator out 0 * Encounter
Patient out 0 1 Patient
SCIP VTE Selected Surgery out 0 * Procedure
SDE Ethnicity out 0 * Coding
SDE Payer out 0 * Any
SDE Race out 0 * Coding
SDE Sex out 0 1 Coding
VTE Prophylaxis by Medication Administered or Device Applied out 0 * Any
Data Requirements:
typepathvalueSet or systemcode
Condition
Condition
Condition code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.202
Condition code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.279
Coverage type http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Encounter type http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Encounter type http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
Encounter type http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292
Location
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.134
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.134
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.218
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.205
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.41
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211
MedicationAdministration medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232
MedicationRequest medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39
MedicationRequest medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219
MedicationRequest medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211
MedicationRequest medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232
MedicationRequest medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39
MedicationRequest medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219
MedicationRequest medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211
MedicationRequest medication http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232
Observation code 72136-5
Observation code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.213
Patient
Patient
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.48
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.48
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1743
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1743
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.259
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.261
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1743
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.48
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.48
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1743
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1743
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1743
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.255
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.257
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.258
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.259
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.260
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.261
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.272
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45
Procedure code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1743
ServiceRequest code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.230
ServiceRequest code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.214
ServiceRequest code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.256
ServiceRequest code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.230
ServiceRequest code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.214
ServiceRequest code http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.256
ServiceRequest code http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45
ServiceRequest code http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45
Direct Reference Codes:
displaycodesystem
active
recurrence
relapse
inactive
remission
resolved
Risk for venous thromboembolism 72136-5
Supplemental Data:
expressionsystem
SDE Ethnicity http://terminology.hl7.org/CodeSystem/measure-data-usage
SDE Payer http://terminology.hl7.org/CodeSystem/measure-data-usage
SDE Race http://terminology.hl7.org/CodeSystem/measure-data-usage
SDE Sex http://terminology.hl7.org/CodeSystem/measure-data-usage
Use Context:
codevalue
program
Jurisdiction: US
Topic: 57024-2
Copyright: Measure specifications are in the Public Domain. LOINC(R) is a registered trademark of the Regenstrief Institute. This material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2017 International Health Terminology Standards Development Organization. All rights reserved.
Disclaimer: These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty
Approval Date: 2019-03-08
Last Review Date: 2019-03-08
Effective Period: 2018-01-01..2018-12-31
Related Artifacts:

Dependencies

  • http://hl7.org/fhir/us/cqfmeasures/Library/SupplementalDataElements|2.0.000
  • http://hl7.org/fhir/us/cqfmeasures/Library/MATGlobalCommonFunctions|5.0.000
  • http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1
  • http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1
  • http://hl7.org/fhir/us/cqfmeasures/Library/TJCOverall|4.0.000
  • http://hl7.org/fhir/us/cqfmeasures/Library/MATGlobalCommonFunctions|5.0.000
  • http://hl7.org/fhir/us/cqfmeasures/Library/VTEICU|5.0.000
  • http://hl7.org/fhir/us/cqfmeasures/Library/MATGlobalCommonFunctions|5.0.000
  • http://terminology.hl7.org/CodeSystem/condition-clinical
  • http://loinc.org
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.263
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.279
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.264
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.223
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.48
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.214
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.230
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.256
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1743
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.134
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.202
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.259
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.261
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.400
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.213
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.218
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.222
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.205
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.41
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.23
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1004
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.212
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.255
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.257
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.258
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.260
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.272
  • http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45
Logic Definitions:
Library NameNamesequence
EXM108 Admission Without VTE or Obstetrical Conditions
define "Admission Without VTE or Obstetrical Conditions":
	  	Global."Inpatient Encounter" InpatientEncounter
		    where not (exists (Global.EncounterDiagnosis(InpatientEncounter)) EncounterDiagnosis
              where (EncounterDiagnosis.code in "Obstetrics"
								or EncounterDiagnosis.code in "Venous Thromboembolism"
								or EncounterDiagnosis.code in "Obstetrics VTE"
			         )
        )


Library NameNamesequence
EXM108 Denominator
define "Denominator":
      "Initial Population"


Library NameNamesequence
EXM108 Denominator Exclusion
define "Denominator Exclusion":
    "Encounter Less Than 2 Days"
     union "Encounter With ICU Location Stay 1 Day or More"
     union "Encounter With Principal Diagnosis of Mental Disorder or Stroke"
     union "Encounter With Principal Procedure of SCIP VTE Selected Surgery"
     union "Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission"
     union "Encounter With Intervention Comfort Measures on Day of or Day After Procedure"


Library NameNamesequence
EXM108 Encounter Less Than 2 Days
define "Encounter Less Than 2 Days":
  "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
  	where Global."LengthInDays"(QualifyingEncounter.period)< 2


Library NameNamesequence
EXM108 Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions
// Note: added FHIRHelpers.ToDate() in R4 
define "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions":
    ( Global."Inpatient Encounter" InpatientEncounter
    		with ["Patient"] BirthDate
    			such that Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(BirthDate.birthDate), start of InpatientEncounter.period) >= 18
    )
    intersect "Admission Without VTE or Obstetrical Conditions"


Library NameNamesequence
EXM108 Encounter With ICU Location Stay 1 Day or More
define "Encounter With ICU Location Stay 1 Day or More":
  "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    where exists ( QualifyingEncounter.location Location
    		where Global.GetLocation(Location.location).type in "Intensive Care Unit"
    			and Global."LengthInDays"(Location.period)>= 1
    			and Location.period starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period)
	    )


Library NameNamesequence
EXM108 Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission
define "Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission":
	"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
		with "Intervention Comfort Measures" ComfortMeasure
		such that Coalesce(start of Global."Normalize Interval"(ComfortMeasure.performed), ComfortMeasure.authoredOn) during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)


Library NameNamesequence
EXM108 Encounter With Intervention Comfort Measures on Day of or Day After Procedure
define "Encounter With Intervention Comfort Measures on Day of or Day After Procedure":
  from
  		"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
  		["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
  		"Intervention Comfort Measures" ComfortMeasure
		where AnesthesiaProcedure.status = 'completed'
				and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
        and Coalesce(start of Global."Normalize Interval"(ComfortMeasure.performed), ComfortMeasure.authoredOn) during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
    return QualifyingEncounter


Library NameNamesequence
EXM108 Encounter With Low Risk for VTE or Anticoagulant Administered
define "Encounter With Low Risk for VTE or Anticoagulant Administered":
   "Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission"
   	 union "Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure"


Library NameNamesequence
EXM108 Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure
define "Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure":
	( from
    		"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
  			["MedicationAdministration": medication in "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication
    where FactorXaMedication.status = 'completed'
      and Global."Normalize Interval"(FactorXaMedication.effective) starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period)
    return QualifyingEncounter
    )
    union ( from
    				  "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
      				["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
      				["MedicationAdministration": medication in "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication
      			where FactorXaMedication.status = 'completed'
                and AnesthesiaProcedure.status = 'completed'
      			    and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
      					and Global."Normalize Interval"(FactorXaMedication.effective) starts during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
      			return QualifyingEncounter
      		)


Library NameNamesequence
EXM108 Encounter With No VTE Prophylaxis Due to Medical Reason
define "Encounter With No VTE Prophylaxis Due to Medical Reason":
   ( "No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission"
     intersect "No VTE Prophylaxis Device Due to Medical Reason From Day of Start of Hospitalization To Day After Admission"
   )
   union ( "No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure"
       intersect "No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure"
       )


Library NameNamesequence
EXM108 Encounter With No VTE Prophylaxis Due to Patient Refusal
define "Encounter With No VTE Prophylaxis Due to Patient Refusal":
 "No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission"
 	union "No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure"


Library NameNamesequence
EXM108 Encounter With Principal Diagnosis of Mental Disorder or Stroke
define "Encounter With Principal Diagnosis of Mental Disorder or Stroke":
  "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    where Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Mental Health Diagnoses"
        or Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Hemorrhagic Stroke"
        or Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Ischemic Stroke"


Library NameNamesequence
EXM108 Encounter With Principal Procedure of SCIP VTE Selected Surgery
/* NOTE: 2 options to express Principal Procedure to retrive "encounter Procedure as an url" and proedure "rank as extension" in R4
          VTE-1 uses Option 1 - generic extension funtion
          VTE-2 uses Option 2 - Specific extension functions
  TODO:  Mapping Table needs revision on using "Encounter.procedure.code", "Encounter.procedure.sequence"
*/define "Encounter With Principal Procedure of SCIP VTE Selected Surgery":
  from
      "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
      "SCIP VTE Selected Surgery" SelectedProcedure
      let EncounterProcedure: Global.GetExtension(QualifyingEncounter, 'qicore-encounter-procedure')
  where FHIRHelpers.ToInteger(Global.GetExtension(EncounterProcedure, 'rank').value as FHIR.positiveInt) = 1
      and Global.GetId(FHIRHelpers.ToString((Global.GetExtension(EncounterProcedure, 'procedure').value as FHIR.Reference).reference)) = SelectedProcedure.id
      and Global."Normalize Interval"(SelectedProcedure.performed) during QualifyingEncounter.period


Library NameNamesequence
EXM108 Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE
/*NOTE: Feedback at Digitial Quality Summit 2019 indicates verificationStatus may be difficult for implementers to retrieve
        both condition.clinicalStatus and condition.verificationStatus = 'confirmed'
*/define "Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE":
	( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
		with ["Condition": code in "Atrial Fibrillation/Flutter"] AtrialFibrillation
		such that FHIRHelpers.ToConcept(AtrialFibrillation.clinicalStatus) in { Global."active", Global."recurrence", Global."relapse" }
			and Global."Normalize Interval"(AtrialFibrillation.onset) starts on or before end of QualifyingEncounter.period
    )
    union ( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    				where Global.EncounterDiagnosis(QualifyingEncounter).code in "Atrial Fibrillation/Flutter"
    			)
    union ( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    				with ["Condition": code in "Venous Thromboembolism"] VTEDiagnosis
    				such that  FHIRHelpers.ToConcept(VTEDiagnosis.clinicalStatus) in { Global."inactive", Global."remission", Global."resolved" }
      					//and VTEDiagnosis.verificationStatus = 'confirmed'
    				and Global."Normalize Interval"(VTEDiagnosis.onset) before start of QualifyingEncounter.period
      		)


Library NameNamesequence
EXM108 Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery
define "Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery":
	"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
	with ( ["Procedure": "Hip Replacement Surgery"]
    			union ["Procedure": "Knee Replacement Surgery"] ) HipKneeProcedure
	such that HipKneeProcedure.status = 'completed'
	     and Global."Normalize Interval"(HipKneeProcedure.performed) starts on or before end of QualifyingEncounter.period


Library NameNamesequence
EXM108 Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure
define "Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure":
 	( from
   			"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
   			"VTE Prophylaxis by Medication Administered or Device Applied" VTEProphylaxis
  		where Coalesce(Global."Normalize Interval"(VTEProphylaxis.effective), Global."Normalize Interval"(VTEProphylaxis.performed)) starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period)
  		return QualifyingEncounter
 	)
 	union (
    from
  			"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
  			["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
  			"VTE Prophylaxis by Medication Administered or Device Applied" VTEProphylaxis
			where Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
				and Coalesce(Global."Normalize Interval"(VTEProphylaxis.effective), Global."Normalize Interval"(VTEProphylaxis.performed)) starts during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
			return QualifyingEncounter
	)


Library NameNamesequence
EXM108 Initial Population
define "Initial Population":
  "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions"


Library NameNamesequence
MATGlobalCommonFunctions Inpatient Encounter
define "Inpatient Encounter":
	[Encounter: "Encounter Inpatient"] EncounterInpatient
		where EncounterInpatient.status = 'finished'
		    and "LengthInDays"(EncounterInpatient.period) <= 120
			and EncounterInpatient.period ends during "Measurement Period"


Library NameNamesequence
EXM108 Intervention Comfort Measures
define "Intervention Comfort Measures":
	(["ServiceRequest": "Comfort Measures"] P
    		where P.intent = 'order'
  )
  	union
    	(["Procedure": "Comfort Measures"] InterventionPerformed
      	where InterventionPerformed.status in {'completed', 'in-progress'})


Library NameNamesequence
EXM108 Is In Low Risk for VTE or On Anticoagulant
define "Is In Low Risk for VTE or On Anticoagulant":
	  ( ["Observation": "Risk for venous thromboembolism"] VTERiskAssessment
			  where VTERiskAssessment.value in "Low Risk"
        and VTERiskAssessment.status in {'final','amended', 'corrected'}
	  )
  union ( ["Observation": "INR"] INRLabTest
        where INRLabTest.value as Quantity > 3.0
            and INRLabTest.status in {'final','amended', 'corrected'}
        return "Observation" { id: INRLabTest.id, effective: INRLabTest.issued }
        )
  union ((( ["MedicationAdministration": "Unfractionated Heparin"] UnfractionatedHeparin
          where UnfractionatedHeparin.dosage.route in "Intravenous route"
         )
         union ["MedicationAdministration": "Direct Thrombin Inhibitor"]
         union ["MedicationAdministration": "Glycoprotein IIb/IIIa Inhibitors"] ) AnticoagulantMedication
         where AnticoagulantMedication.status = 'complete'
         return "Observation" { id: AnticoagulantMedication.id, effective: AnticoagulantMedication.effective }
      )


Library NameNamesequence
EXM108 Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission
define "Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission":
 	"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    with "Is In Low Risk for VTE or On Anticoagulant" VTERiskAssessment
    such that Global."Normalize Interval"(VTERiskAssessment.effective) starts during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)


Library NameNamesequence
EXM108 Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure
define "Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure":
 	from
   		"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
   		["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
   		"Is In Low Risk for VTE or On Anticoagulant" VTERiskAssessment
	where Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
 			and Global."Normalize Interval"(VTERiskAssessment.effective) starts during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
	return QualifyingEncounter


Library NameNamesequence
EXM108 No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission
define "No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission":
   	"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
       with	"No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
     	such that Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Medical Reason"
      			and Coalesce(NoVTEMedication.authoredOn, start of Global."Normalize Interval"(NoVTEMedication.effective)) during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)


Library NameNamesequence
EXM108 No VTE Prophylaxis Medication Administered or Ordered
define "No VTE Prophylaxis Medication Administered or Ordered":
   ((	["MedicationAdministration": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
     union
	    ["MedicationAdministration": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"]
     union
	    ["MedicationAdministration": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
     union
	    ["MedicationAdministration": medication in "Warfarin"]
       ) MedicationAdm
       where MedicationAdm.status = 'not-done'
        )
  union
	   ((	["MedicationRequest": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
  	union
  	 ["MedicationRequest": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"]
    union
    	["MedicationRequest": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
    union
    	["MedicationRequest": medication in "Warfarin"]
    ) MedicationOrder
    	where	MedicationOrder.doNotPerform is true
        and MedicationOrder.status in {'completed', 'cancelled'}
        //11/5 discussion: all expressions for QI-Core must include a status.
        //Therefore, we need ServiceRequest.status = completed; and MedicationRequest.status = cancelled (or completed, since cancelled indicates it was once ordered but intentionally never filled).
        //So the not done issue is handled by ServiceRequest.doNotPerform = True  Or MedicationRequest.doNotPerform = True
    )


Library NameNamesequence
EXM108 No VTE Prophylaxis Device Due to Medical Reason From Day of Start of Hospitalization To Day After Admission
define "No VTE Prophylaxis Device Due to Medical Reason From Day of Start of Hospitalization To Day After Admission":
  "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
  	with "No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice
      such that NoVTEDevice.requestStatusReason in "Medical Reason"
        and  NoVTEDevice.authoredOn during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)


Library NameNamesequence
EXM108 No VTE Prophylaxis Device Applied or Ordered
define "No VTE Prophylaxis Device Applied or Ordered":
  ((
    ["ServiceRequest": "Venous foot pumps (VFP)"]
    union ["ServiceRequest": "Intermittent pneumatic compression devices (IPC)"]
    union ["ServiceRequest": "Graduated compression stockings (GCS)"]
    ) DeviceOrder
    where DeviceOrder.status = 'completed'
    //11/5 discussion: all expressions for QI-Core must include a status
    //ServiceRequest.status -  draft | active | suspended | completed | entered-in-error | cancelled
        and DeviceOrder.doNotPerform is true
    return {id: DeviceOrder.id, requestStatusReason: GetStatusReason(DeviceOrder), authoredOn: DeviceOrder.authoredOn}
    )
  union
    (
      ["Procedure": "Device Application"] DeviceApplied
      let DeviceNotDoneTiming: Global.GetExtension(DeviceApplied, 'qicore-recorded').value
      where (DeviceApplied.usedCode in "Intermittent pneumatic compression devices (IPC)"
            or DeviceApplied.usedCode in "Venous foot pumps (VFP)"
            or DeviceApplied.usedCode in "Graduated compression stockings (GCS)"
            )
         and  DeviceApplied.status = 'not-done'
         return {id: DeviceApplied.id, requestStatusReason: DeviceApplied.statusReason, authoredOn: DeviceNotDoneTiming}

    )


Library NameNamesequence
EXM108 No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure
define "No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure":
	from
  		"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
  		["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
  		"No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
	where Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Medical Reason"
			and AnesthesiaProcedure.status = 'completed'
			and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
			and Coalesce(NoVTEMedication.authoredOn, start of Global."Normalize Interval"(NoVTEMedication.effective)) during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
  return QualifyingEncounter


Library NameNamesequence
EXM108 No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure
define "No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure":
  from
  		"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
  		["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
  		"No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice
  where  NoVTEDevice.requestStatusReason in "Medical Reason"
      and AnesthesiaProcedure.status = 'completed'
  		and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
      and NoVTEDevice.authoredOn during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
  return QualifyingEncounter


Library NameNamesequence
EXM108 No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission
define "No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission":
 	"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
	 with "No VTE Prophylaxis Medication or Device Due to Patient Refusal" PatientRefusal
   such that Coalesce(start of Global."Normalize Interval"(PatientRefusal.effective), PatientRefusal.authoredOn)
         during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)


Library NameNamesequence
EXM108 No VTE Prophylaxis Medication or Device Due to Patient Refusal
define "No VTE Prophylaxis Medication or Device Due to Patient Refusal":
    ( "No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
        where Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Patient Refusal"
    )
  union ("No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice
           where NoVTEDevice.requestStatusReason in "Patient Refusal"
        )


Library NameNamesequence
EXM108 No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure
define "No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure":
 	from
   		"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
   		["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
   		"No VTE Prophylaxis Medication or Device Due to Patient Refusal" PatientRefusal
	where Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
 			and Coalesce(start of Global."Normalize Interval"(PatientRefusal.effective), PatientRefusal.authoredOn)
             during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
	return QualifyingEncounter


Library NameNamesequence
EXM108 Numerator
define "Numerator":
    "Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure"
    union ( "Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure"
    			  intersect ( "Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE"
    						    union "Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery"
    			            )
          )
    union "Encounter With Low Risk for VTE or Anticoagulant Administered"
    union "Encounter With No VTE Prophylaxis Due to Medical Reason"
    union "Encounter With No VTE Prophylaxis Due to Patient Refusal"


Library NameNamesequence
EXM108 SDE Payer
define "SDE Payer":
	SDE."SDE Payer"


Library NameNamesequence
SupplementalDataElements SDE Payer
define "SDE Payer":
  [Coverage: type in "Payer"] Payer
        return {
          code: Payer.type,
          period: Payer.period
        }


Library NameNamesequence
EXM108 Initial Population
define "Initial Population":
  "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions"


Library NameNamesequence
EXM108 SCIP VTE Selected Surgery
define "SCIP VTE Selected Surgery":
  (	["Procedure": "General Surgery"]
    union ["Procedure": "Gynecological Surgery"]
    union ["Procedure": "Hip Fracture Surgery"]
    union ["Procedure": "Hip Replacement Surgery"]
    union ["Procedure": "Intracranial Neurosurgery"]
    union ["Procedure": "Knee Replacement Surgery"]
    union ["Procedure": "Urological Surgery"] ) Procedure
  where Procedure.status = 'completed'


Library NameNamesequence
EXM108 SDE Ethnicity
define "SDE Ethnicity":
  SDE."SDE Ethnicity"


Library NameNamesequence
SupplementalDataElements SDE Ethnicity
define "SDE Ethnicity":
  (flatten (
      Patient.extension Extension
        where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity'
          return Extension.extension
    )) E
      where E.url = 'ombCategory'
        or E.url = 'detailed'
      return E.value as Coding


Library NameNamesequence
EXM108 SDE Race
define "SDE Race":
  SDE."SDE Race"


Library NameNamesequence
EXM108 SDE Sex
define "SDE Sex":
	SDE."SDE Sex"


Library NameNamesequence
SupplementalDataElements SDE Sex
define "SDE Sex":
  case
      when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }
      when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }
      else null
    end


Library NameNamesequence
SupplementalDataElements SDE Race
define "SDE Race":
  (flatten (
      Patient.extension Extension
        where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race'
          return Extension.extension
    )) E
      where E.url = 'ombCategory'
        or E.url = 'detailed'
      return E.value as Coding


Library NameNamesequence
EXM108 VTE Prophylaxis by Medication Administered or Device Applied
// 10/29: Replaced DeviceUseStatement with Procedure with a new value set and procedure.usdCode for specifying devicesdefine "VTE Prophylaxis by Medication Administered or Device Applied":
  ( ["MedicationAdministration": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"] VTEMedication
      where VTEMedication.status ='completed'
			     and VTEMedication.dosage.route in "Subcutaneous route"
  )
   union (["MedicationAdministration": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"] LMWH where LMWH.status = 'completed')
    union (["MedicationAdministration": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"] FactorXa where FactorXa.status = 'completed')
     union (["MedicationAdministration": medication in "Warfarin"] Warfarin where Warfarin.status = 'completed')
      union (
          ["Procedure": "Device Application"] DeviceApplied
          where DeviceApplied.status = 'complete'
                and (DeviceApplied.usedCode in "Intermittent pneumatic compression devices (IPC)"
                    or DeviceApplied.usedCode in"Venous foot pumps (VFP)"
                    or DeviceApplied.usedCode in "Graduated compression stockings (GCS)"
                    )
          )