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\n \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n \n \n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n \n \n \n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n \n \n \n \n\n\n\n\n \n \n \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n \n \n \n \n\n\n\n\n\n\n \n \n \n\n\n\n\n\n\n\n\n\n\n\n\n \n \n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n \n\n \n \n \n \n \n \n \n \n \n\n\n\n\n \n \n \n \n\n \n \n\n \n \n \n \n \n \n \n \n \n\n\n\n\n \n \n \n \n\n \n \n\n \n \n \n \n \n \n \n \n \n\n\n\n\n \n \n \n \n\n \n \n\n \n \n \n \n \n \n \n \n \n\n\n\n\n \n \n \n \n\n \n \n\n \n \n \n \n \n \n \n \n \n\n\n\n\n \n \n \n \n\n \n \n\n \n \n \n\n \n\n\n \n\n\n\n\n\n\n\n \n \n \n \n \n \n\n\n\n\n\n\n\n\n \n\n\n\n\n \n\n\n\n\n\n\n\n\n\n \n\n\n\n\n \n\n\n\n \n\n\n\n\n \n\n\n\n \n\n\n\n\n \n\n\n\n \n\n\n\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n \n \n\n\n\n \n\n\n\n\n\n\n \n \n \n\n \n \n \n \n \n\n\n\n\n\n\n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n \n\n\n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n \n\n\n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n \n\n\n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n \n\n\n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n \n\n\n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n \n \n\n \n \n \n\n \n\n\n \n\n\n \n\n \n \n\n\n \n\n\n\n\n\n\n \n \n \n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n\n \n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n\n \n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n\n \n \n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n 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Metadata
TitlePreventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up PlanFHIR\n
Version1.0.000
Short NameCMS69FHIR
GUID (Version Independent)urn:uuid:5d929142-0109-4dc3-97b5-27c9296b3cf9
GUID (Version Specific)urn:uuid:6788e67b-9cd5-40f8-a8fd-75540dc16238
CMS Identifier69FHIR
Effective Period2026-01-01 through 2026-12-31
Steward (Publisher)Centers for Medicare & Medicaid Services (CMS)
DeveloperAmerican Institutes for Research (AIR)
Description

Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the measurement period AND who had a follow-up plan documented if BMI was outside of normal parameters

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Copyright

This electronic clinical quality measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract # 75FCMC18D0027/ Task Order #: 75FCMC24F0144) with the American Institutes for Research (AIR) to develop this electronic measure. AIR is not responsible for any use of the Measure. AIR makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and AIR has no liability to anyone who relies on such measures or specifications. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. AIR disclaims all liability for use or accuracy of any third-party codes 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.

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Disclaimer

These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

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Rationale

BMI Above Normal Parameters "Obesity is a chronic, multifactorial disease with complex psychological, environmental (social and cultural), genetic, physiologic, metabolic, and behavioral causes and consequences. The prevalence of overweight and obese people is increasing worldwide at an alarming rate in both developing and developed countries. Environmental and behavioral changes brought about by economic development, modernization, and urbanization have been linked to the rise in global obesity. The health consequences are becoming apparent" (Fitch et al., 2013). More than a third of United States (U.S.) adults have a body mass index (BMI) >= 30 kg/m2 and are at increased risk for diabetes, cardiovascular disease (CVD), and obstructive sleep apnea (Flegal et al., 2012; Ogden et al., 2015; Dong et al., 2020). Hales et al. (2017) reported that the prevalence of obesity among adults and youth in the U.S. was 39.8 percent and 18.5 percent, respectively, from 2015-2016. Furthermore, the prevalence of obesity in adults increased to 42.4 percent in 2018, with the highest percentage among adults in the 40-59 age bracket compared with other age groups (Hales et al., 2020). Hales et al. (2020) also disaggregated the data according to race/ethnicity and noted that obesity prevalence was higher among non-Hispanic Black adults and Hispanic adults when compared with other races and ethnicities. Obesity prevalence was lowest among non-Hispanic Asian men and women. Among males, obesity prevalence was higher among Hispanic males compared with non-Hispanic Black males and non-Hispanic White males. Among females, the prevalence among non-Hispanic Black females was 56.9 percent, which was higher than all other races/ethnicities. In general, the prevalence of obesity in the U.S. remains higher than the Healthy People 2020 goal of 30.5 percent among adults (Hales et al., 2020). BMI continues to be a common and reasonably reliable measurement to identify overweight and obese adults who may be at an increased risk for future morbidity. Although good quality evidence supports obtaining a BMI, it is important to recognize it is not a perfect measurement. For example, BMI and its associated disease and mortality risk appear to vary among ethnic subgroups. Black/African Americans appear to have the lowest mortality risk at a BMI of 26.2-28.5 kg/m2 in Black women and 27.1-30.2 kg/m2 in Black men. In contrast, Asian populations may experience the lowest mortality rates, starting at a BMI of 23 to 24 kg/m2. The correlation between BMI and diabetes risk also varies by ethnicity (LeBlanc et al., 2011). BMI is not a direct measure of adiposity; consequently, it can over or underestimate adiposity. However, overall, BMI is a derived value that correlates well with total body fat and markers of secondary complications, e.g., hypertension and dyslipidemia (Barlow & the Expert Committee, 2007). It is important to enhance beneficiary access to appropriate treatments for obesity, which could result in decreased healthcare costs and lower obesity rates. Behavioral weight management treatment has been identified as an effective first-line treatment for obesity, with an average initial weight loss of 8-10 percent. This percentage of weight loss is associated with a significant risk reduction for diabetes and CVD (Wadden, Butryn & Wilson, 2007). Evidence also shows that when provided 14 or more high-intensity behavioral intervention sessions of face-to-face individual or group treatment across 6 months, participants lose up to 8 percent of their weight during that time and experience improvements in heart disease risk factors and quality of life (Wadden, Tronieri, & Butryn, 2020). There is also evidence that high-intensity behavioral counseling is effective, whether delivered in-person, by phone, or electronically (Tronieri et al., 2019). Moreover, intensive behavioral therapy for obesity provided by registered dietitian nutritionists for 6-12 months shows a significant mean weight loss of up to 10 percent of body weight, maintained over one year's time (Raynor & Champagne, 2016). Despite the evidence that supports weight management counseling, the rate of use in primary care for patients with obesity decreased by 10 percent from 39.9 percent in 1995-1996 to 29.9 percent in 2007-2008 (Kraschnewski et al., 2013). Weight management counseling during primary care visits further declined from 33 percent to 21 percent between 2008-2009 and 2012-2013. This suggests that obesity management in primary care remains suboptimal (Fitzpatrick & Stevens, 2017). Therefore, screening for BMI and follow-up is critical and will help in reaching the quality goals of population health and cost reduction. However, due to concerns for other underlying conditions (such as bone health) or nutrition-related deficiencies, providers are cautioned to use their best clinical judgment when considering weight management programs for overweight patients, especially the elderly (National Heart, Lung, and Blood Institute [NHLBI] Obesity Education Initiative, 1998). BMI Below Normal Parameters On the other end of the body weight spectrum is underweight (BMI < 18.5 kg/m2), which is also detrimental to population health. When compared to normal-weight individuals (BMI 18.5-25 kg/m2), underweight individuals have significantly higher death rates with a Hazard Ratio of 2.27 and 95 percent confidence intervals = 1.78, 2.90 (Borrell & Samuel, 2014). Individuals with a BMI < 18.5 kg/m2 have been shown to be at a higher risk for adverse events, postoperative infection, and/or mortality following a surgical procedure (Katakam et al., 2021; Ottesen et al., 2020; Ottesen et al., 2022; Rudasill et al., 2021). BMI below normal parameters is a risk factor for developing severe illness from respiratory infections such as influenza and COVID-19 (Moser et al., 2019; Ye et al., 2021). BMI below normal parameters can negatively impact both male and female fertility (Boutari et al., 2020; Guo et al., 2019). Poor nutrition or underlying health conditions can result in underweight (Fryar & Ogden, 2012). The National Health and Nutrition Examination Survey (NHANES) results from 2007-2010 indicate that women are more likely to be underweight than men (Fryar & Ogden, 2012). However, all patients should be equally screened for underweight and followed up with nutritional counseling or another clinically appropriate intervention to reduce mortality and morbidity associated with underweight.

\n
Clinical Recommendation Statement

All adults should be screened annually using a BMI measurement. BMI measurements >= 25 kg/m2 should be used to initiate further evaluation of overweight or obesity after taking into account age, gender, ethnicity, fluid status, and muscularity; therefore, clinical evaluation and judgment must be used when BMI is employed as the anthropometric indicator of excess adiposity, particularly in athletes and those with sarcopenia (Garvey et al., 2016) (Grade A).

\n

Overweight and Underweight Categories:

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Underweight < 18.5; Normal weight 18.5-24.9; Overweight 25-29.9; Obese class I 30-34.9; Obese class II 35-39.9; Obese class III >= 40 (Garvey et al., 2016).

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BMI cutoff point value of >= 23 kg/m2 should be used in the screening and confirmation of excess adiposity in Asian adults (Garvey et al., 2016) (Grade B).

\n

Lifestyle/behavioral therapy for overweight and obesity should include behavioral interventions that enhance adherence to prescriptions for a reduced-calorie meal plan and increased physical activity (behavioral interventions can include: self-monitoring of weight, food intake, and physical activity; clear and reasonable goal-setting; education pertaining to obesity, nutrition, and physical activity; face-to-face and group meetings; stimulus control; systematic approaches for problem-solving; stress reduction; cognitive restructuring [i.e., cognitive behavioral therapy], motivational interviewing; behavioral contracting; psychological counseling; and mobilization of social support structures) (Garvey et al., 2016) (Grade A).

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Behavioral lifestyle intervention should be tailored to a patient's ethnic, cultural, socioeconomic, and educational background (Garvey et al., 2016) (Grade B).

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The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians offer or refer adults with a BMI of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions (USPSTF, 2018) (Grade B).

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Interventions:

\n
    \n
  • \n

    Effective intensive behavioral interventions were designed to help participants achieve or maintain weight loss of at least five percent through a combination of dietary changes and increased physical activity

    \n
    • \n
  • \n

    Most interventions lasted for one to two years, and the majority had at least 12 sessions in the first year

    \n
    • \n
  • \n

    Most behavioral interventions focused on problem-solving to identify barriers, self-monitoring of weight, peer support, and relapse prevention

    \n
    • \n
  • \n

    Interventions also provided tools to support weight loss or weight loss maintenance (e.g., pedometers, food scales, or exercise videos) (USPSTF, 2018)

    \n
    • \n
\n

Nutritional safety for the elderly should be considered when recommending weight reduction. "A clinical decision to forego obesity treatment in older adults should be guided by an evaluation of the potential benefits of weight reduction for day-to-day functioning and reduction of the risk of future cardiovascular events, as well as the patient's motivation for weight reduction. Care must be taken to ensure that any weight reduction program minimizes the likelihood of adverse effects on bone health or other aspects of nutritional status" (NHLBI Obesity Education Initiative, 1998) (Evidence Category D). In addition, weight reduction prescriptions in older persons should be accompanied by proper nutritional counseling and regular body weight monitoring (NHLBI Obesity Education Initiative, 1998).

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The possibility that a standard approach to weight loss will work differently in diverse patient populations must be considered when setting expectations about treatment outcomes (NHLBI Obesity Education Initiative, 1998) (Evidence Category B).

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Citation\n \n \n \n

Barlow, S. E., & the Expert Committee. (2007). Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics, 120(Suppl. 4), S164-S192. doi:10.1542/peds.2007-2329C

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Borrell, L. N., & Samuel, L. (2014). Body mass index categories and mortality risk in U.S. adults: The effect of overweight and obesity on advancing death. American Journal of Public Health, 104(3), 512-519. doi:10.2105/AJPH.2013.301597

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Boutari, C., Pappas, P. D., Mintziori, G., Nigdelis, M. P., Athanasiadis, L., Goulis, D. G., & Mantzoros, C. S. (2020). The effect of underweight on female and male reproduction. Metabolism, 107, 154229. https://doi.org/10.1016/j.metabol.2020.154229

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Centers for Disease Control and Prevention (CDC). (2012). National Health and Nutrition Examination Survey (NHANES). Prevalence of underweight among adults aged 20 and over: United States, 1960--1962 Through 2011--2012. Retrieved from https://www.cdc.gov/nchs/data/hestat/underweight_adult_11_12/underweight_adult_11_12.htm

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Diehr, P., O'Meara, E. S., Fitzpatrick A., Newman, A. B., Kuller, L., Burke, G. (2008). Weight, mortality, years of healthy life, and active life expectancy in older adults. Journal of the American Geriatrics Society, 56(1), 76-83. https://doi.org/10.1111/j.1532-5415.2007.01500.x

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Dong, Z., Xu, X., Wang, C., Cartledge, S., Maddison, R., & Mohammed Shariful Islam, S. (2020). Association of overweight and obesity with obstructive sleep apnoea: A systematic review and meta-analysis. Obesity Medicine, 17. doi:https://doi.org/10.1016/j.obmed.2020.100185

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Donini, L. M., Savina, C., Gennaro, E., De Felice, M. R., Rosano, A., Pandolfo, M. M., Del Balzo, V., ...Chumlea, W. C. et al. (2012). A systematic review of the literature concerning the relationship between obesity and mortality in the elderly. The Journal of Nutrition, Health & Aging, 16(1), 89-98. doi:10.1007/s12603-011-0073-x

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Fitch, A., Everling, L., Fox, C.,Goldberg, J., Heim, C., Johnson, K., ...Webb, B. (2013, May). Prevention and management of obesity for adults. Bloomington, MN: Institute for Clinical Systems Improvement.

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Fitzpatrick, S. L., & Stevens, V. J. (2017). Adult obesity management in primary care, 2008-2013. Preventive medicine, 99, 128--133. https://doi.org/10.1016/j.ypmed.2017.02.020

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Fryar, C. D., & Ogden, C. L. (2012). Prevalence of underweight among adults aged 20 and over: United States, 1960-1962 through 2007-2010. Hyattsville, MD: NCHS, Division of Health and Nutrition Examination Surveys. Retrieved from http://www.cdc.gov/nchs/data/hestat/underweight_adult_07_10/underweight_adult_07_10.pdf

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Guo, D., Xu, M., Zhou, Q., Wu, C., Ju, R., & Dai, J. (2019). Is low body mass index a risk factor for semen quality? A PRISMA -compliant meta-analysis. Medicine, 98(32), e16677. https://doi.org/10.1097/MD.0000000000016677

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Holme, I., & Tonstad, S. (2015). Survival in elderly men in relation to midlife and current BMI. Age and Ageing, 44(3), 434-439

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Katakam , A., Melnic, C. M., Bragdon, C. R., Sauder, N., Collins, A. K., & Bedair, H. S. (2021). Low body mass index is a predictor for mortality and increased length of stay following total joint arthroplasty. The Journal of Arthroplasty, 36(1), 72-77. https://doi.org/10.1016/j.arth.2020.07.055

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LeBlanc, E., O'Connor, E., Whitlock, E. P., et al. (2011). Screening for and management of obesity and overweight in adults (Evidence Report No. 89; AHRQ Publication No. 11-05159-EF-1). Rockville, MD: Agency for Healthcare Research and Quality

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Moser, J. S., Galindo-Fraga, A., Ortiz-Hernández, A. A., Gu, W., Hunsberger, S., Galán-Herrera, J. F., Guerrero, M. L., Ruiz-Palacios, G. M., Beigel, J. H., & La Red ILI 002 Study Group. (2019). Underweight, overweight, and obesity as independent risk factors for hospitalization in adults and children from influenza and other respiratory viruses. Influenza and Other Respiratory Viruses, 13(1), 3-9. https://doi.org/10.1111/irv.12618

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NHLBI Obesity Education Initiative. (1998). Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults (Report No. 98-4083). Bethesda, MD: NHLBI

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Ogden, C.L., Carroll, M.D., Fryar, C.D., Flegal, K.M. (2015). Prevalence of obesity among adults and youth: United States, 2011--2014. NCHS data brief, no 219. Hyattsville, MD: National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db219.pdf

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Ottesen, T. D., Galivanche, A. R., Greene, J. D., Malpani, R., Varthi, A. G., & Grauer, J. N. (2022). Underweight patients are the highest risk body mass index group for perioperative adverse events following stand-alone anterior lumbar interbody fusion. The Spine Journal: Official Journal of the North American Spine Society, 22(7), 1139-1148. https://doi.org/10.1016/j.spinee.2022.02.012

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Ottesen, T. D., Malpani, R., Galivanche, A. R., Zogg, C. K., Varthi, A. G., & Grauer, J. N. (2020). Underweight patients are at just as much risk as super morbidly obese patients when undergoing anterior cervical spine surgery. The Spine Journal: Official Journal of the North American Spine Society, 20(7), 1085-1095. https://doi.org/10.1016/j.spinee.2020.03.007

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Raynor, H. A., & Champagne, C. M. (2016). Position of the Academy of Nutrition and Dietetics: Interventions for the treatment of overweight and obesity in adults. Journal of the Academy of Nutrition and Dietetics, 116(1), 129-147. doi:10.1016/jand.2015.10.031

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Rudasill, S. E., Dillon, D., Karunungan, K., Mardock, A. L., Hadaya, J., Sanaiha, Y., Tran, Z., & Benharash, P. (2021). The obesity paradox: Underweight patients are at the greatest risk of mortality after cholecystectomy. Surgery, 170(3), 675-681. https://doi.org/10.1016/j.surg.2021.03.034

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Tronieri, J. S., Wadden, T. A., Chao, A. M., & Tsai, A. G. (2019). Primary Care Interventions for Obesity: Review of the Evidence. Current obesity reports, 8(2), 128--136. https://doi.org/10.1007/s13679-019-00341-5

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U.S. Preventive Services Task Force (USPSTF). (2018). Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: U.S. Preventive Services Task Force recommendation statement. JAMA, 320(11), 1163--1171. doi:10.1001/jama.2018.13022

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Wadden, T. A, Butryn, M. L., Wilson, C. (2007). Lifestyle modification for the management of obesity. Gastroenterology, 132 (6), 2226-2238. doi: 10.1053/j.gastro.2007.03.051

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Wadden, T. A., Tronieri, J. S., & Butryn, M. L. (2020). Lifestyle modification approaches for the treatment of obesity in adults. American Psychologist, 75(2), 235--251

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Ye, P., Pang, R., Li, L., Li, H. R., Liu, S. L., & Zhao, L. (2021). Both underweight and obesity are associated with an increased risk of coronavirus disease 2019 (COVID-19) severity. Frontiers in Nutrition, 8, 649422. https://doi.org/10.3389/fnut.2021.649422

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Guidance (Usage)This eCQM is a patient-based measure. This measure is to be reported a minimum of once per measurement period for patients seen during the measurement period.\n\nThis measure may be reported by eligible clinicians who perform the quality actions described in the measure based on the services provided at the time of the qualifying encounter or during the measurement period and the measure-specific denominator coding.\n\nTelehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.\n\nBMI Measurement Guidance:\n\n* Height and Weight\n\n * An eligible clinician or their staff is required to measure both height and weight. Both height and weight must be measured during the measurement period. Self-reported values cannot be used.\n\n* The BMI may be documented in the provider's medical record or outside medical records obtained by the provider.\n\n * If the documented BMI is outside of normal parameters, then a follow-up plan is documented during the encounter or measurement period.\n\n * If more than one BMI is reported during the measurement period, and any of the documented BMI assessments is outside of normal parameters, documentation of an appropriate follow-up plan will be used to determine if performance has been met.\n\n* Review the exclusions and exceptions criteria to determine those patients that BMI measurement may not be appropriate or necessary.\n\nFollow-Up Plan Guidance:\n\nThe documented follow-up plan must be based on the documented BMI, outside of normal parameters, for example: "Patient referred to nutrition counseling for BMI above or below normal parameters." See the Definition section for examples of follow-up plan treatments.\n\nVariation has been noted in studies exploring optimal BMI ranges for the elderly (see Donini et al., 2012; Holme \\& Tonstad, 2015; Diehr et al., 2008). Notably, however, all these studies have arrived at ranges that differ from the standard range for ages 18 and older, which is \\>= 18.5 and \\< 25 kg/m2. For instance, both Donini et al. and Holme and Tonstad reported findings that suggest that a higher BMI (higher than the upper end of 25 kg/m2) in the elderly may be beneficial. Similarly, worse outcomes have been associated with being underweight (at a threshold higher than 18.5 kg/m2) at age 65 (Diehr et al., 2008). Because of optimal BMI range variation recommendations from these studies, no specific optimal BMI range for the elderly is used. However, exempting certain patients from a follow-up plan may be appropriate by applying the exception criteria. See Denominator Exception section for examples.\n\nDenominator Exception Guidance:\n\nIf a patient meets exception criteria for the denominator (i.e., the patient refuses height or weight measurement or has a documented medical reason for not documenting BMI or a follow-up plan), an eligible clinician must document those criteria on the same day as the qualifying encounter.\n\nThis FHIR-based measure has been derived from the QDM-based measure CMS69v14. 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).\n
Measure Group (Rate) (ID: Group_1)
SummaryPercentage of patients aged 18 years and older with a BMI documented during the current encounter or during the measurement period AND who had a follow-up plan documented if BMI was outside of normal parameters\n
Basisboolean
Scoring\n Proportion\n\n\n
Improvement Notation\n Increased score indicates improvement\n\n\n
Type\n Process\n\n\n
Initial Population\n \n ID: InitialPopulation_1\n
\n \n \n Description:\n

All patients aged 18 and older on the date of the encounter with at least one qualifying encounter during the measurement period\n

\n \n \n \n \n \n Criteria: Initial Population \n \n \n \n \n \n \n
Denominator\n \n ID: Denominator_1\n
\n \n \n Description:\n

Equals Initial Population\n

\n \n \n \n \n \n Criteria: Denominator \n \n \n \n \n \n \n
Denominator Exclusion\n \n ID: DenominatorExclusion_1\n
\n \n \n Description:\n

Patients who are pregnant at any time during the measurement period. Patients receiving palliative or hospice care at any time during the measurement period.\n

\n \n \n \n \n \n Criteria: Denominator Exclusions \n \n \n \n \n \n \n
Denominator Exception\n \n ID: DenominatorException_1\n
\n \n \n Description:\n

* Patients with a documented medical reason for not documenting BMI or for not documenting a follow-up plan for a BMI outside normal parameters (e.g., elderly patients 65 years of age or older for whom weight reduction/weight gain would complicate other underlying health conditions such as illness or physical disability, mental illness, dementia, confusion, or nutritional deficiency such as vitamin/mineral deficiency; patients in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient's health status).\n\n* Patients who refuse measurement of height and/or weight.\n\n

\n \n \n \n \n \n Criteria: Denominator Exceptions \n \n \n \n \n \n \n
Numerator\n \n ID: Numerator_1\n
\n \n \n Description:\n

Patients with a documented BMI during the encounter or during the measurement period, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the measurement period\n

\n \n \n \n \n \n Criteria: Numerator \n \n \n \n \n \n \n
\n\n\n\nFor every patient evaluated by this measure also identify payer, race, ethnicity and sex
Supplemental Data Elements
Supplemental Data Element\n \n ID: sde-ethnicity\n \n
\n \n \n \n \n \n Usage Code: Supplemental Data\n \n
\n \n \n \n Description: SDE Ethnicity\n\n \n \n \n
\n \n \n Logic Definition: SDE Ethnicity \n \n \n \n
Supplemental Data Element\n \n ID: sde-payer\n \n
\n \n \n \n \n \n Usage Code: Supplemental Data\n \n
\n \n \n \n Description: SDE Payer\n\n \n \n \n
\n \n \n Logic Definition: SDE Payer \n \n \n \n
Supplemental Data Element\n \n ID: sde-race\n \n
\n \n \n \n \n \n Usage Code: Supplemental Data\n \n
\n \n \n \n Description: SDE Race\n\n \n \n \n
\n \n \n Logic Definition: SDE Race \n \n \n \n
Supplemental Data Element\n \n ID: sde-sex\n \n
\n \n \n \n \n \n Usage Code: Supplemental Data\n \n
\n \n \n \n Description: SDE Sex\n\n \n \n \n
\n \n \n Logic Definition: SDE Sex \n \n \n \n
Measure Logic
Primary Libraryhttps://madie.cms.gov/Library/CMS69FHIRPCSBMIScreenAndFollowUp
Contents\n Population Criteria\n
\n Logic Definitions\n
\n Terminology\n
\n Dependencies\n
\n Data Requirements\n
\n Parameters\n
\n
Population Criteria
Measure Group (Rate) (ID: Group_1)
\n \n Initial Population\n \n
\n \n \n \n \n \n \n \n 
define "Initial Population":\n  exists "Qualifying Encounter During Day Of Measurement Period" QualifyingEncounter\n    where "AgeInYearsAt"(date from start of QualifyingEncounter.period) >= 18
\n \n \n Definition\n \n
\n \n Denominator\n \n
\n \n \n \n \n \n \n \n 
define "Denominator":\n  "Initial Population"
\n \n \n Definition\n \n
\n \n Denominator Exclusion\n \n
\n \n \n \n \n \n \n \n 
define "Denominator Exclusions":\n  Hospice."Has Hospice Services"\n    or PalliativeCare."Has Palliative Care in the Measurement Period"\n    or "Is Pregnant During Measurement Period"
\n \n \n Definition\n \n
\n \n Denominator Exception\n \n
\n \n \n \n \n \n \n \n 
define "Denominator Exceptions":\n  exists "Medical Reason For Not Documenting A Follow Up Plan For Low Or High BMI"\n    or exists "Medical Reason Or Patient Reason For Not Performing BMI Exam"
\n \n \n Definition\n \n
\n \n Numerator\n \n
\n \n \n \n \n \n \n \n 
define "Numerator":\n  exists "High BMI And Follow Up Provided"\n    or exists "Low BMI And Follow Up Provided"\n    or "Has Normal BMI"
\n \n \n Definition\n \n
Logic Definitions
\n Logic Definition\n Library Name: Hospice
\n \n \n \n \n \n \n 
define "Has Hospice Services":\n  exists ((([USQualityCore.Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter\n      where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"\n          or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"\n      )\n        and InpatientEncounter.period ends during day of "Measurement Period"\n  )\n    or exists ((([USQualityCore.Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter\n        where HospiceEncounter.period overlaps day of "Measurement Period"\n    )\n    // TODO: Shouldn't need to specify a code path here (see https://jira.hl7.org/browse/FHIR-53941)\n    or exists ((([USQualityCore.ObservationScreeningAssessment: code ~ "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment\n        where HospiceAssessment.value ~ "Yes (qualifier value)"\n          and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"\n    )\n    or exists ((([USQualityCore.ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder\n        where HospiceOrder.authoredOn during day of "Measurement Period"\n    )\n    or exists ((([USQualityCore.Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed\n        where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"\n    )\n    // TODO: Consider whether to keep this as the union of Problems and EncounterDiagnosis\n    or exists ((([FHIR.Condition: "Hospice Diagnosis"]).verified()) HospiceCareDiagnosis\n        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"\n    )
\n
\n Logic Definition\n Library Name: PalliativeCare
\n \n \n \n \n \n \n 
define "Has Palliative Care in the Measurement Period":\n  // TODO: Shouldn't need to specify a code path here (see https://jira.hl7.org/browse/FHIR-53941)\n  exists ((([USQualityCore.ObservationScreeningAssessment: code ~ "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment\n      where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period"\n  )\n    // TODO: Consider whether to keep this as the union of the problems and encounter diagnosis list? Anything enforced by the profiles that is expected but isn't stated here?\n    or exists ((([FHIR.Condition: "Palliative Care Diagnosis"]).verified()) PalliativeDiagnosis\n        where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"\n    )\n    or exists ((([USQualityCore.Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter\n        where PalliativeEncounter.period overlaps day of "Measurement Period"\n    )\n    or exists ((([USQualityCore.Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention\n        where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement Period"\n    )
\n
\n Logic Definition\n Library Name: SupplementalDataElements
\n \n \n \n \n \n \n 
define "SDE Sex":\n  case\n    when Patient.sex() = '248153007' then "Male (finding)"\n    when Patient.sex() = '248152002' then "Female (finding)"\n    else null\n  end
\n
\n Logic Definition\n Library Name: SupplementalDataElements
\n \n \n \n \n \n \n 
define "SDE Payer":\n  [USQualityCore.Coverage: type in "Payer Type"] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }
\n
\n Logic Definition\n Library Name: SupplementalDataElements
\n \n \n \n \n \n \n 
define "SDE Ethnicity":\n  (Patient.ethnicity()) E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }
\n
\n Logic Definition\n Library Name: SupplementalDataElements
\n \n \n \n \n \n \n 
define "SDE Race":\n  (Patient.race()) R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "SDE Sex":\n  SDE."SDE Sex"
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "BMI During Measurement Period":\n  ( ( [USCore.BMIProfile] ).isObservationBMI ( ) ) BMI\n    where BMI.value > 0 'kg/m2'\n      and BMI.effective.toInterval ( ) during day of "Measurement Period"
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "Documented High BMI During Measurement Period":\n  "BMI During Measurement Period" BMI\n    where BMI.value >= 25 'kg/m2'
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "High BMI Interventions Ordered":\n  ( ( [ServiceRequest: "Follow Up for Above Normal BMI"]\n      union [ServiceRequest: "Referrals Where Weight Assessment May Occur"]\n      union [MedicationRequest: "Medications for Above Normal BMI"] ) HighInterventionsOrdered\n      where HighInterventionsOrdered.reasonCode in "Overweight or Obese"\n        or ( exists ( [ConditionProblemsHealthConcerns: "Overweight or Obese"]\n            union [ConditionEncounterDiagnosis: "Overweight or Obese"] ) OverweightObese\n            where OverweightObese.onset.toInterval ( ) starts before or on day of HighInterventionsOrdered.authoredOn\n        )\n  )
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "High BMI Interventions Performed":\n  ( [Procedure: "Follow Up for Above Normal BMI"] HighInterventionsPerformed\n      where HighInterventionsPerformed.reasonCode in "Overweight or Obese"\n        or ( exists [ConditionProblemsHealthConcerns: "Overweight or Obese"] OverweightObese\n            where OverweightObese.prevalenceInterval ( ) starts before or on day of start of HighInterventionsPerformed.performed.toInterval ( )\n              and not ( OverweightObese.prevalenceInterval ( ) ends before day of start of HighInterventionsPerformed.performed.toInterval ( ) )\n        )\n  )
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "High BMI And Follow Up Provided":\n  "Documented High BMI During Measurement Period" HighBMI\n    with ( "High BMI Interventions Ordered"\n      union "High BMI Interventions Performed" ) HighBMIInterventions\n      such that Coalesce(HighBMIInterventions.performed.toInterval(), HighBMIInterventions.authoredOn.toInterval()) starts during day of "Measurement Period"
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "Documented Low BMI During Measurement Period":\n  "BMI During Measurement Period" BMI\n    where BMI.value < 18.5 'kg/m2'
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "Low BMI Interventions Ordered":\n  ( ( [ServiceRequest: "Follow Up for Below Normal BMI"]\n      union [ServiceRequest: "Referrals Where Weight Assessment May Occur"]\n      union [MedicationRequest: "Medications for Below Normal BMI"] ) LowInterventionsOrdered\n      where LowInterventionsOrdered.reasonCode in "Underweight"\n        or ( exists ( [ConditionProblemsHealthConcerns: "Underweight"]\n            union [ConditionEncounterDiagnosis: "Underweight"] ) UnderweightDiagnosis\n            where UnderweightDiagnosis.onset.toInterval ( ) starts before or on day of LowInterventionsOrdered.authoredOn\n              and LowInterventionsOrdered.authoredOn during day of "Measurement Period"\n        )\n  )
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "Low BMI Interventions Performed":\n  ( [Procedure: "Follow Up for Below Normal BMI"] LowInterventionsPerformed\n      where LowInterventionsPerformed.reasonCode in "Underweight"\n        and LowInterventionsPerformed.status = 'completed'\n        or ( exists [ConditionProblemsHealthConcerns: "Underweight"] UnderweightDiagnosis\n            where ( UnderweightDiagnosis.isHealthConcern ( ) )\n              and UnderweightDiagnosis.prevalenceInterval ( ) starts before or on day of start of LowInterventionsPerformed.performed.toInterval ( )\n              and LowInterventionsPerformed.performed.toInterval ( ) during day of "Measurement Period"\n              and not ( UnderweightDiagnosis.prevalenceInterval ( ) ends before day of start of LowInterventionsPerformed.performed.toInterval ( ) )\n        )\n  )
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "Low BMI And Follow Up Provided":\n  ( "Documented Low BMI During Measurement Period" LowBMI\n      with ( "Low BMI Interventions Ordered"\n        union "Low BMI Interventions Performed" ) LowBMIInterventions\n        such that Coalesce(LowBMIInterventions.performed.toInterval(), LowBMIInterventions.authoredOn.toInterval()) starts during day of "Measurement Period"\n  )
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "Has Normal BMI":\n  exists ( "BMI During Measurement Period" BMI\n      where BMI.value >= 18.5 'kg/m2'\n        and BMI.value < 25 'kg/m2'\n  )\n    and not ( exists "Documented High BMI During Measurement Period"\n        or exists "Documented Low BMI During Measurement Period"\n    )
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "Numerator":\n  exists "High BMI And Follow Up Provided"\n    or exists "Low BMI And Follow Up Provided"\n    or "Has Normal BMI"
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "Qualifying Encounter During Day Of Measurement Period":\n  [Encounter: "Encounter to Evaluate BMI"] BMIEncounter\n    where BMIEncounter.period during day of "Measurement Period"\n      and BMIEncounter.class !~ "virtual"\n      and BMIEncounter.status = 'finished'
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "Initial Population":\n  exists "Qualifying Encounter During Day Of Measurement Period" QualifyingEncounter\n    where "AgeInYearsAt"(date from start of QualifyingEncounter.period) >= 18
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "Denominator":\n  "Initial Population"
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "SDE Payer":\n  SDE."SDE Payer"
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "SDE Ethnicity":\n  SDE."SDE Ethnicity"
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "Is Pregnant During Measurement Period":\n  exists ( ( [ConditionProblemsHealthConcerns: "Pregnancy or Other Related Diagnoses"]\n      union [ConditionEncounterDiagnosis: "Pregnancy or Other Related Diagnoses"] ) PregnancyDiagnosis\n      where PregnancyDiagnosis.onset.toInterval ( ) overlaps day of "Measurement Period"\n  )\n    or exists ( [USCore.ObservationPregnancyStatusProfile] PregnantObservation\n        where PregnantObservation.effective.toInterval ( ) overlaps day of "Measurement Period"\n          and PregnantObservation.status in { 'final', 'amended', 'corrected' }\n          and ( PregnantObservation.value in "Pregnancy or Other Related Diagnoses" )\n    )
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "Denominator Exclusions":\n  Hospice."Has Hospice Services"\n    or PalliativeCare."Has Palliative Care in the Measurement Period"\n    or "Is Pregnant During Measurement Period"
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "SDE Race":\n  SDE."SDE Race"
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "Medical Reason For Not Documenting A Follow Up Plan For Low Or High BMI":\n  ( ( [ServiceNotRequested: "Referrals Where Weight Assessment May Occur"]\n      union [ServiceNotRequested: "Follow Up for Above Normal BMI"]\n      union [ServiceNotRequested: "Follow Up for Below Normal BMI"] ) NoBMIFollowUp\n      with "Qualifying Encounter During Day Of Measurement Period" QualifyingEncounter\n        such that NoBMIFollowUp.authoredOn same day as start of QualifyingEncounter.period\n      where NoBMIFollowUp.status ~ 'completed'\n        and NoBMIFollowUp.reasonRefused ( ) in "Medical Reason"\n  )\n    union ( ( [MedicationNotRequested: "Medications for Above Normal BMI"]\n        union [MedicationNotRequested: "Medications for Below Normal BMI"] ) NoBMIFollowUp\n        with "Qualifying Encounter During Day Of Measurement Period" QualifyingEncounter\n          such that NoBMIFollowUp.authoredOn same day as start of QualifyingEncounter.period\n        where NoBMIFollowUp.status ~ 'completed'\n          and NoBMIFollowUp.reasonCode in "Medical Reason"\n    )
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "Medical Reason Or Patient Reason For Not Performing BMI Exam":\n  [ObservationCancelled: "Body mass index (BMI) [Ratio]"] NoBMI\n    with "Qualifying Encounter During Day Of Measurement Period" QualifyingEncounter\n      such that NoBMI.effective.toInterval ( ) ends same day as start of QualifyingEncounter.period\n    where ( NoBMI.notDoneReason ( ) in "Patient Declined"\n        or NoBMI.notDoneReason ( ) in "Medical Reason"\n    )
\n
\n Logic Definition\n Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
\n \n \n \n \n \n \n 
define "Denominator Exceptions":\n  exists "Medical Reason For Not Documenting A Follow Up Plan For Low Or High BMI"\n    or exists "Medical Reason Or Patient Reason For Not Performing BMI Exam"
\n
\n Logic Definition\n Library Name: Status
\n \n \n \n \n \n \n 
define fluent function isObservationBMI(Obs List<BMIProfile>):\n  Obs O\n    where O.status in { 'final', 'amended', 'corrected' }
\n
\n Logic Definition\n Library Name: Status
\n \n \n \n \n \n \n 
//Encounter, Performed\n//General usage unless required otherwise by measure intent (e.g., follow-up encounters)\ndefine fluent function isEncounterPerformed(Enc List<FHIR.Encounter>):\n  Enc E\n    where E.status = 'finished'
\n
\n Logic Definition\n Library Name: Status
\n \n \n \n \n \n \n 
//Assessment, Performed\ndefine fluent function isAssessmentPerformed(Obs List<ObservationScreeningAssessment>):\n  Obs O\n    where O.status in { 'final', 'amended', 'corrected' }
\n
\n Logic Definition\n Library Name: Status
\n \n \n \n \n \n \n 
//Intervention, Order\ndefine fluent function isInterventionOrder(ServiceRequest List<FHIR.ServiceRequest>):\n  ServiceRequest S\n    where S.status in { 'active', 'completed' }\n      and S.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}
\n
\n Logic Definition\n Library Name: Status
\n \n \n \n \n \n \n 
//Intervention, Performed\ndefine fluent function isInterventionPerformed(Proc List<FHIR.Procedure>):\n  Proc P\n    where P.status ~ 'completed'
\n
\n Logic Definition\n Library Name: FHIRCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns the single extension (if present) on the given resource with the specified url.\n@comment: This function uses singleton from to ensure that a run-time exception is thrown if there\nis more than one extension on the given resource with the specified url.\n*/\ndefine fluent function ext(domainResource DomainResource, url String):\n  singleton from domainResource.exts(url)
\n
\n Logic Definition\n Library Name: FHIRCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns any extensions defined on the given resource with the specified url\n*/\ndefine fluent function exts(domainResource DomainResource, url String):\n  domainResource.extension E\n    where E.url = url\n    return E
\n
\n Logic Definition\n Library Name: FHIRCommon
\n \n \n \n \n \n \n 
/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in FHIR, allowing this function to be used across any resource.\n\nThe input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime.\nIf the input is a Period, the result is a DateTime Interval.\nIf the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing.\nIf the input is an instant, the result is a DateTime Interval beginning and ending on that instant.\nIf the input is a string, an error is raised indicating a single interval cannot be computed from a string.\nIf the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age,\nand ending immediately prior to when the patient was the given Age plus one year.\nIf the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given\nby the low end of the Range, and ending immediately prior to when the patient was the Age given by the\nhigh end of the Range plus one year.\n\nNOTE: Due to the\ncomplexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used\nwith a Timing or String.\n*/\ndefine fluent function toInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>):\n  case\n    when choice is FHIR.dateTime then\n      Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]\n    when choice is FHIR.Period then\n      FHIRHelpers.ToInterval(choice as FHIR.Period)\n    when choice is FHIR.instant then\n      Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]\n    when choice is FHIR.Age then\n      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),\n        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)\n    when choice is FHIR.Range then\n      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),\n        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)\n    when choice is FHIR.Timing then\n      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported')\n    when choice is FHIR.string then\n      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')\n    else\n      null as Interval<DateTime>\n  end
\n
\n Logic Definition\n Library Name: FHIRCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition resource.\n@comment: Uses the toInterval and toAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ "active"\n  or condition.clinicalStatus ~ "recurrence"\n  or condition.clinicalStatus ~ "relapse" then\n  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n  (end of condition.abatementInterval()) abatementDate\n    return \n\t  if abatementDate is null then\n        Interval[start of condition.onset.toInterval(), abatementDate)\n      else\n        Interval[start of condition.onset.toInterval(), abatementDate]
\n
\n Logic Definition\n Library Name: FHIRCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns an interval representing the normalized Abatement of a given Condition resource.\n@comment: @comment: If the abatement element of the Condition is represented as a DateTime, the result\nis an interval beginning and ending on that DateTime.\nIf 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\nresult is an interval from the date the patient turned that age to immediately before one year later.\nIf the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during\nwhich the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately\nbefore one year later than the date the patient turned the ending age of the quantity interval.\n\nNOTE: Due to the complexity of determining an interval from a String, this function will throw\na run-time exception if used with a Condition instance that has a String as the abatement value.\n*/\ndefine fluent function abatementInterval(condition Condition):\n  if condition.abatement is FHIR.dateTime then\n    Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)]\n  else if condition.abatement is FHIR.Period then\n    FHIRHelpers.ToInterval(condition.abatement as FHIR.Period)\n  else if condition.abatement is FHIR.string then\n    Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')\n  else if condition.abatement is FHIR.Age then\n    Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age),\n      FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year)\n  else if condition.abatement is FHIR.Range then\n    Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low),\n      FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year)\n  else if condition.abatement is FHIR.boolean then\n    Interval[end of condition.onset.toInterval(), condition.recordedDate)\n  else \n    null
\n
\n Logic Definition\n Library Name: FHIRCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns the single extension (if present) on the given element with the specified url.\n@comment: This function uses singleton from to ensure that a run-time exception is thrown if there\nis more than one extension on the given element with the specified url.\n*/\ndefine fluent function ext(element Element, url String):\n  singleton from element.exts(url)
\n
\n Logic Definition\n Library Name: FHIRCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns any extensions defined on the given element with the specified url.\n*/\ndefine fluent function exts(element Element, url String):\n  element.extension E\n    where E.url = url\n    return E
\n
\n Logic Definition\n Library Name: FHIRCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns conditions in the given list that either have no verification status or have a verification status of confirmed, unconfirmed, provisional, or differential\n*/\ndefine fluent function verified(conditions List<FHIR.Condition>):\n  conditions C\n    where C.verificationStatus is not null implies\n      (C.verificationStatus ~ "confirmed"\n        or C.verificationStatus ~ "unconfirmed"\n        or C.verificationStatus ~ "provisional"\n        or C.verificationStatus ~ "differential"\n      )
\n
\n Logic Definition\n Library Name: USCoreCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns the sex element as defined for the USCore patient profile\n*/\ndefine fluent function sex(patient Patient):\n  patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex').value as FHIR.code
\n
\n Logic Definition\n Library Name: USCoreCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns true if the given condition is a health concern\n*/\ndefine fluent function isHealthConcern(condition FHIR.Condition):\n  exists (\n    condition.category C\n      where C ~ "health-concern"\n  )
\n
\n Logic Definition\n Library Name: USCoreCommon
\n \n \n \n \n \n \n 
define fluent function ethnicity(patient Patient):\n  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity')) E\n    return {\n      ombCategory: E.ext('ombCategory').value as FHIR.Coding,\n      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,\n      text: E.ext('text').value as FHIR.string\n    }
\n
\n Logic Definition\n Library Name: USCoreCommon
\n \n \n \n \n \n \n 
define fluent function race(patient Patient):\n  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-race')) E\n    return {\n      ombCategory: (E.exts('ombCategory')) o return o.value as FHIR.Coding,\n      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,\n      text: E.ext('text').value as FHIR.string\n    }
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
define function ToString(value string): value.value
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
define function ToString(value uri): value.value
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
define function ToString(value ObservationStatus): value.value
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
/*\n@description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) \nvalue to a CQL Quantity\n@comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity\nhas a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`)\nan error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used.\n@seealso: ToCalendarUnit\n*/\ndefine function ToQuantity(quantity FHIR.Quantity):\n    case\n        when quantity is null then null\n        when quantity.value is null then null\n        when quantity.comparator is not null then\n            Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')\n        when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'\n              or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then\n            System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }\n        else\n            Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')\n    end
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
/*\n@description: Converts a UCUM definite duration unit to a CQL calendar duration\nunit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities) \ntopic of the CQL specification.\n@comment: Note that for durations above days (or weeks), the conversion is understood to be approximate\n*/\ndefine function ToCalendarUnit(unit System.String):\n    case unit\n        when 'ms' then 'millisecond'\n        when 's' then 'second'\n        when 'min' then 'minute'\n        when 'h' then 'hour'\n        when 'd' then 'day'\n        when 'wk' then 'week'\n        when 'mo' then 'month'\n        when 'a' then 'year'\n        else unit\n    end
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
define function ToDateTime(value dateTime): value.value
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
/*\n@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)\nvalue to a CQL DateTime Interval\n@comment: If the start value of the given period is unspecified, the starting\nboundary of the resulting interval will be open (meaning the start of the interval\nis unknown, as opposed to interpreted as the beginning of time).\n*/\ndefine function ToInterval(period FHIR.Period):\n    if period is null then\n        null\n    else\n        if period."start" is null then\n            Interval(period."start".value, period."end".value]\n        else\n            Interval[period."start".value, period."end".value]
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
define function ToDateTime(value instant): value.value
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
define function ToDate(value date): value.value
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
define function ToString(value ProcedureStatus): value.value
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
define function ToString(value EncounterStatus): value.value
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
define function ToString(value ServiceRequestStatus): value.value
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
define function ToString(value ServiceRequestIntent): value.value
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
define function ToString(value MedicationRequestStatus): value.value
\n
\n Logic Definition\n Library Name: USQualityCoreCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns the value of the recorded extension for a Medication Administration Not Done\n*/\ndefine fluent function reasonRefused(serviceNotRequested ServiceNotRequested):\n  serviceNotRequested.ext('http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-doNotPerformReason').value as FHIR.CodeableConcept
\n
\n Logic Definition\n Library Name: USQualityCoreCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns the notDoneReason for an ObservationCancelled\n*/\ndefine fluent function notDoneReason(observationCancelled ObservationCancelled):\n  observationCancelled.ext('http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneReason').value as FHIR.CodeableConcept
\n
Terminology
Code System\n \n Description: Code system SNOMEDCT\n \n
\n \n \n \n \n \n \n Resource: SNOMED CT (all versions)\n
\n Canonical URL: http://snomed.info/sct\n \n
Code System\n \n Description: Code system ConditionClinicalStatusCodes\n \n
\n \n \n \n \n \n \n Resource: Condition Clinical Status Codes\n
\n Canonical URL: http://terminology.hl7.org/CodeSystem/condition-clinical\n \n
Code System\n \n Description: Code system USCoreConditionCategory\n \n
\n \n \n \n \n \n \n Resource: US Core Condition Category Extension Codes\n
\n Canonical URL: http://hl7.org/fhir/us/core/CodeSystem/condition-category\n \n
Code System\n \n Description: Code system ActCode\n \n
\n \n \n \n \n \n \n Resource: ActCode\n
\n Canonical URL: http://terminology.hl7.org/CodeSystem/v3-ActCode\n \n
Code System\n \n Description: Code system LOINC\n \n
\n \n \n \n \n \n \n Resource: Logical Observation Identifiers, Names and Codes (LOINC)\n
\n Canonical URL: http://loinc.org\n \n
Code System\n \n Description: Code system ConditionVerificationStatusCodes\n \n
\n \n \n \n \n \n \n Resource: ConditionVerificationStatus\n
\n Canonical URL: http://terminology.hl7.org/CodeSystem/condition-ver-status\n \n
Value Set\n \n Description: Value set Follow Up for Above Normal BMI\n \n
\n \n \n \n \n \n \n Resource: Follow Up for Above Normal BMI\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1525\n \n
Value Set\n \n Description: Value set Referrals Where Weight Assessment May Occur\n \n
\n \n \n \n \n \n \n Resource: Referrals Where Weight Assessment May Occur\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1527\n \n
Value Set\n \n Description: Value set Medications for Above Normal BMI\n \n
\n \n \n \n \n \n \n Resource: Medications for Above Normal BMI\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1561\n \n
Value Set\n \n Description: Value set Overweight or Obese\n \n
\n \n \n \n \n \n \n Resource: Overweight or Obese\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1047.502\n \n
Value Set\n \n Description: Value set Follow Up for Below Normal BMI\n \n
\n \n \n \n \n \n \n Resource: Follow Up for Below Normal BMI\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1528\n \n
Value Set\n \n Description: Value set Medications for Below Normal BMI\n \n
\n \n \n \n \n \n \n Resource: Medications for Below Normal BMI\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1562\n \n
Value Set\n \n Description: Value set Underweight\n \n
\n \n \n \n \n \n \n Resource: Underweight\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1563\n \n
Value Set\n \n Description: Value set Encounter to Evaluate BMI\n \n
\n \n \n \n \n \n \n Resource: Encounter to Evaluate BMI\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1751\n \n
Value Set\n \n Description: Value set Payer Type\n \n
\n \n \n \n \n \n \n Resource: Payer Type\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591\n \n
Value Set\n \n Description: Value set Encounter Inpatient\n \n
\n \n \n \n \n \n \n Resource: Encounter Inpatient\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307\n \n
Value Set\n \n Description: Value set Hospice Encounter\n \n
\n \n \n \n \n \n \n Resource: Hospice Encounter\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003\n \n
Value Set\n \n Description: Value set Hospice Care Ambulatory\n \n
\n \n \n \n \n \n \n Resource: Hospice Care Ambulatory\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584\n \n
Value Set\n \n Description: Value set Hospice Diagnosis\n \n
\n \n \n \n \n \n \n Resource: Hospice Diagnosis\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165\n \n
Value Set\n \n Description: Value set Palliative Care Diagnosis\n \n
\n \n \n \n \n \n \n Resource: Palliative Care Diagnosis\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167\n \n
Value Set\n \n Description: Value set Palliative Care Encounter\n \n
\n \n \n \n \n \n \n Resource: Palliative Care Encounter\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090\n \n
Value Set\n \n Description: Value set Palliative Care Intervention\n \n
\n \n \n \n \n \n \n Resource: Palliative Care Intervention\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135\n \n
Value Set\n \n Description: Value set Pregnancy or Other Related Diagnoses\n \n
\n \n \n \n \n \n \n Resource: Pregnancy Obstetric or Maternal Diagnoses\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1623\n \n
Value Set\n \n Description: Value set Medical Reason\n \n
\n \n \n \n \n \n \n Resource: Medical Reason\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007\n \n
Value Set\n \n Description: Value set Patient Declined\n \n
\n \n \n \n \n \n \n Resource: Patient Declined\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1582\n \n
Direct Reference Code\n \n Display: Male (finding)\n
\n \n Code: 248153007\n
\n System: http://snomed.info/sct\n
Direct Reference Code\n \n Display: Female (finding)\n
\n \n Code: 248152002\n
\n System: http://snomed.info/sct\n
Direct Reference Code\n \n Code: active\n
\n System: http://terminology.hl7.org/CodeSystem/condition-clinical\n
Direct Reference Code\n \n Code: recurrence\n
\n System: http://terminology.hl7.org/CodeSystem/condition-clinical\n
Direct Reference Code\n \n Code: relapse\n
\n System: http://terminology.hl7.org/CodeSystem/condition-clinical\n
Direct Reference Code\n \n Display: Health Concern\n
\n \n Code: health-concern\n
\n System: http://hl7.org/fhir/us/core/CodeSystem/condition-category\n
Direct Reference Code\n \n Display: virtual\n
\n \n Code: VR\n
\n System: http://terminology.hl7.org/CodeSystem/v3-ActCode\n
Direct Reference Code\n \n Display: Discharge to home for hospice care (procedure)\n
\n \n Code: 428361000124107\n
\n System: http://snomed.info/sct\n
Direct Reference Code\n \n Display: Discharge to healthcare facility for hospice care (procedure)\n
\n \n Code: 428371000124100\n
\n System: http://snomed.info/sct\n
Direct Reference Code\n \n Display: Yes (qualifier value)\n
\n \n Code: 373066001\n
\n System: http://snomed.info/sct\n
Direct Reference Code\n \n Display: Hospice care [Minimum Data Set]\n
\n \n Code: 45755-6\n
\n System: http://loinc.org\n
Direct Reference Code\n \n Code: confirmed\n
\n System: http://terminology.hl7.org/CodeSystem/condition-ver-status\n
Direct Reference Code\n \n Code: unconfirmed\n
\n System: http://terminology.hl7.org/CodeSystem/condition-ver-status\n
Direct Reference Code\n \n Code: provisional\n
\n System: http://terminology.hl7.org/CodeSystem/condition-ver-status\n
Direct Reference Code\n \n Code: differential\n
\n System: http://terminology.hl7.org/CodeSystem/condition-ver-status\n
Direct Reference Code\n \n Display: Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)\n
\n \n Code: 71007-9\n
\n System: http://loinc.org\n
Direct Reference Code\n \n Display: Body mass index (BMI) [Ratio]\n
\n \n Code: 39156-5\n
\n System: http://loinc.org\n
Dependencies
Dependency\n \n Description: USQualityCore model information\n \n
\n \n \n \n \n \n \n Resource: https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild\n
\n Canonical URL: https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild\n \n
Dependency\n \n Description: USCore model information\n \n
\n \n \n \n \n \n \n Resource: http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived\n
\n Canonical URL: http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived\n \n
Dependency\n \n Description: FHIR model information\n \n
\n \n \n \n \n \n \n Resource: http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1\n
\n Canonical URL: http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1\n \n
Dependency\n \n Description: Library SDE\n \n
\n \n \n \n \n \n \n Resource: SupplementalDataElements version: 6.1.000\n
\n Canonical URL: https://madie.cms.gov/Library/SupplementalDataElements|6.1.000\n \n
Dependency\n \n Description: Library FHIRHelpers\n \n
\n \n \n \n \n \n \n Resource: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1\n
\n Canonical URL: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1\n \n
Dependency\n \n Description: Library USCommon\n \n
\n \n \n \n \n \n \n Resource: http://hl7.org/fhir/us/cql/Library/USCoreCommon|2.0.0-ballot\n
\n Canonical URL: http://hl7.org/fhir/us/cql/Library/USCoreCommon|2.0.0-ballot\n \n
Dependency\n \n Description: Library FHIRCommon\n \n
\n \n \n \n \n \n \n Resource: http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0\n
\n Canonical URL: http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0\n \n
Dependency\n \n Description: Library Status\n \n
\n \n \n \n \n \n \n Resource: Status version: 2.1.000\n
\n Canonical URL: https://madie.cms.gov/Library/Status|2.1.000\n \n
Dependency\n \n Description: Library Hospice\n \n
\n \n \n \n \n \n \n Resource: Hospice version: 7.1.000\n
\n Canonical URL: https://madie.cms.gov/Library/Hospice|7.1.000\n \n
Dependency\n \n Description: Library PalliativeCare\n \n
\n \n \n \n \n \n \n Resource: PalliativeCare version: 2.1.000\n
\n Canonical URL: https://madie.cms.gov/Library/PalliativeCare|2.1.000\n \n
Dependency\n \n Description: Library USQualityCoreCommon\n \n
\n \n \n \n \n \n \n Resource: US Quality Core Common version: 0.1.0-cibuild\n
\n Canonical URL: https://madie.cms.gov/Library/USQualityCoreCommon|0.1.0-cibuild\n \n
Data Requirements
Data Requirement\n Type: Patient\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient\n
\n \n \n \n Must Support Elements: ombCategory, detailed, text\n
\n \n \n
Data Requirement\n Type: Patient\n
\n \n Profile(s): \n \n Patient\n
\n \n \n \n Must Support Elements: birthDate\n
\n \n \n
Data Requirement\n Type: Observation\n
\n \n Profile(s): \n \n US Core BMI Profile\n
\n \n \n \n Must Support Elements: value, effective, status\n
\n \n \n
Data Requirement\n Type: Medication\n
\n \n Profile(s): \n \n Medication\n
\n \n \n \n Must Support Elements: id, code\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Medications for Above Normal BMI\n
\n \n \n \n \n
Data Requirement\n Type: Medication\n
\n \n Profile(s): \n \n Medication\n
\n \n \n \n Must Support Elements: id, code\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Medications for Below Normal BMI\n
\n \n \n \n \n
Data Requirement\n Type: MedicationRequest\n
\n \n Profile(s): \n \n MedicationRequest\n
\n \n \n \n Must Support Elements: medication\n
\n \n \n Code Filter(s): \n
\n \n \n Path: medication\n
\n \n \n \n ValueSet: Medications for Above Normal BMI\n
\n \n \n \n \n
Data Requirement\n Type: MedicationRequest\n
\n \n Profile(s): \n \n MedicationRequest\n
\n \n \n \n Must Support Elements: medication.reference\n
\n \n \n
Data Requirement\n Type: MedicationRequest\n
\n \n Profile(s): \n \n MedicationRequest\n
\n \n \n \n Must Support Elements: medication\n
\n \n \n Code Filter(s): \n
\n \n \n Path: medication\n
\n \n \n \n ValueSet: Medications for Below Normal BMI\n
\n \n \n \n \n
Data Requirement\n Type: ServiceRequest\n
\n \n Profile(s): \n \n ServiceRequest\n
\n \n \n \n Must Support Elements: code, status, intent\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Follow Up for Above Normal BMI\n
\n \n \n \n \n
Data Requirement\n Type: ServiceRequest\n
\n \n Profile(s): \n \n ServiceRequest\n
\n \n \n \n Must Support Elements: code, status, intent\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Follow Up for Below Normal BMI\n
\n \n \n \n \n
Data Requirement\n Type: ServiceRequest\n
\n \n Profile(s): \n \n ServiceRequest\n
\n \n \n \n Must Support Elements: code, status, intent\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Referrals Where Weight Assessment May Occur\n
\n \n \n \n \n
Data Requirement\n Type: Condition\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns\n
\n \n \n \n Must Support Elements: code\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Overweight or Obese\n
\n \n \n \n \n
Data Requirement\n Type: Condition\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns\n
\n \n \n \n Must Support Elements: code\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Underweight\n
\n \n \n \n \n
Data Requirement\n Type: Condition\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns\n
\n \n \n \n Must Support Elements: code\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Pregnancy Obstetric or Maternal Diagnoses\n
\n \n \n \n \n
Data Requirement\n Type: Condition\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis\n
\n \n \n \n Must Support Elements: code\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Overweight or Obese\n
\n \n \n \n \n
Data Requirement\n Type: Condition\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis\n
\n \n \n \n Must Support Elements: code\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Underweight\n
\n \n \n \n \n
Data Requirement\n Type: Condition\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis\n
\n \n \n \n Must Support Elements: code\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Pregnancy Obstetric or Maternal Diagnoses\n
\n \n \n \n \n
Data Requirement\n Type: Condition\n
\n \n Profile(s): \n \n Condition\n
\n \n \n \n Must Support Elements: abatement, verificationStatus, onset, recordedDate, clinicalStatus\n
\n \n \n
Data Requirement\n Type: Condition\n
\n \n Profile(s): \n \n Condition\n
\n \n \n \n Must Support Elements: code, verificationStatus\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Hospice Diagnosis\n
\n \n \n \n \n
Data Requirement\n Type: Condition\n
\n \n Profile(s): \n \n Condition\n
\n \n \n \n Must Support Elements: code, verificationStatus\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Palliative Care Diagnosis\n
\n \n \n \n \n
Data Requirement\n Type: Procedure\n
\n \n Profile(s): \n \n Procedure\n
\n \n \n \n Must Support Elements: code, reasonCode, performed, status\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Follow Up for Above Normal BMI\n
\n \n \n \n \n
Data Requirement\n Type: Procedure\n
\n \n Profile(s): \n \n Procedure\n
\n \n \n \n Must Support Elements: code, reasonCode, status, performed\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Follow Up for Below Normal BMI\n
\n \n \n \n \n
Data Requirement\n Type: Encounter\n
\n \n Profile(s): \n \n Encounter\n
\n \n \n \n Must Support Elements: type, period, class, status\n
\n \n \n Code Filter(s): \n
\n \n \n Path: type\n
\n \n \n \n ValueSet: Encounter to Evaluate BMI\n
\n \n \n \n \n Path: class\n
\n \n \n \n \n \n \n Path: status\n
\n \n \n \n \n Code(s): \n \n \n [not stated]: finished (finished)\n \n \n \n
\n \n \n \n
Data Requirement\n Type: Coverage\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-coverage\n
\n \n \n \n Must Support Elements: type, period\n
\n \n \n Code Filter(s): \n
\n \n \n Path: type\n
\n \n \n \n ValueSet: Payer Type\n
\n \n \n \n \n
Data Requirement\n Type: Encounter\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter\n
\n \n \n \n Must Support Elements: type, hospitalization, hospitalization.dischargeDisposition, period\n
\n \n \n Code Filter(s): \n
\n \n \n Path: type\n
\n \n \n \n ValueSet: Encounter Inpatient\n
\n \n \n \n \n
Data Requirement\n Type: Encounter\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter\n
\n \n \n \n Must Support Elements: type, period\n
\n \n \n Code Filter(s): \n
\n \n \n Path: type\n
\n \n \n \n ValueSet: Hospice Encounter\n
\n \n \n \n \n
Data Requirement\n Type: Encounter\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter\n
\n \n \n \n Must Support Elements: type, period\n
\n \n \n Code Filter(s): \n
\n \n \n Path: type\n
\n \n \n \n ValueSet: Palliative Care Encounter\n
\n \n \n \n \n
Data Requirement\n Type: Observation\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-screening-assessment\n
\n \n \n \n Must Support Elements: code, value, effective, status\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n \n Code(s): \n \n \n LOINC: 45755-6 (Hospice care [Minimum Data Set])\n \n \n \n
\n \n \n \n Path: value\n
\n \n \n \n \n \n \n
Data Requirement\n Type: Observation\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-screening-assessment\n
\n \n \n \n Must Support Elements: code, effective, status\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n \n Code(s): \n \n \n LOINC: 71007-9 (Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal))\n \n \n \n
\n \n \n \n
Data Requirement\n Type: ServiceRequest\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-servicerequest\n
\n \n \n \n Must Support Elements: code, authoredOn\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Hospice Care Ambulatory\n
\n \n \n \n \n
Data Requirement\n Type: Procedure\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-procedure\n
\n \n \n \n Must Support Elements: code, performed\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Hospice Care Ambulatory\n
\n \n \n \n \n
Data Requirement\n Type: Procedure\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-procedure\n
\n \n \n \n Must Support Elements: code, performed\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Palliative Care Intervention\n
\n \n \n \n \n
Data Requirement\n Type: Observation\n
\n \n Profile(s): \n \n US Core Observation Pregnancy Status Profile\n
\n \n \n \n Must Support Elements: effective, status, value\n
\n \n \n Code Filter(s): \n
\n \n \n Path: value\n
\n \n \n \n ValueSet: Pregnancy Obstetric or Maternal Diagnoses\n
\n \n \n \n \n
Data Requirement\n Type: ServiceRequest\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-servicenotrequested\n
\n \n \n \n Must Support Elements: code, authoredOn, status\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Referrals Where Weight Assessment May Occur\n
\n \n \n \n \n
Data Requirement\n Type: ServiceRequest\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-servicenotrequested\n
\n \n \n \n Must Support Elements: code, authoredOn, status\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Follow Up for Above Normal BMI\n
\n \n \n \n \n
Data Requirement\n Type: ServiceRequest\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-servicenotrequested\n
\n \n \n \n Must Support Elements: code, authoredOn, status\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Follow Up for Below Normal BMI\n
\n \n \n \n \n
Data Requirement\n Type: MedicationRequest\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-medicationnotrequested\n
\n \n \n \n Must Support Elements: medication, authoredOn, status, reasonCode\n
\n \n \n Code Filter(s): \n
\n \n \n Path: medication\n
\n \n \n \n ValueSet: Medications for Above Normal BMI\n
\n \n \n \n \n
Data Requirement\n Type: MedicationRequest\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-medicationnotrequested\n
\n \n \n \n Must Support Elements: medication, authoredOn, status, reasonCode\n
\n \n \n Code Filter(s): \n
\n \n \n Path: medication\n
\n \n \n \n ValueSet: Medications for Below Normal BMI\n
\n \n \n \n \n
Data Requirement\n Type: Observation\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observationcancelled\n
\n \n \n \n Must Support Elements: code, effective\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n \n Code(s): \n \n \n LOINC: 39156-5 (Body mass index (BMI) [Ratio])\n \n \n \n
\n \n \n \n
Parameters
\n\n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n
NameUseCard.TypeDocumentation
Measurement PeriodIn0..1Period\n
SDE SexOut0..1Coding\n
NumeratorOut0..1boolean\n
DenominatorOut0..1boolean\n
SDE PayerOut0..*Resource\n
Initial PopulationOut0..1boolean\n
SDE EthnicityOut0..1Resource\n
Denominator ExclusionsOut0..1boolean\n
SDE RaceOut0..1Resource\n
Denominator ExceptionsOut0..1boolean\n
\n
Generated using version 0.5.4 of the sample-content-ig Liquid templates
\n
" }, "contained" : [{ "resourceType" : "Library", "id" : "effective-data-requirements", "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "248153007", "display" : "Male (finding)" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "248152002", "display" : "Female (finding)" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical", "code" : "active" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical", "code" : "recurrence" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical", "code" : "relapse" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://hl7.org/fhir/us/core/CodeSystem/condition-category", "code" : "health-concern", "display" : "Health Concern" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code" : "VR", "display" : "virtual" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "428361000124107", "display" : "Discharge to home for hospice care (procedure)" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "428371000124100", "display" : "Discharge to healthcare facility for hospice care (procedure)" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "373066001", "display" : "Yes (qualifier value)" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://loinc.org", "code" : "45755-6", "display" : "Hospice care [Minimum Data Set]" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code" : "confirmed" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code" : "unconfirmed" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code" : "provisional" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code" : "differential" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://loinc.org", "code" : "71007-9", "display" : "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://loinc.org", "code" : "39156-5", "display" : "Body mass index (BMI) [Ratio]" } }, { "extension" : [{ "url" : "libraryName", "valueString" : "SupplementalDataElements" }, { "url" : "name", "valueString" : "SDE Sex" }, { "url" : "statement", "valueString" : "define \"SDE Sex\":\n case\n when Patient.sex() = '248153007' then \"Male (finding)\"\n when Patient.sex() = '248152002' then \"Female (finding)\"\n else null\n end" }, { "url" : "displaySequence", "valueInteger" : 0 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "SDE Sex" }, { "url" : "statement", "valueString" : "define \"SDE Sex\":\n SDE.\"SDE Sex\"" }, { "url" : "displaySequence", "valueInteger" : 1 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "BMI During Measurement Period" }, { "url" : "statement", "valueString" : "define \"BMI During Measurement Period\":\n ( ( [USCore.BMIProfile] ).isObservationBMI ( ) ) BMI\n where BMI.value > 0 'kg/m2'\n and BMI.effective.toInterval ( ) during day of \"Measurement Period\"" }, { "url" : "displaySequence", "valueInteger" : 2 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "Documented High BMI During Measurement Period" }, { "url" : "statement", "valueString" : "define \"Documented High BMI During Measurement Period\":\n \"BMI During Measurement Period\" BMI\n where BMI.value >= 25 'kg/m2'" }, { "url" : "displaySequence", "valueInteger" : 3 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "High BMI Interventions Ordered" }, { "url" : "statement", "valueString" : "define \"High BMI Interventions Ordered\":\n ( ( [ServiceRequest: \"Follow Up for Above Normal BMI\"]\n union [ServiceRequest: \"Referrals Where Weight Assessment May Occur\"]\n union [MedicationRequest: \"Medications for Above Normal BMI\"] ) HighInterventionsOrdered\n where HighInterventionsOrdered.reasonCode in \"Overweight or Obese\"\n or ( exists ( [ConditionProblemsHealthConcerns: \"Overweight or Obese\"]\n union [ConditionEncounterDiagnosis: \"Overweight or Obese\"] ) OverweightObese\n where OverweightObese.onset.toInterval ( ) starts before or on day of HighInterventionsOrdered.authoredOn\n )\n )" }, { "url" : "displaySequence", "valueInteger" : 4 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "High BMI Interventions Performed" }, { "url" : "statement", "valueString" : "define \"High BMI Interventions Performed\":\n ( [Procedure: \"Follow Up for Above Normal BMI\"] HighInterventionsPerformed\n where HighInterventionsPerformed.reasonCode in \"Overweight or Obese\"\n or ( exists [ConditionProblemsHealthConcerns: \"Overweight or Obese\"] OverweightObese\n where OverweightObese.prevalenceInterval ( ) starts before or on day of start of HighInterventionsPerformed.performed.toInterval ( )\n and not ( OverweightObese.prevalenceInterval ( ) ends before day of start of HighInterventionsPerformed.performed.toInterval ( ) )\n )\n )" }, { "url" : "displaySequence", "valueInteger" : 5 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "High BMI And Follow Up Provided" }, { "url" : "statement", "valueString" : "define \"High BMI And Follow Up Provided\":\n \"Documented High BMI During Measurement Period\" HighBMI\n with ( \"High BMI Interventions Ordered\"\n union \"High BMI Interventions Performed\" ) HighBMIInterventions\n such that Coalesce(HighBMIInterventions.performed.toInterval(), HighBMIInterventions.authoredOn.toInterval()) starts during day of \"Measurement Period\"" }, { "url" : "displaySequence", "valueInteger" : 6 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "Documented Low BMI During Measurement Period" }, { "url" : "statement", "valueString" : "define \"Documented Low BMI During Measurement Period\":\n \"BMI During Measurement Period\" BMI\n where BMI.value < 18.5 'kg/m2'" }, { "url" : "displaySequence", "valueInteger" : 7 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "Low BMI Interventions Ordered" }, { "url" : "statement", "valueString" : "define \"Low BMI Interventions Ordered\":\n ( ( [ServiceRequest: \"Follow Up for Below Normal BMI\"]\n union [ServiceRequest: \"Referrals Where Weight Assessment May Occur\"]\n union [MedicationRequest: \"Medications for Below Normal BMI\"] ) LowInterventionsOrdered\n where LowInterventionsOrdered.reasonCode in \"Underweight\"\n or ( exists ( [ConditionProblemsHealthConcerns: \"Underweight\"]\n union [ConditionEncounterDiagnosis: \"Underweight\"] ) UnderweightDiagnosis\n where UnderweightDiagnosis.onset.toInterval ( ) starts before or on day of LowInterventionsOrdered.authoredOn\n and LowInterventionsOrdered.authoredOn during day of \"Measurement Period\"\n )\n )" }, { "url" : "displaySequence", "valueInteger" : 8 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "Low BMI Interventions Performed" }, { "url" : "statement", "valueString" : "define \"Low BMI Interventions Performed\":\n ( [Procedure: \"Follow Up for Below Normal BMI\"] LowInterventionsPerformed\n where LowInterventionsPerformed.reasonCode in \"Underweight\"\n and LowInterventionsPerformed.status = 'completed'\n or ( exists [ConditionProblemsHealthConcerns: \"Underweight\"] UnderweightDiagnosis\n where ( UnderweightDiagnosis.isHealthConcern ( ) )\n and UnderweightDiagnosis.prevalenceInterval ( ) starts before or on day of start of LowInterventionsPerformed.performed.toInterval ( )\n and LowInterventionsPerformed.performed.toInterval ( ) during day of \"Measurement Period\"\n and not ( UnderweightDiagnosis.prevalenceInterval ( ) ends before day of start of LowInterventionsPerformed.performed.toInterval ( ) )\n )\n )" }, { "url" : "displaySequence", "valueInteger" : 9 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "Low BMI And Follow Up Provided" }, { "url" : "statement", "valueString" : "define \"Low BMI And Follow Up Provided\":\n ( \"Documented Low BMI During Measurement Period\" LowBMI\n with ( \"Low BMI Interventions Ordered\"\n union \"Low BMI Interventions Performed\" ) LowBMIInterventions\n such that Coalesce(LowBMIInterventions.performed.toInterval(), LowBMIInterventions.authoredOn.toInterval()) starts during day of \"Measurement Period\"\n )" }, { "url" : "displaySequence", "valueInteger" : 10 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "Has Normal BMI" }, { "url" : "statement", "valueString" : "define \"Has Normal BMI\":\n exists ( \"BMI During Measurement Period\" BMI\n where BMI.value >= 18.5 'kg/m2'\n and BMI.value < 25 'kg/m2'\n )\n and not ( exists \"Documented High BMI During Measurement Period\"\n or exists \"Documented Low BMI During Measurement Period\"\n )" }, { "url" : "displaySequence", "valueInteger" : 11 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "Numerator" }, { "url" : "statement", "valueString" : "define \"Numerator\":\n exists \"High BMI And Follow Up Provided\"\n or exists \"Low BMI And Follow Up Provided\"\n or \"Has Normal BMI\"" }, { "url" : "displaySequence", "valueInteger" : 12 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "Qualifying Encounter During Day Of Measurement Period" }, { "url" : "statement", "valueString" : "define \"Qualifying Encounter During Day Of Measurement Period\":\n [Encounter: \"Encounter to Evaluate BMI\"] BMIEncounter\n where BMIEncounter.period during day of \"Measurement Period\"\n and BMIEncounter.class !~ \"virtual\"\n and BMIEncounter.status = 'finished'" }, { "url" : "displaySequence", "valueInteger" : 13 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "Initial Population" }, { "url" : "statement", "valueString" : "define \"Initial Population\":\n exists \"Qualifying Encounter During Day Of Measurement Period\" QualifyingEncounter\n where \"AgeInYearsAt\"(date from start of QualifyingEncounter.period) >= 18" }, { "url" : "displaySequence", "valueInteger" : 14 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "Denominator" }, { "url" : "statement", "valueString" : "define \"Denominator\":\n \"Initial Population\"" }, { "url" : "displaySequence", "valueInteger" : 15 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "SupplementalDataElements" }, { "url" : "name", "valueString" : "SDE Payer" }, { "url" : "statement", "valueString" : "define \"SDE Payer\":\n [USQualityCore.Coverage: type in \"Payer Type\"] Payer\n return {\n code: Payer.type,\n period: Payer.period\n }" }, { "url" : "displaySequence", "valueInteger" : 16 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "SDE Payer" }, { "url" : "statement", "valueString" : "define \"SDE Payer\":\n SDE.\"SDE Payer\"" }, { "url" : "displaySequence", "valueInteger" : 17 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "SupplementalDataElements" }, { "url" : "name", "valueString" : "SDE Ethnicity" }, { "url" : "statement", "valueString" : "define \"SDE Ethnicity\":\n (Patient.ethnicity()) E\n return Tuple {\n codes: { E.ombCategory } union E.detailed,\n display: E.text\n }" }, { "url" : "displaySequence", "valueInteger" : 18 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "SDE Ethnicity" }, { "url" : "statement", "valueString" : "define \"SDE Ethnicity\":\n SDE.\"SDE Ethnicity\"" }, { "url" : "displaySequence", "valueInteger" : 19 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "Hospice" }, { "url" : "name", "valueString" : "Has Hospice Services" }, { "url" : "statement", "valueString" : "define \"Has Hospice Services\":\n exists ((([USQualityCore.Encounter: \"Encounter Inpatient\"]).isEncounterPerformed()) InpatientEncounter\n where (InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n or InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\"\n )\n and InpatientEncounter.period ends during day of \"Measurement Period\"\n )\n or exists ((([USQualityCore.Encounter: \"Hospice Encounter\"]).isEncounterPerformed()) HospiceEncounter\n where HospiceEncounter.period overlaps day of \"Measurement Period\"\n )\n // TODO: Shouldn't need to specify a code path here (see https://jira.hl7.org/browse/FHIR-53941)\n or exists ((([USQualityCore.ObservationScreeningAssessment: code ~ \"Hospice care [Minimum Data Set]\"]).isAssessmentPerformed()) HospiceAssessment\n where HospiceAssessment.value ~ \"Yes (qualifier value)\"\n and HospiceAssessment.effective.toInterval() overlaps day of \"Measurement Period\"\n )\n or exists ((([USQualityCore.ServiceRequest: \"Hospice Care Ambulatory\"]).isInterventionOrder()) HospiceOrder\n where HospiceOrder.authoredOn during day of \"Measurement Period\"\n )\n or exists ((([USQualityCore.Procedure: \"Hospice Care Ambulatory\"]).isInterventionPerformed()) HospicePerformed\n where HospicePerformed.performed.toInterval() overlaps day of \"Measurement Period\"\n )\n // TODO: Consider whether to keep this as the union of Problems and EncounterDiagnosis\n or exists ((([FHIR.Condition: \"Hospice Diagnosis\"]).verified()) HospiceCareDiagnosis\n where HospiceCareDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"\n )" }, { "url" : "displaySequence", "valueInteger" : 20 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "PalliativeCare" }, { "url" : "name", "valueString" : "Has Palliative Care in the Measurement Period" }, { "url" : "statement", "valueString" : "define \"Has Palliative Care in the Measurement Period\":\n // TODO: Shouldn't need to specify a code path here (see https://jira.hl7.org/browse/FHIR-53941)\n exists ((([USQualityCore.ObservationScreeningAssessment: code ~ \"Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)\"]).isAssessmentPerformed()) PalliativeAssessment\n where PalliativeAssessment.effective.toInterval() overlaps day of \"Measurement Period\"\n )\n // TODO: Consider whether to keep this as the union of the problems and encounter diagnosis list? Anything enforced by the profiles that is expected but isn't stated here?\n or exists ((([FHIR.Condition: \"Palliative Care Diagnosis\"]).verified()) PalliativeDiagnosis\n where PalliativeDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"\n )\n or exists ((([USQualityCore.Encounter: \"Palliative Care Encounter\"]).isEncounterPerformed()) PalliativeEncounter\n where PalliativeEncounter.period overlaps day of \"Measurement Period\"\n )\n or exists ((([USQualityCore.Procedure: \"Palliative Care Intervention\"]).isInterventionPerformed()) PalliativeIntervention\n where PalliativeIntervention.performed.toInterval() overlaps day of \"Measurement Period\"\n )" }, { "url" : "displaySequence", "valueInteger" : 21 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "Is Pregnant During Measurement Period" }, { "url" : "statement", "valueString" : "define \"Is Pregnant During Measurement Period\":\n exists ( ( [ConditionProblemsHealthConcerns: \"Pregnancy or Other Related Diagnoses\"]\n union [ConditionEncounterDiagnosis: \"Pregnancy or Other Related Diagnoses\"] ) PregnancyDiagnosis\n where PregnancyDiagnosis.onset.toInterval ( ) overlaps day of \"Measurement Period\"\n )\n or exists ( [USCore.ObservationPregnancyStatusProfile] PregnantObservation\n where PregnantObservation.effective.toInterval ( ) overlaps day of \"Measurement Period\"\n and PregnantObservation.status in { 'final', 'amended', 'corrected' }\n and ( PregnantObservation.value in \"Pregnancy or Other Related Diagnoses\" )\n )" }, { "url" : "displaySequence", "valueInteger" : 22 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "Denominator Exclusions" }, { "url" : "statement", "valueString" : "define \"Denominator Exclusions\":\n Hospice.\"Has Hospice Services\"\n or PalliativeCare.\"Has Palliative Care in the Measurement Period\"\n or \"Is Pregnant During Measurement Period\"" }, { "url" : "displaySequence", "valueInteger" : 23 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "SupplementalDataElements" }, { "url" : "name", "valueString" : "SDE Race" }, { "url" : "statement", "valueString" : "define \"SDE Race\":\n (Patient.race()) R\n return Tuple {\n codes: R.ombCategory union R.detailed,\n display: R.text\n }" }, { "url" : "displaySequence", "valueInteger" : 24 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "SDE Race" }, { "url" : "statement", "valueString" : "define \"SDE Race\":\n SDE.\"SDE Race\"" }, { "url" : "displaySequence", "valueInteger" : 25 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "Medical Reason For Not Documenting A Follow Up Plan For Low Or High BMI" }, { "url" : "statement", "valueString" : "define \"Medical Reason For Not Documenting A Follow Up Plan For Low Or High BMI\":\n ( ( [ServiceNotRequested: \"Referrals Where Weight Assessment May Occur\"]\n union [ServiceNotRequested: \"Follow Up for Above Normal BMI\"]\n union [ServiceNotRequested: \"Follow Up for Below Normal BMI\"] ) NoBMIFollowUp\n with \"Qualifying Encounter During Day Of Measurement Period\" QualifyingEncounter\n such that NoBMIFollowUp.authoredOn same day as start of QualifyingEncounter.period\n where NoBMIFollowUp.status ~ 'completed'\n and NoBMIFollowUp.reasonRefused ( ) in \"Medical Reason\"\n )\n union ( ( [MedicationNotRequested: \"Medications for Above Normal BMI\"]\n union [MedicationNotRequested: \"Medications for Below Normal BMI\"] ) NoBMIFollowUp\n with \"Qualifying Encounter During Day Of Measurement Period\" QualifyingEncounter\n such that NoBMIFollowUp.authoredOn same day as start of QualifyingEncounter.period\n where NoBMIFollowUp.status ~ 'completed'\n and NoBMIFollowUp.reasonCode in \"Medical Reason\"\n )" }, { "url" : "displaySequence", "valueInteger" : 26 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "Medical Reason Or Patient Reason For Not Performing BMI Exam" }, { "url" : "statement", "valueString" : "define \"Medical Reason Or Patient Reason For Not Performing BMI Exam\":\n [ObservationCancelled: \"Body mass index (BMI) [Ratio]\"] NoBMI\n with \"Qualifying Encounter During Day Of Measurement Period\" QualifyingEncounter\n such that NoBMI.effective.toInterval ( ) ends same day as start of QualifyingEncounter.period\n where ( NoBMI.notDoneReason ( ) in \"Patient Declined\"\n or NoBMI.notDoneReason ( ) in \"Medical Reason\"\n )" }, { "url" : "displaySequence", "valueInteger" : 27 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS69FHIRPCSBMIScreenAndFollowUp" }, { "url" : "name", "valueString" : "Denominator Exceptions" }, { "url" : "statement", "valueString" : "define \"Denominator Exceptions\":\n exists \"Medical Reason For Not Documenting A Follow Up Plan For Low Or High BMI\"\n or exists \"Medical Reason Or Patient Reason For Not Performing BMI Exam\"" }, { "url" : "displaySequence", "valueInteger" : 28 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToString" }, { "url" : "statement", "valueString" : "define function ToString(value string): value.value" }, { "url" : "displaySequence", "valueInteger" : 29 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "USCoreCommon" }, { "url" : "name", "valueString" : "sex" }, { "url" : "statement", "valueString" : "/*\n@description: Returns the sex element as defined for the USCore patient profile\n*/\ndefine fluent function sex(patient Patient):\n patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex').value as FHIR.code" }, { "url" : "displaySequence", "valueInteger" : 30 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRCommon" }, { "url" : "name", "valueString" : "ext" }, { "url" : "statement", "valueString" : "/*\n@description: Returns the single extension (if present) on the given resource with the specified url.\n@comment: This function uses singleton from to ensure that a run-time exception is thrown if there\nis more than one extension on the given resource with the specified url.\n*/\ndefine fluent function ext(domainResource DomainResource, url String):\n singleton from domainResource.exts(url)" }, { "url" : "displaySequence", "valueInteger" : 31 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRCommon" }, { "url" : "name", "valueString" : "exts" }, { "url" : "statement", "valueString" : "/*\n@description: Returns any extensions defined on the given resource with the specified url\n*/\ndefine fluent function exts(domainResource DomainResource, url String):\n domainResource.extension E\n where E.url = url\n return E" }, { "url" : "displaySequence", "valueInteger" : 32 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToString" }, { "url" : "statement", "valueString" : "define function ToString(value uri): value.value" }, { "url" : "displaySequence", "valueInteger" : 33 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "Status" }, { "url" : "name", "valueString" : "isObservationBMI" }, { "url" : "statement", "valueString" : "define fluent function isObservationBMI(Obs List):\n Obs O\n where O.status in { 'final', 'amended', 'corrected' }" }, { "url" : "displaySequence", "valueInteger" : 34 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToString" }, { "url" : "statement", "valueString" : "define function ToString(value ObservationStatus): value.value" }, { "url" : "displaySequence", "valueInteger" : 35 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToQuantity" }, { "url" : "statement", "valueString" : "/*\n@description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) \nvalue to a CQL Quantity\n@comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity\nhas a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`)\nan error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used.\n@seealso: ToCalendarUnit\n*/\ndefine function ToQuantity(quantity FHIR.Quantity):\n case\n when quantity is null then null\n when quantity.value is null then null\n when quantity.comparator is not null then\n Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')\n when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'\n or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then\n System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }\n else\n Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')\n end" }, { "url" : "displaySequence", "valueInteger" : 36 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToCalendarUnit" }, { "url" : "statement", "valueString" : "/*\n@description: Converts a UCUM definite duration unit to a CQL calendar duration\nunit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities) \ntopic of the CQL specification.\n@comment: Note that for durations above days (or weeks), the conversion is understood to be approximate\n*/\ndefine function ToCalendarUnit(unit System.String):\n case unit\n when 'ms' then 'millisecond'\n when 's' then 'second'\n when 'min' then 'minute'\n when 'h' then 'hour'\n when 'd' then 'day'\n when 'wk' then 'week'\n when 'mo' then 'month'\n when 'a' then 'year'\n else unit\n end" }, { "url" : "displaySequence", "valueInteger" : 37 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRCommon" }, { "url" : "name", "valueString" : "toInterval" }, { "url" : "statement", "valueString" : "/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in FHIR, allowing this function to be used across any resource.\n\nThe input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime.\nIf the input is a Period, the result is a DateTime Interval.\nIf the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing.\nIf the input is an instant, the result is a DateTime Interval beginning and ending on that instant.\nIf the input is a string, an error is raised indicating a single interval cannot be computed from a string.\nIf the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age,\nand ending immediately prior to when the patient was the given Age plus one year.\nIf the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given\nby the low end of the Range, and ending immediately prior to when the patient was the Age given by the\nhigh end of the Range plus one year.\n\nNOTE: Due to the\ncomplexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used\nwith a Timing or String.\n*/\ndefine fluent function toInterval(choice Choice):\n case\n when choice is FHIR.dateTime then\n Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]\n when choice is FHIR.Period then\n FHIRHelpers.ToInterval(choice as FHIR.Period)\n when choice is FHIR.instant then\n Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]\n when choice is FHIR.Age then\n Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),\n FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)\n when choice is FHIR.Range then\n Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),\n FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)\n when choice is FHIR.Timing then\n Message(null as Interval, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported')\n when choice is FHIR.string then\n Message(null as Interval, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')\n else\n null as Interval\n end" }, { "url" : "displaySequence", "valueInteger" : 38 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToDateTime" }, { "url" : "statement", "valueString" : "define function ToDateTime(value dateTime): value.value" }, { "url" : "displaySequence", "valueInteger" : 39 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToInterval" }, { "url" : "statement", "valueString" : "/*\n@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)\nvalue to a CQL DateTime Interval\n@comment: If the start value of the given period is unspecified, the starting\nboundary of the resulting interval will be open (meaning the start of the interval\nis unknown, as opposed to interpreted as the beginning of time).\n*/\ndefine function ToInterval(period FHIR.Period):\n if period is null then\n null\n else\n if period.\"start\" is null then\n Interval(period.\"start\".value, period.\"end\".value]\n else\n Interval[period.\"start\".value, period.\"end\".value]" }, { "url" : "displaySequence", "valueInteger" : 40 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToDateTime" }, { "url" : "statement", "valueString" : "define function ToDateTime(value instant): value.value" }, { "url" : "displaySequence", "valueInteger" : 41 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToDate" }, { "url" : "statement", "valueString" : "define function ToDate(value date): value.value" }, { "url" : "displaySequence", "valueInteger" : 42 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToConcept" }, { "url" : "statement", "valueString" : "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n if concept is null then\n null\n else\n System.Concept {\n codes: concept.coding C return ToCode(C),\n display: concept.text.value\n }" }, { "url" : "displaySequence", "valueInteger" : 43 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToCode" }, { "url" : "statement", "valueString" : "/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n if coding is null then\n null\n else\n System.Code {\n code: coding.code.value,\n system: coding.system.value,\n version: coding.version.value,\n display: coding.display.value\n }" }, { "url" : "displaySequence", "valueInteger" : 44 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRCommon" }, { "url" : "name", "valueString" : "prevalenceInterval" }, { "url" : "statement", "valueString" : "/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition resource.\n@comment: Uses the toInterval and toAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ \"active\"\n or condition.clinicalStatus ~ \"recurrence\"\n or condition.clinicalStatus ~ \"relapse\" then\n Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n (end of condition.abatementInterval()) abatementDate\n return \n\t if abatementDate is null then\n Interval[start of condition.onset.toInterval(), abatementDate)\n else\n Interval[start of condition.onset.toInterval(), abatementDate]" }, { "url" : "displaySequence", "valueInteger" : 45 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRCommon" }, { "url" : "name", "valueString" : "abatementInterval" }, { "url" : "statement", "valueString" : "/*\n@description: Returns an interval representing the normalized Abatement of a given Condition resource.\n@comment: @comment: If the abatement element of the Condition is represented as a DateTime, the result\nis an interval beginning and ending on that DateTime.\nIf 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\nresult is an interval from the date the patient turned that age to immediately before one year later.\nIf the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during\nwhich the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately\nbefore one year later than the date the patient turned the ending age of the quantity interval.\n\nNOTE: Due to the complexity of determining an interval from a String, this function will throw\na run-time exception if used with a Condition instance that has a String as the abatement value.\n*/\ndefine fluent function abatementInterval(condition Condition):\n if condition.abatement is FHIR.dateTime then\n Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)]\n else if condition.abatement is FHIR.Period then\n FHIRHelpers.ToInterval(condition.abatement as FHIR.Period)\n else if condition.abatement is FHIR.string then\n Message(null as Interval, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')\n else if condition.abatement is FHIR.Age then\n Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age),\n FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year)\n else if condition.abatement is FHIR.Range then\n Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low),\n FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year)\n else if condition.abatement is FHIR.boolean then\n Interval[end of condition.onset.toInterval(), condition.recordedDate)\n else \n null" }, { "url" : "displaySequence", "valueInteger" : 46 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToString" }, { "url" : "statement", "valueString" : "define function ToString(value ProcedureStatus): value.value" }, { "url" : "displaySequence", "valueInteger" : 47 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "USCoreCommon" }, { "url" : "name", "valueString" : "isHealthConcern" }, { "url" : "statement", "valueString" : "/*\n@description: Returns true if the given condition is a health concern\n*/\ndefine fluent function isHealthConcern(condition FHIR.Condition):\n exists (\n condition.category C\n where C ~ \"health-concern\"\n )" }, { "url" : "displaySequence", "valueInteger" : 48 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToString" }, { "url" : "statement", "valueString" : "define function ToString(value EncounterStatus): value.value" }, { "url" : "displaySequence", "valueInteger" : 49 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "USCoreCommon" }, { "url" : "name", "valueString" : "ethnicity" }, { "url" : "statement", "valueString" : "define fluent function ethnicity(patient Patient):\n (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity')) E\n return {\n ombCategory: E.ext('ombCategory').value as FHIR.Coding,\n detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,\n text: E.ext('text').value as FHIR.string\n }" }, { "url" : "displaySequence", "valueInteger" : 50 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRCommon" }, { "url" : "name", "valueString" : "ext" }, { "url" : "statement", "valueString" : "/*\n@description: Returns the single extension (if present) on the given element with the specified url.\n@comment: This function uses singleton from to ensure that a run-time exception is thrown if there\nis more than one extension on the given element with the specified url.\n*/\ndefine fluent function ext(element Element, url String):\n singleton from element.exts(url)" }, { "url" : "displaySequence", "valueInteger" : 51 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRCommon" }, { "url" : "name", "valueString" : "exts" }, { "url" : "statement", "valueString" : "/*\n@description: Returns any extensions defined on the given element with the specified url.\n*/\ndefine fluent function exts(element Element, url String):\n element.extension E\n where E.url = url\n return E" }, { "url" : "displaySequence", "valueInteger" : 52 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "Status" }, { "url" : "name", "valueString" : "isEncounterPerformed" }, { "url" : "statement", "valueString" : "//Encounter, Performed\n//General usage unless required otherwise by measure intent (e.g., follow-up encounters)\ndefine fluent function isEncounterPerformed(Enc List):\n Enc E\n where E.status = 'finished'" }, { "url" : "displaySequence", "valueInteger" : 53 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "Status" }, { "url" : "name", "valueString" : "isAssessmentPerformed" }, { "url" : "statement", "valueString" : "//Assessment, Performed\ndefine fluent function isAssessmentPerformed(Obs List):\n Obs O\n where O.status in { 'final', 'amended', 'corrected' }" }, { "url" : "displaySequence", "valueInteger" : 54 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "Status" }, { "url" : "name", "valueString" : "isInterventionOrder" }, { "url" : "statement", "valueString" : "//Intervention, Order\ndefine fluent function isInterventionOrder(ServiceRequest List):\n ServiceRequest S\n where S.status in { 'active', 'completed' }\n and S.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}" }, { "url" : "displaySequence", "valueInteger" : 55 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToString" }, { "url" : "statement", "valueString" : "define function ToString(value ServiceRequestStatus): value.value" }, { "url" : "displaySequence", "valueInteger" : 56 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToString" }, { "url" : "statement", "valueString" : "define function ToString(value ServiceRequestIntent): value.value" }, { "url" : "displaySequence", "valueInteger" : 57 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "Status" }, { "url" : "name", "valueString" : "isInterventionPerformed" }, { "url" : "statement", "valueString" : "//Intervention, Performed\ndefine fluent function isInterventionPerformed(Proc List):\n Proc P\n where P.status ~ 'completed'" }, { "url" : "displaySequence", "valueInteger" : 58 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRCommon" }, { "url" : "name", "valueString" : "verified" }, { "url" : "statement", "valueString" : "/*\n@description: Returns conditions in the given list that either have no verification status or have a verification status of confirmed, unconfirmed, provisional, or differential\n*/\ndefine fluent function verified(conditions List):\n conditions C\n where C.verificationStatus is not null implies\n (C.verificationStatus ~ \"confirmed\"\n or C.verificationStatus ~ \"unconfirmed\"\n or C.verificationStatus ~ \"provisional\"\n or C.verificationStatus ~ \"differential\"\n )" }, { "url" : "displaySequence", "valueInteger" : 59 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "USCoreCommon" }, { "url" : "name", "valueString" : "race" }, { "url" : "statement", "valueString" : "define fluent function race(patient Patient):\n (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-race')) E\n return {\n ombCategory: (E.exts('ombCategory')) o return o.value as FHIR.Coding,\n detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,\n text: E.ext('text').value as FHIR.string\n }" }, { "url" : "displaySequence", "valueInteger" : 60 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "USQualityCoreCommon" }, { "url" : "name", "valueString" : "reasonRefused" }, { "url" : "statement", "valueString" : "/*\n@description: Returns the value of the recorded extension for a Medication Administration Not Done\n*/\ndefine fluent function reasonRefused(serviceNotRequested ServiceNotRequested):\n serviceNotRequested.ext('http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-doNotPerformReason').value as FHIR.CodeableConcept" }, { "url" : "displaySequence", "valueInteger" : 61 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToString" }, { "url" : "statement", "valueString" : "define function ToString(value MedicationRequestStatus): value.value" }, { "url" : "displaySequence", "valueInteger" : 62 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "USQualityCoreCommon" }, { "url" : "name", "valueString" : "notDoneReason" }, { "url" : "statement", "valueString" : "/*\n@description: Returns the notDoneReason for an ObservationCancelled\n*/\ndefine fluent function notDoneReason(observationCancelled ObservationCancelled):\n observationCancelled.ext('http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-notDoneReason').value as FHIR.CodeableConcept" }, { "url" : "displaySequence", "valueInteger" : 63 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }], "name" : "EffectiveDataRequirements", "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/library-type", "code" : "module-definition" }] }, "relatedArtifact" : [{ "type" : "depends-on", "display" : "USQualityCore model information", "resource" : "https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild" }, { "type" : "depends-on", "display" : "USCore model information", "resource" : "http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived" }, { "type" : "depends-on", "display" : "FHIR model information", "resource" : "http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1" }, { "type" : "depends-on", "display" : "Library SDE", "resource" : "https://madie.cms.gov/Library/SupplementalDataElements|6.1.000" }, { "type" : "depends-on", "display" : "Library FHIRHelpers", "resource" : "http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1" }, { "type" : "depends-on", "display" : "Library USCommon", "resource" : "http://hl7.org/fhir/us/cql/Library/USCoreCommon|2.0.0-ballot" }, { "type" : "depends-on", "display" : "Library FHIRCommon", "resource" : "http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0" }, { "type" : "depends-on", "display" : "Library Status", "resource" : "https://madie.cms.gov/Library/Status|2.1.000" }, { "type" : "depends-on", "display" : "Library Hospice", "resource" : "https://madie.cms.gov/Library/Hospice|7.1.000" }, { "type" : "depends-on", "display" : "Library PalliativeCare", "resource" : "https://madie.cms.gov/Library/PalliativeCare|2.1.000" }, { "type" : "depends-on", "display" : "Library USQualityCoreCommon", "resource" : "https://madie.cms.gov/Library/USQualityCoreCommon|0.1.0-cibuild" }, { "type" : "depends-on", "display" : "Code system SNOMEDCT", "resource" : "http://snomed.info/sct" }, { "type" : "depends-on", "display" : "Code system ConditionClinicalStatusCodes", "resource" : "http://terminology.hl7.org/CodeSystem/condition-clinical" }, { "type" : "depends-on", "display" : "Code system USCoreConditionCategory", "resource" : "http://hl7.org/fhir/us/core/CodeSystem/condition-category" }, { "type" : "depends-on", "display" : "Code system ActCode", "resource" : "http://terminology.hl7.org/CodeSystem/v3-ActCode" }, { "type" : "depends-on", "display" : "Code system LOINC", "resource" : "http://loinc.org" }, { "type" : "depends-on", "display" : "Code system ConditionVerificationStatusCodes", "resource" : "http://terminology.hl7.org/CodeSystem/condition-ver-status" }, { "type" : "depends-on", "display" : "Value set Follow Up for Above Normal BMI", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1525" }, { "type" : "depends-on", "display" : "Value set Referrals Where Weight Assessment May Occur", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1527" }, { "type" : "depends-on", "display" : "Value set Medications for Above Normal BMI", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1561" }, { "type" : "depends-on", "display" : "Value set Overweight or Obese", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1047.502" }, { "type" : "depends-on", "display" : "Value set Follow Up for Below Normal BMI", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1528" }, { "type" : "depends-on", "display" : "Value set Medications for Below Normal BMI", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1562" }, { "type" : "depends-on", "display" : "Value set Underweight", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1563" }, { "type" : "depends-on", "display" : "Value set Encounter to Evaluate BMI", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1751" }, { "type" : "depends-on", "display" : "Value set Payer Type", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591" }, { "type" : "depends-on", "display" : "Value set Encounter Inpatient", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307" }, { "type" : "depends-on", "display" : "Value set Hospice Encounter", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003" }, { "type" : "depends-on", "display" : "Value set Hospice Care Ambulatory", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584" }, { "type" : "depends-on", "display" : "Value set Hospice Diagnosis", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165" }, { "type" : "depends-on", "display" : "Value set Palliative Care Diagnosis", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167" }, { "type" : "depends-on", "display" : "Value set Palliative Care Encounter", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090" }, { "type" : "depends-on", "display" : "Value set Palliative Care Intervention", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135" }, { "type" : "depends-on", "display" : "Value set Pregnancy or Other Related Diagnoses", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1623" }, { "type" : "depends-on", "display" : "Value set Medical Reason", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007" }, { "type" : "depends-on", "display" : "Value set Patient Declined", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1582" }], "parameter" : [{ "name" : "Measurement Period", "use" : "in", "min" : 0, "max" : "1", "type" : "Period" }, { "name" : "SDE Sex", "use" : "out", "min" : 0, "max" : "1", "type" : "Coding" }, { "name" : "Numerator", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "Denominator", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "SDE Payer", "use" : "out", "min" : 0, "max" : "*", "type" : "Resource" }, { "name" : "Initial Population", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "SDE Ethnicity", "use" : "out", "min" : 0, "max" : "1", "type" : "Resource" }, { "name" : "Denominator Exclusions", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "SDE Race", "use" : "out", "min" : 0, "max" : "1", "type" : "Resource" }, { "name" : "Denominator Exceptions", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }], "dataRequirement" : [{ "type" : "Patient", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient"], "mustSupport" : ["ombCategory", "detailed", "text"] }, { "type" : "Patient", "profile" : ["http://hl7.org/fhir/StructureDefinition/Patient"], "mustSupport" : ["birthDate"] }, { "type" : "Observation", "profile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi"], "mustSupport" : ["value", "effective", "status"] }, { "type" : "Medication", "profile" : ["http://hl7.org/fhir/StructureDefinition/Medication"], "mustSupport" : ["id", "code"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1561" }] }, { "type" : "Medication", "profile" : ["http://hl7.org/fhir/StructureDefinition/Medication"], "mustSupport" : ["id", "code"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1562" }] }, { "type" : "MedicationRequest", "profile" : ["http://hl7.org/fhir/StructureDefinition/MedicationRequest"], "mustSupport" : ["medication"], "codeFilter" : [{ "path" : "medication", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1561" }] }, { "type" : "MedicationRequest", "profile" : ["http://hl7.org/fhir/StructureDefinition/MedicationRequest"], "mustSupport" : ["medication.reference"] }, { "type" : "MedicationRequest", "profile" : ["http://hl7.org/fhir/StructureDefinition/MedicationRequest"], "mustSupport" : ["medication"], "codeFilter" : [{ "path" : "medication", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1562" }] }, { "type" : "ServiceRequest", "profile" : ["http://hl7.org/fhir/StructureDefinition/ServiceRequest"], "mustSupport" : ["code", "status", "intent"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1525" }] }, { "type" : "ServiceRequest", "profile" : ["http://hl7.org/fhir/StructureDefinition/ServiceRequest"], "mustSupport" : ["code", "status", "intent"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1528" }] }, { "type" : "ServiceRequest", "profile" : ["http://hl7.org/fhir/StructureDefinition/ServiceRequest"], "mustSupport" : ["code", "status", "intent"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1527" }] }, { "type" : "Condition", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns"], "mustSupport" : ["code"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1047.502" }] }, { "type" : "Condition", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns"], "mustSupport" : ["code"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1563" }] }, { "type" : "Condition", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns"], "mustSupport" : ["code"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1623" }] }, { "type" : "Condition", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis"], "mustSupport" : ["code"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1047.502" }] }, { "type" : "Condition", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis"], "mustSupport" : ["code"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1563" }] }, { "type" : "Condition", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis"], "mustSupport" : ["code"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1623" }] }, { "type" : "Condition", "profile" : ["http://hl7.org/fhir/StructureDefinition/Condition"], "mustSupport" : ["abatement", "verificationStatus", "onset", "recordedDate", "clinicalStatus"] }, { "type" : "Condition", "profile" : ["http://hl7.org/fhir/StructureDefinition/Condition"], "mustSupport" : ["code", "verificationStatus"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165" }] }, { "type" : "Condition", "profile" : ["http://hl7.org/fhir/StructureDefinition/Condition"], "mustSupport" : ["code", "verificationStatus"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167" }] }, { "type" : "Procedure", "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"], "mustSupport" : ["code", "reasonCode", "performed", "status"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1525" }] }, { "type" : "Procedure", "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"], "mustSupport" : ["code", "reasonCode", "status", "performed"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1528" }] }, { "type" : "Encounter", "profile" : ["http://hl7.org/fhir/StructureDefinition/Encounter"], "mustSupport" : ["type", "period", "class", "status"], "codeFilter" : [{ "path" : "type", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1751" }, { "path" : "class" }, { "path" : "status", "code" : [{ "code" : "finished" }] }] }, { "type" : "Coverage", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-coverage"], "mustSupport" : ["type", "period"], "codeFilter" : [{ "path" : "type", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591" }] }, { "type" : "Encounter", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter"], "mustSupport" : ["type", "hospitalization", "hospitalization.dischargeDisposition", "period"], "codeFilter" : [{ "path" : "type", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307" }] }, { "type" : "Encounter", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter"], "mustSupport" : ["type", "period"], "codeFilter" : [{ "path" : "type", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003" }] }, { "type" : "Encounter", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter"], "mustSupport" : ["type", "period"], "codeFilter" : [{ "path" : "type", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090" }] }, { "type" : "Observation", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-screening-assessment"], "mustSupport" : ["code", "value", "effective", "status"], "codeFilter" : [{ "path" : "code", "code" : [{ "system" : "http://loinc.org", "code" : "45755-6", "display" : "Hospice care [Minimum Data Set]" }] }, { "path" : "value" }] }, { "type" : "Observation", "profile" : 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"value" : "69FHIR", "assigner" : { "display" : "CMS" } }], "version" : "1.0.000", "name" : "CMS69FHIRPCSBMIScreenAndFollowUp", "title" : "Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up PlanFHIR\n", "status" : "active", "experimental" : false, "date" : "2026-01-16T18:18:13+00:00", "publisher" : "Centers for Medicare & Medicaid Services (CMS)", "contact" : [{ "telecom" : [{ "system" : "url", "value" : "https://www.cms.gov/" }] }], "description" : "Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the measurement period AND who had a follow-up plan documented if BMI was outside of normal parameters\n", "usage" : "This eCQM is a patient-based measure. This measure is to be reported a minimum of once per measurement period for patients seen during the measurement period.\n\nThis measure may be reported by eligible clinicians who perform the quality actions described in the measure based on the services provided at the time of the qualifying encounter or during the measurement period and the measure-specific denominator coding.\n\nTelehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.\n\nBMI Measurement Guidance:\n\n* Height and Weight\n\n * An eligible clinician or their staff is required to measure both height and weight. Both height and weight must be measured during the measurement period. Self-reported values cannot be used.\n\n* The BMI may be documented in the provider's medical record or outside medical records obtained by the provider.\n\n * If the documented BMI is outside of normal parameters, then a follow-up plan is documented during the encounter or measurement period.\n\n * If more than one BMI is reported during the measurement period, and any of the documented BMI assessments is outside of normal parameters, documentation of an appropriate follow-up plan will be used to determine if performance has been met.\n\n* Review the exclusions and exceptions criteria to determine those patients that BMI measurement may not be appropriate or necessary.\n\nFollow-Up Plan Guidance:\n\nThe documented follow-up plan must be based on the documented BMI, outside of normal parameters, for example: \"Patient referred to nutrition counseling for BMI above or below normal parameters.\" See the Definition section for examples of follow-up plan treatments.\n\nVariation has been noted in studies exploring optimal BMI ranges for the elderly (see Donini et al., 2012; Holme \\& Tonstad, 2015; Diehr et al., 2008). Notably, however, all these studies have arrived at ranges that differ from the standard range for ages 18 and older, which is \\>= 18.5 and \\< 25 kg/m2. For instance, both Donini et al. and Holme and Tonstad reported findings that suggest that a higher BMI (higher than the upper end of 25 kg/m2) in the elderly may be beneficial. Similarly, worse outcomes have been associated with being underweight (at a threshold higher than 18.5 kg/m2) at age 65 (Diehr et al., 2008). Because of optimal BMI range variation recommendations from these studies, no specific optimal BMI range for the elderly is used. However, exempting certain patients from a follow-up plan may be appropriate by applying the exception criteria. See Denominator Exception section for examples.\n\nDenominator Exception Guidance:\n\nIf a patient meets exception criteria for the denominator (i.e., the patient refuses height or weight measurement or has a documented medical reason for not documenting BMI or a follow-up plan), an eligible clinician must document those criteria on the same day as the qualifying encounter.\n\nThis FHIR-based measure has been derived from the QDM-based measure CMS69v14. 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).\n", "copyright" : "This electronic clinical quality measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare \\& Medicaid Services (CMS). CMS contracted (Contract # 75FCMC18D0027/ Task Order #: 75FCMC24F0144) with the American Institutes for Research (AIR) to develop this electronic measure. AIR is not responsible for any use of the Measure. AIR makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and AIR has no liability to anyone who relies on such measures or specifications. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. AIR disclaims all liability for use or accuracy of any third-party codes 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.\n", "effectivePeriod" : { "start" : "2026-01-01", "end" : "2026-12-31" }, "author" : [{ "name" : "American Institutes for Research (AIR)", "telecom" : [{ "system" : "url", "value" : "https://www.air.org" }] }], "relatedArtifact" : [{ "type" : "citation", "citation" : "Barlow, S. E., \\& the Expert Committee. (2007). Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics, 120(Suppl. 4), S164-S192. doi:10.1542/peds.2007-2329C\n" }, { "type" : "citation", "citation" : "Borrell, L. N., \\& Samuel, L. (2014). Body mass index categories and mortality risk in U.S. adults: The effect of overweight and obesity on advancing death. American Journal of Public Health, 104(3), 512-519. doi:10.2105/AJPH.2013.301597\n" }, { "type" : "citation", "citation" : "Boutari, C., Pappas, P. D., Mintziori, G., Nigdelis, M. P., Athanasiadis, L., Goulis, D. G., \\& Mantzoros, C. S. (2020). The effect of underweight on female and male reproduction. Metabolism, 107, 154229. https://doi.org/10.1016/j.metabol.2020.154229\n" }, { "type" : "citation", "citation" : "Centers for Disease Control and Prevention (CDC). (2012). National Health and Nutrition Examination Survey (NHANES). Prevalence of underweight among adults aged 20 and over: United States, 1960--1962 Through 2011--2012. Retrieved from https://www.cdc.gov/nchs/data/hestat/underweight_adult_11_12/underweight_adult_11_12.htm\n" }, { "type" : "citation", "citation" : "Diehr, P., O'Meara, E. S., Fitzpatrick A., Newman, A. B., Kuller, L., Burke, G. (2008). Weight, mortality, years of healthy life, and active life expectancy in older adults. Journal of the American Geriatrics Society, 56(1), 76-83. https://doi.org/10.1111/j.1532-5415.2007.01500.x\n" }, { "type" : "citation", "citation" : "Dong, Z., Xu, X., Wang, C., Cartledge, S., Maddison, R., \\& Mohammed Shariful Islam, S. (2020). Association of overweight and obesity with obstructive sleep apnoea: A systematic review and meta-analysis. Obesity Medicine, 17. doi:https://doi.org/10.1016/j.obmed.2020.100185\n" }, { "type" : "citation", "citation" : "Donini, L. M., Savina, C., Gennaro, E., De Felice, M. R., Rosano, A., Pandolfo, M. M., Del Balzo, V., ...Chumlea, W. C. et al. (2012). A systematic review of the literature concerning the relationship between obesity and mortality in the elderly. The Journal of Nutrition, Health \\& Aging, 16(1), 89-98. doi:10.1007/s12603-011-0073-x\n" }, { "type" : "citation", "citation" : "Fitch, A., Everling, L., Fox, C.,Goldberg, J., Heim, C., Johnson, K., ...Webb, B. (2013, May). Prevention and management of obesity for adults. Bloomington, MN: Institute for Clinical Systems Improvement.\n" }, { "type" : "citation", "citation" : "Fitzpatrick, S. L., \\& Stevens, V. J. (2017). Adult obesity management in primary care, 2008-2013. Preventive medicine, 99, 128--133. https://doi.org/10.1016/j.ypmed.2017.02.020\n" }, { "type" : "citation", "citation" : "Flegal, K. M., Carroll, M. D., Kit, B. K., \\& Ogden, C. L. (2012). Prevalence of obesity and trends in the distribution of body mass index among U. S. adults, 1999-2010. JAMA, 307(5), 491-497. doi.10.1001/jama.2012.39\n" }, { "type" : "citation", "citation" : "Fryar, C. D., \\& Ogden, C. L. (2012). Prevalence of underweight among adults aged 20 and over: United States, 1960-1962 through 2007-2010. Hyattsville, MD: NCHS, Division of Health and Nutrition Examination Surveys. Retrieved from http://www.cdc.gov/nchs/data/hestat/underweight_adult_07_10/underweight_adult_07_10.pdf\n" }, { "type" : "citation", "citation" : "Garvey, W. T., Mechanick, J. I., Brett, E. M., Garber, A. J., Hurley, D. L., Jastrebodd. A. M., ...and Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines. (2016). American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive clinical practice guidelines for medical care of patients with obesity. Endocrine Practice, 22(Suppl. 3), 1-203. https://doi.org/10.4158/EP161365.GL\n" }, { "type" : "citation", "citation" : "Guo, D., Xu, M., Zhou, Q., Wu, C., Ju, R., \\& Dai, J. (2019). Is low body mass index a risk factor for semen quality? A PRISMA -compliant meta-analysis. Medicine, 98(32), e16677. https://doi.org/10.1097/MD.0000000000016677\n" }, { "type" : "citation", "citation" : "Hales, C. M., Carroll, M. D., Fryar, C. D., \\& Ogden, C.L. (2020). Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017-2018. NCHS Data Brief No. 360. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db360.htm\n" }, { "type" : "citation", "citation" : "Hales, C. M., Carroll, M. D., Fryar, C. D., et al. (2017). Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS Data Brief No. 288. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db288.htm\n" }, { "type" : "citation", "citation" : "Holme, I., \\& Tonstad, S. (2015). Survival in elderly men in relation to midlife and current BMI. Age and Ageing, 44(3), 434-439\n" }, { "type" : "citation", "citation" : "Katakam , A., Melnic, C. M., Bragdon, C. R., Sauder, N., Collins, A. K., \\& Bedair, H. S. (2021). Low body mass index is a predictor for mortality and increased length of stay following total joint arthroplasty. The Journal of Arthroplasty, 36(1), 72-77. https://doi.org/10.1016/j.arth.2020.07.055\n" }, { "type" : "citation", "citation" : "Kraschnewski, J. L., Sciamanna, C. N., Stuckey, H. L., Chuang, C. H., Lehman, E. B., Hwang, K. O., Sherwood, L. L., \\& Nembhard, H. B. (2013). A silent response to the obesity epidemic: decline in US physician weight counseling. Medical care, 51(2), 186--192. https://doi.org/10.1097/MLR.0b013e3182726c33\n" }, { "type" : "citation", "citation" : "LeBlanc, E., O'Connor, E., Whitlock, E. P., et al. (2011). Screening for and management of obesity and overweight in adults (Evidence Report No. 89; AHRQ Publication No. 11-05159-EF-1). Rockville, MD: Agency for Healthcare Research and Quality\n" }, { "type" : "citation", "citation" : "Moser, J. S., Galindo-Fraga, A., Ortiz-Hernández, A. A., Gu, W., Hunsberger, S., Galán-Herrera, J. F., Guerrero, M. L., Ruiz-Palacios, G. M., Beigel, J. H., \\& La Red ILI 002 Study Group. (2019). Underweight, overweight, and obesity as independent risk factors for hospitalization in adults and children from influenza and other respiratory viruses. Influenza and Other Respiratory Viruses, 13(1), 3-9. https://doi.org/10.1111/irv.12618\n" }, { "type" : "citation", "citation" : "NHLBI Obesity Education Initiative. (1998). Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults (Report No. 98-4083). Bethesda, MD: NHLBI\n" }, { "type" : "citation", "citation" : "Ogden, C.L., Carroll, M.D., Fryar, C.D., Flegal, K.M. (2015). Prevalence of obesity among adults and youth: United States, 2011--2014. NCHS data brief, no 219. Hyattsville, MD: National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db219.pdf\n" }, { "type" : "citation", "citation" : "Ottesen, T. D., Galivanche, A. R., Greene, J. D., Malpani, R., Varthi, A. G., \\& Grauer, J. N. (2022). Underweight patients are the highest risk body mass index group for perioperative adverse events following stand-alone anterior lumbar interbody fusion. The Spine Journal: Official Journal of the North American Spine Society, 22(7), 1139-1148. https://doi.org/10.1016/j.spinee.2022.02.012\n" }, { "type" : "citation", "citation" : "Ottesen, T. D., Malpani, R., Galivanche, A. R., Zogg, C. K., Varthi, A. G., \\& Grauer, J. N. (2020). Underweight patients are at just as much risk as super morbidly obese patients when undergoing anterior cervical spine surgery. The Spine Journal: Official Journal of the North American Spine Society, 20(7), 1085-1095. https://doi.org/10.1016/j.spinee.2020.03.007\n" }, { "type" : "citation", "citation" : "Raynor, H. A., \\& Champagne, C. M. (2016). Position of the Academy of Nutrition and Dietetics: Interventions for the treatment of overweight and obesity in adults. Journal of the Academy of Nutrition and Dietetics, 116(1), 129-147. doi:10.1016/jand.2015.10.031\n" }, { "type" : "citation", "citation" : "Rudasill, S. E., Dillon, D., Karunungan, K., Mardock, A. L., Hadaya, J., Sanaiha, Y., Tran, Z., \\& Benharash, P. (2021). The obesity paradox: Underweight patients are at the greatest risk of mortality after cholecystectomy. Surgery, 170(3), 675-681. https://doi.org/10.1016/j.surg.2021.03.034\n" }, { "type" : "citation", "citation" : "Tronieri, J. S., Wadden, T. A., Chao, A. M., \\& Tsai, A. G. (2019). Primary Care Interventions for Obesity: Review of the Evidence. Current obesity reports, 8(2), 128--136. https://doi.org/10.1007/s13679-019-00341-5\n" }, { "type" : "citation", "citation" : "U.S. Preventive Services Task Force (USPSTF). (2018). Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: U.S. Preventive Services Task Force recommendation statement. JAMA, 320(11), 1163--1171. doi:10.1001/jama.2018.13022\n" }, { "type" : "citation", "citation" : "Wadden, T. A, Butryn, M. L., Wilson, C. (2007). Lifestyle modification for the management of obesity. Gastroenterology, 132 (6), 2226-2238. doi: 10.1053/j.gastro.2007.03.051\n" }, { "type" : "citation", "citation" : "Wadden, T. A., Tronieri, J. S., \\& Butryn, M. L. (2020). Lifestyle modification approaches for the treatment of obesity in adults. American Psychologist, 75(2), 235--251\n" }, { "type" : "citation", "citation" : "Ye, P., Pang, R., Li, L., Li, H. R., Liu, S. L., \\& Zhao, L. (2021). Both underweight and obesity are associated with an increased risk of coronavirus disease 2019 (COVID-19) severity. Frontiers in Nutrition, 8, 649422. https://doi.org/10.3389/fnut.2021.649422\n" }], "library" : ["https://madie.cms.gov/Library/CMS69FHIRPCSBMIScreenAndFollowUp"], "disclaimer" : "These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or \\[R\\] and unregistered trademarks are indicated by (TM) or \\[TM\\].\n", "rationale" : "BMI Above Normal Parameters \"Obesity is a chronic, multifactorial disease with complex psychological, environmental (social and cultural), genetic, physiologic, metabolic, and behavioral causes and consequences. The prevalence of overweight and obese people is increasing worldwide at an alarming rate in both developing and developed countries. Environmental and behavioral changes brought about by economic development, modernization, and urbanization have been linked to the rise in global obesity. The health consequences are becoming apparent\" (Fitch et al., 2013). More than a third of United States (U.S.) adults have a body mass index (BMI) \\>= 30 kg/m2 and are at increased risk for diabetes, cardiovascular disease (CVD), and obstructive sleep apnea (Flegal et al., 2012; Ogden et al., 2015; Dong et al., 2020). Hales et al. (2017) reported that the prevalence of obesity among adults and youth in the U.S. was 39.8 percent and 18.5 percent, respectively, from 2015-2016. Furthermore, the prevalence of obesity in adults increased to 42.4 percent in 2018, with the highest percentage among adults in the 40-59 age bracket compared with other age groups (Hales et al., 2020). Hales et al. (2020) also disaggregated the data according to race/ethnicity and noted that obesity prevalence was higher among non-Hispanic Black adults and Hispanic adults when compared with other races and ethnicities. Obesity prevalence was lowest among non-Hispanic Asian men and women. Among males, obesity prevalence was higher among Hispanic males compared with non-Hispanic Black males and non-Hispanic White males. Among females, the prevalence among non-Hispanic Black females was 56.9 percent, which was higher than all other races/ethnicities. In general, the prevalence of obesity in the U.S. remains higher than the Healthy People 2020 goal of 30.5 percent among adults (Hales et al., 2020). BMI continues to be a common and reasonably reliable measurement to identify overweight and obese adults who may be at an increased risk for future morbidity. Although good quality evidence supports obtaining a BMI, it is important to recognize it is not a perfect measurement. For example, BMI and its associated disease and mortality risk appear to vary among ethnic subgroups. Black/African Americans appear to have the lowest mortality risk at a BMI of 26.2-28.5 kg/m2 in Black women and 27.1-30.2 kg/m2 in Black men. In contrast, Asian populations may experience the lowest mortality rates, starting at a BMI of 23 to 24 kg/m2. The correlation between BMI and diabetes risk also varies by ethnicity (LeBlanc et al., 2011). BMI is not a direct measure of adiposity; consequently, it can over or underestimate adiposity. However, overall, BMI is a derived value that correlates well with total body fat and markers of secondary complications, e.g., hypertension and dyslipidemia (Barlow \\& the Expert Committee, 2007). It is important to enhance beneficiary access to appropriate treatments for obesity, which could result in decreased healthcare costs and lower obesity rates. Behavioral weight management treatment has been identified as an effective first-line treatment for obesity, with an average initial weight loss of 8-10 percent. This percentage of weight loss is associated with a significant risk reduction for diabetes and CVD (Wadden, Butryn \\& Wilson, 2007). Evidence also shows that when provided 14 or more high-intensity behavioral intervention sessions of face-to-face individual or group treatment across 6 months, participants lose up to 8 percent of their weight during that time and experience improvements in heart disease risk factors and quality of life (Wadden, Tronieri, \\& Butryn, 2020). There is also evidence that high-intensity behavioral counseling is effective, whether delivered in-person, by phone, or electronically (Tronieri et al., 2019). Moreover, intensive behavioral therapy for obesity provided by registered dietitian nutritionists for 6-12 months shows a significant mean weight loss of up to 10 percent of body weight, maintained over one year's time (Raynor \\& Champagne, 2016). Despite the evidence that supports weight management counseling, the rate of use in primary care for patients with obesity decreased by 10 percent from 39.9 percent in 1995-1996 to 29.9 percent in 2007-2008 (Kraschnewski et al., 2013). Weight management counseling during primary care visits further declined from 33 percent to 21 percent between 2008-2009 and 2012-2013. This suggests that obesity management in primary care remains suboptimal (Fitzpatrick \\& Stevens, 2017). Therefore, screening for BMI and follow-up is critical and will help in reaching the quality goals of population health and cost reduction. However, due to concerns for other underlying conditions (such as bone health) or nutrition-related deficiencies, providers are cautioned to use their best clinical judgment when considering weight management programs for overweight patients, especially the elderly (National Heart, Lung, and Blood Institute \\[NHLBI\\] Obesity Education Initiative, 1998). BMI Below Normal Parameters On the other end of the body weight spectrum is underweight (BMI \\< 18.5 kg/m2), which is also detrimental to population health. When compared to normal-weight individuals (BMI 18.5-25 kg/m2), underweight individuals have significantly higher death rates with a Hazard Ratio of 2.27 and 95 percent confidence intervals = 1.78, 2.90 (Borrell \\& Samuel, 2014). Individuals with a BMI \\< 18.5 kg/m2 have been shown to be at a higher risk for adverse events, postoperative infection, and/or mortality following a surgical procedure (Katakam et al., 2021; Ottesen et al., 2020; Ottesen et al., 2022; Rudasill et al., 2021). BMI below normal parameters is a risk factor for developing severe illness from respiratory infections such as influenza and COVID-19 (Moser et al., 2019; Ye et al., 2021). BMI below normal parameters can negatively impact both male and female fertility (Boutari et al., 2020; Guo et al., 2019). Poor nutrition or underlying health conditions can result in underweight (Fryar \\& Ogden, 2012). The National Health and Nutrition Examination Survey (NHANES) results from 2007-2010 indicate that women are more likely to be underweight than men (Fryar \\& Ogden, 2012). However, all patients should be equally screened for underweight and followed up with nutritional counseling or another clinically appropriate intervention to reduce mortality and morbidity associated with underweight.\n", "clinicalRecommendationStatement" : "All adults should be screened annually using a BMI measurement. BMI measurements \\>= 25 kg/m2 should be used to initiate further evaluation of overweight or obesity after taking into account age, gender, ethnicity, fluid status, and muscularity; therefore, clinical evaluation and judgment must be used when BMI is employed as the anthropometric indicator of excess adiposity, particularly in athletes and those with sarcopenia (Garvey et al., 2016) (Grade A). \n\n\nOverweight and Underweight Categories:\n\nUnderweight \\< 18.5; Normal weight 18.5-24.9; Overweight 25-29.9; Obese class I 30-34.9; Obese class II 35-39.9; Obese class III \\>= 40 (Garvey et al., 2016).\n\nBMI cutoff point value of \\>= 23 kg/m2 should be used in the screening and confirmation of excess adiposity in Asian adults (Garvey et al., 2016) (Grade B).\n\nLifestyle/behavioral therapy for overweight and obesity should include behavioral interventions that enhance adherence to prescriptions for a reduced-calorie meal plan and increased physical activity (behavioral interventions can include: self-monitoring of weight, food intake, and physical activity; clear and reasonable goal-setting; education pertaining to obesity, nutrition, and physical activity; face-to-face and group meetings; stimulus control; systematic approaches for problem-solving; stress reduction; cognitive restructuring \\[i.e., cognitive behavioral therapy\\], motivational interviewing; behavioral contracting; psychological counseling; and mobilization of social support structures) (Garvey et al., 2016) (Grade A).\n\nBehavioral lifestyle intervention should be tailored to a patient's ethnic, cultural, socioeconomic, and educational background (Garvey et al., 2016) (Grade B).\n\nThe U.S. Preventive Services Task Force (USPSTF) recommends that clinicians offer or refer adults with a BMI of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions (USPSTF, 2018) (Grade B).\n\nInterventions:\n\n* Effective intensive behavioral interventions were designed to help participants achieve or maintain weight loss of at least five percent through a combination of dietary changes and increased physical activity\n\n* Most interventions lasted for one to two years, and the majority had at least 12 sessions in the first year\n\n* Most behavioral interventions focused on problem-solving to identify barriers, self-monitoring of weight, peer support, and relapse prevention\n\n* Interventions also provided tools to support weight loss or weight loss maintenance (e.g., pedometers, food scales, or exercise videos) (USPSTF, 2018)\n\nNutritional safety for the elderly should be considered when recommending weight reduction. \"A clinical decision to forego obesity treatment in older adults should be guided by an evaluation of the potential benefits of weight reduction for day-to-day functioning and reduction of the risk of future cardiovascular events, as well as the patient's motivation for weight reduction. Care must be taken to ensure that any weight reduction program minimizes the likelihood of adverse effects on bone health or other aspects of nutritional status\" (NHLBI Obesity Education Initiative, 1998) (Evidence Category D). In addition, weight reduction prescriptions in older persons should be accompanied by proper nutritional counseling and regular body weight monitoring (NHLBI Obesity Education Initiative, 1998).\n\nThe possibility that a standard approach to weight loss will work differently in diverse patient populations must be considered when setting expectations about treatment outcomes (NHLBI Obesity Education Initiative, 1998) (Evidence Category B).\n", "group" : [{ "id" : "Group_1", "extension" : [{ "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring", "code" : "proportion", "display" : "Proportion" }] } }, { "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis", "valueCode" : "boolean" }, { "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-type", "code" : "process", "display" : "Process" }] } }, { "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation", "code" : "increase", "display" : "Increased score indicates improvement" }] } }], "description" : "Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the measurement period AND who had a follow-up plan documented if BMI was outside of normal parameters\n", "population" : [{ "id" : "InitialPopulation_1", "code" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "initial-population", "display" : "Initial Population" }] }, "description" : "All patients aged 18 and older on the date of the encounter with at least one qualifying encounter during the measurement period\n", "criteria" : { "language" : "text/cql-identifier", "expression" : "Initial Population" } }, { "id" : "Denominator_1", "code" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "denominator", "display" : "Denominator" }] }, "description" : "Equals Initial Population\n", "criteria" : { "language" : "text/cql-identifier", "expression" : "Denominator" } }, { "id" : "DenominatorExclusion_1", "code" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "denominator-exclusion", "display" : "Denominator Exclusion" }] }, "description" : "Patients who are pregnant at any time during the measurement period. Patients receiving palliative or hospice care at any time during the measurement period.\n", "criteria" : { "language" : "text/cql-identifier", "expression" : "Denominator Exclusions" } }, { "id" : "Numerator_1", "code" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "numerator", "display" : "Numerator" }] }, "description" : "Patients with a documented BMI during the encounter or during the measurement period, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the measurement period\n", "criteria" : { "language" : "text/cql-identifier", "expression" : "Numerator" } }, { "id" : "DenominatorException_1", "code" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "denominator-exception", "display" : "Denominator Exception" }] }, "description" : "* Patients with a documented medical reason for not documenting BMI or for not documenting a follow-up plan for a BMI outside normal parameters (e.g., elderly patients 65 years of age or older for whom weight reduction/weight gain would complicate other underlying health conditions such as illness or physical disability, mental illness, dementia, confusion, or nutritional deficiency such as vitamin/mineral deficiency; patients in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient's health status).\n\n* Patients who refuse measurement of height and/or weight.\n\n", "criteria" : { "language" : "text/cql-identifier", "expression" : "Denominator Exceptions" } }] }], "supplementalData" : [{ "id" : "sde-ethnicity", "usage" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage", "code" : "supplemental-data" }] }], "description" : "SDE Ethnicity\n", "criteria" : { "language" : "text/cql-identifier", "expression" : "SDE Ethnicity" } }, { "id" : "sde-payer", "usage" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage", "code" : "supplemental-data" }] }], "description" : "SDE Payer\n", "criteria" : { "language" : "text/cql-identifier", "expression" : "SDE Payer" } }, { "id" : "sde-race", "usage" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage", "code" : "supplemental-data" }] }], "description" : "SDE Race\n", "criteria" : { "language" : "text/cql-identifier", "expression" : "SDE Race" } }, { "id" : "sde-sex", "usage" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage", "code" : "supplemental-data" }] }], "description" : "SDE Sex\n", "criteria" : { "language" : "text/cql-identifier", "expression" : "SDE Sex" } }] }