Clinical Quality Language Specification
1.5.3 - Release 1 Errata 2
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
<?xml version="1.0" encoding="UTF-8"?>
<library xmlns="urn:hl7-org:elm:r1" xmlns:t="urn:hl7-org:elm-types:r1" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema" xmlns:fhir="http://hl7.org/fhir" xmlns:a="urn:hl7-org:cql-annotations:r1">
<annotation startLine="19" startChar="31" endLine="19" endChar="81" message="Could not resolve code path medication.code for the type of the retrieve QUICK.MedicationAdministration." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
<annotation startLine="19" startChar="31" endLine="19" endChar="81" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
<annotation message="List-valued expression was demoted to a singleton." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
<annotation message="List-valued expression was demoted to a singleton." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
<identifier id="CMS179" version="2"/>
<schemaIdentifier id="urn:hl7-org:elm" version="r1"/>
<usings>
<def localIdentifier="System" uri="urn:hl7-org:elm-types:r1"/>
<def localIdentifier="QUICK" uri="http://hl7.org/fhir"/>
</usings>
<parameters>
<def name="MeasurementPeriod" accessLevel="Public">
<default lowClosed="true" highClosed="false" xsi:type="Interval">
<low xsi:type="DateTime">
<year valueType="t:Integer" value="2013" xsi:type="Literal"/>
<month valueType="t:Integer" value="1" xsi:type="Literal"/>
<day valueType="t:Integer" value="1" xsi:type="Literal"/>
<hour valueType="t:Integer" value="0" xsi:type="Literal"/>
<minute valueType="t:Integer" value="0" xsi:type="Literal"/>
<second valueType="t:Integer" value="0" xsi:type="Literal"/>
<millisecond valueType="t:Integer" value="0" xsi:type="Literal"/>
</low>
<high xsi:type="DateTime">
<year valueType="t:Integer" value="2014" xsi:type="Literal"/>
<month valueType="t:Integer" value="1" xsi:type="Literal"/>
<day valueType="t:Integer" value="1" xsi:type="Literal"/>
<hour valueType="t:Integer" value="0" xsi:type="Literal"/>
<minute valueType="t:Integer" value="0" xsi:type="Literal"/>
<second valueType="t:Integer" value="0" xsi:type="Literal"/>
<millisecond valueType="t:Integer" value="0" xsi:type="Literal"/>
</high>
</default>
</def>
</parameters>
<valueSets>
<def name="Flutter Diagnosis" id="2.16.840.1.113883.3.117.1.7.1.202" accessLevel="Public"/>
<def name="Warfarin Medication" id="2.16.840.1.113883.3.117.1.7.1.232" accessLevel="Public"/>
<def name="Face-to-face Encounter" id="2.16.840.1.113883.3.464.1003.101.12.1048" accessLevel="Public"/>
<def name="Office Visit" id="2.16.840.1.113883.3.464.1003.101.12.1001" accessLevel="Public"/>
<def name="Valvular Heart Disease" id="2.16.840.1.113883.3.464.1003.104.12.1017" accessLevel="Public"/>
<def name="INR Lab Result" id="2.16.840.1.113883.3.117.1.7.1.213" accessLevel="Public"/>
</valueSets>
<statements>
<def name="Patient" context="Patient">
<expression xsi:type="SingletonFrom">
<operand dataType="fhir:Patient" templateId="patient-qicore-qicore-patient" xsi:type="Retrieve"/>
</expression>
</def>
<def name="FlutterDiagnoses" context="Patient" accessLevel="Public">
<expression dataType="fhir:Condition" templateId="condition-qicore-qicore-condition" codeProperty="code" xsi:type="Retrieve">
<codes name="Flutter Diagnosis" xsi:type="ValueSetRef"/>
</expression>
</def>
<def name="WarfarinMedications" context="Patient" accessLevel="Public">
<expression dataType="fhir:MedicationAdministration" templateId="medicationadministration-qicore-qicore-medicationadministration" codeProperty="medication.code" xsi:type="Retrieve">
<codes name="Warfarin Medication" xsi:type="ValueSetRef"/>
</expression>
</def>
<def name="FaceToFaceEncounters" context="Patient" accessLevel="Public">
<expression dataType="fhir:Encounter" templateId="encounter-qicore-qicore-encounter" codeProperty="type" xsi:type="Retrieve">
<codes name="Face-to-face Encounter" xsi:type="ValueSetRef"/>
</expression>
</def>
<def name="OfficeVisitEncounters" context="Patient" accessLevel="Public">
<expression dataType="fhir:Encounter" templateId="encounter-qicore-qicore-encounter" codeProperty="type" xsi:type="Retrieve">
<codes name="Office Visit" xsi:type="ValueSetRef"/>
</expression>
</def>
<def name="ValvularHeartDiseaseDiagnoses" context="Patient" accessLevel="Public">
<expression dataType="fhir:Condition" templateId="condition-qicore-qicore-condition" codeProperty="code" xsi:type="Retrieve">
<codes name="Valvular Heart Disease" xsi:type="ValueSetRef"/>
</expression>
</def>
<def name="INRLabResults" context="Patient" accessLevel="Public">
<expression dataType="fhir:Observation" templateId="observation-qicore-qicore-observation" codeProperty="code" xsi:type="Retrieve">
<codes name="INR Lab Result" xsi:type="ValueSetRef"/>
</expression>
</def>
<def name="InDemographic" context="Patient" accessLevel="Public">
<expression xsi:type="GreaterOrEqual">
<operand precision="Year" xsi:type="CalculateAgeAt">
<operand path="birthDate" xsi:type="Property">
<source name="Patient" xsi:type="ExpressionRef"/>
</operand>
<operand xsi:type="Start">
<operand name="MeasurementPeriod" xsi:type="ParameterRef"/>
</operand>
</operand>
<operand valueType="t:Integer" value="18" xsi:type="Literal"/>
</expression>
</def>
<def name="InpatientEncounters" context="Patient" accessLevel="Public">
<expression xsi:type="Union">
<operand name="FaceToFaceEncounters" xsi:type="ExpressionRef"/>
<operand name="OfficeVisitEncounters" xsi:type="ExpressionRef"/>
</expression>
</def>
<def name="ActiveFlutterDiagnoses" context="Patient" accessLevel="Public">
<expression xsi:type="Query">
<source alias="F">
<expression name="FlutterDiagnoses" xsi:type="ExpressionRef"/>
</source>
<where xsi:type="OverlapsBefore">
<operand lowClosed="true" highClosed="true" xsi:type="Interval">
<low path="onsetDateTime" scope="F" xsi:type="Property"/>
<high path="abatementDate" scope="F" xsi:type="Property"/>
</operand>
<operand name="MeasurementPeriod" xsi:type="ParameterRef"/>
</where>
</expression>
</def>
<def name="ActiveValvularHeartDiseaseDiagnoses" context="Patient" accessLevel="Public">
<expression xsi:type="Query">
<source alias="D">
<expression name="ValvularHeartDiseaseDiagnoses" xsi:type="ExpressionRef"/>
</source>
<where xsi:type="OverlapsBefore">
<operand lowClosed="true" highClosed="true" xsi:type="Interval">
<low path="onsetDateTime" scope="D" xsi:type="Property"/>
<high path="abatementDate" scope="D" xsi:type="Property"/>
</operand>
<operand name="MeasurementPeriod" xsi:type="ParameterRef"/>
</where>
</expression>
</def>
<def name="LookbackInterval" context="Patient" accessLevel="Public">
<expression lowClosed="true" highClosed="true" xsi:type="Interval">
<low xsi:type="Subtract">
<operand xsi:type="Start">
<operand name="MeasurementPeriod" xsi:type="ParameterRef"/>
</operand>
<operand value="200" unit="days" xsi:type="Quantity"/>
</low>
<high xsi:type="Start">
<operand name="MeasurementPeriod" xsi:type="ParameterRef"/>
</high>
</expression>
</def>
<def name="ActiveWarfarinDuringLookback" context="Patient" accessLevel="Public">
<expression xsi:type="Query">
<source alias="M">
<expression name="WarfarinMedications" xsi:type="ExpressionRef"/>
</source>
<where xsi:type="Overlaps">
<operand path="effectiveTimePeriod" scope="M" xsi:type="Property"/>
<operand name="LookbackInterval" xsi:type="ExpressionRef"/>
</where>
</expression>
</def>
<def name="WarfarinUsageIntervals" context="Patient" accessLevel="Public">
<expression xsi:type="Collapse">
<operand xsi:type="Query">
<source alias="M">
<expression name="ActiveWarfarinDuringLookback" xsi:type="ExpressionRef"/>
</source>
<return>
<expression xsi:type="Intersect">
<operand path="effectiveTimePeriod" scope="M" xsi:type="Property"/>
<operand name="LookbackInterval" xsi:type="ExpressionRef"/>
</expression>
</return>
</operand>
</expression>
</def>
<def name="WarfarinUsage" context="Patient" accessLevel="Public">
<expression xsi:type="Sum">
<source xsi:type="Query">
<source alias="I">
<expression name="WarfarinUsageIntervals" xsi:type="ExpressionRef"/>
</source>
<return>
<expression precision="Day" xsi:type="DurationBetween">
<operand xsi:type="Start">
<operand name="I" xsi:type="AliasRef"/>
</operand>
<operand xsi:type="End">
<operand name="I" xsi:type="AliasRef"/>
</operand>
</expression>
</return>
</source>
</expression>
</def>
<def name="INROutpatientLabResult" context="Patient" accessLevel="Public">
<expression xsi:type="Query">
<source alias="R">
<expression name="INRLabResults" xsi:type="ExpressionRef"/>
</source>
<where xsi:type="Not">
<operand xsi:type="Exists">
<operand xsi:type="Query">
<source alias="E">
<expression name="InpatientEncounters" xsi:type="ExpressionRef"/>
</source>
<where xsi:type="And">
<operand xsi:type="Greater">
<operand precision="Hour" xsi:type="DurationBetween">
<operand xsi:type="Start">
<operand path="period" scope="E" xsi:type="Property"/>
</operand>
<operand xsi:type="End">
<operand path="period" scope="E" xsi:type="Property"/>
</operand>
</operand>
<operand valueType="t:Integer" value="23" xsi:type="Literal"/>
</operand>
<operand xsi:type="In">
<operand path="appliesDateTime" scope="R" xsi:type="Property"/>
<operand path="period" scope="E" xsi:type="Property"/>
</operand>
</where>
</operand>
</operand>
</where>
</expression>
</def>
<def name="INRResultsByDay" context="Patient" accessLevel="Public">
<expression xsi:type="Query">
<source alias="L">
<expression name="INROutpatientLabResult" xsi:type="ExpressionRef"/>
</source>
<where xsi:type="Greater">
<operand path="value" xsi:type="Property">
<source path="valueQuantity" scope="L" xsi:type="Property"/>
</operand>
<operand valueType="t:Decimal" value="0.8" xsi:type="Literal"/>
</where>
<return>
<expression xsi:type="Tuple">
<element name="resultDate">
<value xsi:type="DateFrom">
<operand path="appliesDateTime" scope="L" xsi:type="Property"/>
</value>
</element>
<element name="result">
<value xsi:type="If">
<condition asType="t:Boolean" xsi:type="As">
<operand xsi:type="Greater">
<operand path="value" xsi:type="Property">
<source path="valueQuantity" scope="L" xsi:type="Property"/>
</operand>
<operand valueType="t:Decimal" value="10.0" xsi:type="Literal"/>
</operand>
<asTypeSpecifier name="t:Boolean" xsi:type="NamedTypeSpecifier"/>
</condition>
<then valueType="t:Decimal" value="10.0" xsi:type="Literal"/>
<else path="value" xsi:type="Property">
<source path="valueQuantity" scope="L" xsi:type="Property"/>
</else>
</value>
</element>
<element name="distanceFromMidpoint">
<value xsi:type="Abs">
<operand xsi:type="Subtract">
<operand valueType="t:Decimal" value="2.5" xsi:type="Literal"/>
<operand path="value" xsi:type="Property">
<source path="valueQuantity" scope="L" xsi:type="Property"/>
</operand>
</operand>
</value>
</element>
</expression>
</return>
</expression>
</def>
<def name="INRResultsPerDay" context="Patient" accessLevel="Public">
<expression xsi:type="Query">
<source alias="X">
<expression xsi:type="Query">
<source alias="D">
<expression xsi:type="Distinct">
<operand xsi:type="Query">
<source alias="X">
<expression name="INRResultsByDay" xsi:type="ExpressionRef"/>
</source>
<return>
<expression path="resultDate" scope="X" xsi:type="Property"/>
</return>
</operand>
</expression>
</source>
<return>
<expression xsi:type="First">
<source xsi:type="Query">
<source alias="R">
<expression name="INRResultsByDay" xsi:type="ExpressionRef"/>
</source>
<where xsi:type="Equal">
<operand path="resultDate" scope="R" xsi:type="Property"/>
<operand name="D" xsi:type="AliasRef"/>
</where>
<sort>
<by direction="asc" xsi:type="ByExpression">
<expression path="distanceFromMidpoint" scope="R" xsi:type="Property"/>
</by>
</sort>
</source>
</expression>
</return>
</expression>
</source>
<sort>
<by direction="asc" xsi:type="ByExpression">
<expression path="resultDate" scope="X" xsi:type="Property"/>
</by>
</sort>
</expression>
</def>
<def name="TherapeuticRange" context="Patient" accessLevel="Public">
<expression lowClosed="true" highClosed="true" xsi:type="Interval">
<low valueType="t:Decimal" value="2.0" xsi:type="Literal"/>
<high valueType="t:Decimal" value="3.0" xsi:type="Literal"/>
</expression>
</def>
<def name="INRIntervals" context="Patient" accessLevel="Public">
<expression xsi:type="Query">
<source alias="X">
<expression xsi:type="Query">
<source alias="S">
<expression name="INRResultsPerDay" xsi:type="ExpressionRef"/>
</source>
<return>
<expression xsi:type="Tuple">
<element name="startResult">
<value name="S" xsi:type="AliasRef"/>
</element>
<element name="endResult">
<value xsi:type="First">
<source xsi:type="Query">
<source alias="E">
<expression name="INRResultsPerDay" xsi:type="ExpressionRef"/>
</source>
<where xsi:type="Greater">
<operand path="resultDate" scope="S" xsi:type="Property"/>
<operand path="resultDate" scope="E" xsi:type="Property"/>
</where>
</source>
</value>
</element>
</expression>
</return>
</expression>
</source>
<return>
<expression xsi:type="Tuple">
<element name="startDate">
<value path="resultDate" xsi:type="Property">
<source path="startResult" scope="X" xsi:type="Property"/>
</value>
</element>
<element name="endDate">
<value path="resultDate" xsi:type="Property">
<source path="endResult" scope="X" xsi:type="Property"/>
</value>
</element>
<element name="resultDays">
<value precision="Day" xsi:type="DurationBetween">
<operand path="resultDate" xsi:type="Property">
<source path="startResult" scope="X" xsi:type="Property"/>
</operand>
<operand path="resultDate" xsi:type="Property">
<source path="endResult" scope="X" xsi:type="Property"/>
</operand>
</value>
</element>
<element name="resultDifference">
<value xsi:type="Subtract">
<operand path="result" xsi:type="Property">
<source path="endResult" scope="X" xsi:type="Property"/>
</operand>
<operand path="result" xsi:type="Property">
<source path="startResult" scope="X" xsi:type="Property"/>
</operand>
</value>
</element>
<element name="resultsWithinBounds">
<value xsi:type="And">
<operand xsi:type="In">
<operand path="result" xsi:type="Property">
<source path="startResult" scope="X" xsi:type="Property"/>
</operand>
<operand name="TherapeuticRange" xsi:type="ExpressionRef"/>
</operand>
<operand xsi:type="In">
<operand path="result" xsi:type="Property">
<source path="endResult" scope="X" xsi:type="Property"/>
</operand>
<operand name="TherapeuticRange" xsi:type="ExpressionRef"/>
</operand>
</value>
</element>
<element name="boundedDifference">
<value xsi:type="If">
<condition asType="t:Boolean" xsi:type="As">
<operand xsi:type="GreaterOrEqual">
<operand path="result" xsi:type="Property">
<source path="endResult" scope="X" xsi:type="Property"/>
</operand>
<operand path="result" xsi:type="Property">
<source path="startResult" scope="X" xsi:type="Property"/>
</operand>
</operand>
<asTypeSpecifier name="t:Boolean" xsi:type="NamedTypeSpecifier"/>
</condition>
<then xsi:type="If">
<condition asType="t:Boolean" xsi:type="As">
<operand xsi:type="Or">
<operand xsi:type="Greater">
<operand path="result" xsi:type="Property">
<source path="startResult" scope="X" xsi:type="Property"/>
</operand>
<operand xsi:type="End">
<operand name="TherapeuticRange" xsi:type="ExpressionRef"/>
</operand>
</operand>
<operand xsi:type="Less">
<operand path="result" xsi:type="Property">
<source path="endResult" scope="X" xsi:type="Property"/>
</operand>
<operand xsi:type="Start">
<operand name="TherapeuticRange" xsi:type="ExpressionRef"/>
</operand>
</operand>
</operand>
<asTypeSpecifier name="t:Boolean" xsi:type="NamedTypeSpecifier"/>
</condition>
<then asType="t:Decimal" xsi:type="As">
<operand xsi:type="Null"/>
<asTypeSpecifier name="t:Decimal" xsi:type="NamedTypeSpecifier"/>
</then>
<else xsi:type="Subtract">
<operand xsi:type="Min">
<source xsi:type="List">
<element path="result" xsi:type="Property">
<source path="endResult" scope="X" xsi:type="Property"/>
</element>
<element xsi:type="End">
<operand name="TherapeuticRange" xsi:type="ExpressionRef"/>
</element>
</source>
</operand>
<operand xsi:type="Max">
<source xsi:type="List">
<element path="result" xsi:type="Property">
<source path="startResult" scope="X" xsi:type="Property"/>
</element>
<element xsi:type="Start">
<operand name="TherapeuticRange" xsi:type="ExpressionRef"/>
</element>
</source>
</operand>
</else>
</then>
<else xsi:type="If">
<condition asType="t:Boolean" xsi:type="As">
<operand xsi:type="Or">
<operand xsi:type="Greater">
<operand path="result" xsi:type="Property">
<source path="endResult" scope="X" xsi:type="Property"/>
</operand>
<operand xsi:type="End">
<operand name="TherapeuticRange" xsi:type="ExpressionRef"/>
</operand>
</operand>
<operand xsi:type="Less">
<operand path="result" xsi:type="Property">
<source path="startResult" scope="X" xsi:type="Property"/>
</operand>
<operand xsi:type="Start">
<operand name="TherapeuticRange" xsi:type="ExpressionRef"/>
</operand>
</operand>
</operand>
<asTypeSpecifier name="t:Boolean" xsi:type="NamedTypeSpecifier"/>
</condition>
<then asType="t:Decimal" xsi:type="As">
<operand xsi:type="Null"/>
<asTypeSpecifier name="t:Decimal" xsi:type="NamedTypeSpecifier"/>
</then>
<else xsi:type="Subtract">
<operand xsi:type="Min">
<source xsi:type="List">
<element path="result" xsi:type="Property">
<source path="startResult" scope="X" xsi:type="Property"/>
</element>
<element xsi:type="End">
<operand name="TherapeuticRange" xsi:type="ExpressionRef"/>
</element>
</source>
</operand>
<operand xsi:type="Max">
<source xsi:type="List">
<element path="result" xsi:type="Property">
<source path="endResult" scope="X" xsi:type="Property"/>
</element>
<element xsi:type="Start">
<operand name="TherapeuticRange" xsi:type="ExpressionRef"/>
</element>
</source>
</operand>
</else>
</else>
</value>
</element>
<element name="isValid">
<value xsi:type="LessOrEqual">
<operand precision="Day" xsi:type="DurationBetween">
<operand path="resultDate" xsi:type="Property">
<source path="startResult" scope="X" xsi:type="Property"/>
</operand>
<operand path="resultDate" xsi:type="Property">
<source path="endResult" scope="X" xsi:type="Property"/>
</operand>
</operand>
<operand valueType="t:Integer" value="56" xsi:type="Literal"/>
</value>
</element>
</expression>
</return>
</expression>
</def>
<def name="TherapeuticDays" context="Patient" accessLevel="Public">
<expression xsi:type="Query">
<source alias="I">
<expression name="INRIntervals" xsi:type="ExpressionRef"/>
</source>
<return>
<expression xsi:type="Tuple">
<element name="startDate">
<value path="startDate" scope="I" xsi:type="Property"/>
</element>
<element name="endDate">
<value path="endDate" scope="I" xsi:type="Property"/>
</element>
<element name="isValid">
<value path="isValid" scope="I" xsi:type="Property"/>
</element>
<element name="resultDays">
<value path="resultDays" scope="I" xsi:type="Property"/>
</element>
<element name="daysInRange">
<value xsi:type="If">
<condition asType="t:Boolean" xsi:type="As">
<operand path="resultsWithinBounds" scope="I" xsi:type="Property"/>
<asTypeSpecifier name="t:Boolean" xsi:type="NamedTypeSpecifier"/>
</condition>
<then xsi:type="ToDecimal">
<operand path="resultDays" scope="I" xsi:type="Property"/>
</then>
<else xsi:type="Coalesce">
<operand xsi:type="Multiply">
<operand xsi:type="ToDecimal">
<operand path="resultDays" scope="I" xsi:type="Property"/>
</operand>
<operand xsi:type="Abs">
<operand xsi:type="Divide">
<operand path="boundedDifference" scope="I" xsi:type="Property"/>
<operand xsi:type="ToDecimal">
<operand xsi:type="If">
<condition asType="t:Boolean" xsi:type="As">
<operand xsi:type="Equal">
<operand path="resultDays" scope="I" xsi:type="Property"/>
<operand valueType="t:Integer" value="0" xsi:type="Literal"/>
</operand>
<asTypeSpecifier name="t:Boolean" xsi:type="NamedTypeSpecifier"/>
</condition>
<then asType="t:Integer" xsi:type="As">
<operand xsi:type="Null"/>
<asTypeSpecifier name="t:Integer" xsi:type="NamedTypeSpecifier"/>
</then>
<else path="resultDays" scope="I" xsi:type="Property"/>
</operand>
</operand>
</operand>
</operand>
</operand>
<operand xsi:type="ToDecimal">
<operand valueType="t:Integer" value="0" xsi:type="Literal"/>
</operand>
</else>
</value>
</element>
</expression>
</return>
</expression>
</def>
<def name="TherapeuticTimeInRange" context="Patient" accessLevel="Public">
<expression xsi:type="Round">
<operand xsi:type="Multiply">
<operand xsi:type="ToDecimal">
<operand valueType="t:Integer" value="100" xsi:type="Literal"/>
</operand>
<operand xsi:type="Divide">
<operand xsi:type="Sum">
<source xsi:type="Query">
<source alias="X">
<expression name="TherapeuticDays" xsi:type="ExpressionRef"/>
</source>
<return>
<expression path="daysInRange" scope="X" xsi:type="Property"/>
</return>
</source>
</operand>
<operand xsi:type="ToDecimal">
<operand xsi:type="Sum">
<source xsi:type="Query">
<source alias="X">
<expression name="TherapeuticDays" xsi:type="ExpressionRef"/>
</source>
<return>
<expression path="resultDays" scope="X" xsi:type="Property"/>
</return>
</source>
</operand>
</operand>
</operand>
</operand>
</expression>
</def>
<def name="NumberOfValidIntervals" context="Patient" accessLevel="Public">
<expression xsi:type="Count">
<source xsi:type="Query">
<source alias="D">
<expression name="TherapeuticDays" xsi:type="ExpressionRef"/>
</source>
<where path="isValid" scope="D" xsi:type="Property"/>
</source>
</expression>
</def>
<def name="HasValidIntervals" context="Patient" accessLevel="Public">
<expression xsi:type="GreaterOrEqual">
<operand name="NumberOfValidIntervals" xsi:type="ExpressionRef"/>
<operand valueType="t:Integer" value="2" xsi:type="Literal"/>
</expression>
</def>
<def name="InitialPopulation" context="Patient" accessLevel="Public">
<expression xsi:type="And">
<operand xsi:type="And">
<operand xsi:type="And">
<operand xsi:type="And">
<operand name="InDemographic" xsi:type="ExpressionRef"/>
<operand xsi:type="Exists">
<operand name="InpatientEncounters" xsi:type="ExpressionRef"/>
</operand>
</operand>
<operand xsi:type="Exists">
<operand name="ActiveFlutterDiagnoses" xsi:type="ExpressionRef"/>
</operand>
</operand>
<operand xsi:type="GreaterOrEqual">
<operand name="WarfarinUsage" xsi:type="ExpressionRef"/>
<operand valueType="t:Integer" value="180" xsi:type="Literal"/>
</operand>
</operand>
<operand xsi:type="Not">
<operand xsi:type="Exists">
<operand name="ActiveValvularHeartDiseaseDiagnoses" xsi:type="ExpressionRef"/>
</operand>
</operand>
</expression>
</def>
<def name="MeasurePopulation" context="Patient" accessLevel="Public">
<expression name="HasValidIntervals" xsi:type="ExpressionRef"/>
</def>
<def name="MeasureObservation" context="Patient" accessLevel="Public">
<expression name="TherapeuticTimeInRange" xsi:type="ExpressionRef"/>
</def>
<def name="MeasureScore" context="Population" accessLevel="Public">
<expression xsi:type="Avg">
<source name="MeasureObservation" xsi:type="ExpressionRef"/>
</expression>
</def>
</statements>
</library>