Situational Awareness for Novel Epidemic Response
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Situational Awareness for Novel Epidemic Response, published by HL7 International / Public Health. This guide is not an authorized publication; it is the continuous build for version 1.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-saner/ and changes regularly. See the Directory of published versions

: Patients By Risk Factor - XML Representation

Draft as of 2024-01-25

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<Measure xmlns="http://hl7.org/fhir">
  <id value="PatientsByRiskFactorWithSupplementalData"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/uv/saner/StructureDefinition/PublicHealthMeasure"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Measure</b><a name="PatientsByRiskFactorWithSupplementalData"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Measure &quot;PatientsByRiskFactorWithSupplementalData&quot; </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-PublicHealthMeasure.html">Public Health Measure</a></p></div><p><b>Enables specification of proposed measure reporting</b>: Once per 1 days</p><p><b>wg</b>: pher</p><p><b>url</b>: <code>http://hl7.org/fhir/uv/saner/Measure/PatientsByRiskFactorWithSupplementalData</code></p><p><b>version</b>: 1.0.1</p><p><b>name</b>: PatientsByRiskFactor</p><p><b>title</b>: COVID-19 Patients By Risk Factor</p><p><b>status</b>: draft</p><p><b>experimental</b>: true</p><p><b>date</b>: 2024-01-25 13:42:59+0000</p><p><b>publisher</b>: HL7 International / Public Health</p><p><b>contact</b>: <a href="http://www.hl7.org/Special/committees/pher">http://www.hl7.org/Special/committees/pher</a>, <a href="mailto:pher@lists.hl7.org">pher@lists.hl7.org</a>, Keith W. Boone: <a href="mailto:mailto:kboone@ainq.com">mailto:kboone@ainq.com</a></p><p><b>description</b>: This measure demonstrates automated reporting of patients with COVID-19 stratified by condition, and reporting supplemental data</p><h3>UseContexts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style="display: none">*</td><td>Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'null')</td><td>COVID-19 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#840539006)</span></td></tr></table><p><b>jurisdiction</b>: World <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (m49.htm#001)</span></p><p><b>author</b>: Centers for Disease Control/National Healthcare Safety Network (CDC/NHSN): <a href="mailto:mailto:nhsn@cdc.gov">mailto:nhsn@cdc.gov</a></p><blockquote><p><b>relatedArtifact</b></p><p><b>type</b>: documentation</p><p><b>label</b>: NHSN COVID-19 Reporting</p><p><b>display</b>: CDC/NHSN COVID-19 Patient Impact &amp; Hospital Capacity Module Home Page</p><p><b>url</b>: <a href="https://web.archive.org/web/20200501215043/https://www.cdc.gov/nhsn/acute-care-hospital/covid19/">https://web.archive.org/web/20200501215043/https://www.cdc.gov/nhsn/acute-care-hospital/covid19/</a></p><blockquote><p><b>document</b></p></blockquote></blockquote><blockquote><p><b>relatedArtifact</b></p><p><b>type</b>: documentation</p><p><b>label</b>: How to import COVID-19 Summary Data</p><p><b>display</b>: Importing COVID-19 Patient Module Denominator data for Patient Safety Component</p><p><b>url</b>: <a href="https://web.archive.org/web/20200501215043/https://www.cdc.gov/nhsn/pdfs/covid19/import-covid19-data-508.pdf">https://web.archive.org/web/20200501215043/https://www.cdc.gov/nhsn/pdfs/covid19/import-covid19-data-508.pdf</a></p><blockquote><p><b>document</b></p></blockquote></blockquote><blockquote><p><b>relatedArtifact</b></p><p><b>type</b>: documentation</p><p><b>label</b>: Table of Instructions</p><p><b>display</b>: Instructions for Completion of the COVID-19 Patient Impact and Hospital Capacity Module Form (CDC 57.130)</p><p><b>url</b>: <a href="https://web.archive.org/web/20200501215043/https://www.cdc.gov/nhsn/pdfs/covid19/57.130-toi-508.pdf">https://web.archive.org/web/20200501215043/https://www.cdc.gov/nhsn/pdfs/covid19/57.130-toi-508.pdf</a></p><blockquote><p><b>document</b></p></blockquote></blockquote><blockquote><p><b>relatedArtifact</b></p><p><b>type</b>: documentation</p><p><b>label</b>: CSV File Template</p><p><b>display</b>: CDC/NHSN COVID-19 Reporting CSV File Template</p><p><b>url</b>: <a href="https://web.archive.org/web/20200501215043/https://www.cdc.gov/nhsn/pdfs/covid19/covid19-test-csv-import.csv">https://web.archive.org/web/20200501215043/https://www.cdc.gov/nhsn/pdfs/covid19/covid19-test-csv-import.csv</a></p><blockquote><p><b>document</b></p></blockquote></blockquote><p><b>library</b>: <a href="Library-ComputableNHSNMeasureLibrary.html">Computable NHSN Patient Impact and Hospital Capacity Measure Library</a></p><blockquote><p><b>group</b></p><blockquote><p><b>Attributes describing a group of measures</b></p><blockquote><p><b>url</b></p><code>subject</code></blockquote><p><b>value</b>: Patient in room <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R4/codesystem-resource-types.html">ResourceType</a>#Encounter; <a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#398284004)</span></p><blockquote><p><b>url</b></p><code>scoring</code></blockquote><p><b>value</b>: Queue Length <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-PublicHealthMeasureScoring.html">Public Health Measure Scoring</a>#queue-length)</span></p><blockquote><p><b>url</b></p><code>type</code></blockquote><p><b>value</b>: Structure <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-measure-type.html">MeasureType</a>#structure)</span></p><blockquote><p><b>url</b></p><code>improvementNotation</code></blockquote><p><b>value</b>: Decreased score indicates improvement <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-measure-improvement-notation.html">MeasureImprovementNotation</a>#decrease)</span></p><blockquote><p><b>url</b></p><code>rateAggregation</code></blockquote><p><b>value</b>: point-in-time</p></blockquote><p><b>code</b>: Hospital COVID-19 Patient Encounters Reporting <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-MeasureGroupSystem.html">Measure Group System</a>#Encounters &quot;Encounters&quot;)</span></p><blockquote><p><b>population</b></p><p><b>code</b>: Patients with confirmed COVID-19 in any location. <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-MeasuredValues.html">Measured Values in Sample Measures</a>#confirmedC19Pats &quot;All Confirmed COVID-19 Patients&quot;; <a href="http://terminology.hl7.org/5.3.0/CodeSystem-measure-population.html">MeasurePopulationType</a>#initial-population)</span></p><p><b>description</b>: Active encounters where the encounter diagnosis is suspected or confirmed COVID-19,
or a Condition of confirmed COVID-19 was created during that encounter.  This includes the patients with laboratory-confirmed
or clinically diagnosed COVID-19.</p><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Description</b></td><td><b>Name</b></td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>This expression finds encounters that were active or finished in the reporting period, and their referenced Patient, Condition
and Observation resources. It filters these based on cases where Encounter reports a reason or condition in the
ConfirmedCOVID19Diagnoses value set, or where a positive lab test from the Covid19Labs valueset, or where the patient
has any such associated Condition or Observation resources in the prior two weeks.</td><td>ConfirmedC19Pats</td><td>text/fhirpath</td><td>findAll('Encounter',
    including('subject','condition','reasonReference'),
    with('status').equalTo('in-progress,finished'),
    with('date').within(%ReportingPeriod)
 ).onServers(%Base).
 where(
   iif(
     (Encounter.reasonCode | Condition.code).member0f(%ConfirmedCOVID19Diagnoses.url) |
     Observation.where(code.member0f(%Covid19Labs.url) and value.member0f(%PositiveResults.url)),
     true,
     iif(
       Patient.distinct()
          .whereExists('Observation',
            for('patient', $this.id),
            with('status').equalTo(
                'registered,preliminary,final,amended,corrected'),
            with('date').greaterThan(%ReportingPeriod.start - 1 'year'),
            with('code').in(%Covid19Labs),
            with('value-concept').in(%PositiveResults)
       ).onServers(%Base),
       true,
       Patient.distinct()
          .whereExists('Condition',
            for('patient', $this.id),
            with('verification-status').notEqualTo('refuted,entered-in-error').
            with('date').greaterThan(%ReportingPeriod.start - 1 'year'),
            with('code').in(%ConfirmedCOVID19Diagnoses.url)
       ).onServers(%Base)
     )
  )
)
.ofType(Encounter)
.distinct()
.aggregate(
  iif($total.subject contains $this.subject, $total, $total | $this )
)</td></tr></table></blockquote><blockquote><p><b>stratifier</b></p><p><b>code</b>: By Risk Factor <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p><p><b>description</b>: Stratifies the population by Condition/RiskFactor</p><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Description</b></td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>Final all conditions for each patient in the AllCOVID19RiskFactors ValueSet
and stratify by membership in subsets of that value set.  NOTE: A patient
can belong to multiple strata in this example.</td><td>text/fhirpath</td><td>findAll('Condition',
	for('patient', $this.subject),
	with('code').in(%AllCOVID19RiskFactors.url),
       with('onset-date').greaterThan(%ReportingPeriod.start - 1 'year')
   ).onServers(%Base).select(
   	iif(code.member0f(%NeoplasticCOVID19RiskFactors.url), 'Neoplastic Disease', {}) |
   	iif(code.member0f(%COPDCOVID19RiskFactors.url), 'COPD', {}) |
   	iif(code.member0f(%TobaccoCOVID19RiskFactors.url), 'Tobacco User', {}) |
   	iif(code.member0f(%HypertensionCOVID19RiskFactors.url), 'Hypertension', {}) |	// Calling out Hypertension separately for reasons
   	iif(code.member0f(%CardiovascularCOVID19RiskFactors.url), 'Cardiovascular Disease', {}) |	// Even though it isa Cardiovascular disease
   	iif(code.member0f(%ObesityCOVID19RiskFactors.url), 'Obesity', {}) |
   	iif(code.member0f(%SickleCellCOVID19RiskFactors.url), 'Sickle cell Disease', {}) |
   	iif(code.member0f(%KidneyDiseaseCOVID19RiskFactors.url), 'Chronic Kidney Disease', {}) |
   	iif(code.member0f(%PregnancyCOVID19RiskFactors.url), 'Pregnant', {}) |
   	iif(code.member0f(%DiabetesCOVID19RiskFactors.url), 'Diabetes', {})
   )</td></tr></table></blockquote></blockquote><blockquote><p><b>supplementalData</b></p><p><b>code</b>: Encounter <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R4/codesystem-resource-types.html">ResourceType</a>#Encounter)</span></p><p><b>usage</b>: Supplemental Data <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-measure-data-usage.html">MeasureDataUsage</a>#supplemental-data)</span></p><p><b>description</b>: The patient encounter</p><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Description</b></td><td><b>Name</b></td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>Encounter dates, reason (e.g., Chief Complaint), discharge disposition</td><td>Encounter</td><td>text/fhirpath</td><td>Encounter</td></tr></table></blockquote><blockquote><p><b>supplementalData</b></p><p><b>code</b>: Patient <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R4/codesystem-resource-types.html">ResourceType</a>#Patient)</span></p><p><b>usage</b>: Supplemental Data <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-measure-data-usage.html">MeasureDataUsage</a>#supplemental-data)</span></p><p><b>description</b>: The patient</p><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Description</b></td><td><b>Name</b></td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>The Patient, including sex, dob, race and ethnicity</td><td>Patient</td><td>text/fhirpath</td><td>Encounter.subject.resolve()</td></tr></table></blockquote><blockquote><p><b>supplementalData</b></p><p><b>code</b>: Location <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R4/codesystem-resource-types.html">ResourceType</a>#Location)</span></p><p><b>usage</b>: Supplemental Data <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-measure-data-usage.html">MeasureDataUsage</a>#supplemental-data)</span></p><p><b>description</b>: The patient location</p><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Description</b></td><td><b>Name</b></td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>The Patient Location</td><td>PatientLocation</td><td>text/fhirpath</td><td>Encounter.location.location.resolve()</td></tr></table></blockquote><blockquote><p><b>supplementalData</b></p><p><b>code</b>: Condition <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R4/codesystem-resource-types.html">ResourceType</a>#Condition)</span></p><p><b>usage</b>: Supplemental Data <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-measure-data-usage.html">MeasureDataUsage</a>#supplemental-data)</span></p><p><b>description</b>: The encounter and other diagnosis</p><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Description</b></td><td><b>Name</b></td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>Retrieves all conditions associated with the encounter</td><td>EncounterDiagnosis</td><td>text/fhirpath</td><td>(Encounter.reasonReference|Encounter.diagnosis.condition).resolve() |
findAll('Condition',
	for('patient', $this.subject),
	with('encounter').equalTo($this.id)
).onServers(%Base)</td></tr></table></blockquote><blockquote><p><b>supplementalData</b></p><p><b>code</b>: MedicationRequest <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R4/codesystem-resource-types.html">ResourceType</a>#MedicationRequest; <a href="http://hl7.org/fhir/R4/codesystem-resource-types.html">ResourceType</a>#MedicationAdministration; <a href="http://hl7.org/fhir/R4/codesystem-resource-types.html">ResourceType</a>#Immunization)</span></p><p><b>usage</b>: Supplemental Data <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-measure-data-usage.html">MeasureDataUsage</a>#supplemental-data)</span></p><p><b>description</b>: Medications/Immunizations given during the encounter</p><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Description</b></td><td><b>Name</b></td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>Retrieves all medications/immunizations associated with the encounter</td><td>EncounterMeds</td><td>text/fhirpath</td><td>findAll('MedicationRequest',
	for('patient', $this.subject),
	with('encounter').equalTo($this.id)  // alternately, this could be within encounter dates
).onServers(%Base) |
findAll('MedicationAdministration',
	for('patient', $this.subject),
	with('effective-time').within(%ReportingPeriod)
).onServers(%Base) |
findAll('Immunization',
	for('patient', $this.subject),
	with('date').within(%ReportingPeriod)
).onServers(%Base)</td></tr></table></blockquote><blockquote><p><b>supplementalData</b></p><p><b>code</b>: Observation <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R4/codesystem-resource-types.html">ResourceType</a>#Observation)</span></p><p><b>usage</b>: Supplemental Data <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-measure-data-usage.html">MeasureDataUsage</a>#supplemental-data)</span></p><p><b>description</b>: COVID-19 Lab Results</p><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Description</b></td><td><b>Name</b></td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>Retrieves all Observations associated with COVID-19 Labs</td><td>COVID19Labs</td><td>text/fhirpath</td><td>findAll('Observation',
	for('patient', $this.subject),
	with('code').in(%Covid19Labs.url),
	with('date').greaterThan(%ReportingPeriod.start - 1 'year')
).onServers(%Base)</td></tr></table></blockquote><blockquote><p><b>supplementalData</b></p><p><b>code</b>: DiagnosticReport <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R4/codesystem-resource-types.html">ResourceType</a>#DiagnosticReport; <a href="http://hl7.org/fhir/R4/codesystem-resource-types.html">ResourceType</a>#DocumentReference; <a href="http://hl7.org/fhir/R4/codesystem-resource-types.html">ResourceType</a>#Observation; <a href="http://hl7.org/fhir/R4/codesystem-resource-types.html">ResourceType</a>#ServiceRequest)</span></p><p><b>usage</b>: Supplemental Data <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-measure-data-usage.html">MeasureDataUsage</a>#supplemental-data)</span></p><p><b>description</b>: VTE Diagnostic Results</p><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Description</b></td><td><b>Name</b></td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>Retrieves diagnostics associated with VTE</td><td>VTEDiagnostics</td><td>text/fhirpath</td><td>findAll('DiagnosticReport',
	for('patient', $this.subject),
	including('result', 'media'), // what else?
	with('date').greaterThan(%ReportingPeriod.start - 1 'year'),
	with('code').in(%VTEReports.url)
).onServers(%Base) |
findAll('DocumentReference',
	for('patient', $this.subject),
	including('related'), // what else?
	with('date').greaterThan(%ReportingPeriod.start - 1 'year'),
	with('type').in(%VTEReports.url)
).onServers(%Base) |
findAll('Observation',
	for('patient', $this.subject),
	including('based-on'), // what else?
	with('date').greaterThan(%ReportingPeriod.start - 1 'year'),
	with('code').in(%VTEReports.url)
).onServers(%Base) |
findAll('ServiceRequest',
	for('patient', $this.subject),
	including('based-on'), // what else?
	with('date').greaterThan(%ReportingPeriod.start - 1 'year'),
	with('code').in(%VTEReports.url)
).onServers(%Base)</td></tr></table></blockquote><blockquote><p><b>supplementalData</b></p><p><b>code</b>: Procedure <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R4/codesystem-resource-types.html">ResourceType</a>#Procedure; <a href="http://hl7.org/fhir/R4/codesystem-resource-types.html">ResourceType</a>#ServiceRequest)</span></p><p><b>usage</b>: Supplemental Data <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-measure-data-usage.html">MeasureDataUsage</a>#supplemental-data)</span></p><p><b>description</b>: Isolation Precautions</p><h3>Criteria</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Description</b></td><td><b>Name</b></td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>Retrieves orders or procedures associated with Isolation Precautions</td><td>IsolationOrders</td><td>text/fhirpath</td><td>findAll('ServiceRequest',
	for('patient', $this.subject),
	for('encounter', $this.id),
	with('code').in(%IsolationPrecautions.url)
).onServers(%Base) |
findAll('Procedure',
	for('patient', $this.subject),
	for('encounter', $this.id),
	with('code').in(%IsolationPrecautions.url)
).onServers(%Base)</td></tr></table></blockquote></div>
  </text>
  <extension
             url="http://hl7.org/fhir/uv/saner/StructureDefinition/ReportingPeriod">
    <valueTiming>
      <repeat>
        <frequency value="1"/>
        <period value="1"/>
        <periodUnit value="d"/>
      </repeat>
    </valueTiming>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="pher"/>
  </extension>
  <url
       value="http://hl7.org/fhir/uv/saner/Measure/PatientsByRiskFactorWithSupplementalData"/>
  <version value="1.0.1"/>
  <name value="PatientsByRiskFactor"/>
  <title value="COVID-19 Patients By Risk Factor"/>
  <status value="draft"/>
  <experimental value="true"/>
  <date value="2024-01-25T13:42:59+00:00"/>
  <publisher value="HL7 International / Public Health"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/pher"/>
    </telecom>
  </contact>
  <contact>
    <telecom>
      <system value="email"/>
      <value value="pher@lists.hl7.org"/>
    </telecom>
  </contact>
  <contact>
    <name value="Keith W. Boone"/>
    <telecom>
      <system value="email"/>
      <value value="mailto:kboone@ainq.com"/>
    </telecom>
  </contact>
  <description
               value="This measure demonstrates automated reporting of patients with COVID-19 stratified by condition, and reporting supplemental data"/>
  <useContext>
    <code>
      <system
              value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
      <code value="focus"/>
    </code>
    <valueCodeableConcept>
      <coding>
        <system value="http://snomed.info/sct"/>
        <code value="840539006"/>
        <display value="COVID-19"/>
      </coding>
    </valueCodeableConcept>
  </useContext>
  <jurisdiction>
    <coding>
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
      <display value="World"/>
    </coding>
  </jurisdiction>
  <author>
    <name
          value="Centers for Disease Control/National Healthcare Safety Network (CDC/NHSN)"/>
    <telecom>
      <system value="email"/>
      <value value="mailto:nhsn@cdc.gov"/>
    </telecom>
  </author>
  <relatedArtifact>
    <type value="documentation"/>
    <label value="NHSN COVID-19 Reporting"/>
    <display
             value="CDC/NHSN COVID-19 Patient Impact &amp; Hospital Capacity Module Home Page"/>
    <url
         value="https://web.archive.org/web/20200501215043/https://www.cdc.gov/nhsn/acute-care-hospital/covid19/"/>
    <document>
      <url
           value="https://web.archive.org/web/20200501215043/https://www.cdc.gov/nhsn/acute-care-hospital/covid19/"/>
    </document>
  </relatedArtifact>
  <relatedArtifact>
    <type value="documentation"/>
    <label value="How to import COVID-19 Summary Data"/>
    <display
             value="Importing COVID-19 Patient Module Denominator data for Patient Safety Component"/>
    <url
         value="https://web.archive.org/web/20200501215043/https://www.cdc.gov/nhsn/pdfs/covid19/import-covid19-data-508.pdf"/>
    <document>
      <url
           value="https://web.archive.org/web/20200501215043/https://www.cdc.gov/nhsn/pdfs/covid19/import-covid19-data-508.pdf"/>
    </document>
  </relatedArtifact>
  <relatedArtifact>
    <type value="documentation"/>
    <label value="Table of Instructions"/>
    <display
             value="Instructions for Completion of the COVID-19 Patient Impact and Hospital Capacity Module Form (CDC 57.130)"/>
    <url
         value="https://web.archive.org/web/20200501215043/https://www.cdc.gov/nhsn/pdfs/covid19/57.130-toi-508.pdf"/>
    <document>
      <url
           value="https://web.archive.org/web/20200501215043/https://www.cdc.gov/nhsn/pdfs/covid19/57.130-toi-508.pdf"/>
    </document>
  </relatedArtifact>
  <relatedArtifact>
    <type value="documentation"/>
    <label value="CSV File Template"/>
    <display value="CDC/NHSN COVID-19 Reporting CSV File Template"/>
    <url
         value="https://web.archive.org/web/20200501215043/https://www.cdc.gov/nhsn/pdfs/covid19/covid19-test-csv-import.csv"/>
    <document>
      <url
           value="https://web.archive.org/web/20200501215043/https://www.cdc.gov/nhsn/pdfs/covid19/covid19-test-csv-import.csv"/>
    </document>
  </relatedArtifact>
  <library
           value="http://hl7.org/fhir/uv/saner/Library/ComputableNHSNMeasureLibrary"/>
  <group>
    <extension
               url="http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes">
      <extension url="subject">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/resource-types"/>
            <code value="Encounter"/>
          </coding>
          <coding>
            <system value="http://snomed.info/sct"/>
            <code value="398284004"/>
            <display value="Patient in room"/>
          </coding>
          <text value="Patient in room"/>
        </valueCodeableConcept>
      </extension>
      <extension url="scoring">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://hl7.org/fhir/uv/saner/CodeSystem/PublicHealthMeasureScoring"/>
            <code value="queue-length"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="type">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-type"/>
            <code value="structure"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="improvementNotation">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
            <code value="decrease"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="rateAggregation">
        <valueString value="point-in-time"/>
      </extension>
    </extension>
    <code>
      <coding>
        <system
                value="http://hl7.org/fhir/uv/saner/CodeSystem/MeasureGroupSystem"/>
        <code value="Encounters"/>
        <display value="Encounters"/>
      </coding>
      <text value="Hospital COVID-19 Patient Encounters Reporting"/>
    </code>
    <population>
      <code>
        <coding>
          <system
                  value="http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues"/>
          <code value="confirmedC19Pats"/>
          <display value="All Confirmed COVID-19 Patients"/>
        </coding>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="initial-population"/>
        </coding>
        <text value="Patients with confirmed COVID-19 in any location."/>
      </code>
      <description
                   value="Active encounters where the encounter diagnosis is suspected or confirmed COVID-19,
or a Condition of confirmed COVID-19 was created during that encounter.  This includes the patients with laboratory-confirmed
or clinically diagnosed COVID-19."/>
      <criteria>
        <description
                     value="This expression finds encounters that were active or finished in the reporting period, and their referenced Patient, Condition
and Observation resources. It filters these based on cases where Encounter reports a reason or condition in the
ConfirmedCOVID19Diagnoses value set, or where a positive lab test from the Covid19Labs valueset, or where the patient
has any such associated Condition or Observation resources in the prior two weeks."/>
        <name value="ConfirmedC19Pats"/>
        <language value="text/fhirpath"/>
        <expression
                    value="findAll('Encounter',
    including('subject','condition','reasonReference'),
    with('status').equalTo('in-progress,finished'),
    with('date').within(%ReportingPeriod)
 ).onServers(%Base).
 where(
   iif(
     (Encounter.reasonCode | Condition.code).member0f(%ConfirmedCOVID19Diagnoses.url) |
     Observation.where(code.member0f(%Covid19Labs.url) and value.member0f(%PositiveResults.url)),
     true,
     iif(
       Patient.distinct()
          .whereExists('Observation',
            for('patient', $this.id),
            with('status').equalTo(
                'registered,preliminary,final,amended,corrected'),
            with('date').greaterThan(%ReportingPeriod.start - 1 'year'),
            with('code').in(%Covid19Labs),
            with('value-concept').in(%PositiveResults)
       ).onServers(%Base),
       true,
       Patient.distinct()
          .whereExists('Condition',
            for('patient', $this.id),
            with('verification-status').notEqualTo('refuted,entered-in-error').
            with('date').greaterThan(%ReportingPeriod.start - 1 'year'),
            with('code').in(%ConfirmedCOVID19Diagnoses.url)
       ).onServers(%Base)
     )
  )
)
.ofType(Encounter)
.distinct()
.aggregate(
  iif($total.subject contains $this.subject, $total, $total | $this )
)"/>
      </criteria>
    </population>
    <stratifier>
      <code>
        <text value="By Risk Factor"/>
      </code>
      <description value="Stratifies the population by Condition/RiskFactor"/>
      <criteria>
        <description
                     value="Final all conditions for each patient in the AllCOVID19RiskFactors ValueSet
and stratify by membership in subsets of that value set.  NOTE: A patient
can belong to multiple strata in this example."/>
        <language value="text/fhirpath"/>
        <expression
                    value="findAll('Condition',
	for('patient', $this.subject),
	with('code').in(%AllCOVID19RiskFactors.url),
       with('onset-date').greaterThan(%ReportingPeriod.start - 1 'year')
   ).onServers(%Base).select(
   	iif(code.member0f(%NeoplasticCOVID19RiskFactors.url), 'Neoplastic Disease', {}) |
   	iif(code.member0f(%COPDCOVID19RiskFactors.url), 'COPD', {}) |
   	iif(code.member0f(%TobaccoCOVID19RiskFactors.url), 'Tobacco User', {}) |
   	iif(code.member0f(%HypertensionCOVID19RiskFactors.url), 'Hypertension', {}) |	// Calling out Hypertension separately for reasons
   	iif(code.member0f(%CardiovascularCOVID19RiskFactors.url), 'Cardiovascular Disease', {}) |	// Even though it isa Cardiovascular disease
   	iif(code.member0f(%ObesityCOVID19RiskFactors.url), 'Obesity', {}) |
   	iif(code.member0f(%SickleCellCOVID19RiskFactors.url), 'Sickle cell Disease', {}) |
   	iif(code.member0f(%KidneyDiseaseCOVID19RiskFactors.url), 'Chronic Kidney Disease', {}) |
   	iif(code.member0f(%PregnancyCOVID19RiskFactors.url), 'Pregnant', {}) |
   	iif(code.member0f(%DiabetesCOVID19RiskFactors.url), 'Diabetes', {})
   )"/>
      </criteria>
    </stratifier>
  </group>
  <supplementalData>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/resource-types"/>
        <code value="Encounter"/>
      </coding>
    </code>
    <usage>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="The patient encounter"/>
    <criteria>
      <description
                   value="Encounter dates, reason (e.g., Chief Complaint), discharge disposition"/>
      <name value="Encounter"/>
      <language value="text/fhirpath"/>
      <expression value="Encounter"/>
    </criteria>
  </supplementalData>
  <supplementalData>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/resource-types"/>
        <code value="Patient"/>
      </coding>
    </code>
    <usage>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="The patient"/>
    <criteria>
      <description
                   value="The Patient, including sex, dob, race and ethnicity"/>
      <name value="Patient"/>
      <language value="text/fhirpath"/>
      <expression value="Encounter.subject.resolve()"/>
    </criteria>
  </supplementalData>
  <supplementalData>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/resource-types"/>
        <code value="Location"/>
      </coding>
    </code>
    <usage>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="The patient location"/>
    <criteria>
      <description value="The Patient Location"/>
      <name value="PatientLocation"/>
      <language value="text/fhirpath"/>
      <expression value="Encounter.location.location.resolve()"/>
    </criteria>
  </supplementalData>
  <supplementalData>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/resource-types"/>
        <code value="Condition"/>
      </coding>
    </code>
    <usage>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="The encounter and other diagnosis"/>
    <criteria>
      <description
                   value="Retrieves all conditions associated with the encounter"/>
      <name value="EncounterDiagnosis"/>
      <language value="text/fhirpath"/>
      <expression
                  value="(Encounter.reasonReference|Encounter.diagnosis.condition).resolve() |
findAll('Condition',
	for('patient', $this.subject),
	with('encounter').equalTo($this.id)
).onServers(%Base)"/>
    </criteria>
  </supplementalData>
  <supplementalData>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/resource-types"/>
        <code value="MedicationRequest"/>
      </coding>
      <coding>
        <system value="http://hl7.org/fhir/resource-types"/>
        <code value="MedicationAdministration"/>
      </coding>
      <coding>
        <system value="http://hl7.org/fhir/resource-types"/>
        <code value="Immunization"/>
      </coding>
    </code>
    <usage>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description
                 value="Medications/Immunizations given during the encounter"/>
    <criteria>
      <description
                   value="Retrieves all medications/immunizations associated with the encounter"/>
      <name value="EncounterMeds"/>
      <language value="text/fhirpath"/>
      <expression
                  value="findAll('MedicationRequest',
	for('patient', $this.subject),
	with('encounter').equalTo($this.id)  // alternately, this could be within encounter dates
).onServers(%Base) |
findAll('MedicationAdministration',
	for('patient', $this.subject),
	with('effective-time').within(%ReportingPeriod)
).onServers(%Base) |
findAll('Immunization',
	for('patient', $this.subject),
	with('date').within(%ReportingPeriod)
).onServers(%Base)"/>
    </criteria>
  </supplementalData>
  <supplementalData>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/resource-types"/>
        <code value="Observation"/>
      </coding>
    </code>
    <usage>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="COVID-19 Lab Results"/>
    <criteria>
      <description
                   value="Retrieves all Observations associated with COVID-19 Labs"/>
      <name value="COVID19Labs"/>
      <language value="text/fhirpath"/>
      <expression
                  value="findAll('Observation',
	for('patient', $this.subject),
	with('code').in(%Covid19Labs.url),
	with('date').greaterThan(%ReportingPeriod.start - 1 'year')
).onServers(%Base)"/>
    </criteria>
  </supplementalData>
  <supplementalData>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/resource-types"/>
        <code value="DiagnosticReport"/>
      </coding>
      <coding>
        <system value="http://hl7.org/fhir/resource-types"/>
        <code value="DocumentReference"/>
      </coding>
      <coding>
        <system value="http://hl7.org/fhir/resource-types"/>
        <code value="Observation"/>
      </coding>
      <coding>
        <system value="http://hl7.org/fhir/resource-types"/>
        <code value="ServiceRequest"/>
      </coding>
    </code>
    <usage>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="VTE Diagnostic Results"/>
    <criteria>
      <description value="Retrieves diagnostics associated with VTE"/>
      <name value="VTEDiagnostics"/>
      <language value="text/fhirpath"/>
      <expression
                  value="findAll('DiagnosticReport',
	for('patient', $this.subject),
	including('result', 'media'), // what else?
	with('date').greaterThan(%ReportingPeriod.start - 1 'year'),
	with('code').in(%VTEReports.url)
).onServers(%Base) |
findAll('DocumentReference',
	for('patient', $this.subject),
	including('related'), // what else?
	with('date').greaterThan(%ReportingPeriod.start - 1 'year'),
	with('type').in(%VTEReports.url)
).onServers(%Base) |
findAll('Observation',
	for('patient', $this.subject),
	including('based-on'), // what else?
	with('date').greaterThan(%ReportingPeriod.start - 1 'year'),
	with('code').in(%VTEReports.url)
).onServers(%Base) |
findAll('ServiceRequest',
	for('patient', $this.subject),
	including('based-on'), // what else?
	with('date').greaterThan(%ReportingPeriod.start - 1 'year'),
	with('code').in(%VTEReports.url)
).onServers(%Base)"/>
    </criteria>
  </supplementalData>
  <supplementalData>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/resource-types"/>
        <code value="Procedure"/>
      </coding>
      <coding>
        <system value="http://hl7.org/fhir/resource-types"/>
        <code value="ServiceRequest"/>
      </coding>
    </code>
    <usage>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="Isolation Precautions"/>
    <criteria>
      <description
                   value="Retrieves orders or procedures associated with Isolation Precautions"/>
      <name value="IsolationOrders"/>
      <language value="text/fhirpath"/>
      <expression
                  value="findAll('ServiceRequest',
	for('patient', $this.subject),
	for('encounter', $this.id),
	with('code').in(%IsolationPrecautions.url)
).onServers(%Base) |
findAll('Procedure',
	for('patient', $this.subject),
	for('encounter', $this.id),
	with('code').in(%IsolationPrecautions.url)
).onServers(%Base)"/>
    </criteria>
  </supplementalData>
</Measure>