Clinical Quality Language Specification
1.5.3 - Release 1 Errata 2

Clinical Quality Language Specification, published by Clinical Decision Support WG. This guide is not an authorized publication; it is the continuous build for version 1.5.3 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/cql/ and changes regularly. See the Directory of published versions

Binary: Example CMS179v2 Quality Measure ELM in JSON

    
{
   "library" : {
      "identifier" : {
         "id" : "CMS179",
         "version" : "2"
      },
      "schemaIdentifier" : {
         "id" : "urn:hl7-org:elm",
         "version" : "r1"
      },
      "usings" : {
         "def" : [ {
            "localIdentifier" : "System",
            "uri" : "urn:hl7-org:elm-types:r1"
         }, {
            "localIdentifier" : "QUICK",
            "uri" : "http://hl7.org/fhir"
         } ]
      },
      "parameters" : {
         "def" : [ {
            "name" : "MeasurementPeriod",
            "accessLevel" : "Public",
            "default" : {
               "lowClosed" : true,
               "highClosed" : false,
               "type" : "Interval",
               "low" : {
                  "type" : "DateTime",
                  "year" : {
                     "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                     "value" : "2013",
                     "type" : "Literal"
                  },
                  "month" : {
                     "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                     "value" : "1",
                     "type" : "Literal"
                  },
                  "day" : {
                     "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                     "value" : "1",
                     "type" : "Literal"
                  },
                  "hour" : {
                     "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                     "value" : "0",
                     "type" : "Literal"
                  },
                  "minute" : {
                     "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                     "value" : "0",
                     "type" : "Literal"
                  },
                  "second" : {
                     "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                     "value" : "0",
                     "type" : "Literal"
                  },
                  "millisecond" : {
                     "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                     "value" : "0",
                     "type" : "Literal"
                  }
               },
               "high" : {
                  "type" : "DateTime",
                  "year" : {
                     "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                     "value" : "2014",
                     "type" : "Literal"
                  },
                  "month" : {
                     "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                     "value" : "1",
                     "type" : "Literal"
                  },
                  "day" : {
                     "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                     "value" : "1",
                     "type" : "Literal"
                  },
                  "hour" : {
                     "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                     "value" : "0",
                     "type" : "Literal"
                  },
                  "minute" : {
                     "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                     "value" : "0",
                     "type" : "Literal"
                  },
                  "second" : {
                     "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                     "value" : "0",
                     "type" : "Literal"
                  },
                  "millisecond" : {
                     "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                     "value" : "0",
                     "type" : "Literal"
                  }
               }
            }
         } ]
      },
      "valueSets" : {
         "def" : [ {
            "name" : "Flutter Diagnosis",
            "id" : "2.16.840.1.113883.3.117.1.7.1.202",
            "accessLevel" : "Public"
         }, {
            "name" : "Warfarin Medication",
            "id" : "2.16.840.1.113883.3.117.1.7.1.232",
            "accessLevel" : "Public"
         }, {
            "name" : "Face-to-face Encounter",
            "id" : "2.16.840.1.113883.3.464.1003.101.12.1048",
            "accessLevel" : "Public"
         }, {
            "name" : "Office Visit",
            "id" : "2.16.840.1.113883.3.464.1003.101.12.1001",
            "accessLevel" : "Public"
         }, {
            "name" : "Valvular Heart Disease",
            "id" : "2.16.840.1.113883.3.464.1003.104.12.1017",
            "accessLevel" : "Public"
         }, {
            "name" : "INR Lab Result",
            "id" : "2.16.840.1.113883.3.117.1.7.1.213",
            "accessLevel" : "Public"
         } ]
      },
      "statements" : {
         "def" : [ {
            "name" : "Patient",
            "context" : "Patient",
            "expression" : {
               "type" : "SingletonFrom",
               "operand" : {
                  "dataType" : "{http://hl7.org/fhir}Patient",
                  "templateId" : "patient-qicore-qicore-patient",
                  "type" : "Retrieve"
               }
            }
         }, {
            "name" : "FlutterDiagnoses",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "dataType" : "{http://hl7.org/fhir}Condition",
               "templateId" : "condition-qicore-qicore-condition",
               "codeProperty" : "code",
               "type" : "Retrieve",
               "codes" : {
                  "name" : "Flutter Diagnosis",
                  "type" : "ValueSetRef"
               }
            }
         }, {
            "name" : "WarfarinMedications",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "dataType" : "{http://hl7.org/fhir}MedicationAdministration",
               "templateId" : "medicationadministration-qicore-qicore-medicationadministration",
               "codeProperty" : "medication.code",
               "type" : "Retrieve",
               "codes" : {
                  "name" : "Warfarin Medication",
                  "type" : "ValueSetRef"
               }
            }
         }, {
            "name" : "FaceToFaceEncounters",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "dataType" : "{http://hl7.org/fhir}Encounter",
               "templateId" : "encounter-qicore-qicore-encounter",
               "codeProperty" : "type",
               "type" : "Retrieve",
               "codes" : {
                  "name" : "Face-to-face Encounter",
                  "type" : "ValueSetRef"
               }
            }
         }, {
            "name" : "OfficeVisitEncounters",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "dataType" : "{http://hl7.org/fhir}Encounter",
               "templateId" : "encounter-qicore-qicore-encounter",
               "codeProperty" : "type",
               "type" : "Retrieve",
               "codes" : {
                  "name" : "Office Visit",
                  "type" : "ValueSetRef"
               }
            }
         }, {
            "name" : "ValvularHeartDiseaseDiagnoses",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "dataType" : "{http://hl7.org/fhir}Condition",
               "templateId" : "condition-qicore-qicore-condition",
               "codeProperty" : "code",
               "type" : "Retrieve",
               "codes" : {
                  "name" : "Valvular Heart Disease",
                  "type" : "ValueSetRef"
               }
            }
         }, {
            "name" : "INRLabResults",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "dataType" : "{http://hl7.org/fhir}Observation",
               "templateId" : "observation-qicore-qicore-observation",
               "codeProperty" : "code",
               "type" : "Retrieve",
               "codes" : {
                  "name" : "INR Lab Result",
                  "type" : "ValueSetRef"
               }
            }
         }, {
            "name" : "InDemographic",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "type" : "GreaterOrEqual",
               "operand" : [ {
                  "precision" : "Year",
                  "type" : "CalculateAgeAt",
                  "operand" : [ {
                     "path" : "birthDate",
                     "type" : "Property",
                     "source" : {
                        "name" : "Patient",
                        "type" : "ExpressionRef"
                     }
                  }, {
                     "type" : "Start",
                     "operand" : {
                        "name" : "MeasurementPeriod",
                        "type" : "ParameterRef"
                     }
                  } ]
               }, {
                  "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                  "value" : "18",
                  "type" : "Literal"
               } ]
            }
         }, {
            "name" : "InpatientEncounters",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "type" : "Union",
               "operand" : [ {
                  "name" : "FaceToFaceEncounters",
                  "type" : "ExpressionRef"
               }, {
                  "name" : "OfficeVisitEncounters",
                  "type" : "ExpressionRef"
               } ]
            }
         }, {
            "name" : "ActiveFlutterDiagnoses",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "type" : "Query",
               "source" : [ {
                  "alias" : "F",
                  "expression" : {
                     "name" : "FlutterDiagnoses",
                     "type" : "ExpressionRef"
                  }
               } ],
               "relationship" : [ ],
               "where" : {
                  "type" : "OverlapsBefore",
                  "operand" : [ {
                     "lowClosed" : true,
                     "highClosed" : true,
                     "type" : "Interval",
                     "low" : {
                        "path" : "onsetDateTime",
                        "scope" : "F",
                        "type" : "Property"
                     },
                     "high" : {
                        "path" : "abatementDate",
                        "scope" : "F",
                        "type" : "Property"
                     }
                  }, {
                     "name" : "MeasurementPeriod",
                     "type" : "ParameterRef"
                  } ]
               }
            }
         }, {
            "name" : "ActiveValvularHeartDiseaseDiagnoses",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "type" : "Query",
               "source" : [ {
                  "alias" : "D",
                  "expression" : {
                     "name" : "ValvularHeartDiseaseDiagnoses",
                     "type" : "ExpressionRef"
                  }
               } ],
               "relationship" : [ ],
               "where" : {
                  "type" : "OverlapsBefore",
                  "operand" : [ {
                     "lowClosed" : true,
                     "highClosed" : true,
                     "type" : "Interval",
                     "low" : {
                        "path" : "onsetDateTime",
                        "scope" : "D",
                        "type" : "Property"
                     },
                     "high" : {
                        "path" : "abatementDate",
                        "scope" : "D",
                        "type" : "Property"
                     }
                  }, {
                     "name" : "MeasurementPeriod",
                     "type" : "ParameterRef"
                  } ]
               }
            }
         }, {
            "name" : "LookbackInterval",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "lowClosed" : true,
               "highClosed" : true,
               "type" : "Interval",
               "low" : {
                  "type" : "Subtract",
                  "operand" : [ {
                     "type" : "Start",
                     "operand" : {
                        "name" : "MeasurementPeriod",
                        "type" : "ParameterRef"
                     }
                  }, {
                     "value" : 200,
                     "unit" : "days",
                     "type" : "Quantity"
                  } ]
               },
               "high" : {
                  "type" : "Start",
                  "operand" : {
                     "name" : "MeasurementPeriod",
                     "type" : "ParameterRef"
                  }
               }
            }
         }, {
            "name" : "ActiveWarfarinDuringLookback",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "type" : "Query",
               "source" : [ {
                  "alias" : "M",
                  "expression" : {
                     "name" : "WarfarinMedications",
                     "type" : "ExpressionRef"
                  }
               } ],
               "relationship" : [ ],
               "where" : {
                  "type" : "Overlaps",
                  "operand" : [ {
                     "path" : "effectiveTimePeriod",
                     "scope" : "M",
                     "type" : "Property"
                  }, {
                     "name" : "LookbackInterval",
                     "type" : "ExpressionRef"
                  } ]
               }
            }
         }, {
            "name" : "WarfarinUsageIntervals",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "type" : "Collapse",
               "operand" : {
                  "type" : "Query",
                  "source" : [ {
                     "alias" : "M",
                     "expression" : {
                        "name" : "ActiveWarfarinDuringLookback",
                        "type" : "ExpressionRef"
                     }
                  } ],
                  "relationship" : [ ],
                  "return" : {
                     "expression" : {
                        "type" : "Intersect",
                        "operand" : [ {
                           "path" : "effectiveTimePeriod",
                           "scope" : "M",
                           "type" : "Property"
                        }, {
                           "name" : "LookbackInterval",
                           "type" : "ExpressionRef"
                        } ]
                     }
                  }
               }
            }
         }, {
            "name" : "WarfarinUsage",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "type" : "Sum",
               "source" : {
                  "type" : "Query",
                  "source" : [ {
                     "alias" : "I",
                     "expression" : {
                        "name" : "WarfarinUsageIntervals",
                        "type" : "ExpressionRef"
                     }
                  } ],
                  "relationship" : [ ],
                  "return" : {
                     "expression" : {
                        "precision" : "Day",
                        "type" : "DurationBetween",
                        "operand" : [ {
                           "type" : "Start",
                           "operand" : {
                              "name" : "I",
                              "type" : "AliasRef"
                           }
                        }, {
                           "type" : "End",
                           "operand" : {
                              "name" : "I",
                              "type" : "AliasRef"
                           }
                        } ]
                     }
                  }
               }
            }
         }, {
            "name" : "INROutpatientLabResult",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "type" : "Query",
               "source" : [ {
                  "alias" : "R",
                  "expression" : {
                     "name" : "INRLabResults",
                     "type" : "ExpressionRef"
                  }
               } ],
               "relationship" : [ ],
               "where" : {
                  "type" : "Not",
                  "operand" : {
                     "type" : "Exists",
                     "operand" : {
                        "type" : "Query",
                        "source" : [ {
                           "alias" : "E",
                           "expression" : {
                              "name" : "InpatientEncounters",
                              "type" : "ExpressionRef"
                           }
                        } ],
                        "relationship" : [ ],
                        "where" : {
                           "type" : "And",
                           "operand" : [ {
                              "type" : "Greater",
                              "operand" : [ {
                                 "precision" : "Hour",
                                 "type" : "DurationBetween",
                                 "operand" : [ {
                                    "type" : "Start",
                                    "operand" : {
                                       "path" : "period",
                                       "scope" : "E",
                                       "type" : "Property"
                                    }
                                 }, {
                                    "type" : "End",
                                    "operand" : {
                                       "path" : "period",
                                       "scope" : "E",
                                       "type" : "Property"
                                    }
                                 } ]
                              }, {
                                 "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                                 "value" : "23",
                                 "type" : "Literal"
                              } ]
                           }, {
                              "type" : "In",
                              "operand" : [ {
                                 "path" : "appliesDateTime",
                                 "scope" : "R",
                                 "type" : "Property"
                              }, {
                                 "path" : "period",
                                 "scope" : "E",
                                 "type" : "Property"
                              } ]
                           } ]
                        }
                     }
                  }
               }
            }
         }, {
            "name" : "INRResultsByDay",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "type" : "Query",
               "source" : [ {
                  "alias" : "L",
                  "expression" : {
                     "name" : "INROutpatientLabResult",
                     "type" : "ExpressionRef"
                  }
               } ],
               "relationship" : [ ],
               "where" : {
                  "type" : "Greater",
                  "operand" : [ {
                     "path" : "value",
                     "type" : "Property",
                     "source" : {
                        "path" : "valueQuantity",
                        "scope" : "L",
                        "type" : "Property"
                     }
                  }, {
                     "valueType" : "{urn:hl7-org:elm-types:r1}Decimal",
                     "value" : "0.8",
                     "type" : "Literal"
                  } ]
               },
               "return" : {
                  "expression" : {
                     "type" : "Tuple",
                     "element" : [ {
                        "name" : "resultDate",
                        "value" : {
                           "type" : "DateFrom",
                           "operand" : {
                              "path" : "appliesDateTime",
                              "scope" : "L",
                              "type" : "Property"
                           }
                        }
                     }, {
                        "name" : "result",
                        "value" : {
                           "type" : "If",
                           "condition" : {
                              "asType" : "{urn:hl7-org:elm-types:r1}Boolean",
                              "type" : "As",
                              "operand" : {
                                 "type" : "Greater",
                                 "operand" : [ {
                                    "path" : "value",
                                    "type" : "Property",
                                    "source" : {
                                       "path" : "valueQuantity",
                                       "scope" : "L",
                                       "type" : "Property"
                                    }
                                 }, {
                                    "valueType" : "{urn:hl7-org:elm-types:r1}Decimal",
                                    "value" : "10.0",
                                    "type" : "Literal"
                                 } ]
                              },
                              "asTypeSpecifier" : {
                                 "name" : "{urn:hl7-org:elm-types:r1}Boolean",
                                 "type" : "NamedTypeSpecifier"
                              }
                           },
                           "then" : {
                              "valueType" : "{urn:hl7-org:elm-types:r1}Decimal",
                              "value" : "10.0",
                              "type" : "Literal"
                           },
                           "else" : {
                              "path" : "value",
                              "type" : "Property",
                              "source" : {
                                 "path" : "valueQuantity",
                                 "scope" : "L",
                                 "type" : "Property"
                              }
                           }
                        }
                     }, {
                        "name" : "distanceFromMidpoint",
                        "value" : {
                           "type" : "Abs",
                           "operand" : {
                              "type" : "Subtract",
                              "operand" : [ {
                                 "valueType" : "{urn:hl7-org:elm-types:r1}Decimal",
                                 "value" : "2.5",
                                 "type" : "Literal"
                              }, {
                                 "path" : "value",
                                 "type" : "Property",
                                 "source" : {
                                    "path" : "valueQuantity",
                                    "scope" : "L",
                                    "type" : "Property"
                                 }
                              } ]
                           }
                        }
                     } ]
                  }
               }
            }
         }, {
            "name" : "INRResultsPerDay",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "type" : "Query",
               "source" : [ {
                  "alias" : "X",
                  "expression" : {
                     "type" : "Query",
                     "source" : [ {
                        "alias" : "D",
                        "expression" : {
                           "type" : "Distinct",
                           "operand" : {
                              "type" : "Query",
                              "source" : [ {
                                 "alias" : "X",
                                 "expression" : {
                                    "name" : "INRResultsByDay",
                                    "type" : "ExpressionRef"
                                 }
                              } ],
                              "relationship" : [ ],
                              "return" : {
                                 "expression" : {
                                    "path" : "resultDate",
                                    "scope" : "X",
                                    "type" : "Property"
                                 }
                              }
                           }
                        }
                     } ],
                     "relationship" : [ ],
                     "return" : {
                        "expression" : {
                           "type" : "First",
                           "source" : {
                              "type" : "Query",
                              "source" : [ {
                                 "alias" : "R",
                                 "expression" : {
                                    "name" : "INRResultsByDay",
                                    "type" : "ExpressionRef"
                                 }
                              } ],
                              "relationship" : [ ],
                              "where" : {
                                 "type" : "Equal",
                                 "operand" : [ {
                                    "path" : "resultDate",
                                    "scope" : "R",
                                    "type" : "Property"
                                 }, {
                                    "name" : "D",
                                    "type" : "AliasRef"
                                 } ]
                              },
                              "sort" : {
                                 "by" : [ {
                                    "direction" : "asc",
                                    "type" : "ByExpression",
                                    "expression" : {
                                       "path" : "distanceFromMidpoint",
                                       "scope" : "R",
                                       "type" : "Property"
                                    }
                                 } ]
                              }
                           }
                        }
                     }
                  }
               } ],
               "relationship" : [ ],
               "sort" : {
                  "by" : [ {
                     "direction" : "asc",
                     "type" : "ByExpression",
                     "expression" : {
                        "path" : "resultDate",
                        "scope" : "X",
                        "type" : "Property"
                     }
                  } ]
               }
            }
         }, {
            "name" : "TherapeuticRange",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "lowClosed" : true,
               "highClosed" : true,
               "type" : "Interval",
               "low" : {
                  "valueType" : "{urn:hl7-org:elm-types:r1}Decimal",
                  "value" : "2.0",
                  "type" : "Literal"
               },
               "high" : {
                  "valueType" : "{urn:hl7-org:elm-types:r1}Decimal",
                  "value" : "3.0",
                  "type" : "Literal"
               }
            }
         }, {
            "name" : "INRIntervals",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "type" : "Query",
               "source" : [ {
                  "alias" : "X",
                  "expression" : {
                     "type" : "Query",
                     "source" : [ {
                        "alias" : "S",
                        "expression" : {
                           "name" : "INRResultsPerDay",
                           "type" : "ExpressionRef"
                        }
                     } ],
                     "relationship" : [ ],
                     "return" : {
                        "expression" : {
                           "type" : "Tuple",
                           "element" : [ {
                              "name" : "startResult",
                              "value" : {
                                 "name" : "S",
                                 "type" : "AliasRef"
                              }
                           }, {
                              "name" : "endResult",
                              "value" : {
                                 "type" : "First",
                                 "source" : {
                                    "type" : "Query",
                                    "source" : [ {
                                       "alias" : "E",
                                       "expression" : {
                                          "name" : "INRResultsPerDay",
                                          "type" : "ExpressionRef"
                                       }
                                    } ],
                                    "relationship" : [ ],
                                    "where" : {
                                       "type" : "Greater",
                                       "operand" : [ {
                                          "path" : "resultDate",
                                          "scope" : "S",
                                          "type" : "Property"
                                       }, {
                                          "path" : "resultDate",
                                          "scope" : "E",
                                          "type" : "Property"
                                       } ]
                                    }
                                 }
                              }
                           } ]
                        }
                     }
                  }
               } ],
               "relationship" : [ ],
               "return" : {
                  "expression" : {
                     "type" : "Tuple",
                     "element" : [ {
                        "name" : "startDate",
                        "value" : {
                           "path" : "resultDate",
                           "type" : "Property",
                           "source" : {
                              "path" : "startResult",
                              "scope" : "X",
                              "type" : "Property"
                           }
                        }
                     }, {
                        "name" : "endDate",
                        "value" : {
                           "path" : "resultDate",
                           "type" : "Property",
                           "source" : {
                              "path" : "endResult",
                              "scope" : "X",
                              "type" : "Property"
                           }
                        }
                     }, {
                        "name" : "resultDays",
                        "value" : {
                           "precision" : "Day",
                           "type" : "DurationBetween",
                           "operand" : [ {
                              "path" : "resultDate",
                              "type" : "Property",
                              "source" : {
                                 "path" : "startResult",
                                 "scope" : "X",
                                 "type" : "Property"
                              }
                           }, {
                              "path" : "resultDate",
                              "type" : "Property",
                              "source" : {
                                 "path" : "endResult",
                                 "scope" : "X",
                                 "type" : "Property"
                              }
                           } ]
                        }
                     }, {
                        "name" : "resultDifference",
                        "value" : {
                           "type" : "Subtract",
                           "operand" : [ {
                              "path" : "result",
                              "type" : "Property",
                              "source" : {
                                 "path" : "endResult",
                                 "scope" : "X",
                                 "type" : "Property"
                              }
                           }, {
                              "path" : "result",
                              "type" : "Property",
                              "source" : {
                                 "path" : "startResult",
                                 "scope" : "X",
                                 "type" : "Property"
                              }
                           } ]
                        }
                     }, {
                        "name" : "resultsWithinBounds",
                        "value" : {
                           "type" : "And",
                           "operand" : [ {
                              "type" : "In",
                              "operand" : [ {
                                 "path" : "result",
                                 "type" : "Property",
                                 "source" : {
                                    "path" : "startResult",
                                    "scope" : "X",
                                    "type" : "Property"
                                 }
                              }, {
                                 "name" : "TherapeuticRange",
                                 "type" : "ExpressionRef"
                              } ]
                           }, {
                              "type" : "In",
                              "operand" : [ {
                                 "path" : "result",
                                 "type" : "Property",
                                 "source" : {
                                    "path" : "endResult",
                                    "scope" : "X",
                                    "type" : "Property"
                                 }
                              }, {
                                 "name" : "TherapeuticRange",
                                 "type" : "ExpressionRef"
                              } ]
                           } ]
                        }
                     }, {
                        "name" : "boundedDifference",
                        "value" : {
                           "type" : "If",
                           "condition" : {
                              "asType" : "{urn:hl7-org:elm-types:r1}Boolean",
                              "type" : "As",
                              "operand" : {
                                 "type" : "GreaterOrEqual",
                                 "operand" : [ {
                                    "path" : "result",
                                    "type" : "Property",
                                    "source" : {
                                       "path" : "endResult",
                                       "scope" : "X",
                                       "type" : "Property"
                                    }
                                 }, {
                                    "path" : "result",
                                    "type" : "Property",
                                    "source" : {
                                       "path" : "startResult",
                                       "scope" : "X",
                                       "type" : "Property"
                                    }
                                 } ]
                              },
                              "asTypeSpecifier" : {
                                 "name" : "{urn:hl7-org:elm-types:r1}Boolean",
                                 "type" : "NamedTypeSpecifier"
                              }
                           },
                           "then" : {
                              "type" : "If",
                              "condition" : {
                                 "asType" : "{urn:hl7-org:elm-types:r1}Boolean",
                                 "type" : "As",
                                 "operand" : {
                                    "type" : "Or",
                                    "operand" : [ {
                                       "type" : "Greater",
                                       "operand" : [ {
                                          "path" : "result",
                                          "type" : "Property",
                                          "source" : {
                                             "path" : "startResult",
                                             "scope" : "X",
                                             "type" : "Property"
                                          }
                                       }, {
                                          "type" : "End",
                                          "operand" : {
                                             "name" : "TherapeuticRange",
                                             "type" : "ExpressionRef"
                                          }
                                       } ]
                                    }, {
                                       "type" : "Less",
                                       "operand" : [ {
                                          "path" : "result",
                                          "type" : "Property",
                                          "source" : {
                                             "path" : "endResult",
                                             "scope" : "X",
                                             "type" : "Property"
                                          }
                                       }, {
                                          "type" : "Start",
                                          "operand" : {
                                             "name" : "TherapeuticRange",
                                             "type" : "ExpressionRef"
                                          }
                                       } ]
                                    } ]
                                 },
                                 "asTypeSpecifier" : {
                                    "name" : "{urn:hl7-org:elm-types:r1}Boolean",
                                    "type" : "NamedTypeSpecifier"
                                 }
                              },
                              "then" : {
                                 "asType" : "{urn:hl7-org:elm-types:r1}Decimal",
                                 "type" : "As",
                                 "operand" : {
                                    "type" : "Null"
                                 },
                                 "asTypeSpecifier" : {
                                    "name" : "{urn:hl7-org:elm-types:r1}Decimal",
                                    "type" : "NamedTypeSpecifier"
                                 }
                              },
                              "else" : {
                                 "type" : "Subtract",
                                 "operand" : [ {
                                    "type" : "Min",
                                    "source" : {
                                       "type" : "List",
                                       "element" : [ {
                                          "path" : "result",
                                          "type" : "Property",
                                          "source" : {
                                             "path" : "endResult",
                                             "scope" : "X",
                                             "type" : "Property"
                                          }
                                       }, {
                                          "type" : "End",
                                          "operand" : {
                                             "name" : "TherapeuticRange",
                                             "type" : "ExpressionRef"
                                          }
                                       } ]
                                    }
                                 }, {
                                    "type" : "Max",
                                    "source" : {
                                       "type" : "List",
                                       "element" : [ {
                                          "path" : "result",
                                          "type" : "Property",
                                          "source" : {
                                             "path" : "startResult",
                                             "scope" : "X",
                                             "type" : "Property"
                                          }
                                       }, {
                                          "type" : "Start",
                                          "operand" : {
                                             "name" : "TherapeuticRange",
                                             "type" : "ExpressionRef"
                                          }
                                       } ]
                                    }
                                 } ]
                              }
                           },
                           "else" : {
                              "type" : "If",
                              "condition" : {
                                 "asType" : "{urn:hl7-org:elm-types:r1}Boolean",
                                 "type" : "As",
                                 "operand" : {
                                    "type" : "Or",
                                    "operand" : [ {
                                       "type" : "Greater",
                                       "operand" : [ {
                                          "path" : "result",
                                          "type" : "Property",
                                          "source" : {
                                             "path" : "endResult",
                                             "scope" : "X",
                                             "type" : "Property"
                                          }
                                       }, {
                                          "type" : "End",
                                          "operand" : {
                                             "name" : "TherapeuticRange",
                                             "type" : "ExpressionRef"
                                          }
                                       } ]
                                    }, {
                                       "type" : "Less",
                                       "operand" : [ {
                                          "path" : "result",
                                          "type" : "Property",
                                          "source" : {
                                             "path" : "startResult",
                                             "scope" : "X",
                                             "type" : "Property"
                                          }
                                       }, {
                                          "type" : "Start",
                                          "operand" : {
                                             "name" : "TherapeuticRange",
                                             "type" : "ExpressionRef"
                                          }
                                       } ]
                                    } ]
                                 },
                                 "asTypeSpecifier" : {
                                    "name" : "{urn:hl7-org:elm-types:r1}Boolean",
                                    "type" : "NamedTypeSpecifier"
                                 }
                              },
                              "then" : {
                                 "asType" : "{urn:hl7-org:elm-types:r1}Decimal",
                                 "type" : "As",
                                 "operand" : {
                                    "type" : "Null"
                                 },
                                 "asTypeSpecifier" : {
                                    "name" : "{urn:hl7-org:elm-types:r1}Decimal",
                                    "type" : "NamedTypeSpecifier"
                                 }
                              },
                              "else" : {
                                 "type" : "Subtract",
                                 "operand" : [ {
                                    "type" : "Min",
                                    "source" : {
                                       "type" : "List",
                                       "element" : [ {
                                          "path" : "result",
                                          "type" : "Property",
                                          "source" : {
                                             "path" : "startResult",
                                             "scope" : "X",
                                             "type" : "Property"
                                          }
                                       }, {
                                          "type" : "End",
                                          "operand" : {
                                             "name" : "TherapeuticRange",
                                             "type" : "ExpressionRef"
                                          }
                                       } ]
                                    }
                                 }, {
                                    "type" : "Max",
                                    "source" : {
                                       "type" : "List",
                                       "element" : [ {
                                          "path" : "result",
                                          "type" : "Property",
                                          "source" : {
                                             "path" : "endResult",
                                             "scope" : "X",
                                             "type" : "Property"
                                          }
                                       }, {
                                          "type" : "Start",
                                          "operand" : {
                                             "name" : "TherapeuticRange",
                                             "type" : "ExpressionRef"
                                          }
                                       } ]
                                    }
                                 } ]
                              }
                           }
                        }
                     }, {
                        "name" : "isValid",
                        "value" : {
                           "type" : "LessOrEqual",
                           "operand" : [ {
                              "precision" : "Day",
                              "type" : "DurationBetween",
                              "operand" : [ {
                                 "path" : "resultDate",
                                 "type" : "Property",
                                 "source" : {
                                    "path" : "startResult",
                                    "scope" : "X",
                                    "type" : "Property"
                                 }
                              }, {
                                 "path" : "resultDate",
                                 "type" : "Property",
                                 "source" : {
                                    "path" : "endResult",
                                    "scope" : "X",
                                    "type" : "Property"
                                 }
                              } ]
                           }, {
                              "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                              "value" : "56",
                              "type" : "Literal"
                           } ]
                        }
                     } ]
                  }
               }
            }
         }, {
            "name" : "TherapeuticDays",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "type" : "Query",
               "source" : [ {
                  "alias" : "I",
                  "expression" : {
                     "name" : "INRIntervals",
                     "type" : "ExpressionRef"
                  }
               } ],
               "relationship" : [ ],
               "return" : {
                  "expression" : {
                     "type" : "Tuple",
                     "element" : [ {
                        "name" : "startDate",
                        "value" : {
                           "path" : "startDate",
                           "scope" : "I",
                           "type" : "Property"
                        }
                     }, {
                        "name" : "endDate",
                        "value" : {
                           "path" : "endDate",
                           "scope" : "I",
                           "type" : "Property"
                        }
                     }, {
                        "name" : "isValid",
                        "value" : {
                           "path" : "isValid",
                           "scope" : "I",
                           "type" : "Property"
                        }
                     }, {
                        "name" : "resultDays",
                        "value" : {
                           "path" : "resultDays",
                           "scope" : "I",
                           "type" : "Property"
                        }
                     }, {
                        "name" : "daysInRange",
                        "value" : {
                           "type" : "If",
                           "condition" : {
                              "asType" : "{urn:hl7-org:elm-types:r1}Boolean",
                              "type" : "As",
                              "operand" : {
                                 "path" : "resultsWithinBounds",
                                 "scope" : "I",
                                 "type" : "Property"
                              },
                              "asTypeSpecifier" : {
                                 "name" : "{urn:hl7-org:elm-types:r1}Boolean",
                                 "type" : "NamedTypeSpecifier"
                              }
                           },
                           "then" : {
                              "type" : "ToDecimal",
                              "operand" : {
                                 "path" : "resultDays",
                                 "scope" : "I",
                                 "type" : "Property"
                              }
                           },
                           "else" : {
                              "type" : "Coalesce",
                              "operand" : [ {
                                 "type" : "Multiply",
                                 "operand" : [ {
                                    "type" : "ToDecimal",
                                    "operand" : {
                                       "path" : "resultDays",
                                       "scope" : "I",
                                       "type" : "Property"
                                    }
                                 }, {
                                    "type" : "Abs",
                                    "operand" : {
                                       "type" : "Divide",
                                       "operand" : [ {
                                          "path" : "boundedDifference",
                                          "scope" : "I",
                                          "type" : "Property"
                                       }, {
                                          "type" : "ToDecimal",
                                          "operand" : {
                                             "type" : "If",
                                             "condition" : {
                                                "asType" : "{urn:hl7-org:elm-types:r1}Boolean",
                                                "type" : "As",
                                                "operand" : {
                                                   "type" : "Equal",
                                                   "operand" : [ {
                                                      "path" : "resultDays",
                                                      "scope" : "I",
                                                      "type" : "Property"
                                                   }, {
                                                      "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                                                      "value" : "0",
                                                      "type" : "Literal"
                                                   } ]
                                                },
                                                "asTypeSpecifier" : {
                                                   "name" : "{urn:hl7-org:elm-types:r1}Boolean",
                                                   "type" : "NamedTypeSpecifier"
                                                }
                                             },
                                             "then" : {
                                                "asType" : "{urn:hl7-org:elm-types:r1}Integer",
                                                "type" : "As",
                                                "operand" : {
                                                   "type" : "Null"
                                                },
                                                "asTypeSpecifier" : {
                                                   "name" : "{urn:hl7-org:elm-types:r1}Integer",
                                                   "type" : "NamedTypeSpecifier"
                                                }
                                             },
                                             "else" : {
                                                "path" : "resultDays",
                                                "scope" : "I",
                                                "type" : "Property"
                                             }
                                          }
                                       } ]
                                    }
                                 } ]
                              }, {
                                 "type" : "ToDecimal",
                                 "operand" : {
                                    "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                                    "value" : "0",
                                    "type" : "Literal"
                                 }
                              } ]
                           }
                        }
                     } ]
                  }
               }
            }
         }, {
            "name" : "TherapeuticTimeInRange",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "type" : "Round",
               "operand" : {
                  "type" : "Multiply",
                  "operand" : [ {
                     "type" : "ToDecimal",
                     "operand" : {
                        "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                        "value" : "100",
                        "type" : "Literal"
                     }
                  }, {
                     "type" : "Divide",
                     "operand" : [ {
                        "type" : "Sum",
                        "source" : {
                           "type" : "Query",
                           "source" : [ {
                              "alias" : "X",
                              "expression" : {
                                 "name" : "TherapeuticDays",
                                 "type" : "ExpressionRef"
                              }
                           } ],
                           "relationship" : [ ],
                           "return" : {
                              "expression" : {
                                 "path" : "daysInRange",
                                 "scope" : "X",
                                 "type" : "Property"
                              }
                           }
                        }
                     }, {
                        "type" : "ToDecimal",
                        "operand" : {
                           "type" : "Sum",
                           "source" : {
                              "type" : "Query",
                              "source" : [ {
                                 "alias" : "X",
                                 "expression" : {
                                    "name" : "TherapeuticDays",
                                    "type" : "ExpressionRef"
                                 }
                              } ],
                              "relationship" : [ ],
                              "return" : {
                                 "expression" : {
                                    "path" : "resultDays",
                                    "scope" : "X",
                                    "type" : "Property"
                                 }
                              }
                           }
                        }
                     } ]
                  } ]
               }
            }
         }, {
            "name" : "NumberOfValidIntervals",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "type" : "Count",
               "source" : {
                  "type" : "Query",
                  "source" : [ {
                     "alias" : "D",
                     "expression" : {
                        "name" : "TherapeuticDays",
                        "type" : "ExpressionRef"
                     }
                  } ],
                  "relationship" : [ ],
                  "where" : {
                     "path" : "isValid",
                     "scope" : "D",
                     "type" : "Property"
                  }
               }
            }
         }, {
            "name" : "HasValidIntervals",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "type" : "GreaterOrEqual",
               "operand" : [ {
                  "name" : "NumberOfValidIntervals",
                  "type" : "ExpressionRef"
               }, {
                  "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                  "value" : "2",
                  "type" : "Literal"
               } ]
            }
         }, {
            "name" : "InitialPopulation",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "type" : "And",
               "operand" : [ {
                  "type" : "And",
                  "operand" : [ {
                     "type" : "And",
                     "operand" : [ {
                        "type" : "And",
                        "operand" : [ {
                           "name" : "InDemographic",
                           "type" : "ExpressionRef"
                        }, {
                           "type" : "Exists",
                           "operand" : {
                              "name" : "InpatientEncounters",
                              "type" : "ExpressionRef"
                           }
                        } ]
                     }, {
                        "type" : "Exists",
                        "operand" : {
                           "name" : "ActiveFlutterDiagnoses",
                           "type" : "ExpressionRef"
                        }
                     } ]
                  }, {
                     "type" : "GreaterOrEqual",
                     "operand" : [ {
                        "name" : "WarfarinUsage",
                        "type" : "ExpressionRef"
                     }, {
                        "valueType" : "{urn:hl7-org:elm-types:r1}Integer",
                        "value" : "180",
                        "type" : "Literal"
                     } ]
                  } ]
               }, {
                  "type" : "Not",
                  "operand" : {
                     "type" : "Exists",
                     "operand" : {
                        "name" : "ActiveValvularHeartDiseaseDiagnoses",
                        "type" : "ExpressionRef"
                     }
                  }
               } ]
            }
         }, {
            "name" : "MeasurePopulation",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "name" : "HasValidIntervals",
               "type" : "ExpressionRef"
            }
         }, {
            "name" : "MeasureObservation",
            "context" : "Patient",
            "accessLevel" : "Public",
            "expression" : {
               "name" : "TherapeuticTimeInRange",
               "type" : "ExpressionRef"
            }
         }, {
            "name" : "MeasureScore",
            "context" : "Population",
            "accessLevel" : "Public",
            "expression" : {
               "type" : "Avg",
               "source" : {
                  "name" : "MeasureObservation",
                  "type" : "ExpressionRef"
               }
            }
         } ]
      }
   }
}