Draft dQM CMS Content Implementation Guide
2025.1.0 - CI Build
Draft dQM CMS Content Implementation Guide
2025.1.0 - CI Build
Draft dQM CMS Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2025.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/dqm-content-cms-2025/ and changes regularly. See the Directory of published versions
| Active as of 2026-01-16 |
<Measure xmlns="http://hl7.org/fhir">
<id value="CMS144FHIRHFBetaBlockerForLVSD"/>
<meta>
<profile
value="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareablemeasure"/>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"/>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"/>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"/>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cql-measure-cqfm"/>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/elm-measure-cqfm"/>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b style="color: maroon">Exception generating Narrative: Unable to Parse HTML - node 'td' has unexpected content '=' (last text = 'Moderate or Severe LVSD: LVEF \' at line 377 column 63</b></p></div>
</text>
<contained>
<Library>
<id value="effective-data-requirements"/>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="248153007"/>
<display value="Male (finding)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="248152002"/>
<display value="Female (finding)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="active"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="recurrence"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="relapse"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
<code value="confirmed"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
<code value="unconfirmed"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
<code value="provisional"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
<code value="differential"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="134401001"/>
<display value="Left ventricular systolic dysfunction (disorder)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/CodeSystem/task-code"/>
<code value="fulfill"/>
<display value="Fulfill"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="373254001"/>
<display
value="Substance with beta adrenergic receptor antagonist mechanism of action (substance)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification"/>
<code value="confirmed"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification"/>
<code value="unconfirmed"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Sex"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Sex":
case
when Patient.sex() = '248153007' then "Male (finding)"
when Patient.sex() = '248152002' then "Female (finding)"
else null
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="SDE Sex"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Sex":
SDE."SDE Sex""/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString value="Outpatient Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Outpatient Encounter":
( [Encounter: "Care Services in Long Term Residential Facility"]
union [Encounter: "Home Healthcare Services"]
union [Encounter: "Nursing Facility Visit"]
union [Encounter: "Office Visit"]
union [Encounter: "Outpatient Consultation"]
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString value="Heart Failure Outpatient Encounter"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns certain finished encounter types that overlap a Heart Failure condition and are during the measurement period:
* care services in long term residential facility (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014)
* home healthcare services (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016)
* nursing facility visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012)
* office visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001)
* outpatient consultation (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008)
*/
define "Heart Failure Outpatient Encounter":
"Outpatient Encounter" QualifyingEncounter
with ( [Condition: "Heart Failure"] ) HeartFailure
such that HeartFailure.prevalenceInterval ( ) overlaps day of QualifyingEncounter.period
and HeartFailure.isVerified ( )
where QualifyingEncounter.period during day of "Measurement Period"
and QualifyingEncounter.isEncounterFinished ( )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString value="Moderate or Severe LVSD Findings"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns a union of the following:
* Observations where the final, amended or correction ejection fraction result is <= 40
* Moderate or Severe LVSD conditions where the diagnosis has been confirmed as active
*/
define "Moderate or Severe LVSD Findings":
( [ObservationClinicalResult: "Ejection Fraction"] EjectionFraction
where EjectionFraction.value as Quantity <= 40 '%'
and EjectionFraction.status in { 'final', 'amended', 'corrected' }
)
union ( ( ( [Condition: "Moderate or Severe LVSD"] )
union ( ( [Condition: "Left ventricular systolic dysfunction (disorder)"] ) LVSDDiagnosis
where LVSDDiagnosis.severity in "Moderate or Severe"
) ) ModerateOrSevereLVSD
where ModerateOrSevereLVSD.isVerified ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString
value="Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns heart failure outpatient encounters that start before the end of a moderate or severe LVSD finding
*/
define "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD":
"Heart Failure Outpatient Encounter" HFOutpatientEncounter
with "Moderate or Severe LVSD Findings" LVSDFindings
such that Coalesce(LVSDFindings.prevalenceInterval(), LVSDFindings.effective.toInterval()) starts before end of HFOutpatientEncounter.period"/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="Has Beta Blocker Therapy for LVSD Ordered"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Beta Blocker Therapy for LVSD Ordered":
exists ( [MedicationRequest: medication in "Beta Blocker Therapy for LVSD"] BetaBlockerOrdered
where BetaBlockerOrdered.isOrderedDuringHeartFailureOutpatientEncounter ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString
value="Is Currently Taking Beta Blocker Therapy for LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Is Currently Taking Beta Blocker Therapy for LVSD":
exists ( ["MedicationRequest": "Beta Blocker Therapy for LVSD"] ActiveBetaBlocker
where ActiveBetaBlocker.overlapsAfterHeartFailureOutpatientEncounter ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="Numerator"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator":
"Has Beta Blocker Therapy for LVSD Ordered"
or "Is Currently Taking Beta Blocker Therapy for LVSD""/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString
value="Outpatient Encounter or Patient Provider Interaction"/>
</extension>
<extension url="statement">
<valueString
value="define "Outpatient Encounter or Patient Provider Interaction":
"Outpatient Encounter"
union [Encounter: "Patient Provider Interaction"]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString
value="Qualifying Outpatient Encounter During Measurement Period"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns certain finished encounter types that occurred during the measurement period:
* office visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001)
* outpatient consultation (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008)
* nursing facility visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012)
* care services in long term residential facility (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014)
* home healthcare services (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016)
* patient provider interactions (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012)
*/
define "Qualifying Outpatient Encounter During Measurement Period":
"Outpatient Encounter or Patient Provider Interaction" ValidEncounter
where ValidEncounter.period during day of "Measurement Period"
and ValidEncounter.isEncounterFinished ( )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString
value="Is Adult With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns true if the patient meets the following criteria:
* 18 years of age or older,
* Has two Qualifying Outpatient Encounters During Measurement Period
* Has a Heart Failure Outpatient Encounter
*/
define "Is Adult With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period":
AgeInYearsAt(date from start of "Measurement Period") >= 18
and exists ( "Qualifying Outpatient Encounter During Measurement Period" Encounter1
with "Qualifying Outpatient Encounter During Measurement Period" Encounter2
such that Encounter2.id !~ Encounter1.id
)
and exists "Heart Failure Outpatient Encounter""/>
</extension>
<extension url="displaySequence">
<valueInteger value="11"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="Initial Population"/>
</extension>
<extension url="statement">
<valueString
value="define "Initial Population":
AHA."Is Adult With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period""/>
</extension>
<extension url="displaySequence">
<valueInteger value="12"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="Denominator"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator":
"Initial Population"
and exists AHA."Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD""/>
</extension>
<extension url="displaySequence">
<valueInteger value="13"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Payer"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Payer":
[USQualityCore.Coverage: type in "Payer Type"] Payer
return {
code: Payer.type,
period: Payer.period
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="SDE Payer"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Payer":
SDE."SDE Payer""/>
</extension>
<extension url="displaySequence">
<valueInteger value="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Ethnicity"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Ethnicity":
(Patient.ethnicity()) E
return Tuple {
codes: { E.ombCategory } union E.detailed,
display: E.text
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="16"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="SDE Ethnicity"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Ethnicity":
SDE."SDE Ethnicity""/>
</extension>
<extension url="displaySequence">
<valueInteger value="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString value="Has Heart Transplant"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns completed heart tansplant procedures that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
*/
define "Has Heart Transplant":
exists ( [Procedure: "Heart Transplant"] HeartTransplant
with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
such that HeartTransplant.performed.toInterval ( ) starts before end of ModerateOrSevereLVSDHFOutpatientEncounter.period
where HeartTransplant.status = 'completed'
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="18"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString value="Has Heart Transplant Complications"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns true if patient has confirmed heart transplant complications that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
*/
define "Has Heart Transplant Complications":
exists ( ( [Condition: "Heart Transplant Complications"] ) HeartTransplantComplications
let diagnosisStart: Coalesce(start of HeartTransplantComplications.prevalenceInterval(), HeartTransplantComplications.recordedDate)
with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
such that date from diagnosisStart on or before date from end of ModerateOrSevereLVSDHFOutpatientEncounter.period
where HeartTransplantComplications.isVerified ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="19"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString value="Has Left Ventricular Assist Device"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns true if patient has a completed LVAD placement that starts before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
*/
define "Has Left Ventricular Assist Device":
exists ( [Procedure: "Left Ventricular Assist Device Placement"] LVADPlacement
with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
such that LVADPlacement.performed.toInterval ( ) starts before day of end of ModerateOrSevereLVSDHFOutpatientEncounter.period
where LVADPlacement.status = 'completed'
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="20"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString
value="Has Left Ventricular Assist Device Complications"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns true if patient has active LVAD complications that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
*/
define "Has Left Ventricular Assist Device Complications":
exists ( ( [Condition: "Left Ventricular Assist Device Complications"] ) LVADComplications
let diagnosisStart: Coalesce(start of LVADComplications.prevalenceInterval(), LVADComplications.recordedDate)
with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
such that date from diagnosisStart on or before date from end of ModerateOrSevereLVSDHFOutpatientEncounter.period
where LVADComplications.isVerified ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="Denominator Exclusions"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator Exclusions":
AHA."Has Heart Transplant"
or AHA."Has Heart Transplant Complications"
or AHA."Has Left Ventricular Assist Device"
or AHA."Has Left Ventricular Assist Device Complications""/>
</extension>
<extension url="displaySequence">
<valueInteger value="22"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Race"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Race":
(Patient.race()) R
return Tuple {
codes: R.ombCategory union R.detailed,
display: R.text
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="23"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="SDE Race"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Race":
SDE."SDE Race""/>
</extension>
<extension url="displaySequence">
<valueInteger value="24"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="Has Consecutive Heart Rates Less than 50"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Consecutive Heart Rates Less than 50":
exists ( from
["USCore.HeartRateProfile"] HeartRate,
AHA."Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
let PriorHeartRate: Last(["USCore.HeartRateProfile"] MostRecentPriorHeartRate
where MostRecentPriorHeartRate.effective.toInterval() during ModerateOrSevereLVSDHFOutpatientEncounter.period
and MostRecentPriorHeartRate.effective.toInterval() before HeartRate.effective.toInterval()
sort by start of effective.toInterval()
)
where HeartRate.effective.toInterval ( ) during ModerateOrSevereLVSDHFOutpatientEncounter.period
and HeartRate.status in { 'final', 'amended', 'corrected' }
and HeartRate.value < 50 '/min'
and PriorHeartRate.value < 50 '/min'
return HeartRate
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="25"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD":
exists ( ["MedicationNotRequested": medication in "Beta Blocker Therapy for LVSD"] NoBetaBlockerOrdered
with AHA."Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
such that NoBetaBlockerOrdered.authoredOn during day of ModerateOrSevereLVSDHFOutpatientEncounter.period
where ( NoBetaBlockerOrdered.reasonCode in "Medical Reason"
or NoBetaBlockerOrdered.reasonCode in "Patient Reason"
)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="26"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="Has Arrhythmia Diagnosis"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Arrhythmia Diagnosis":
exists ( ( [ConditionProblemsHealthConcerns: "Arrhythmia"]
union [ConditionEncounterDiagnosis: "Arrhythmia"] ) ArrhythmiaAlias
where ArrhythmiaAlias.overlapsHeartFailureOutpatientEncounter ( )
and ArrhythmiaAlias.isVerified ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="27"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="Has Hypotension Diagnosis"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Hypotension Diagnosis":
exists ( ( ["ConditionProblemsHealthConcerns": "Hypotension"]
union ["ConditionEncounterDiagnosis": "Hypotension"] ) HypotensionAlias
where HypotensionAlias.overlapsHeartFailureOutpatientEncounter ( )
and HypotensionAlias.isVerified ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="28"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="Has Asthma Diagnosis"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Asthma Diagnosis":
exists ( ( [ConditionProblemsHealthConcerns: "Asthma"]
union [ConditionEncounterDiagnosis: "Asthma"] ) AsthmaAlias
where AsthmaAlias.overlapsHeartFailureOutpatientEncounter ( )
and AsthmaAlias.isVerified ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="29"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy":
exists ( ( ( ["ConditionProblemsHealthConcerns": "Allergy to Beta Blocker Therapy"]
union ["ConditionEncounterDiagnosis": "Allergy to Beta Blocker Therapy"]
)
union ( ["ConditionProblemsHealthConcerns": "Intolerance to Beta Blocker Therapy"] )
union ["ConditionEncounterDiagnosis": "Intolerance to Beta Blocker Therapy"] ) BetaBlockerAllergyOrIntoleranceDiagnosis
where BetaBlockerAllergyOrIntoleranceDiagnosis.overlapsAfterHeartFailureOutpatientEncounter ( )
and BetaBlockerAllergyOrIntoleranceDiagnosis.isVerified ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="30"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="Has Bradycardia Diagnosis"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Bradycardia Diagnosis":
exists ( ( [ConditionProblemsHealthConcerns: "Bradycardia"]
union [ConditionEncounterDiagnosis: "Bradycardia"] ) BradycardiaAlias
where BradycardiaAlias.overlapsHeartFailureOutpatientEncounter ( )
and BradycardiaAlias.isVerified ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="31"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Allergy or Intolerance to Beta Blocker Therapy Ingredient"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient":
exists ( ( [AllergyIntolerance: "Beta Blocker Therapy Ingredient"]
union [AllergyIntolerance: "Substance with beta adrenergic receptor antagonist mechanism of action (substance)"] ) BetaBlockerAllergyIntolerance
where BetaBlockerAllergyIntolerance.overlapsAfterHeartFailureOutpatientEncounter ( )
and BetaBlockerAllergyIntolerance.isVerified ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="32"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="Has Atrioventricular Block Diagnosis"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Atrioventricular Block Diagnosis":
exists ( ( [ConditionProblemsHealthConcerns: "Atrioventricular Block"]
union [ConditionEncounterDiagnosis: "Atrioventricular Block"] ) AtrioventricularBlockAlias
where AtrioventricularBlockAlias.overlapsHeartFailureOutpatientEncounter ( )
and AtrioventricularBlockAlias.isVerified ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="33"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="Has Diagnosis of Cardiac Pacer in Situ"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Diagnosis of Cardiac Pacer in Situ":
exists ( ( ["ConditionProblemsHealthConcerns": "Cardiac Pacer in Situ"]
union ["ConditionEncounterDiagnosis": "Cardiac Pacer in Situ"] ) CardiacPacerDiagnosis
where CardiacPacerDiagnosis.overlapsAfterHeartFailureOutpatientEncounter ( )
and CardiacPacerDiagnosis.isVerified ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="34"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="Has Cardiac Pacer Device Implanted"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Cardiac Pacer Device Implanted":
exists ( [Procedure: "Cardiac Pacer"] ImplantedCardiacPacer
with AHA."Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
such that ImplantedCardiacPacer.performed.toInterval ( ) starts before end of ModerateOrSevereLVSDHFOutpatientEncounter.period
where ImplantedCardiacPacer.status = 'completed'
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="35"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="Atrioventricular Block without Cardiac Pacer"/>
</extension>
<extension url="statement">
<valueString
value="define "Atrioventricular Block without Cardiac Pacer":
"Has Atrioventricular Block Diagnosis"
and not "Has Diagnosis of Cardiac Pacer in Situ"
and not "Has Cardiac Pacer Device Implanted""/>
</extension>
<extension url="displaySequence">
<valueInteger value="36"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="Denominator Exceptions"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator Exceptions":
"Has Consecutive Heart Rates Less than 50"
or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
or "Has Arrhythmia Diagnosis"
or "Has Hypotension Diagnosis"
or "Has Asthma Diagnosis"
or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy"
or "Has Bradycardia Diagnosis"
or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient"
or "Atrioventricular Block without Cardiac Pacer""/>
</extension>
<extension url="displaySequence">
<valueInteger value="37"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value string): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="38"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="USCoreCommon"/>
</extension>
<extension url="name">
<valueString value="sex"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the sex element as defined for the USCore patient profile
*/
define fluent function sex(patient Patient):
patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex').value as FHIR.code"/>
</extension>
<extension url="displaySequence">
<valueInteger value="39"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRCommon"/>
</extension>
<extension url="name">
<valueString value="ext"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the single extension (if present) on the given resource with the specified url.
@comment: This function uses singleton from to ensure that a run-time exception is thrown if there
is more than one extension on the given resource with the specified url.
*/
define fluent function ext(domainResource DomainResource, url String):
singleton from domainResource.exts(url)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="40"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRCommon"/>
</extension>
<extension url="name">
<valueString value="exts"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns any extensions defined on the given resource with the specified url
*/
define fluent function exts(domainResource DomainResource, url String):
domainResource.extension E
where E.url = url
return E"/>
</extension>
<extension url="displaySequence">
<valueInteger value="41"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value uri): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="42"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString
value="isOrderedDuringHeartFailureOutpatientEncounter"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns true if the given MedicationRequest is ordered during the heart failure outpatient encounter with history of moderate or severe LVSD at any point
*/
define fluent function isOrderedDuringHeartFailureOutpatientEncounter(MedicationRequest MedicationRequest):
exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
where MedicationRequest.authoredOn during day of ModerateOrSevereLVSDHFOutpatientEncounter.period
and MedicationRequest.status in { 'active', 'completed' }
and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
and not exists ( ["TaskRejected"] TaskReject
where TaskReject.focus.references ( MedicationRequest )
and TaskReject.code ~ USQualityCoreCommon."Fulfill"
)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="43"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRCommon"/>
</extension>
<extension url="name">
<valueString value="prevalenceInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns an interval representing the normalized prevalence period of a given Condition resource.
@comment: Uses the toInterval and toAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
or condition.clinicalStatus ~ "recurrence"
or condition.clinicalStatus ~ "relapse" then
Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
(end of condition.abatementInterval()) abatementDate
return
if abatementDate is null then
Interval[start of condition.onset.toInterval(), abatementDate)
else
Interval[start of condition.onset.toInterval(), abatementDate]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="44"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToConcept"/>
</extension>
<extension url="statement">
<valueString
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
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="45"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToCode"/>
</extension>
<extension url="statement">
<valueString
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
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="46"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRCommon"/>
</extension>
<extension url="name">
<valueString value="toInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in FHIR, allowing this function to be used across any resource.
The input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime.
If the input is a Period, the result is a DateTime Interval.
If the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing.
If the input is an instant, the result is a DateTime Interval beginning and ending on that instant.
If the input is a string, an error is raised indicating a single interval cannot be computed from a string.
If the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age,
and ending immediately prior to when the patient was the given Age plus one year.
If the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given
by the low end of the Range, and ending immediately prior to when the patient was the Age given by the
high end of the Range plus one year.
NOTE: Due to the
complexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used
with a Timing or String.
*/
define fluent function toInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>):
case
when choice is FHIR.dateTime then
Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]
when choice is FHIR.Period then
FHIRHelpers.ToInterval(choice as FHIR.Period)
when choice is FHIR.instant then
Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]
when choice is FHIR.Age then
Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),
FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)
when choice is FHIR.Range then
Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),
FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)
when choice is FHIR.Timing then
Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported')
when choice is FHIR.string then
Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')
else
null as Interval<DateTime>
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="47"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToDateTime"/>
</extension>
<extension url="statement">
<valueString
value="define function ToDateTime(value dateTime): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="48"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToInterval"/>
</extension>
<extension url="statement">
<valueString
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]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="49"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToDateTime"/>
</extension>
<extension url="statement">
<valueString
value="define function ToDateTime(value instant): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="50"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToDate"/>
</extension>
<extension url="statement">
<valueString
value="define function ToDate(value date): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="51"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToQuantity"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity)
value to a CQL Quantity
@comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity
has a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`)
an error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used.
@seealso: ToCalendarUnit
*/
define function ToQuantity(quantity FHIR.Quantity):
case
when quantity is null then null
when quantity.value is null then null
when quantity.comparator is not null then
Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')
when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'
or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then
System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }
else
Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="52"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToCalendarUnit"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Converts a UCUM definite duration unit to a CQL calendar duration
unit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities)
topic of the CQL specification.
@comment: Note that for durations above days (or weeks), the conversion is understood to be approximate
*/
define function ToCalendarUnit(unit System.String):
case unit
when 'ms' then 'millisecond'
when 's' then 'second'
when 'min' then 'minute'
when 'h' then 'hour'
when 'd' then 'day'
when 'wk' then 'week'
when 'mo' then 'month'
when 'a' then 'year'
else unit
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="53"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRCommon"/>
</extension>
<extension url="name">
<valueString value="abatementInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns an interval representing the normalized Abatement of a given Condition resource.
@comment: @comment: If the abatement element of the Condition is represented as a DateTime, the result
is an interval beginning and ending on that DateTime.
If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The
result is an interval from the date the patient turned that age to immediately before one year later.
If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during
which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately
before one year later than the date the patient turned the ending age of the quantity interval.
NOTE: Due to the complexity of determining an interval from a String, this function will throw
a run-time exception if used with a Condition instance that has a String as the abatement value.
*/
define fluent function abatementInterval(condition Condition):
if condition.abatement is FHIR.dateTime then
Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)]
else if condition.abatement is FHIR.Period then
FHIRHelpers.ToInterval(condition.abatement as FHIR.Period)
else if condition.abatement is FHIR.string then
Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')
else if condition.abatement is FHIR.Age then
Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age),
FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year)
else if condition.abatement is FHIR.Range then
Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low),
FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year)
else if condition.abatement is FHIR.boolean then
Interval[end of condition.onset.toInterval(), condition.recordedDate)
else
null"/>
</extension>
<extension url="displaySequence">
<valueInteger value="54"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRCommon"/>
</extension>
<extension url="name">
<valueString value="isVerified"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns true if the given condition either has no verification status or has a verification status of confirmed, unconfirmed, provisional, or differential
*/
define fluent function isVerified(condition FHIR.Condition):
condition.verificationStatus is not null implies
(condition.verificationStatus ~ "confirmed"
or condition.verificationStatus ~ "unconfirmed"
or condition.verificationStatus ~ "provisional"
or condition.verificationStatus ~ "differential"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="55"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString value="isEncounterFinished"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns true if the given Encounter is finished
*/
define fluent function isEncounterFinished(Encounter Encounter):
Encounter.status = 'finished'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="56"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value EncounterStatus): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="57"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value ObservationStatus): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="58"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value MedicationRequestStatus): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="59"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value MedicationRequestIntent): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="60"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRCommon"/>
</extension>
<extension url="name">
<valueString value="references"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns true if the given reference is to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference FHIR.Reference, resource FHIR.Resource):
resource.id = Last(Split(reference.reference, '/'))"/>
</extension>
<extension url="displaySequence">
<valueInteger value="61"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString value="overlapsAfterHeartFailureOutpatientEncounter"/>
</extension>
<extension url="statement">
<valueString
value="/*
@overloaded
@description: Returns true if the given MedicationRequest overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/
define fluent function overlapsAfterHeartFailureOutpatientEncounter(MedicationRequest MedicationRequest):
exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
where First((collapse(MedicationRequest.dosageInstruction.timing.repeat.bounds DoseTime
return TimingBoundToInterval(MedicationRequest.authoredOn, DoseTime)
)) DrugPeriods
sort by start of $this
) overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
and MedicationRequest.status in { 'active', 'completed' }
and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
and not exists ( ["TaskRejected"] TaskReject
where TaskReject.focus.references ( MedicationRequest )
and TaskReject.code ~ USQualityCoreCommon."Fulfill"
)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="62"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString value="TimingBoundToInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Converts the possible representations of the timing bound to an interval using the given date as an anchor for durations
*/
define function TimingBoundToInterval(startDate System.DateTime, choice Choice<FHIR.Duration, FHIR.Range, FHIR.Period>):
case
when choice is FHIR.Period then
choice as FHIR.Period
when choice is FHIR.Range then
Interval[startDate + (choice.low as Quantity), startDate + (choice.high as Quantity)]
when choice is FHIR.Duration then
Interval[startDate, startDate + (choice as FHIR.Duration))
else
null as Interval<DateTime>
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="63"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="USCoreCommon"/>
</extension>
<extension url="name">
<valueString value="ethnicity"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function ethnicity(patient Patient):
(patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity')) E
return {
ombCategory: E.ext('ombCategory').value as FHIR.Coding,
detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,
text: E.ext('text').value as FHIR.string
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="64"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRCommon"/>
</extension>
<extension url="name">
<valueString value="ext"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the single extension (if present) on the given element with the specified url.
@comment: This function uses singleton from to ensure that a run-time exception is thrown if there
is more than one extension on the given element with the specified url.
*/
define fluent function ext(element Element, url String):
singleton from element.exts(url)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="65"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRCommon"/>
</extension>
<extension url="name">
<valueString value="exts"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns any extensions defined on the given element with the specified url.
*/
define fluent function exts(element Element, url String):
element.extension E
where E.url = url
return E"/>
</extension>
<extension url="displaySequence">
<valueInteger value="66"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value ProcedureStatus): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="67"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="USCoreCommon"/>
</extension>
<extension url="name">
<valueString value="race"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function race(patient Patient):
(patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-race')) E
return {
ombCategory: (E.exts('ombCategory')) o return o.value as FHIR.Coding,
detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,
text: E.ext('text').value as FHIR.string
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="68"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString value="overlapsHeartFailureOutpatientEncounter"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns true if the given Condition overlaps the heart failure outpatient encounter with history of moderate or severe LVSD at any point
*/
define fluent function overlapsHeartFailureOutpatientEncounter(Condition USQualityCore.ConditionEncounterDiagnosis):
exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
where Condition.prevalenceInterval ( ) overlaps day of ModerateOrSevereLVSDHFOutpatientEncounter.period
and Condition.isVerified ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="69"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="isVerified"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function isVerified(condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>):
condition.verificationStatus is not null implies ( condition.verificationStatus ~ Status."confirmed"
or condition.verificationStatus ~ Status."unconfirmed"
or condition.verificationStatus ~ Status."provisional"
or condition.verificationStatus ~ Status."differential"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="70"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString value="overlapsAfterHeartFailureOutpatientEncounter"/>
</extension>
<extension url="statement">
<valueString
value="/*
@overloaded
@description: Returns true if the given Condition overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/
define fluent function overlapsAfterHeartFailureOutpatientEncounter(Condition USQualityCore.ConditionEncounterDiagnosis):
exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
where Condition.prevalenceInterval ( ) overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
and Condition.isVerified ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="71"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString value="overlapsAfterHeartFailureOutpatientEncounter"/>
</extension>
<extension url="statement">
<valueString
value="/*
@overloaded
@description: Returns true if the given AllergyIntolerance overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/
define fluent function overlapsAfterHeartFailureOutpatientEncounter(AllergyIntolerance AllergyIntolerance):
exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
where Interval[start of AllergyIntolerance.onset.toInterval ( ), AllergyIntolerance.lastOccurrence]overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
and AllergyIntolerance.isVerified ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="72"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRCommon"/>
</extension>
<extension url="name">
<valueString value="isVerified"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns true if the given condition either has no verification status or has a verification status of confirmed, unconfirmed, provisional, or differential
*/
define fluent function isVerified(allergyIntolerance FHIR.AllergyIntolerance):
allergyIntolerance.verificationStatus is not null implies
(allergyIntolerance.verificationStatus ~ "allergy-confirmed"
or allergyIntolerance.verificationStatus ~ "allergy-unconfirmed"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="73"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS144FHIRHFBetaBlockerForLVSD"/>
</extension>
<extension url="name">
<valueString value="isVerified"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns true if the given condition either has no verification status or has a verification status of confirmed, unconfirmed, provisional, or differential
*/
define fluent function isVerified(allergyIntolerance AllergyIntolerance):
allergyIntolerance.verificationStatus is not null implies ( allergyIntolerance.verificationStatus ~ USQualityCoreCommon."allergy-confirmed"
or allergyIntolerance.verificationStatus ~ USQualityCoreCommon."allergy-unconfirmed"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="74"/>
</extension>
</extension>
<name value="EffectiveDataRequirements"/>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="USQualityCore model information"/>
<resource
value="https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="USCore model information"/>
<resource
value="http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="FHIR model information"/>
<resource
value="http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library SDE"/>
<resource
value="https://madie.cms.gov/Library/SupplementalDataElements|6.1.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource
value="http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library USCommon"/>
<resource
value="http://hl7.org/fhir/us/cql/Library/USCoreCommon|2.0.0-ballot"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRCommon"/>
<resource
value="http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library AHA"/>
<resource value="https://madie.cms.gov/Library/AHAOverall|5.1.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library USQualityCoreCommon"/>
<resource
value="https://madie.cms.gov/Library/USQualityCoreCommon|0.1.0-cibuild"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Status"/>
<resource value="https://madie.cms.gov/Library/Status|2.1.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system SNOMEDCT"/>
<resource value="http://snomed.info/sct"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ConditionClinicalStatusCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ConditionVerificationStatusCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system TaskCodeSystem"/>
<resource value="http://hl7.org/fhir/CodeSystem/task-code"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Code system AllergyIntoleranceVerificationStatusCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Beta Blocker Therapy for LVSD"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1184"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Care Services in Long Term Residential Facility"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Home Healthcare Services"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Nursing Facility Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Office Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Outpatient Consultation"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Heart Failure"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Ejection Fraction"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1134"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Moderate or Severe LVSD"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Moderate or Severe"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1092"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Patient Provider Interaction"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Payer Type"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Heart Transplant"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.33"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Heart Transplant Complications"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.56"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Left Ventricular Assist Device Placement"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.61"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Left Ventricular Assist Device Complications"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.58"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Medical Reason"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Patient Reason"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1008"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Arrhythmia"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.366"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Hypotension"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.370"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Asthma"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.362"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Allergy to Beta Blocker Therapy"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1177"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Intolerance to Beta Blocker Therapy"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1178"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Bradycardia"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.412"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Beta Blocker Therapy Ingredient"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1493"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Atrioventricular Block"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.367"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Cardiac Pacer in Situ"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.368"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Cardiac Pacer"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.53"/>
</relatedArtifact>
<parameter>
<name value="Measurement Period"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="Period"/>
</parameter>
<parameter>
<name value="SDE Sex"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Coding"/>
</parameter>
<parameter>
<name value="Numerator"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Denominator"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="SDE Payer"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Initial Population"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="SDE Ethnicity"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Denominator Exclusions"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="SDE Race"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Denominator Exceptions"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<dataRequirement>
<type value="Patient"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient"/>
<mustSupport value="ombCategory"/>
<mustSupport value="detailed"/>
<mustSupport value="text"/>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<mustSupport value="id"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<mustSupport value="id"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<mustSupport value="id"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<mustSupport value="id"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<mustSupport value="id"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
<mustSupport value="status"/>
<mustSupport value="period"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<mustSupport value="id"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Patient"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Patient"/>
<mustSupport value="birthDate"/>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
<mustSupport value="abatement"/>
<mustSupport value="onset"/>
<mustSupport value="recordedDate"/>
<mustSupport value="clinicalStatus"/>
<mustSupport value="verificationStatus"/>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
<mustSupport value="code"/>
<mustSupport value="severity"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://snomed.info/sct"/>
<code value="134401001"/>
<display
value="Left ventricular systolic dysfunction (disorder)"/>
</code>
</codeFilter>
<codeFilter>
<path value="severity"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1092"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
<mustSupport value="code"/>
<mustSupport value="recordedDate"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.56"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
<mustSupport value="code"/>
<mustSupport value="recordedDate"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.58"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-clinical-result"/>
<mustSupport value="code"/>
<mustSupport value="value"/>
<mustSupport value="status"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1134"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Resource"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Resource"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/>
<mustSupport value="authoredOn"/>
<mustSupport value="timing"/>
<mustSupport value="repeat"/>
<mustSupport value="bounds"/>
<mustSupport value="status"/>
<mustSupport value="intent"/>
</dataRequirement>
<dataRequirement id="383">
<type value="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/>
<mustSupport value="medication.reference"/>
<mustSupport value="timing"/>
<mustSupport value="repeat"/>
<mustSupport value="bounds"/>
</dataRequirement>
<dataRequirement>
<type value="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/>
<mustSupport value="medication"/>
<mustSupport value="timing"/>
<mustSupport value="repeat"/>
<mustSupport value="bounds"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1184"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Task"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-taskrejected"/>
<mustSupport value="focus"/>
<mustSupport value="code"/>
</dataRequirement>
<dataRequirement>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-relatedRequirement">
<extension url="targetId">
<valueString value="383"/>
</extension>
<extension url="targetProperty">
<valueString value="medication"/>
</extension>
</extension>
<type value="Medication"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Medication"/>
<mustSupport value="id"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1184"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Coverage"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-coverage"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
<mustSupport value="code"/>
<mustSupport value="performed"/>
<mustSupport value="status"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.33"/>
</codeFilter>
<codeFilter>
<path value="status"/>
<code>
<code value="completed"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
<mustSupport value="code"/>
<mustSupport value="performed"/>
<mustSupport value="status"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.61"/>
</codeFilter>
<codeFilter>
<path value="status"/>
<code>
<code value="completed"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
<mustSupport value="code"/>
<mustSupport value="performed"/>
<mustSupport value="status"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.53"/>
</codeFilter>
<codeFilter>
<path value="status"/>
<code>
<code value="completed"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate"/>
<mustSupport value="effective"/>
<mustSupport value="value"/>
<mustSupport value="status"/>
</dataRequirement>
<dataRequirement>
<type value="MedicationRequest"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-medicationnotrequested"/>
<mustSupport value="medication"/>
<mustSupport value="authoredOn"/>
<mustSupport value="reasonCode"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1184"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.366"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.370"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.362"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1177"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1178"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.412"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.367"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.368"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.366"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.370"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.362"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1177"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1178"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.412"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.367"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.368"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="AllergyIntolerance"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/AllergyIntolerance"/>
<mustSupport value="verificationStatus"/>
<mustSupport value="onset"/>
<mustSupport value="lastOccurrence"/>
</dataRequirement>
<dataRequirement>
<type value="AllergyIntolerance"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/AllergyIntolerance"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1493"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="AllergyIntolerance"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/AllergyIntolerance"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://snomed.info/sct"/>
<code value="373254001"/>
<display
value="Substance with beta adrenergic receptor antagonist mechanism of action (substance)"/>
</code>
</codeFilter>
</dataRequirement>
</Library>
</contained>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" id="supplementalDataGuidance">
<extension url="guidance">
<valueString
value="<p>For every patient evaluated by this measure also identify payer, race, ethnicity and sex</p>"/>
</extension>
<extension url="usage">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
<display value="Supplemental Data"/>
</coding>
<text value="Supplemental Data Guidance"/>
</valueCodeableConcept>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm">
<extension url="term">
<valueString value="Moderate or Severe LVSD"/>
</extension>
<extension url="definition">
<valueMarkdown
value="LVEF \<=40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction (LVSD). The LVSD may be determined by quantitative or qualitative assessment, which may be current or historical. Examples of a quantitative or qualitative assessment may include an echocardiogram:
1. that provides a numerical value of LVSD or
2. that uses descriptive terms such as moderately or severely depressed left ventricular systolic function. Any current or prior ejection fraction study documenting LVSD can be used to identify patients.
"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem">
<valueReference>
<reference value="Device/cqf-tooling"/>
</valueReference>
</extension>
<extension
url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements">
<valueCanonical value="#effective-data-requirements"/>
</extension>
<url value="https://madie.cms.gov/Measure/CMS144FHIRHFBetaBlockerForLVSD"/>
<identifier>
<use value="usual"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"/>
<code value="short-name"/>
<display value="Short Name"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/shortName"/>
<value value="CMS144FHIR"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"/>
<code value="version-independent"/>
<display value="Version Independent"/>
</coding>
</type>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:73947208-412c-4295-bf7f-43bc907569d3"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"/>
<code value="version-specific"/>
<display value="Version Specific"/>
</coding>
</type>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:94b4a85e-8f32-4155-b1d3-20d139c2e1a7"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"/>
<code value="endorser"/>
<display value="Endorser"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/cbeId"/>
<value value="0083e"/>
<assigner>
<display value="CMS Consensus Based Entity"/>
</assigner>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"/>
<code value="publisher"/>
<display value="Publisher"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/cmsId"/>
<value value="144FHIR"/>
<assigner>
<display value="CMS"/>
</assigner>
</identifier>
<version value="1.0.000"/>
<name value="CMS144FHIRHFBetaBlockerForLVSD"/>
<title
value="Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)FHIR
"/>
<status value="active"/>
<experimental value="false"/>
<date value="2026-01-16T18:18:13+00:00"/>
<publisher value="American Heart Association"/>
<contact>
<telecom>
<system value="url"/>
<value value="https://www.heart.org/"/>
</telecom>
</contact>
<description
value="Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) \<= 40% who were prescribed or already taking beta-blocker therapy during the measurement period
"/>
<usage
value="This eCQM is to be reported as patient-based. To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period.
A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than or equal to 40% threshold noted in the denominator logic. A range that is greater than 40% would not meet the measure requirement.
In order for the Ejection Fraction result pathway to be recognized as below 40%, the result must be reported as a number with unit of %. A text string of "below 40%" or "ejection fraction between 35 and 40%" will not be recognized through electronic data capture. Although, this criteria can also be met using the Diagnosis pathway if specified as "Moderate or Severe."
Beta-blocker therapy: For patients with prior LVEF \<= 40%, beta-blocker therapy should include bisoprolol, carvedilol, or sustained release metoprolol succinate.
The requirement of two or more visits is to establish that the eligible clinician has an existing relationship with the patient.
This FHIR-based measure has been derived from the QDM-based measure CMS144v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).
"/>
<copyright
value="Copyright 2024 American College of Cardiology and American Heart Association. All Rights Reserved.
"/>
<effectivePeriod>
<start value="2026-01-01"/>
<end value="2026-12-31"/>
</effectivePeriod>
<author>
<name value="American Heart Association"/>
<telecom>
<system value="url"/>
<value value="https://www.heart.org/"/>
</telecom>
</author>
<author>
<name value="American Medical Association (AMA)"/>
<telecom>
<system value="url"/>
<value value="https://www.ama-assn.org/"/>
</telecom>
</author>
<relatedArtifact>
<type value="citation"/>
<citation
value="Heidenreich, P.A., Bozkurt, B, Aguilar, D., ... Allen, L. A. (2022). 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18), e895-e1032. doi: 10.1161/CIR.0000000000001063
"/>
</relatedArtifact>
<library
value="https://madie.cms.gov/Library/CMS144FHIRHFBetaBlockerForLVSD"/>
<disclaimer
value="The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.
The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain.
Commercial uses of the Measure require a license agreement between the user and the American College of Cardiology (ACC) or the American Heart Association (AHA). Neither the ACC, nor AHA, nor their members shall be responsible for any use of the Measure.
ACC and AHA encourage use of the Measure by other health care professionals, where appropriate.
THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The ACC and AHA and their members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT\[R\]) or other coding contained in the specifications.
CPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association. LOINC(R) is copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT\[R\]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2024 World Health Organization. All Rights Reserved.
The American Medical Association's and the PCPI(R) Foundation's significant past efforts and contributions to the performance measure are gratefully acknowledged.
Due to technical limitations, registered trademarks are indicated by (R) or \[R\].
"/>
<rationale
value="Beta blockers improve survival and reduce hospitalization for patients with stable heart failure with reduced ejection fraction (HFrEF). Treatment should be initiated as soon as a patient is diagnosed with reduced LVEF and does not have prohibitively low systemic blood pressure, fluid overload, or recent treatment with an intravenous positive inotropic agent. Beta blockers have also been shown to lessen the symptoms of heart failure, improve the clinical status of patients, and reduce future clinical deterioration. Despite these benefits, use of beta blockers in eligible patients remains suboptimal.
"/>
<clinicalRecommendationStatement
value="In patients with HFrEF, with current or previous symptoms, use of 1 of the 3 beta blockers proven to reduce mortality (e.g., bisoprolol, carvedilol, sustained-release metoprolol succinate) is recommended to reduce mortality and hospitalizations (Class I, Level of Evidence A) (Heidenreich, 2022).
Drugs Commonly Used for Stage C HFrEF (abbreviated to align with focus of measure to include only Beta-blocker therapy)
| Drug | Initial Daily Dose(s) | Target Dose(s) | Mean Doses Achieved in Clinical Trials |
|----------------------------------------------------------|-----------------------|----------------|----------------------------------------|
| *Beta Blockers* | <br /> | <br /> | <br /> |
| Bisoprolol | 1.25 mg once | 10 mg once | 8.6 mg/d |
| Carvedilol | 3.125 mg twice | 25-50 mg twice | 37 mg/d |
| Carvedilol CR | 10 mg once | 80 mg once | N/A |
| Metoprolol succinate extended release (metoprolol CR/XL) | 12.5 to 25 mg once | 200 mg once | 159 mg/d |
"/>
<group id="Group_1">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
<valueCode value="boolean"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="process"/>
<display value="Process"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
<code value="increase"/>
<display value="Increased score indicates improvement"/>
</coding>
</valueCodeableConcept>
</extension>
<population id="InitialPopulation_1">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</code>
<description
value="All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of heart failure on or before at least one qualifying encounter
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
</criteria>
</population>
<population id="Denominator_1">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator"/>
<display value="Denominator"/>
</coding>
</code>
<description
value="Equals Initial Population with a current or prior LVEF \<= 40%
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator"/>
</criteria>
</population>
<population id="DenominatorExclusion_1">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exclusion"/>
<display value="Denominator Exclusion"/>
</coding>
</code>
<description
value="Patients with a history of heart transplant or with a Left Ventricular Assist Device (LVAD) prior to the end of the outpatient encounter with Moderate or Severe LVSD
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exclusions"/>
</criteria>
</population>
<population id="Numerator_1">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator"/>
<display value="Numerator"/>
</coding>
</code>
<description
value="Patients who were prescribed or already taking beta-blocker therapy during the measurement period
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator"/>
</criteria>
</population>
<population id="DenominatorException_1">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exception"/>
<display value="Denominator Exception"/>
</coding>
</code>
<description
value="Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., arrhythmia, asthma, bradycardia, hypotension, patients with atrioventricular block without cardiac pacer, observation of consecutive heart rates \<50, allergy, intolerance, other medical reasons).
Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons).
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exceptions"/>
</criteria>
</population>
</group>
<supplementalData id="sde-ethnicity">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Ethnicity
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Ethnicity"/>
</criteria>
</supplementalData>
<supplementalData id="sde-payer">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Payer
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Payer"/>
</criteria>
</supplementalData>
<supplementalData id="sde-race">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Race
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Race"/>
</criteria>
</supplementalData>
<supplementalData id="sde-sex">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Sex
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Sex"/>
</criteria>
</supplementalData>
</Measure>