EXM146-FHIR
type: Measure
node role: treeRoot
resource.id:
  value: EXM146-FHIR
resource.meta:
  meta.profile:
    value: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-proportionmeasure
    index: 0
    link: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-proportionmeasure
  meta.profile:
    value: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure
    index: 1
    link: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure
  meta.profile:
    value: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-cqlmeasure
    index: 2
    link: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-cqlmeasure
  meta.profile:
    value: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure
    index: 3
    link: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure
domain resource.text:
  narrative.status:
    value: extensions
  narrative.div: Metadata Title EXM146 - Appropriate Testing for Children with Pharyngitis Version 4.0.0 Identifier 146 Identifier urn:oid:2.16.840.1.113883.4.642.40.61.29.7 Effective Period 2018-01-01 through 2018-12-31 Approval Date 2016-01-01 Last Review Date 2016-09-01 Experimental true Use Context Clinical Venue = EC Jurisdiction 001 from http://unstats.un.org/unsd/methods/m49/m49.htm Topic Health Quality Measure Document Steward (Publisher) HL7 International / Clinical Quality Information Description Percentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode. Purpose This measure has been developed to support improvement in clinical care. Copyright Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. (c) 2008 -2014 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material cont…
domain resource.contained: Library
  index: 0
  resource.id:
    value: effective-data-requirements
  domain resource.extension:
    index: 0
    extension.url:
      value: http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode
    extension.value coding:
      coding.system:
        value: http://terminology.hl7.org/CodeSystem/condition-clinical
      coding.code:
        value: active
  domain resource.extension:
    index: 1
    extension.url:
      value: http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode
    extension.value coding:
      coding.system:
        value: http://terminology.hl7.org/CodeSystem/condition-ver-status
      coding.code:
        value: confirmed
  domain resource.extension:
    index: 2
    element.extension:
      index: 0
      extension.url:
        value: libraryName
      extension.value string:
        value: EXM146
    element.extension:
      index: 1
      extension.url:
        value: name
      extension.value string:
        value: Is Between 2 and 17 Years of Age at Start of Measurement Period
    element.extension:
      index: 2
      extension.url:
        value: statement
      extension.value string:
        value: define "Is Between 2 and 17 Years of Age at Start of Measurement Period": AgeInYearsAt(start of "Measurement Period") >= 2 and AgeInYearsAt(start of "Measurement Period") <= 17
    element.extension:
      index: 3
      extension.url:
        value: displaySequence
      extension.value integer:
        value: 0
    extension.url:
      value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  domain resource.extension:
    index: 3
    element.extension:
      index: 0
      extension.url:
        value: libraryName
      extension.value string:
        value: EXM146
    element.extension:
      index: 1
      extension.url:
        value: name
      extension.value string:
        value: Measurement Period Encounters
    element.extension:
      index: 2
      extension.url:
        value: statement
      extension.value string:
        value: define "Measurement Period Encounters": [Encounter: "Ambulatory/ED Visit"] Encounter where Encounter.period during "Measurement Period" and Encounter.status = 'finished' and "Is Between 2 and 17 Years of Age at Start of Measurement Period"
    element.extension:
      index: 3
      extension.url:
        value: displaySequence
      extension.value integer:
        value: 1
    extension.url:
      value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  domain resource.extension:
    index: 4
    element.extension:
      index: 0
      extension.url:
        value: libraryName
      extension.value string:
        value: EXM146
    element.extension:
      index: 1
      extension.url:
        value: name
      extension.value string:
        value: Pharyngitis
    element.extension:
      index: 2
      extension.url:
        value: statement
      extension.value string:
        value: define "Pharyngitis": ([Condition: code in "Acute Pharyngitis"] union [Condition: code in "Acute Tonsillitis"]) Pharyngitis where Pharyngitis.clinicalStatus ~ Global.active and Pharyngitis.verificationStatus ~ Global.confirmed
    element.extension:
      index: 3
      extension.url:
        value: displaySequence
      extension.value integer:
        value: 2
    extension.url:
      value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  domain resource.extension:
    index: 5
    element.extension:
      index: 0
      extension.url:
        value: libraryName
      extension.value string:
        value: EXM146
    element.extension:
      index: 1
      extension.url:
        value: name
      extension.value string:
        value: Antibiotics
    element.extension:
      index: 2
      extension.url:
        value: statement
      extension.value string:
        value: define "Antibiotics": [MedicationRequest: medication in "Antibiotic Medications"] Prescription where Prescription.status = 'active' and Prescription.intent = 'order'
    element.extension:
      index: 3
      extension.url:
        value: displaySequence
      extension.value integer:
        value: 3
    extension.url:
      value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  domain resource.extension:
    index: 6
    element.extension:
      index: 0
      extension.url:
        value: libraryName
      extension.value string:
        value: EXM146
    element.extension:
      index: 1
      extension.url:
        value: name
      extension.value string:
        value: Pharyngitis Encounters With Antibiotics
    element.extension:
      index: 2
      extension.url:
        value: statement
      extension.value string:
        value: define "Pharyngitis Encounters With Antibiotics": "Measurement Period Encounters" Encounters with "Pharyngitis" Pharyngitis such that Common."Includes Or Starts During"(Pharyngitis, Encounters) with "Antibiotics" Antibiotics such that Antibiotics.authoredOn 3 days or less after FHIRHelpers.ToInterval(Encounters.period)
    element.extension:
      index: 3
      extension.url:
        value: displaySequence
      extension.value integer:
        value: 4
    extension.url:
      value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  domain resource.extension:
    index: 7
    element.extension:
      index: 0
      extension.url:
        value: libraryName
      extension.value string:
        value: EXM146
    element.extension:
      index: 1
      extension.url:
        value: name
      extension.value string:
        value: Strep Test Encounters
    element.extension:
      index: 2

value: statement

value: define "Strep Test Encounters": "Pharyngitis Encounters With Antibiotics" Encounters with [Observation: code in "Group A Streptococcus Test"] Tests such that Tests.value is not null and Tests.effective starts during Interval[start of FHIRHelpers.ToInterval(Encounters.period) - 3 days, end of FHIRHelpers.ToInterval(Encounters.period) + 3 days]

index: 3
extension.url:
  value: displaySequence
extension.value integer:
  value: 5

index: 8
element.extension:
  index: 0
  extension.url:
    value: libraryName
  extension.value string:
    value: EXM146
element.extension:
  index: 1
  extension.url:
    value: name
  extension.value string:
    value: Numerator
element.extension:
  index: 2
  extension.url:
    value: statement
  extension.value string:
    value: define "Numerator": "Strep Test Encounters"
element.extension:
  index: 3
  extension.url:
    value: displaySequence
  extension.value integer:
    value: 6
extension.url:
  value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

index: 9
element.extension:
  index: 0
  extension.url:
    value: libraryName
  extension.value string:
    value: EXM146
element.extension:
  index: 1
  extension.url:
    value: name
  extension.value string:
    value: Initial Population
element.extension:
  index: 2
  extension.url:
    value: statement
  extension.value string:
    value: define "Initial Population": "Pharyngitis Encounters With Antibiotics"
element.extension:
  index: 3
  extension.url:
    value: displaySequence
  extension.value integer:
    value: 7
extension.url:
  value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

index: 10
element.extension:
  index: 0
  extension.url:
    value: libraryName
  extension.value string:
    value: EXM146
element.extension:
  index: 1
  extension.url:
    value: name
  extension.value string:
    value: Denominator
element.extension:
  index: 2
  extension.url:
    value: statement
  extension.value string:
    value: define "Denominator": "Initial Population"
element.extension:
  index: 3
  extension.url:
    value: displaySequence
  extension.value integer:
    value: 8
extension.url:
  value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

index: 11
element.extension:
  index: 0
  extension.url:
    value: libraryName
  extension.value string:
    value: EXM146
element.extension:
  index: 1
  extension.url:
    value: name
  extension.value string:
    value: Pharyngitis With Prior Antibiotics
element.extension:
  index: 2
  extension.url:
    value: statement
  extension.value string:
    value: define "Pharyngitis With Prior Antibiotics": "Pharyngitis" Pharyngitis with "Antibiotics" Antibiotics such that Antibiotics.authoredOn 30 days or less before Pharyngitis.onset
element.extension:
  index: 3
  extension.url:
    value: displaySequence
  extension.value integer:
    value: 9
extension.url:
  value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

index: 12
element.extension:
  index: 0
  extension.url:
    value: libraryName
  extension.value string:
    value: EXM146
element.extension:
  index: 1
  extension.url:
    value: name
  extension.value string:
    value: Excluded Encounters
element.extension:
  index: 2
  extension.url:
    value: statement
  extension.value string:
    value: define "Excluded Encounters": "Pharyngitis Encounters With Antibiotics" Encounters with "Pharyngitis With Prior Antibiotics" Pharyngitis such that Common."Includes Or Starts During"(Pharyngitis, Encounters)
element.extension:
  index: 3
  extension.url:
    value: displaySequence
  extension.value integer:
    value: 10
extension.url:
  value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

index: 13
element.extension:
  index: 0
  extension.url:
    value: libraryName
  extension.value string:
    value: EXM146
element.extension:
  index: 1
  extension.url:
    value: name
  extension.value string:
    value: Denominator Exclusions
element.extension:
  index: 2
  extension.url:
    value: statement
  extension.value string:
    value: define "Denominator Exclusions": "Excluded Encounters"
element.extension:
  index: 3
  extension.url:
    value: displaySequence
  extension.value integer:
    value: 11
extension.url:
  value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

index: 14
element.extension:
  index: 0
  extension.url:
    value: libraryName
  extension.value string:
    value: FHIRHelpers
element.extension:
  index: 1
  extension.url:
    value: name
  extension.value string:
    value: ToInterval
element.extension:
  index: 2
  extension.url:
    value: statement
  extension.value string:
    value: /* @description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period) value to a CQL DateTime Interval @comment: If the start value of the given period is unspecified, the starting boundary of the resulting interval will be open (meaning the start of the interval is unknown, as opposed to interpreted as the beginning of time). */ define function ToInterval(period FHIR.Period): if period is null then null else if period."start" is null then Interval(period."start".value, period."end".value] else Interval[period."start".value, period."end".value]
element.extension:
  index: 3
  extension.url:
    value: displaySequence
  extension.value integer:
    value: 12
extension.url:
  value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

index: 15
element.extension:
  index: 0
  extension.url:
    value: libraryName
  extension.value string:
    value: FHIRHelpers
element.extension:
  index: 1
  extension.url:
    value: name
  extension.value string:
    value: ToString
element.extension:
  index: 2
  extension.url:
    value: statement
  extension.value string:
    value: define function ToString(value EncounterStatus): value.value
element.extension:
  index: 3
  extension.url:
    value: displaySequence
  extension.value integer:
    value: 13
extension.url:
  value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

index: 16
element.extension:
  index: 0
  extension.url:
    value: libraryName
  extension.value string:
    value: FHIRHelpers
element.extension:
  index: 1
  extension.url:
    value: name
  extension.value string:
    value: ToConcept
element.extension:
  index: 2
  extension.url:
    value: statement
  extension.value string:
    value: /* @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept. */ define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value }
element.extension:
  index: 3
  extension.url:
    value: displaySequence
  extension.value integer:
    value: 14
extension.url:
  value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

index: 17
element.extension:
  index: 0
  extension.url:
    value: libraryName
  extension.value string:
    value: FHIRHelpers
element.extension:
  index: 1
  extension.url:
    value: name
  extension.value string:
    value: ToCode
element.extension:
  index: 2
  extension.url:
    value: statement
  extension.value string:
    value: /* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value }
element.extension:
  index: 3
  extension.url:
    value: displaySequence
  extension.value integer:
    value: 15
extension.url:
  value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

index: 18
element.extension:
  index: 0
  extension.url:
    value: libraryName
  extension.value string:
    value: Common
element.extension:
  index: 1
  extension.url:
    value: name
  extension.value string:
    value: Includes Or Starts During
element.extension:
  index: 2
  extension.url:
    value: statement
  extension.value string:
    value: define function "Includes Or Starts During"(Condition Condition, Encounter Encounter): Interval[Condition.onset, Condition.abatement] includes Encounter.period or Condition.onset during Encounter.period
element.extension:
  index: 3
  extension.url:
    value: displaySequence
  extension.value integer:
    value: 16
extension.url:
  value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

index: 19
element.extension:
  index: 0
  extension.url:
    value: libraryName
  extension.value string:
    value: FHIRHelpers
element.extension:
  index: 1
  extension.url:
    value: name
  extension.value string:
    value: ToDateTime
element.extension:
  index: 2
  extension.url:
    value: statement
  extension.value string:
    value: define function ToDateTime(value dateTime): value.value
element.extension:
  index: 3
  extension.url:
    value: displaySequence
  extension.value integer:
    value: 17
extension.url:
  value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

index: 20
element.extension:
  index: 0
  extension.url:
    value: libraryName
  extension.value string:
    value: FHIRHelpers
element.extension:
  index: 1
  extension.url:
    value: name
  extension.value string:
    value: ToString
element.extension:
  index: 2
  extension.url:
    value: statement
  extension.value string:
    value: define function ToString(value MedicationRequestStatus): value.value
element.extension:
  index: 3
  extension.url:
    value: displaySequence
  extension.value integer:
    value: 18
extension.url:
  value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

index: 21
element.extension:
  index: 0
  extension.url:
    value: libraryName
  extension.value string:
    value: FHIRHelpers
element.extension:
  index: 1
  extension.url:
    value: name
  extension.value string:
    value: ToString
element.extension:
  index: 2
  extension.url:
    value: statement
  extension.value string:
    value: define function ToString(value MedicationRequestIntent): value.value
element.extension:
  index: 3
  extension.url:
    value: displaySequence
  extension.value integer:
    value: 19
extension.url:
  value: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition

value: EffectiveDataRequirements

value: active

codeable concept.coding:
  index: 0
  coding.system:
    value: http://terminology.hl7.org/CodeSystem/library-type
  coding.code:
    value: module-definition

index: 0
related artifact.type:
  value: depends-on
related artifact.display:
  value: FHIR model information
related artifact.resource:
  value: http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1
  link: 4.0
  link: .1

index: 1
related artifact.type:
  value: depends-on
related artifact.display:
  value: Library FHIRHelpers
related artifact.resource:
  value: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1
  link: 4.0
  link: .1

index: 2
related artifact.type:
  value: depends-on
related artifact.display:
  value: Library Global
related artifact.resource:
  value: http://hl7.org/fhir/uv/cqm/Library/MATGlobalCommonFunctions|5.0.000
  link: 5.0
  link: .000

index: 3
related artifact.type:
  value: depends-on
related artifact.display:
  value: Library Common
related artifact.resource:
  value: http://hl7.org/fhir/uv/cqm/Library/Common|2.0.0
  link: 2.0
  link: .0

index: 4
related artifact.type:
  value: depends-on
related artifact.display:
  value: Code system ConditionClinicalStatusCodes
related artifact.resource:
  value: http://terminology.hl7.org/CodeSystem/condition-clinical
  link: http://terminology.hl7.org/CodeSystem/condition-clinical

index: 5
related artifact.type:
  value: depends-on
related artifact.display:
  value: Code system ConditionVerificationStatusCodes
related artifact.resource:
  value: http://terminology.hl7.org/CodeSystem/condition-ver-status
  link: http://terminology.hl7.org/CodeSystem/condition-ver-status

index: 6
related artifact.type:
  value: depends-on
related artifact.display:
  value: Value set Ambulatory/ED Visit
related artifact.resource:
  value: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061
  link: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061

index: 7
related artifact.type:
  value: depends-on
related artifact.display:
  value: Value set Acute Pharyngitis
related artifact.resource:
  value: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011
  link: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011

index: 8
related artifact.type:
  value: depends-on
related artifact.display:
  value: Value set Acute Tonsillitis
related artifact.resource:
  value: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012
  link: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012

index: 9
related artifact.type:
  value: depends-on
related artifact.display:
  value: Value set Antibiotic Medications
related artifact.resource:
  value: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001
  link: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001

index: 10
related artifact.type:
  value: depends-on
related artifact.display:
  value: Value set Group A Streptococcus Test
related artifact.resource:
  value: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012
  link: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012

index: 0
parameter definition.name:
  value: Measurement Period
parameter definition.use:
  value: in
parameter definition.min:
  value: 0
parameter definition.max:
  value: 1
parameter definition.type:
  value: Period

index: 1
parameter definition.name:
  value: Numerator
parameter definition.use:
  value: out
parameter definition.min:
  value: 0
parameter definition.max:
  value: *
parameter definition.type:
  value: Encounter

index: 2
parameter definition.name:
  value: Denominator
parameter definition.use:
  value: out
parameter definition.min:
  value: 0
parameter definition.max:
  value: *
parameter definition.type:
  value: Encounter

index: 3
parameter definition.name:
  value: Initial Population
parameter definition.use:
  value: out
parameter definition.min:
  value: 0
parameter definition.max:
  value: *
parameter definition.type:
  value: Encounter

index: 4
parameter definition.name:
  value: Denominator Exclusions
parameter definition.use:
  value: out
parameter definition.min:
  value: 0
parameter definition.max:
  value: *
parameter definition.type:
  value: Encounter

index: 0
data requirement.type:
  value: Patient
data requirement.profile:
  value: http://hl7.org/fhir/StructureDefinition/Patient
  index: 0
  link: http://hl7.org/fhir/StructureDefinition/Patient

index: 1
data requirement.type:
  value: Encounter
data requirement.profile:
  value: http://hl7.org/fhir/StructureDefinition/Encounter
  index: 0
  link: http://hl7.org/fhir/StructureDefinition/Encounter
data requirement.must support:
  value: type
  index: 0
data requirement.must support:
  value: period
  index: 1
data requirement.must support:
  value: status
  index: 2
data requirement.code filter:
  index: 0
  data requirement.code filter.path:
    value: type
  data requirement.code filter.value set:
    value: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061
    link: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1061

index: 2
data requirement.type:
  value: Condition
data requirement.profile:
  value: http://hl7.org/fhir/StructureDefinition/Condition
  index: 0
  link: http://hl7.org/fhir/StructureDefinition/Condition
data requirement.must support:
  value: code
  index: 0
data requirement.must support:
  value: clinicalStatus
  index: 1
data requirement.must support:
  value: verificationStatus
  index: 2
data requirement.must support:
  value: onset
  index: 3
data requirement.code filter:
  index: 0
  data requirement.code filter.path:
    value: code
  data requirement.code filter.value set:
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    link: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011

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data requirement.type:
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data requirement.must support:
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data requirement.must support:
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data requirement.must support:
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data requirement.must support:
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    value: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012
    link: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012

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data requirement.type:
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data requirement.must support:
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data requirement.must support:
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data requirement.must support:
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data requirement.must support:
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    link: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001

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data requirement.type:
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data requirement.must support:
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data requirement.must support:
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data requirement.must support:
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index: 0
extension.url:
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extension.value code:
  value: Encounter

index: 1
extension.url:
  value: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem
extension.value reference:
  link: http://hl7.org/fhir/uv/cqm/Device/software-system-example
  reference.reference:
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index: 2
extension.url:
  value: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements
extension.value canonical:
  value: #effective-data-requirements

index: 0
identifier.use:
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identifier.system:
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identifier.value:
  value: 146

index: 1
identifier.system:
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identifier.value:
  value: urn:oid:2.16.840.1.113883.4.642.40.61.29.7

value: 4.0.0

value: EXM146

value: EXM146 - Appropriate Testing for Children with Pharyngitis

value: active

value: true

value: 2025-08-13

value: HL7 International / Clinical Quality Information

index: 0
contact detail.telecom:
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  contact point.system:
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  contact point.value:
    value: http://www.hl7.org/Special/committees/cqi

value: Percentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode.

index: 0
usage context.code:
  coding.system:
    value: http://terminology.hl7.org/CodeSystem/usage-context-type
  coding.code:
    value: venue
  coding.display:
    value: Clinical Venue
usage context.value codeable concept:
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    index: 0
    coding.system:
      value: http://hl7.org/fhir/uv/cqm/CodeSystem/intended-venue-codes
    coding.code:
      value: ec
    coding.display:
      value: EC

index: 0
codeable concept.coding:
  index: 0
  coding.system:
    value: http://unstats.un.org/unsd/methods/m49/m49.htm
  coding.code:
    value: 001

value: This measure has been developed to support improvement in clinical care.

value: Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. (c) 2008 -2014 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2013 World Health Organization. All Rights Reserved.

value: 2016-01-01

value: 2016-09-01

period.start:
  value: 2018-01-01
period.end:
  value: 2018-12-31

index: 0
codeable concept.coding: http://loinc.org/rdf#57024-2
  index: 0
  coding.system:
    value: http://loinc.org
  coding.code:
    value: 57024-2
  coding.display:
    value: Health Quality Measure Document

value: http://hl7.org/fhir/uv/cqm/Library/EXM146
index: 0
link: http://hl7.org/fhir/uv/cqm/Library/EXM146

value: The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

codeable concept.coding:
  index: 0
  coding.system:
    value: http://terminology.hl7.org/CodeSystem/measure-scoring
  coding.code:
    value: proportion
  coding.display:
    value: Proportion

index: 0
codeable concept.coding:
  index: 0
  coding.system:
    value: http://terminology.hl7.org/CodeSystem/measure-type
  coding.code:
    value: process

value: Group A streptococcal bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (IDSA 2002). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al. 2005). A study on antibiotic treatment of children with sore throat found that although only 15 to 36 percent of children with sore throat have Strep A pharyngitis, physicians prescribed antibiotics to 53 percent of children with a chief complaint of sore throat between 1995 and 2003 (Linder et al. 2005).

value: Institute for Clinical Systems Improvement (ICSI) (2007) Reduce unnecessary use of antibiotics. Antibiotic treatment should be reserved for a bacterial illness. Diagnosis of group A beta streptococcal Pharyngitis should be made by laboratory testing rather than clinically. Infectious Disease Society of America (Bisno et al. 2002) The signs and symptoms of group A streptococcal and other (most frequently viral) pharyngitides overlap broadly. Therefore, unless the physician is able with confidence to exclude the diagnosis of streptococcal pharyngitis on epidemiological and clinical grounds alone, a laboratory test should be done to determine whether group A streptococci are present in the pharynx. With the exception of very rare infections by certain other pharyngeal bacterial pathogens (eg, Corynebacterium diphtheriae and Neisseria gonorrhoeae), antimicrobial therapy is of no proven benefit as treatment for acute pharyngitis due to bacteria other than group A streptococci. Therefore, it is extremely important that physicians exclude the diagnosis of group A streptococcal pharyngitis to prevent inappropriate administration of antimicrobials to large numbers of patients with pharyngitis. Michigan Quality Improvement Consortium (2007) Probability of group A beta hemolytic streptococci (GABHS): Low; Testing: None; Treatment: Symptomatic treatment only. Avoid antibiotics. Probability of GABHS: Intermediate or High; Testing: Throat Culture (TC) OR Rapid Screen; Treatment: If TC is positive, use antibiotics. If TC is negative, use symptomatic treatment only. Avoid antibiotics. If treatment is started and culture result is negative, stop antibiotics. If Rapid Screen is positive, use antibiotics. If Rapid Screen is negative, culture (Culture is optional for age 16 and over) and only use antibiotics if throat culture is positive. (Michigan, 2007)

codeable concept.coding:
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  coding.system:
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  coding.code:
    value: increase
  coding.display:
    value: Increased score indicates improvement

value: This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. If the patient has more than one episode, include all episodes in the measure.

index: 0
element.id:
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element.extension:
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    extension.value string:
      value: primary-exm146-initial-population
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      coding.system:
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      coding.code:
        value: initial-population
      coding.display:
        value: Initial Population
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    expression.expression:
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measure.group.population:
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    extension.url:
      value: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId
    extension.value string:
      value: primary-exm146-numerator
  measure.group.population.code:
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      coding.system:
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      coding.code:
        value: numerator
      coding.display:
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    expression.language:
      value: text/cql-identifier
    expression.expression:
      value: Numerator
measure.group.population:
  index: 2
  element.extension:
    index: 0
    extension.url:
      value: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId
    extension.value string:
      value: primary-exm146-denominator
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      coding.code:
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      coding.display:
        value: Denominator
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      value: text/cql-identifier
    expression.expression:
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measure.group.population:
  index: 3
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    index: 0
    extension.url:
      value: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId
    extension.value string:
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      coding.code:
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      coding.display:
        value: Denominator Exclusion
  measure.group.population.criteria:
    expression.language:
      value: text/cql-identifier
    expression.expression:
      value: Denominator Exclusions