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="CMS145FHIRCADBBlockerTPMIorLVSD"/>
<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 394 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-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://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://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://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-clinical"/>
<code value="active"/>
</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="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</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="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Qualifying Encounter During Measurement Period"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualifying Encounter During Measurement Period":
( [Encounter: "Office Visit"]
union [Encounter: "Outpatient Consultation"]
union [Encounter: "Nursing Facility Visit"]
union [Encounter: "Care Services in Long Term Residential Facility"]
union [Encounter: "Home Healthcare Services"]
union [Encounter: "Patient Provider Interaction"] ) ValidEncounter
where ValidEncounter.period during day of "Measurement Period"
and ValidEncounter.status = 'finished'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Outpatient Encounter During Measurement Period"/>
</extension>
<extension url="statement">
<valueString
value="define "Outpatient Encounter During Measurement Period":
( [Encounter: "Office Visit"]
union [Encounter: "Outpatient Consultation"]
union [Encounter: "Care Services in Long Term Residential Facility"]
union [Encounter: "Home Healthcare Services"]
union [Encounter: "Nursing Facility Visit"] ) QualifyingEncounter
where QualifyingEncounter.period during day of "Measurement Period"
and QualifyingEncounter.status = 'finished'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString value="Coronary Artery Disease Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Coronary Artery Disease Encounter":
"Outpatient Encounter During Measurement Period" ValidQualifyingEncounter
with ( [ConditionProblemsHealthConcerns: "Coronary Artery Disease No MI"]
union [ConditionEncounterDiagnosis: "Coronary Artery Disease No MI"] ) CoronaryArteryDisease
such that CoronaryArteryDisease.overlapsDayOfEncounter ( ValidQualifyingEncounter )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString value="History of Cardiac Surgery Prior to Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "History of Cardiac Surgery Prior to Encounter":
"Outpatient Encounter During Measurement Period" ValidQualifyingEncounter
with [Procedure: "Cardiac Surgery"] CardiacSurgeryProcedure
such that CardiacSurgeryProcedure.performed.toInterval ( ) starts before end of ValidQualifyingEncounter.period
and CardiacSurgeryProcedure.status = 'completed'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString value="Qualifying CAD Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualifying CAD Encounter":
"Coronary Artery Disease Encounter"
union "History of Cardiac Surgery Prior to Encounter""/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString value="Initial Population"/>
</extension>
<extension url="statement">
<valueString
value="define "Initial Population":
AgeInYearsAt(date from start of "Measurement Period") >= 18
and exists ( "Qualifying Encounter During Measurement Period" Encounter1
with "Qualifying Encounter During Measurement Period" Encounter2
such that Encounter2.id !~ Encounter1.id
)
and exists "Qualifying CAD Encounter""/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</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="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString value="Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualifying CAD Encounter and Prior MI":
"Qualifying CAD Encounter" EncounterWithCADProxy
with ( [FHIR.Condition: "Myocardial Infarction"] ) MyocardialInfarction
such that MyocardialInfarction.prevalenceInterval ( ) starts 3 years or less before day of start of EncounterWithCADProxy.period
and not exists AHA."Moderate or Severe LVSD Findings"
and MyocardialInfarction.isVerified ( )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString value="Denominator 2"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator 2":
"Initial Population"
and exists "Qualifying CAD Encounter and Prior MI""/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualifying CAD Encounter and History of Moderate or Severe LVSD":
"Qualifying CAD Encounter" EncounterWithCADProxy
with AHA."Moderate or Severe LVSD Findings" LVSDFindings
such that Coalesce(LVSDFindings.prevalenceInterval(), LVSDFindings.effective.toInterval()) starts before end of EncounterWithCADProxy.period"/>
</extension>
<extension url="displaySequence">
<valueInteger value="11"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [ConditionProblemsHealthConcerns: "Arrhythmia"] ArrhythmiaDiagnosis
where ArrhythmiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="12"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [ConditionProblemsHealthConcerns: "Asthma"] AsthmaDiagnosis
where AsthmaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and 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="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [ConditionProblemsHealthConcerns: "Bradycardia"] BradycardiaDiagnosis
where BradycardiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [ConditionProblemsHealthConcerns: "Hypotension"] HypotensionDiagnosis
where HypotensionDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="/*
* @code: Heart rate - 8867-4
* @profile: http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate
*/
define "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( from
["HeartRateProfile"] HeartRateExam,
"Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
let PriorHeartRateExam: Last(["HeartRateProfile"] MostRecentPriorHeartRateExam
where MostRecentPriorHeartRateExam.effective.toInterval() during CADEncounterModerateOrSevereLVSD.period
and MostRecentPriorHeartRateExam.status in { 'final', 'amended', 'corrected' }
and MostRecentPriorHeartRateExam.effective.toInterval() before HeartRateExam.effective.toInterval()
sort by start of effective.toInterval()
)
where HeartRateExam.effective.toInterval ( ) during CADEncounterModerateOrSevereLVSD.period
and HeartRateExam.status in { 'final', 'amended', 'corrected' }
and HeartRateExam.value < 50 '/min'
and PriorHeartRateExam.value < 50 '/min'
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="16"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( ( [AllergyIntolerance: "Beta Blocker Therapy Ingredient"]
union [AllergyIntolerance: "Substance with beta adrenergic receptor antagonist mechanism of action (substance)"] ) BetaBlockerAllergyIntolerance
where BetaBlockerAllergyIntolerance.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( ( [ConditionProblemsHealthConcerns: "Allergy to Beta Blocker Therapy"]
union [ConditionProblemsHealthConcerns: "Intolerance to Beta Blocker Therapy"] ) BetaBlockerAllergyOrIntoleranceDiagnosis
where BetaBlockerAllergyOrIntoleranceDiagnosis.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="18"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</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"] NoBetaBlockerForLVSDOrdered
with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" LVSDVisit
such that NoBetaBlockerForLVSDOrdered.authoredOn during day of LVSDVisit.period
where NoBetaBlockerForLVSDOrdered.status in { 'active', 'completed' }
and NoBetaBlockerForLVSDOrdered.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
and ( NoBetaBlockerForLVSDOrdered.reasonCode in "Medical Reason"
or NoBetaBlockerForLVSDOrdered.reasonCode in "Patient Reason"
)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="19"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [ConditionProblemsHealthConcerns: "Atrioventricular Block"] AtrioventricularBlock
where AtrioventricularBlock.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="20"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [ConditionProblemsHealthConcerns: "Cardiac Pacer in Situ"] CardiacPacerDiagnosis
where CardiacPacerDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [Procedure: "Cardiac Pacer"] ImplantedCardiacPacer
with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
such that ImplantedCardiacPacer.performed.toInterval ( ) starts before end of CADEncounterModerateOrSevereLVSD.period
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="22"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer":
"Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
and not "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
and not "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and History of Moderate or Severe LVSD""/>
</extension>
<extension url="displaySequence">
<valueInteger value="23"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString value="Denominator Exceptions 1"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator Exceptions 1":
"Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
or "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer""/>
</extension>
<extension url="displaySequence">
<valueInteger value="24"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</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"] BetaBlockerForLVSDOrdered
where BetaBlockerForLVSDOrdered.authoredDuringDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="25"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</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: medication in "Beta Blocker Therapy for LVSD"] ActiveBetaBlockerForLVSD
with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
such that First((collapse(ActiveBetaBlockerForLVSD.dosageInstruction.timing.repeat.bounds DoseTime
return DoseTime.toInterval()
)) DrugPeriod
sort by start of $this
) overlaps after day of CADEncounterModerateOrSevereLVSD.period
where ActiveBetaBlockerForLVSD.status in { 'active', 'completed' }
and ActiveBetaBlockerForLVSD.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="26"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString value="Numerator 1"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator 1":
"Has Beta Blocker Therapy for LVSD Ordered"
or "Is Currently Taking Beta Blocker Therapy for LVSD""/>
</extension>
<extension url="displaySequence">
<valueInteger value="27"/>
</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="28"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</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="29"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString value="Has Beta Blocker Therapy Ordered"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Beta Blocker Therapy Ordered":
exists ( [MedicationRequest: medication in "Beta Blocker Therapy"] BetaBlockerOrdered
where BetaBlockerOrdered.authoredDuringDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="30"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString value="Is Currently Taking Beta Blocker Therapy"/>
</extension>
<extension url="statement">
<valueString
value="define "Is Currently Taking Beta Blocker Therapy":
exists ( [MedicationRequest: medication in "Beta Blocker Therapy"] ActiveBetaBlocker
with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
such that First((collapse(ActiveBetaBlocker.dosageInstruction.timing.repeat.bounds DoseTime
return DoseTime.toInterval()
)) DrugPeriod
sort by start of $this
) overlaps after day of CADEncounterMI.period
where ActiveBetaBlocker.status in { 'active', 'completed' }
and ActiveBetaBlocker.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="31"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString value="Numerator 2"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator 2":
"Has Beta Blocker Therapy Ordered"
or "Is Currently Taking Beta Blocker Therapy""/>
</extension>
<extension url="displaySequence">
<valueInteger value="32"/>
</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="33"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</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="34"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Arrhythmia with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Arrhythmia with Qualifying CAD Encounter and Prior MI":
exists ( [ConditionProblemsHealthConcerns: "Arrhythmia"] ArrhythmiaDiagnosis
where ArrhythmiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="35"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Asthma with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Asthma with Qualifying CAD Encounter and Prior MI":
exists ( [ConditionProblemsHealthConcerns: "Asthma"] AsthmaDiagnosis
where AsthmaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="36"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Bradycardia with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Bradycardia with Qualifying CAD Encounter and Prior MI":
exists ( [ConditionProblemsHealthConcerns: "Bradycardia"] BradycardiaDiagnosis
where BradycardiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="37"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Hypotension with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Hypotension with Qualifying CAD Encounter and Prior MI":
exists ( ( [ConditionProblemsHealthConcerns: "Hypotension"]
union [ConditionEncounterDiagnosis: "Hypotension"] ) HypotensionDiagnosis
where HypotensionDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="38"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="/*
* @code: Heart rate - 8867-4
* @profile: http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate
*/
define "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI":
exists ( from
// TODO: Consider best practice of always qualifying type names
["HeartRateProfile"] HeartRateExam,
"Qualifying CAD Encounter and Prior MI" CADEncounterMI
let PriorHeartRateExam: Last(["HeartRateProfile"] MostRecentPriorHeartRateExam
where MostRecentPriorHeartRateExam.effective.toInterval() during CADEncounterMI.period
and MostRecentPriorHeartRateExam.status in { 'final', 'amended', 'corrected' }
and MostRecentPriorHeartRateExam.effective.toInterval() before HeartRateExam.effective.toInterval()
sort by start of effective.toInterval()
)
where HeartRateExam.effective.toInterval ( ) during CADEncounterMI.period
and HeartRateExam.status in { 'final', 'amended', 'corrected' }
and HeartRateExam.value < 50 '/min'
and PriorHeartRateExam.value < 50 '/min'
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="39"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI":
exists ( ( [AllergyIntolerance: "Beta Blocker Therapy Ingredient"]
union [AllergyIntolerance: "Substance with beta adrenergic receptor antagonist mechanism of action (substance)"] ) BetaBlockerAllergyIntolerance
where BetaBlockerAllergyIntolerance.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="40"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI":
exists ( ( [ConditionProblemsHealthConcerns: "Allergy to Beta Blocker Therapy"]
union [ConditionProblemsHealthConcerns: "Intolerance to Beta Blocker Therapy"] ) BetaBlockerAllergyOrIntoleranceDiagnosis
where BetaBlockerAllergyOrIntoleranceDiagnosis.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="41"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy":
exists ( [MedicationNotRequested: medication in "Beta Blocker Therapy for LVSD"] NoBetaBlockerForLVSDOrdered
with "Qualifying CAD Encounter and Prior MI" PriorMIVisit
such that NoBetaBlockerForLVSDOrdered.authoredOn during day of PriorMIVisit.period
where NoBetaBlockerForLVSDOrdered.status in { 'active', 'completed' }
and NoBetaBlockerForLVSDOrdered.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
and ( NoBetaBlockerForLVSDOrdered.reasonCode in "Medical Reason"
or NoBetaBlockerForLVSDOrdered.reasonCode in "Patient Reason"
)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="42"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI":
exists ( [ConditionProblemsHealthConcerns: "Atrioventricular Block"] AtrioventricularBlockDiagnosis
where AtrioventricularBlockDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="43"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and Prior MI":
exists ( [ConditionProblemsHealthConcerns: "Cardiac Pacer in Situ"] CardiacPacerDiagnosis
where CardiacPacerDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="44"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI":
exists ( [Procedure: "Cardiac Pacer"] ImplantedCardiacPacer
with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
such that ImplantedCardiacPacer.performed.toInterval ( ) starts before end of CADEncounterMI.period
and ImplantedCardiacPacer.status = 'completed'
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="45"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString
value="Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer":
"Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI"
and not "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and Prior MI"
and not "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI""/>
</extension>
<extension url="displaySequence">
<valueInteger value="46"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString value="Denominator Exceptions 2"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator Exceptions 2":
"Has Arrhythmia with Qualifying CAD Encounter and Prior MI"
or "Has Asthma with Qualifying CAD Encounter and Prior MI"
or "Has Bradycardia with Qualifying CAD Encounter and Prior MI"
or "Has Hypotension with Qualifying CAD Encounter and Prior MI"
or "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI"
or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI"
or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI"
or "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
or "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer""/>
</extension>
<extension url="displaySequence">
<valueInteger value="47"/>
</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="48"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</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="49"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString value="Denominator 1"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator 1":
"Initial Population"
and exists "Qualifying CAD Encounter and History of Moderate or Severe LVSD""/>
</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="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value string): 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="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="52"/>
</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="53"/>
</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="54"/>
</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="55"/>
</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="56"/>
</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="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 EncounterStatus): 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="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString value="overlapsDayOfEncounter"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function overlapsDayOfEncounter(Diagnosis ConditionProblemsHealthConcerns, TheEncounter Encounter):
TheEncounter Visit
where Diagnosis.isVerified ( )
return Diagnosis.prevalenceInterval ( ) overlaps day of Visit.period"/>
</extension>
<extension url="displaySequence">
<valueInteger value="59"/>
</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="60"/>
</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="61"/>
</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="62"/>
</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="63"/>
</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="64"/>
</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="65"/>
</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="66"/>
</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="67"/>
</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="68"/>
</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="69"/>
</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="70"/>
</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="71"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString value="overlapsDayOfEncounter"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function overlapsDayOfEncounter(Diagnosis ConditionProblemsHealthConcerns, EncounterList List<Encounter>):
AnyTrue(EncounterList Visit
return Diagnosis.overlapsDayOfEncounter(Visit)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="72"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString value="overlapsAfterDayOfEncounter"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function overlapsAfterDayOfEncounter(Event Choice<AllergyIntolerance, ConditionProblemsHealthConcerns>, EncounterList List<Encounter>):
AnyTrue(EncounterList Visit
return
case
when Event is AllergyIntolerance then Interval[start of Event.onset.toInterval(), Event.lastOccurrence]overlaps after day of Visit.period
and(Event.clinicalStatus is null
or Event.clinicalStatus ~ FHIRCommon."allergy-active"
)
and(Event.verificationStatus is null
or Event.verificationStatus ~ FHIRCommon."allergy-confirmed"
)
when Event is ConditionProblemsHealthConcerns then Event.isVerified()
and Event.prevalenceInterval() overlaps after day of Visit.period
else false
end
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="73"/>
</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="74"/>
</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(allergyIntolerance AllergyIntolerance):
if allergyIntolerance.clinicalStatus ~ "allergy-active" then
Interval[start of allergyIntolerance.onset.toInterval(), end of allergyIntolerance.abatementInterval()]
else
(end of allergyIntolerance.abatementInterval()) abatementDate
return
if abatementDate is null then
Interval[start of allergyIntolerance.onset.toInterval(), abatementDate)
else
Interval[start of allergyIntolerance.onset.toInterval(), abatementDate]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="75"/>
</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 AllergyIntolerance resource.
@comment: This function uses the abatement extension, if present, otherwise the resolutionAge.
If the abatement of the AllergyIntolerance is a DateTime, the result is an interval beginning and ending on that DateTime.
If the abatement is a Period, the result is the Period converted to an Interval of DateTime.
If the abatement is an Age, the result is an interval from the date the patient turned that age to immediately before one year later.
If the abatement is a Range, 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.
If the resolutionAge is present, the result is an interval from the date the patient turned that age to immediately before one year later.
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(allergyIntolerance AllergyIntolerance):
allergyIntolerance A
let
abatement: A.abatement(),
resolutionAge: A.resolutionAge()
return
if abatement is FHIR.dateTime then
Interval[FHIRHelpers.ToDateTime(abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(abatement as FHIR.dateTime)]
else if abatement is FHIR.Period then
FHIRHelpers.ToInterval(abatement as FHIR.Period)
else if 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 abatement is FHIR.Age then
Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(abatement as FHIR.Age),
FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(abatement as FHIR.Age) + 1 year)
else if abatement is FHIR.Range then
Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((abatement as FHIR.Range).low),
FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((abatement as FHIR.Range).high) + 1 year)
else if abatement is FHIR.boolean then
Interval[end of A.onset.toInterval(), A.recordedDate)
else if resolutionAge is not null then
Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(resolutionAge),
FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(resolutionAge) + 1 year)
else
null"/>
</extension>
<extension url="displaySequence">
<valueInteger value="76"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRCommon"/>
</extension>
<extension url="name">
<valueString value="abatement"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the abatement of the given AllergyIntolerance, if present
*/
define fluent function abatement(allergyIntolerance AllergyIntolerance):
allergyIntolerance.ext('http://hl7.org/fhir/StructureDefinition/allergyintolerance-abatement').value
as Choice<dateTime, Age, Period, Range, string>"/>
</extension>
<extension url="displaySequence">
<valueInteger value="77"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRCommon"/>
</extension>
<extension url="name">
<valueString value="resolutionAge"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the resolutionAge of the given AllergyIntolerance, if present
*/
define fluent function resolutionAge(allergyIntolerance AllergyIntolerance):
allergyIntolerance.ext('http://hl7.org/fhir/StructureDefinition/allergyintolerance-resolutionAge').value
as Age"/>
</extension>
<extension url="displaySequence">
<valueInteger value="78"/>
</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="79"/>
</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="80"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
</extension>
<extension url="name">
<valueString value="authoredDuringDayOfEncounter"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function authoredDuringDayOfEncounter(Order Choice<MedicationRequest, MedicationNotRequested>, EncounterList List<Encounter>):
AnyTrue(EncounterList Visit
return
case
when Order is MedicationRequest then Order.authoredOn during day of Visit.period
and Order.status in { 'active', 'completed' }
and Order.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
and Order.doNotPerform is not true
when Order is MedicationNotRequested then Order.authoredOn during day of Visit.period
and Order.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
else false
end
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="81"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToBoolean"/>
</extension>
<extension url="statement">
<valueString
value="define function ToBoolean(value boolean): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="82"/>
</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="83"/>
</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="84"/>
</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="85"/>
</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>
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value="Substance with beta adrenergic receptor antagonist mechanism of action (substance)"/>
</code>
</codeFilter>
</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="status"/>
<mustSupport value="intent"/>
<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="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/>
<mustSupport value="medication"/>
<mustSupport value="dosageInstruction"/>
<mustSupport value="status"/>
<mustSupport value="intent"/>
<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="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/>
<mustSupport value="medication"/>
<mustSupport value="dosageInstruction"/>
<mustSupport value="status"/>
<mustSupport value="intent"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1174"/>
</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>
</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/StructureDefinition/cqf-definitionTerm">
<extension url="term">
<valueString value="Prescribed"/>
</extension>
<extension url="definition">
<valueMarkdown
value="Denotes that a prescription has been given to the patient for ACE inhibitor or ARB or ARNI therapy at one or more visits in the measurement period OR that the patient is already taking an ACE inhibitor or ARB or ARNI therapy as documented in their current medication list
"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm">
<extension url="term">
<valueString value="Prior Myocardial Infarction (MI)"/>
</extension>
<extension url="definition">
<valueMarkdown
value="Prior Myocardial Infarction (MI) for Denominator 2 is limited to those occurring within the past 3 years
"/>
</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/CMS145FHIRCADBBlockerTPMIorLVSD"/>
<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="CMS145FHIR"/>
</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:466e5d36-1e01-478b-9dcb-edac33594dd5"/>
</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:1d9adbb1-6f66-47d1-b97e-9e7593117c18"/>
</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="0070e"/>
<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="145FHIR"/>
<assigner>
<display value="CMS"/>
</assigner>
</identifier>
<version value="1.0.000"/>
<name value="CMS145FHIRCADBBlockerTPMIorLVSD"/>
<title
value="Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF less than or equal to 40%)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 coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior left ventricular ejection fraction (LVEF) \<=40% who were prescribed beta-blocker therapy
"/>
<usage
value="Beta-blocker therapy:
* For patients with prior MI, beta-blocker therapy includes any agent within the beta-blocker drug class. As of 2015, no recommendations or evidence are cited in current stable ischemic heart disease guidelines for preferential use of specific agents.
* For patients with prior LVEF \<=40%, beta-blocker therapy includes the following: 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.
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."
If a patient has had a myocardial infarction (MI) within the past 3 years and a current or prior LVEF \<=40% (or moderate or severe LVSD), the patient should only be counted in Population Criteria 1.
This eCQM is a patient-based measure.
This FHIR-based measure has been derived from the QDM-based measure CMS145v14. 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 2025 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="Fihn, S. D., Gardin, J. M., Abrams, J., Berra, K., Blankenship, J. C., Dallas, A. P., ... Williams, S. V. (2012). 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation, 126(25), e354--e471. doi: 10.1161/cir.0b013e318277d6a0
"/>
</relatedArtifact>
<relatedArtifact>
<type value="citation"/>
<citation
value="Gibbons, R. J., Abrams, J., Chatterjee, K., Daley, J., Deedwania, P.K, Douglas J.S., ... Smith Jr., S.C. (2002). ACC/AHA 2002 Guideline update for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to update the 1999 guidelines for the management of patients with chronic stable angina). Circulation, 107(1), 149-158. doi:10.1161/01.CIR.0000047041.66447.29
"/>
</relatedArtifact>
<relatedArtifact>
<type value="citation"/>
<citation
value="Virani, S.S., Newby, L.K., Arnold, S.V., Bittner, V., Brewer, L.C., Demeter, S.H., ... Dixon, D.L. (2023). 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the management for patients with chronic coronary disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Practice Guidelines. Circulation, 148, e9-e119. doi: 10.1161/CIR.0000000000001168
"/>
</relatedArtifact>
<library
value="https://madie.cms.gov/Library/CMS145FHIRCADBBlockerTPMIorLVSD"/>
<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="For patients with coronary artery disease (CAD), beta-blockers are recommended for 3 years after myocardial infarction or acute coronary syndrome. Beta-blockers, particularly carvedilol, metoprolol succinate, or bisoprolol which have been shown to reduce risk of death, are recommended indefinitely for patients with CAD and LV systolic dysfunction. These agents have proven efficacy in reducing angina onset and improving the ischemic threshold during exercise. In patients who have suffered an MI, beta-blockers significantly reduce deaths and recurrent MIs (Fihn et al., 2012).
Nonadherence to cardioprotective medications is prevalent among outpatients with CAD and can be associated with a broad range of adverse outcomes, including all-cause and cardiovascular mortality, cardiovascular hospitalizations, and the need for revascularization procedures (Gibbons et al., 2002).
This measure is intended to promote beta-blocker usage in select patients with CAD.
"/>
<clinicalRecommendationStatement
value="Beta-blocker therapy should be started and continued for 3 years in all patients with normal LV function after MI or acute coronary syndrome (ACS) (Class I, Level of Evidence: B) (Fihn et al., 2012).
Beta-blocker therapy should be used in all patients with LV systolic dysfunction (EF \<= 40%) with heart failure or prior MI, unless contraindicated. (Use should be limited to carvedilol, metoprolol succinate, or bisoprolol, which have been shown to reduce risk of death.) (Class I, Level of Evidence: A) (Fihn et al., 2012).
In patients with chronic coronary disease (CCD) and LVEF ≤40% with or without previous MI, the use of beta-blocker therapy is recommended to reduce the risk of future Major Adverse Cardiac Events (MACE), including cardiovascular death. (Class 1, Level of Evidence: A) (Virani et al., 2023)
"/>
<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-rateAggregation">
<valueString
value="This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes:
* Population 1: Patients with left ventricular systolic dysfunction (LVEF \<=40%)
* Population 2: Patients with a prior (within the past 3 years) myocardial infarction
For the purposes of this measure, a single performance rate can be calculated as follows: Performance Rate = (Numerator 1 + Numerator 2)/ \[(Denominator 1 - Denominator Exceptions 1) + (Denominator 2 - Denominator Exceptions 2)\]
"/>
</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 coronary artery disease
"/>
<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 who also have prior (within the past 3 years) MI or a current or prior LVEF \<=40%
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator 1"/>
</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 beta-blocker therapy
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator 1"/>
</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 1"/>
</criteria>
</population>
</group>
<group id="Group_2">
<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-rateAggregation">
<valueString
value="This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes:
* Population 1: Patients with left ventricular systolic dysfunction (LVEF \<=40%)
* Population 2: Patients with a prior (within the past 3 years) myocardial infarction
For the purposes of this measure, a single performance rate can be calculated as follows: Performance Rate = (Numerator 1 + Numerator 2)/ \[(Denominator 1 - Denominator Exceptions 1) + (Denominator 2 - Denominator Exceptions 2)\]
"/>
</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_2">
<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 coronary artery disease
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
</criteria>
</population>
<population id="Denominator_2">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator"/>
<display value="Denominator"/>
</coding>
</code>
<description
value="Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF \<=40%
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator 2"/>
</criteria>
</population>
<population id="Numerator_2">
<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 beta-blocker therapy
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator 2"/>
</criteria>
</population>
<population id="DenominatorException_2">
<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 2"/>
</criteria>
</population>
</group>
<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>
<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-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-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>
</Measure>