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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 \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n\n \n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n\n \n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n \n\n\n\n\n \n\n\n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\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
TitleAntithrombotic Therapy by End of Hospital Day 2FHIR\n
Version1.0.000
Short NameCMS72FHIR
GUID (Version Independent)urn:uuid:b6ae4357-9baa-4195-a9cd-50391b7d0dab
GUID (Version Specific)urn:uuid:5de3156a-7293-40aa-9ec3-f3df76d3579c
CMS Identifier72FHIR
Effective Period2026-01-01 through 2026-12-31
Steward (Publisher)The Joint Commission
DeveloperThe Joint Commission
Description

Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2

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Copyright

Measure specifications are in the Public Domain

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LOINC(R) 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 copyright 2024 World Health Organization. All Rights Reserved.

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Disclaimer

These performance measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.

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Rationale

The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks (TIA) continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist.

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Aspirin is the recommended antithrombotic medication for early antithrombotic therapy and most frequently administered unless contraindicated. Anticoagulants at doses to prevent venous thromboembolism (VTE) are insufficient. Subcutaneous Lovenox (enoxaparin) and unfractionated heparin (UFH) SQ at lower dosages used for VTE prophylaxis (i.e., enoxaparin SQ 40 mg once daily; enoxaparin SQ 30 mg Q12 hours; UFH 5,000 units or less two or three times daily) are not sufficient for early antithrombotic therapy.

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Anticoagulants at doses to prevent VTE are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA.

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Clinical Recommendation Statement

Antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist

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Citation\n \n \n \n

Adams, H. P., Jr., del Zoppo, G., Alberts, M. J., et al. (2007, May). Guidelines for the early management of adults with ischemic stroke: A guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Stroke, 38(5), 1655-1711.

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Adams, H., Adams, R., del Zoppo, G., et al. (2005, April). Guidelines for the early management of patients with ischemic stroke: 2005 guidelines update-A scientific statement from the Stroke Council of the American Heart Association/American Stroke Association. Stroke, 36(4): 916-923.

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Albers, G. W, Amarenco, P., Easton, J. D., et al. (2001). Antithrombotic and thrombolytic therapy for ischemic stroke. Chest, 119, 300-320.

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Antithrombotic Trialists' Collaboration. (2002, January 12). Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high-risk patients. BMJ, 324(7329), 71-86.

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Brott, T. G., Clark, W. M., Fagan, S. C., et al. (2000). Stroke: The first hours. Guidelines for acute treatment. Washington, DC: National Stroke Association.

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Centers for Disease Control and Prevention. (2009, May 1). Prevalence and most common causes of disability among adults-United States, 2005. Morbidity and Mortality Weekly Report, 58(16), 421-426.

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Chen, Z. M., Sandercock, P., Pan, H. C., et al. (2000, June). Indications for early aspirin use in acute ischemic stroke: A combined analysis of 40,000 randomized patients from the Chinese Acute Stroke Trial and the International Stroke Trial. Stroke, 31(6), 1240-1249.

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Coull, B. M., Williams, L. S., Goldstein, L. B., et al. (2002, July). Anticoagulants and antiplatelet agents in acute ischemic stroke: Report of the Joint Stroke Guideline Development Committee of the American Academy of Neurology and the American Stroke Association (a Division of the American Heart Association). Stroke, 33(7), 1934-1942.

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Eccles, M., Freemantle, N., & Mason, J. (1998, April 25). North of England Evidence-Based Guideline Development Project: Guideline on the use of aspirin as secondary prophylaxis for vascular disease in primary care. BMJ, 316(7140), 1303-1309.

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ESPS Group. (1987, December 12). The European Stroke Prevention Study (ESPS): Principal end-points. Lancet, 2(8572), 1351-1354.

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Citation\n \n \n \n

Furie, K. L., Kasner, S. E., Adams, R. J., et al. (2011, January). Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: A guideline for health care professionals from the American Heart Association/American Stroke Association. Stroke, 42(1), 227-276.

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Gaspoz, J. M., Coxson, P. G., Goldman, P. A., et al. (2002, June 6). Cost effectiveness of aspirin, clopidogrel, or both for secondary prevention of coronary heart disease. New England Journal of Medicine, 346(23), 1800-1806.

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Guyatt, G. H., Akl, E. A., Crowther, M., et al. (2012, February). Executive summary: Antithrombotic therapy and prevention of thrombosis, 9th ed.: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2 Suppl.), 7S-47S.

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International Stroke Trial Collaborative Group. (1997, May 31). The International Stroke Trial (IST): A randomised trial of aspirin, subcutaneous heparin, both, or neither among 19,435 patients with acute ischaemic stroke. Lancet, 349(9065), 1569-1581.

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Jauch, E. C., Saver, J. L., Adams, H. P., Jr., et al. (2013). Guidelines for the early management of patients with acute ischemic stroke: A guideline for health care professionals from the American Heart Association/American Stroke Association. Stroke, 44(3), 870-947.

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Johnson, E. S., Lanes, S. F., Wentworth, C. E., III, et al. (1999, June 14). A metaregression analysis of the dose-response effect of aspirin on stroke. Archives of Internal Medicine, 159(11), 1248-1253.

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Powers, W. J., Rabinstein, A. A., Ackerson, T., et al. (2018, January). 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for health care professionals from the American Heart Association/American Stroke Association. Stroke, 49,

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Roger, V. L., Go, A. S., Lloyd-Jones, D. M., et al. (2012, January 3). Heart disease and stroke statistics-2012 update: A report from the American Heart Association. Circulation, 125(1), e2-e220.

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Citation\n \n \n \n

Sacco, R. L., Adams, R., Albers, G., et al. (2006, February). Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: A statement for health care professionals from the American Heart Association/American Stroke Association Council on Stroke: Co-sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke, 37(2), 577-617.

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Guidance (Usage)The "Nonelective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient Encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective Inpatient Encounters include emergency, urgent, and unplanned admissions.\n\nNPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e., rectal or intravenous).\n\nIn the denominator exclusions, the intent is to only exclude patients with a total length of stay of \\<2 days, including Emergency Department (ED) visit (if there is one). For the dQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits.\n\nThe denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.\n\nThis dQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS72v14. 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)
BasisEncounter
Scoring\n Proportion\n\n\n
Improvement Notation\n Increased score indicates improvement\n\n\n
Type\n Process\n\n\n
Rate AggregationNone\n
Initial Population\n \n ID: InitialPopulation_1\n
\n \n \n Description:\n

Inpatient hospitalization (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke that ends 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

* Inpatient hospitalization for patients who have a duration of stay less than 2 days.\n\n* Inpatient hospitalization for patients with comfort measures documented day of or the day after arrival.\n\n* Inpatient hospitalization for patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy administered within 24 hours prior to arrival or anytime during hospitalization.\n\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

* Inpatient hospitalization for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival\n\n* Inpatient hospitalization for patients who receive Prasugrel as an antithrombotic therapy the day of or day after hospital arrival\n\n* Inpatient hospitalization for patients with an international normalized ratio (INR) greater than 3.5\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

Inpatient hospitalization for patients who had antithrombotic therapy administered the day of or day after hospital arrival\n

\n \n \n \n \n \n Criteria: Numerator \n \n \n \n \n \n \n
\n\n\n\n<p>For every patient evaluated by this measure also identify payer, race, ethnicity and sex</p>
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/CMS72FHIRSTKAntithromboticDay2
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  TJC."Ischemic Stroke Encounter"
\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  "Encounter Less Than Two Days"\n    union "Encounter With Comfort Measures During Day Of Or Day After Arrival"\n    union "Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization"
\n \n \n Definition\n \n
\n \n Denominator Exception\n \n
\n \n \n \n \n \n \n \n 
define "Denominator Exceptions":\n  "Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival"\n    union "Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival"\n    union "Encounter With An INR Greater Than 3.5"
\n \n \n Definition\n \n
\n \n Numerator\n \n
\n \n \n \n \n \n \n \n 
define "Numerator":\n  "Encounter With Antithrombotic Therapy"
\n \n \n Definition\n \n
Logic Definitions
\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: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "SDE Sex":\n  SDE."SDE Sex"
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Encounter With Antithrombotic Therapy":\n  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n    with ["MedicationAdministration": "Antithrombotic Therapy for Ischemic Stroke"] Antithrombotic\n      such that Antithrombotic.status in { 'in-progress', 'completed' }\n        and Antithrombotic.effective.toInterval ( ) starts during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).calendarDayOfOrDayAfter ( )
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Numerator":\n  "Encounter With Antithrombotic Therapy"
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Initial Population":\n  TJC."Ischemic Stroke Encounter"
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Denominator":\n  "Initial Population"
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "SDE Payer":\n  SDE."SDE Payer"
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "SDE Ethnicity":\n  SDE."SDE Ethnicity"
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Encounter Less Than Two Days":\n  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n    where IschemicStrokeEncounter.hospitalizationWithObservation ( ).lengthInDays ( ) < 2
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Encounter With Comfort Measures During Day Of Or Day After Arrival":\n  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n    with TJC."Intervention Comfort Measures" ComfortMeasure\n      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).calendarDayOfOrDayAfter ( )
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Thrombolytic Therapy Medication Or Procedures":\n  ( ["MedicationAdministration": "Thrombolytic tPA Therapy"] ThrombolyticMedication\n      where ThrombolyticMedication.status in { 'in-progress', 'completed' }\n      return {\n        id: ThrombolyticMedication.id,\n        effective: ThrombolyticMedication.effective\n      }\n  )\n    union ( ["Procedure": "Intravenous or Intraarterial Thrombolytic tPA Therapy"] ThrombolyticProcedure\n        where ThrombolyticProcedure.status = 'completed'\n        return {\n          id: ThrombolyticProcedure.id,\n          effective: ThrombolyticProcedure.performed\n        }\n    )
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Encounter With Thrombolytic Therapy Medication Or Procedures":\n  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n    with "Thrombolytic Therapy Medication Or Procedures" ThrombolyticTherapy\n      such that ThrombolyticTherapy.effective.toInterval ( ) starts during Interval[start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) - 24 hours, end of IschemicStrokeEncounter.hospitalizationWithObservation ( ) )
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Encounter With Thrombolytic Therapy Prior To Arrival":\n  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n    where exists ( ( IschemicStrokeEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n        where EncounterDiagnosis.code in "Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival"\n    )
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Encounter With Thrombolytic Therapy Documented As Already Given":\n  ( TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n      where exists [ConditionProblemsHealthConcerns: "Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival"] PriorTPA\n        where PriorTPA.recordedDate during IschemicStrokeEncounter.hospitalizationWithObservation ( )\n          and PriorTPA.verificationStatus is not null implies ( PriorTPA.verificationStatus !~ Status."refuted"\n            and PriorTPA.verificationStatus !~ Status."entered-in-error" \n        )\n  )\n    union TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n      where exists ( ( IschemicStrokeEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n          where EncounterDiagnosis.code in "Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival"\n      )
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization":\n  "Encounter With Thrombolytic Therapy Medication Or Procedures"\n    union "Encounter With Thrombolytic Therapy Prior To Arrival"\n    union "Encounter With Thrombolytic Therapy Documented As Already Given"
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Denominator Exclusions":\n  "Encounter Less Than Two Days"\n    union "Encounter With Comfort Measures During Day Of Or Day After Arrival"\n    union "Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization"
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "SDE Race":\n  SDE."SDE Race"
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Reason For Not Ordering Antithrombotic":\n  ( ["MedicationNotRequested": "Antithrombotic Therapy for Ischemic Stroke"] NoAntithromboticOrder\n      where ( NoAntithromboticOrder.reasonCode in "Medical Reason for Not Providing Treatment"\n          or NoAntithromboticOrder.reasonCode in "Patient Refusal"\n      )\n        and NoAntithromboticOrder.status in { 'active', 'completed' }\n        and NoAntithromboticOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n      return {\n        id: NoAntithromboticOrder.id,\n        authoredOn: NoAntithromboticOrder.authoredOn\n      }\n  )\n    union ( ["MedicationRequest": "Antithrombotic Therapy for Ischemic Stroke"] MedReqAntithrombotic\n        with ["TaskRejected"] TaskReject\n          such that TaskReject.focus.references ( MedReqAntithrombotic )\n            and ( TaskReject.statusReason in "Medical Reason for Not Providing Treatment"\n                or TaskReject.statusReason in "Patient Refusal"\n            )\n            and ( MedReqAntithrombotic.status in { 'active', 'completed' }\n                and TaskReject.code ~ USQualityCoreCommon."Fulfill"\n            )\n        return {\n          id: MedReqAntithrombotic.id,\n          authoredOn: MedReqAntithrombotic.authoredOn\n        }\n    )
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Reason For Not Administering Antithrombotic":\n  ["MedicationAdministrationNotDone": "Antithrombotic Therapy for Ischemic Stroke"] MedicationAdm\n    where ( MedicationAdm.statusReason in "Medical Reason for Not Providing Treatment"\n        or MedicationAdm.statusReason in "Patient Refusal"\n    )\n    return {\n      id: MedicationAdm.id,\n      authoredOn: MedicationAdm.effective\n    }
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Documented Reason For No Antithrombotic Ordered Or Administered":\n  "Reason For Not Ordering Antithrombotic"\n    union "Reason For Not Administering Antithrombotic"
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival":\n  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n    with "Documented Reason For No Antithrombotic Ordered Or Administered" NoAntithrombotic\n      such that NoAntithrombotic.authoredOn during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).calendarDayOfOrDayAfter ( )
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival":\n  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n    with ["MedicationAdministration": "Pharmacological Contraindications For Antithrombotic Therapy"] PharmacologicalContraindications\n      such that PharmacologicalContraindications.status in { 'in-progress', 'completed' }\n        and PharmacologicalContraindications.effective.toInterval ( ) starts during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).calendarDayOfOrDayAfter ( )
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Encounter With An INR Greater Than 3.5":\n  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n    with ["LaboratoryResultObservation": "INR"] INR\n      such that INR.value as Quantity > 3.5\n        and INR.status in { 'final', 'amended', 'corrected' }\n        and INR.issued during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).calendarDayOfOrDayAfter ( )
\n
\n Logic Definition\n Library Name: CMS72FHIRSTKAntithromboticDay2
\n \n \n \n \n \n \n 
define "Denominator Exceptions":\n  "Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival"\n    union "Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival"\n    union "Encounter With An INR Greater Than 3.5"
\n
\n Logic Definition\n Library Name: TJCOverall
\n \n \n \n \n \n \n 
define "Non Elective Inpatient Encounter With Age":\n  ["Encounter": "Nonelective Inpatient Encounter"] NonElectiveEncounter\n        where AgeInYearsAt(date from start of NonElectiveEncounter.period ) >= 18\n         and NonElectiveEncounter.period ends during day of "Measurement Period"
\n
\n Logic Definition\n Library Name: TJCOverall
\n \n \n \n \n \n \n 
define "Ischemic Stroke Encounter":\n  "Non Elective Inpatient Encounter With Age" NonElectiveEncounterWithAge\n   where NonElectiveEncounterWithAge.hasPrincipalDiagnosisOf("Ischemic Stroke" )
\n
\n Logic Definition\n Library Name: TJCOverall
\n \n \n \n \n \n \n 
define "Intervention Comfort Measures":\n  ( ["ServiceRequest": "Comfort Measures"] ComfortCare\n    where ComfortCare.status in { 'active', 'completed', 'on-hold' }\n      and ComfortCare.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n  )  \n  union ( ["Procedure": "Comfort Measures"] ComfortCarePerformed\n        where ComfortCarePerformed.status in { 'completed', 'in-progress' }\n  )
\n
\n Logic Definition\n Library Name: TJCOverall
\n \n \n \n \n \n \n 
define fluent function calendarDayOfOrDayAfter(StartValue DateTime):\n  Interval [date from (StartValue), date from (StartValue) + 1 day]
\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: Returns true if any of the given references are to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(references List<FHIR.Reference>, resource FHIR.Resource):\n  exists (references R where R.references(resource))
\n
\n Logic Definition\n Library Name: FHIRCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns true if the given reference is to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(reference FHIR.Reference, resource FHIR.Resource):\n  resource.id = Last(Split(reference.reference, '/'))
\n
\n Logic Definition\n Library Name: FHIRCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns true if the given code is in the given codeList\n@comment: Returns true if the `code` is equivalent to any of the codes in the given `codeList`, false otherwise.\n*/\ndefine fluent function includesCode(codeList List<CodeableConcept>, code Concept):\n  exists (codeList C where C ~ code)
\n
\n Logic Definition\n Library Name: FHIRCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns true if the given reference is to the given resourceId\n@comment: Returns true if the `resourceId` parameter exactly equals the tail of the given reference.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(reference FHIR.Reference, resourceId String):\n  resourceId = Last(Split(reference.reference, '/'))
\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 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: CQMCommon
\n \n \n \n \n \n \n 
/*\n @description: Returns the condition that is specified as the principal diagnosis for the encounter and has a code in the given valueSet.\n @comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information\n */\n define fluent function hasPrincipalDiagnosisOf(encounter Encounter, valueSet System.ValueSet):\n   (encounter.principalDiagnosis()) PD\n     return PD.diagnosis in valueSet\n       or PD.diagnosis.getCondition().code in valueSet
\n
\n Logic Definition\n Library Name: CQMCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns the claim diagnosis element that is specified as the principal diagnosis for the encounter\n @comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information\n*/\ndefine fluent function principalDiagnosis(encounter Encounter):\nsingleton from (\n     (encounter.claimDiagnosis()) CD\n       where CD.type.includesCode("Principal Diagnosis")\n   )
\n
\n Logic Definition\n Library Name: CQMCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns the claim diagnosis elements for the given encounter\n@comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information\n*/\ndefine fluent function claimDiagnosis(encounter Encounter):\n  encounter E\n    let \n      claim: ([Claim] C where C.status = 'active' and C.use = 'claim' and exists (C.item I where I.encounter.references(E))),\n      claimItem: (claim.item I where I.encounter.references(E))\n    return claim.diagnosis D where D.sequence in claimItem.diagnosisSequence
\n
\n Logic Definition\n Library Name: CQMCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns the Condition resource for the given reference\n*/\ndefine fluent function getCondition(reference Reference):\n  singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where reference.references(C.id))
\n
\n Logic Definition\n Library Name: CQMCommon
\n \n \n \n \n \n \n 
/*\n@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter\n*/\ndefine fluent function hospitalizationWithObservation(TheEncounter Encounter ):\n  TheEncounter Visit\n  \t\tlet ObsVisit: Last([Encounter: "Observation Services"] LastObs\n  \t\t\t\twhere LastObs.status = 'finished'\n            and LastObs.period ends 1 hour or less on or before start of Visit.period\n  \t\t\t\tsort by end of period\n  \t\t\t),\n  \t\t\tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n  \t\t\tEDVisit: Last([Encounter: "Emergency Department Visit"] LastED\n  \t\t\t\twhere LastED.status = 'finished'\n            and LastED.period ends 1 hour or less on or before VisitStart\n  \t\t\t\tsort by end of period\n  \t\t\t)\n  \t\treturn Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]
\n
\n Logic Definition\n Library Name: CQMCommon
\n \n \n \n \n \n \n 
/*\n@description: Calculates the difference in calendar days between the start and end of the given interval.\n*/\ndefine fluent function lengthInDays(Value Interval<DateTime> ):\n  difference in days between start of Value and end of Value
\n
\n Logic Definition\n Library Name: CQMCommon
\n \n \n \n \n \n \n 
/*  \n@description: Returns the Condition resources referenced by the diagnosis element of the Encounter  \n*/\ndefine fluent function encounterDiagnosis(Encounter Encounter ):\n  Encounter.reasonReference D\n    return singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where D.references(C.id))
\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 
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 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 [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 ToString(value ClaimStatus): value.value
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
define function ToString(value Use): 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 MedicationAdministrationStatus): value.value
\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 
define function ToDateTime(value instant): 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 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 ProcedureStatus): 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: FHIRHelpers
\n \n \n \n \n \n \n 
define function ToString(value MedicationRequestIntent): 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
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 Diagnosis Type\n \n
\n \n \n \n \n \n \n Resource: Example Diagnosis Type Codes\n
\n Canonical URL: http://terminology.hl7.org/CodeSystem/ex-diagnosistype\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
Code System\n \n Description: Code system TaskCodeSystem\n \n
\n \n \n \n \n \n \n Resource: Task Codes\n
\n Canonical URL: http://hl7.org/fhir/CodeSystem/task-code\n \n
Value Set\n \n Description: Value set Nonelective Inpatient Encounter\n \n
\n \n \n \n \n \n \n Resource: Nonelective Inpatient Encounter\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424\n \n
Value Set\n \n Description: Value set Ischemic Stroke\n \n
\n \n \n \n \n \n \n Resource: Ischemic Stroke\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247\n \n
Value Set\n \n Description: Value set Antithrombotic Therapy for Ischemic Stroke\n \n
\n \n \n \n \n \n \n Resource: Antithrombotic Therapy for Ischemic Stroke\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62\n \n
Value Set\n \n Description: Value set Observation Services\n \n
\n \n \n \n \n \n \n Resource: Observation Services\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143\n \n
Value Set\n \n Description: Value set Emergency Department Visit\n \n
\n \n \n \n \n \n \n Resource: Emergency Department Visit\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292\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 Comfort Measures\n \n
\n \n \n \n \n \n \n Resource: Comfort Measures\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45\n \n
Value Set\n \n Description: Value set Thrombolytic tPA Therapy\n \n
\n \n \n \n \n \n \n Resource: Thrombolytic tPA Therapy\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.226\n \n
Value Set\n \n Description: Value set Intravenous or Intraarterial Thrombolytic tPA Therapy\n \n
\n \n \n \n \n \n \n Resource: Intravenous or Intraarterial Thrombolytic tPA Therapy\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.21\n \n
Value Set\n \n Description: Value set Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival\n \n
\n \n \n \n \n \n \n Resource: Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.21\n \n
Value Set\n \n Description: Value set Medical Reason for Not Providing Treatment\n \n
\n \n \n \n \n \n \n Resource: Medical Reason For Not Providing Treatment\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473\n \n
Value Set\n \n Description: Value set Patient Refusal\n \n
\n \n \n \n \n \n \n Resource: Patient Refusal\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93\n \n
Value Set\n \n Description: Value set Pharmacological Contraindications For Antithrombotic Therapy\n \n
\n \n \n \n \n \n \n Resource: Pharmacological Contraindications For Antithrombotic Therapy\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52\n \n
Value Set\n \n Description: Value set INR\n \n
\n \n \n \n \n \n \n Resource: INR\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.213\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 Display: Principal Diagnosis\n
\n \n Code: principal\n
\n System: http://terminology.hl7.org/CodeSystem/ex-diagnosistype\n
Direct Reference Code\n \n Display: refuted\n
\n \n Code: refuted\n
\n System: http://terminology.hl7.org/CodeSystem/condition-ver-status\n
Direct Reference Code\n \n Display: entered-in-error\n
\n \n Code: entered-in-error\n
\n System: http://terminology.hl7.org/CodeSystem/condition-ver-status\n
Direct Reference Code\n \n Display: Fulfill\n
\n \n Code: fulfill\n
\n System: http://hl7.org/fhir/CodeSystem/task-code\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 TJC\n \n
\n \n \n \n \n \n \n Resource: TJCOverall version: 9.1.000\n
\n Canonical URL: https://madie.cms.gov/Library/TJCOverall|9.1.000\n \n
Dependency\n \n Description: Library CQMCommon\n \n
\n \n \n \n \n \n \n Resource: CQMCommon version: 5.1.000\n
\n Canonical URL: https://madie.cms.gov/Library/CQMCommon|5.1.000\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 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: Encounter\n
\n \n Profile(s): \n \n Encounter\n
\n \n \n \n Must Support Elements: type, status, period, diagnosis, diagnosis.code\n
\n \n \n Code Filter(s): \n
\n \n \n Path: type\n
\n \n \n \n ValueSet: Observation Services\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: Encounter\n
\n \n Profile(s): \n \n Encounter\n
\n \n \n \n Must Support Elements: type, status, period, diagnosis, diagnosis.code\n
\n \n \n Code Filter(s): \n
\n \n \n Path: type\n
\n \n \n \n ValueSet: Emergency Department Visit\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: Encounter\n
\n \n Profile(s): \n \n Encounter\n
\n \n \n \n Must Support Elements: type, period, diagnosis, diagnosis.code\n
\n \n \n Code Filter(s): \n
\n \n \n Path: type\n
\n \n \n \n ValueSet: Nonelective Inpatient Encounter\n
\n \n \n \n \n
Data Requirement\n Type: Resource\n
\n \n Profile(s): \n \n Resource\n
\n \n \n \n Must Support Elements: id\n
\n \n \n
Data Requirement\n Type: Claim\n
\n \n Profile(s): \n \n Claim\n
\n \n \n \n Must Support Elements: status, use, item\n
\n \n \n Code Filter(s): \n
\n \n \n Path: status\n
\n \n \n \n \n Code(s): \n \n \n [not stated]: active (active)\n \n \n \n
\n \n \n \n Path: use\n
\n \n \n \n \n Code(s): \n \n \n [not stated]: claim (claim)\n \n \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 \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 \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, recordedDate, verificationStatus\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival\n
\n \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: 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: Antithrombotic Therapy for Ischemic Stroke\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: Thrombolytic tPA Therapy\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: Antithrombotic Therapy for Ischemic Stroke\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: Pharmacological Contraindications For Antithrombotic Therapy\n
\n \n \n \n \n
Data Requirement\n Type: MedicationAdministration\n
\n \n Profile(s): \n \n MedicationAdministration\n
\n \n \n \n Must Support Elements: medication, status, effective, id\n
\n \n \n Code Filter(s): \n
\n \n \n Path: medication\n
\n \n \n \n ValueSet: Antithrombotic Therapy for Ischemic Stroke\n
\n \n \n \n \n
Data Requirement\n Type: MedicationAdministration\n
\n \n Profile(s): \n \n MedicationAdministration\n
\n \n \n \n Must Support Elements: medication, status, effective, id\n
\n \n \n Code Filter(s): \n
\n \n \n Path: medication\n
\n \n \n \n ValueSet: Thrombolytic tPA Therapy\n
\n \n \n \n \n
Data Requirement\n Type: MedicationAdministration\n
\n \n Profile(s): \n \n MedicationAdministration\n
\n \n \n \n Must Support Elements: medication.reference, status, effective, id\n
\n \n \n
Data Requirement\n Type: MedicationAdministration\n
\n \n Profile(s): \n \n MedicationAdministration\n
\n \n \n \n Must Support Elements: medication, status, effective, id\n
\n \n \n Code Filter(s): \n
\n \n \n Path: medication\n
\n \n \n \n ValueSet: Pharmacological Contraindications For Antithrombotic Therapy\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: 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: Comfort Measures\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, status\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Comfort Measures\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, status, id, performed\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Intravenous or Intraarterial Thrombolytic tPA Therapy\n
\n \n \n \n \n Path: status\n
\n \n \n \n \n Code(s): \n \n \n [not stated]: completed (completed)\n \n \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, reasonCode, status, intent, id, authoredOn\n
\n \n \n Code Filter(s): \n
\n \n \n Path: medication\n
\n \n \n \n ValueSet: Antithrombotic Therapy for Ischemic Stroke\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, status, id, authoredOn\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, status, id, authoredOn\n
\n \n \n Code Filter(s): \n
\n \n \n Path: medication\n
\n \n \n \n ValueSet: Antithrombotic Therapy for Ischemic Stroke\n
\n \n \n \n \n
Data Requirement\n Type: Task\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-taskrejected\n
\n \n \n \n Must Support Elements: focus, statusReason, code\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n \n \n \n
Data Requirement\n Type: MedicationAdministration\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-medicationadministrationnotdone\n
\n \n \n \n Must Support Elements: medication, statusReason, id, effective\n
\n \n \n Code Filter(s): \n
\n \n \n Path: medication\n
\n \n \n \n ValueSet: Antithrombotic Therapy for Ischemic Stroke\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-lab\n
\n \n \n \n Must Support Elements: code, value, status, issued\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: INR\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..*Encounter\n
DenominatorOut0..*Encounter\n
SDE PayerOut0..*Resource\n
Initial PopulationOut0..*Encounter\n
SDE EthnicityOut0..1Resource\n
Denominator ExclusionsOut0..*Encounter\n
SDE RaceOut0..1Resource\n
Denominator ExceptionsOut0..*Encounter\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/ex-diagnosistype", "code" : "principal", "display" : "Principal Diagnosis" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code" : "refuted", "display" : "refuted" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code" : "entered-in-error", "display" : "entered-in-error" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://hl7.org/fhir/CodeSystem/task-code", "code" : "fulfill", "display" : "Fulfill" } }, { "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" : "CMS72FHIRSTKAntithromboticDay2" }, { "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" : "TJCOverall" }, { "url" : "name", "valueString" : "Non Elective Inpatient Encounter With Age" }, { "url" : "statement", "valueString" : "define \"Non Elective Inpatient Encounter With Age\":\n [\"Encounter\": \"Nonelective Inpatient Encounter\"] NonElectiveEncounter\n where AgeInYearsAt(date from start of NonElectiveEncounter.period ) >= 18\n and NonElectiveEncounter.period ends during day of \"Measurement Period\"" }, { "url" : "displaySequence", "valueInteger" : 2 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "TJCOverall" }, { "url" : "name", "valueString" : "Ischemic Stroke Encounter" }, { "url" : "statement", "valueString" : "define \"Ischemic Stroke Encounter\":\n \"Non Elective Inpatient Encounter With Age\" NonElectiveEncounterWithAge\n where NonElectiveEncounterWithAge.hasPrincipalDiagnosisOf(\"Ischemic Stroke\" )" }, { "url" : "displaySequence", "valueInteger" : 3 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Encounter With Antithrombotic Therapy" }, { "url" : "statement", "valueString" : "define \"Encounter With Antithrombotic Therapy\":\n TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n with [\"MedicationAdministration\": \"Antithrombotic Therapy for Ischemic Stroke\"] Antithrombotic\n such that Antithrombotic.status in { 'in-progress', 'completed' }\n and Antithrombotic.effective.toInterval ( ) starts during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).calendarDayOfOrDayAfter ( )" }, { "url" : "displaySequence", "valueInteger" : 4 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Numerator" }, { "url" : "statement", "valueString" : "define \"Numerator\":\n \"Encounter With Antithrombotic Therapy\"" }, { "url" : "displaySequence", "valueInteger" : 5 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Initial Population" }, { "url" : "statement", "valueString" : "define \"Initial Population\":\n TJC.\"Ischemic Stroke Encounter\"" }, { "url" : "displaySequence", "valueInteger" : 6 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Denominator" }, { "url" : "statement", "valueString" : "define \"Denominator\":\n \"Initial Population\"" }, { "url" : "displaySequence", "valueInteger" : 7 }], "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" : 8 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "SDE Payer" }, { "url" : "statement", "valueString" : "define \"SDE Payer\":\n SDE.\"SDE Payer\"" }, { "url" : "displaySequence", "valueInteger" : 9 }], "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" : 10 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "SDE Ethnicity" }, { "url" : "statement", "valueString" : "define \"SDE Ethnicity\":\n SDE.\"SDE Ethnicity\"" }, { "url" : "displaySequence", "valueInteger" : 11 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Encounter Less Than Two Days" }, { "url" : "statement", "valueString" : "define \"Encounter Less Than Two Days\":\n TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n where IschemicStrokeEncounter.hospitalizationWithObservation ( ).lengthInDays ( ) < 2" }, { "url" : "displaySequence", "valueInteger" : 12 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "TJCOverall" }, { "url" : "name", "valueString" : "Intervention Comfort Measures" }, { "url" : "statement", "valueString" : "define \"Intervention Comfort Measures\":\n ( [\"ServiceRequest\": \"Comfort Measures\"] ComfortCare\n where ComfortCare.status in { 'active', 'completed', 'on-hold' }\n and ComfortCare.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n ) \n union ( [\"Procedure\": \"Comfort Measures\"] ComfortCarePerformed\n where ComfortCarePerformed.status in { 'completed', 'in-progress' }\n )" }, { "url" : "displaySequence", "valueInteger" : 13 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Encounter With Comfort Measures During Day Of Or Day After Arrival" }, { "url" : "statement", "valueString" : "define \"Encounter With Comfort Measures During Day Of Or Day After Arrival\":\n TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n with TJC.\"Intervention Comfort Measures\" ComfortMeasure\n such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).calendarDayOfOrDayAfter ( )" }, { "url" : "displaySequence", "valueInteger" : 14 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Thrombolytic Therapy Medication Or Procedures" }, { "url" : "statement", "valueString" : "define \"Thrombolytic Therapy Medication Or Procedures\":\n ( [\"MedicationAdministration\": \"Thrombolytic tPA Therapy\"] ThrombolyticMedication\n where ThrombolyticMedication.status in { 'in-progress', 'completed' }\n return {\n id: ThrombolyticMedication.id,\n effective: ThrombolyticMedication.effective\n }\n )\n union ( [\"Procedure\": \"Intravenous or Intraarterial Thrombolytic tPA Therapy\"] ThrombolyticProcedure\n where ThrombolyticProcedure.status = 'completed'\n return {\n id: ThrombolyticProcedure.id,\n effective: ThrombolyticProcedure.performed\n }\n )" }, { "url" : "displaySequence", "valueInteger" : 15 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Encounter With Thrombolytic Therapy Medication Or Procedures" }, { "url" : "statement", "valueString" : "define \"Encounter With Thrombolytic Therapy Medication Or Procedures\":\n TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n with \"Thrombolytic Therapy Medication Or Procedures\" ThrombolyticTherapy\n such that ThrombolyticTherapy.effective.toInterval ( ) starts during Interval[start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) - 24 hours, end of IschemicStrokeEncounter.hospitalizationWithObservation ( ) )" }, { "url" : "displaySequence", "valueInteger" : 16 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Encounter With Thrombolytic Therapy Prior To Arrival" }, { "url" : "statement", "valueString" : "define \"Encounter With Thrombolytic Therapy Prior To Arrival\":\n TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n where exists ( ( IschemicStrokeEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n where EncounterDiagnosis.code in \"Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival\"\n )" }, { "url" : "displaySequence", "valueInteger" : 17 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Encounter With Thrombolytic Therapy Documented As Already Given" }, { "url" : "statement", "valueString" : "define \"Encounter With Thrombolytic Therapy Documented As Already Given\":\n ( TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n where exists [ConditionProblemsHealthConcerns: \"Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival\"] PriorTPA\n where PriorTPA.recordedDate during IschemicStrokeEncounter.hospitalizationWithObservation ( )\n and PriorTPA.verificationStatus is not null implies ( PriorTPA.verificationStatus !~ Status.\"refuted\"\n and PriorTPA.verificationStatus !~ Status.\"entered-in-error\" \n )\n )\n union TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n where exists ( ( IschemicStrokeEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n where EncounterDiagnosis.code in \"Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival\"\n )" }, { "url" : "displaySequence", "valueInteger" : 18 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization" }, { "url" : "statement", "valueString" : "define \"Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization\":\n \"Encounter With Thrombolytic Therapy Medication Or Procedures\"\n union \"Encounter With Thrombolytic Therapy Prior To Arrival\"\n union \"Encounter With Thrombolytic Therapy Documented As Already Given\"" }, { "url" : "displaySequence", "valueInteger" : 19 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Denominator Exclusions" }, { "url" : "statement", "valueString" : "define \"Denominator Exclusions\":\n \"Encounter Less Than Two Days\"\n union \"Encounter With Comfort Measures During Day Of Or Day After Arrival\"\n union \"Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization\"" }, { "url" : "displaySequence", "valueInteger" : 20 }], "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" : 21 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "SDE Race" }, { "url" : "statement", "valueString" : "define \"SDE Race\":\n SDE.\"SDE Race\"" }, { "url" : "displaySequence", "valueInteger" : 22 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Reason For Not Ordering Antithrombotic" }, { "url" : "statement", "valueString" : "define \"Reason For Not Ordering Antithrombotic\":\n ( [\"MedicationNotRequested\": \"Antithrombotic Therapy for Ischemic Stroke\"] NoAntithromboticOrder\n where ( NoAntithromboticOrder.reasonCode in \"Medical Reason for Not Providing Treatment\"\n or NoAntithromboticOrder.reasonCode in \"Patient Refusal\"\n )\n and NoAntithromboticOrder.status in { 'active', 'completed' }\n and NoAntithromboticOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n return {\n id: NoAntithromboticOrder.id,\n authoredOn: NoAntithromboticOrder.authoredOn\n }\n )\n union ( [\"MedicationRequest\": \"Antithrombotic Therapy for Ischemic Stroke\"] MedReqAntithrombotic\n with [\"TaskRejected\"] TaskReject\n such that TaskReject.focus.references ( MedReqAntithrombotic )\n and ( TaskReject.statusReason in \"Medical Reason for Not Providing Treatment\"\n or TaskReject.statusReason in \"Patient Refusal\"\n )\n and ( MedReqAntithrombotic.status in { 'active', 'completed' }\n and TaskReject.code ~ USQualityCoreCommon.\"Fulfill\"\n )\n return {\n id: MedReqAntithrombotic.id,\n authoredOn: MedReqAntithrombotic.authoredOn\n }\n )" }, { "url" : "displaySequence", "valueInteger" : 23 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Reason For Not Administering Antithrombotic" }, { "url" : "statement", "valueString" : "define \"Reason For Not Administering Antithrombotic\":\n [\"MedicationAdministrationNotDone\": \"Antithrombotic Therapy for Ischemic Stroke\"] MedicationAdm\n where ( MedicationAdm.statusReason in \"Medical Reason for Not Providing Treatment\"\n or MedicationAdm.statusReason in \"Patient Refusal\"\n )\n return {\n id: MedicationAdm.id,\n authoredOn: MedicationAdm.effective\n }" }, { "url" : "displaySequence", "valueInteger" : 24 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Documented Reason For No Antithrombotic Ordered Or Administered" }, { "url" : "statement", "valueString" : "define \"Documented Reason For No Antithrombotic Ordered Or Administered\":\n \"Reason For Not Ordering Antithrombotic\"\n union \"Reason For Not Administering Antithrombotic\"" }, { "url" : "displaySequence", "valueInteger" : 25 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival" }, { "url" : "statement", "valueString" : "define \"Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival\":\n TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n with \"Documented Reason For No Antithrombotic Ordered Or Administered\" NoAntithrombotic\n such that NoAntithrombotic.authoredOn during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).calendarDayOfOrDayAfter ( )" }, { "url" : "displaySequence", "valueInteger" : 26 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival" }, { "url" : "statement", "valueString" : "define \"Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival\":\n TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n with [\"MedicationAdministration\": \"Pharmacological Contraindications For Antithrombotic Therapy\"] PharmacologicalContraindications\n such that PharmacologicalContraindications.status in { 'in-progress', 'completed' }\n and PharmacologicalContraindications.effective.toInterval ( ) starts during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).calendarDayOfOrDayAfter ( )" }, { "url" : "displaySequence", "valueInteger" : 27 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Encounter With An INR Greater Than 3.5" }, { "url" : "statement", "valueString" : "define \"Encounter With An INR Greater Than 3.5\":\n TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n with [\"LaboratoryResultObservation\": \"INR\"] INR\n such that INR.value as Quantity > 3.5\n and INR.status in { 'final', 'amended', 'corrected' }\n and INR.issued during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).calendarDayOfOrDayAfter ( )" }, { "url" : "displaySequence", "valueInteger" : 28 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS72FHIRSTKAntithromboticDay2" }, { "url" : "name", "valueString" : "Denominator Exceptions" }, { "url" : "statement", "valueString" : "define \"Denominator Exceptions\":\n \"Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival\"\n union \"Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival\"\n union \"Encounter With An INR Greater Than 3.5\"" }, { "url" : "displaySequence", "valueInteger" : 29 }], "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" : 30 }], "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" : 31 }], "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" : 32 }], "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" : 33 }], "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" : 34 }], "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" : 35 }], "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" : 36 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CQMCommon" }, { "url" : "name", "valueString" : "hasPrincipalDiagnosisOf" }, { "url" : "statement", "valueString" : "/*\n @description: Returns the condition that is specified as the principal diagnosis for the encounter and has a code in the given valueSet.\n @comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information\n */\n define fluent function hasPrincipalDiagnosisOf(encounter Encounter, valueSet System.ValueSet):\n (encounter.principalDiagnosis()) PD\n return PD.diagnosis in valueSet\n or PD.diagnosis.getCondition().code in valueSet" }, { "url" : "displaySequence", "valueInteger" : 37 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CQMCommon" }, { "url" : "name", "valueString" : "principalDiagnosis" }, { "url" : "statement", "valueString" : "/*\n@description: Returns the claim diagnosis element that is specified as the principal diagnosis for the encounter\n @comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information\n*/\ndefine fluent function principalDiagnosis(encounter Encounter):\nsingleton from (\n (encounter.claimDiagnosis()) CD\n where CD.type.includesCode(\"Principal Diagnosis\")\n )" }, { "url" : "displaySequence", "valueInteger" : 38 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CQMCommon" }, { "url" : "name", "valueString" : "claimDiagnosis" }, { "url" : "statement", "valueString" : "/*\n@description: Returns the claim diagnosis elements for the given encounter\n@comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information\n*/\ndefine fluent function claimDiagnosis(encounter Encounter):\n encounter E\n let \n claim: ([Claim] C where C.status = 'active' and C.use = 'claim' and exists (C.item I where I.encounter.references(E))),\n claimItem: (claim.item I where I.encounter.references(E))\n return claim.diagnosis D where D.sequence in claimItem.diagnosisSequence" }, { "url" : "displaySequence", "valueInteger" : 39 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToString" }, { "url" : "statement", "valueString" : "define function ToString(value ClaimStatus): value.value" }, { "url" : "displaySequence", "valueInteger" : 40 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToString" }, { "url" : "statement", "valueString" : "define function ToString(value Use): value.value" }, { "url" : "displaySequence", "valueInteger" : 41 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRCommon" }, { "url" : "name", "valueString" : "references" }, { "url" : "statement", "valueString" : "/*\n@description: Returns true if any of the given references are to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(references List, resource FHIR.Resource):\n exists (references R where R.references(resource))" }, { "url" : "displaySequence", "valueInteger" : 42 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRCommon" }, { "url" : "name", "valueString" : "references" }, { "url" : "statement", "valueString" : "/*\n@description: Returns true if the given reference is to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(reference FHIR.Reference, resource FHIR.Resource):\n resource.id = Last(Split(reference.reference, '/'))" }, { "url" : "displaySequence", "valueInteger" : 43 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRCommon" }, { "url" : "name", "valueString" : "includesCode" }, { "url" : "statement", "valueString" : "/*\n@description: Returns true if the given code is in the given codeList\n@comment: Returns true if the `code` is equivalent to any of the codes in the given `codeList`, false otherwise.\n*/\ndefine fluent function includesCode(codeList List, code Concept):\n exists (codeList C where C ~ code)" }, { "url" : "displaySequence", "valueInteger" : 44 }], "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" : 45 }], "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" : 46 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CQMCommon" }, { "url" : "name", "valueString" : "getCondition" }, { "url" : "statement", "valueString" : "/*\n@description: Returns the Condition resource for the given reference\n*/\ndefine fluent function getCondition(reference Reference):\n singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where reference.references(C.id))" }, { "url" : "displaySequence", "valueInteger" : 47 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRCommon" }, { "url" : "name", "valueString" : "references" }, { "url" : "statement", "valueString" : "/*\n@description: Returns true if the given reference is to the given resourceId\n@comment: Returns true if the `resourceId` parameter exactly equals the tail of the given reference.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(reference FHIR.Reference, resourceId String):\n resourceId = Last(Split(reference.reference, '/'))" }, { "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 MedicationAdministrationStatus): value.value" }, { "url" : "displaySequence", "valueInteger" : 49 }], "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" : 50 }], "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" : 51 }], "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" : 52 }], "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" : 53 }], "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" : 54 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "TJCOverall" }, { "url" : "name", "valueString" : "calendarDayOfOrDayAfter" }, { "url" : "statement", "valueString" : "define fluent function calendarDayOfOrDayAfter(StartValue DateTime):\n Interval [date from (StartValue), date from (StartValue) + 1 day]" }, { "url" : "displaySequence", "valueInteger" : 55 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CQMCommon" }, { "url" : "name", "valueString" : "hospitalizationWithObservation" }, { "url" : "statement", "valueString" : "/*\n@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter\n*/\ndefine fluent function hospitalizationWithObservation(TheEncounter Encounter ):\n TheEncounter Visit\n \t\tlet ObsVisit: Last([Encounter: \"Observation Services\"] LastObs\n \t\t\t\twhere LastObs.status = 'finished'\n and LastObs.period ends 1 hour or less on or before start of Visit.period\n \t\t\t\tsort by end of period\n \t\t\t),\n \t\t\tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n \t\t\tEDVisit: Last([Encounter: \"Emergency Department Visit\"] LastED\n \t\t\t\twhere LastED.status = 'finished'\n and LastED.period ends 1 hour or less on or before VisitStart\n \t\t\t\tsort by end of period\n \t\t\t)\n \t\treturn Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]" }, { "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 EncounterStatus): value.value" }, { "url" : "displaySequence", "valueInteger" : 57 }], "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" : 58 }], "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" : 59 }], "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" : 60 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CQMCommon" }, { "url" : "name", "valueString" : "lengthInDays" }, { "url" : "statement", "valueString" : "/*\n@description: Calculates the difference in calendar days between the start and end of the given interval.\n*/\ndefine fluent function lengthInDays(Value Interval ):\n difference in days between start of Value and end of Value" }, { "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 ServiceRequestStatus): value.value" }, { "url" : "displaySequence", "valueInteger" : 62 }], "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" : 63 }], "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" : 64 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CQMCommon" }, { "url" : "name", "valueString" : "encounterDiagnosis" }, { "url" : "statement", "valueString" : "/* \n@description: Returns the Condition resources referenced by the diagnosis element of the Encounter \n*/\ndefine fluent function encounterDiagnosis(Encounter Encounter ):\n Encounter.reasonReference D\n return singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where D.references(C.id))" }, { "url" : "displaySequence", "valueInteger" : 65 }], "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" : 66 }], "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" : 67 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRHelpers" }, { "url" : "name", "valueString" : "ToString" }, { "url" : "statement", "valueString" : "define function ToString(value MedicationRequestIntent): value.value" }, { "url" : "displaySequence", "valueInteger" : 68 }], "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" : 69 }], "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 TJC", "resource" : "https://madie.cms.gov/Library/TJCOverall|9.1.000" }, { "type" : "depends-on", "display" : "Library CQMCommon", "resource" : "https://madie.cms.gov/Library/CQMCommon|5.1.000" }, { "type" : "depends-on", "display" : "Library Status", "resource" : "https://madie.cms.gov/Library/Status|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 Diagnosis Type", "resource" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" }, { "type" : "depends-on", "display" : "Code system ConditionVerificationStatusCodes", "resource" : "http://terminology.hl7.org/CodeSystem/condition-ver-status" }, { "type" : "depends-on", "display" : "Code system TaskCodeSystem", "resource" : "http://hl7.org/fhir/CodeSystem/task-code" }, { "type" : "depends-on", "display" : "Value set Nonelective Inpatient Encounter", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424" }, { "type" : "depends-on", "display" : "Value set Ischemic Stroke", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247" }, { "type" : "depends-on", "display" : "Value set Antithrombotic Therapy for Ischemic Stroke", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62" }, { "type" : "depends-on", "display" : "Value set Observation Services", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143" }, { "type" : "depends-on", "display" : "Value set Emergency Department Visit", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292" }, { "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 Comfort Measures", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45" }, { "type" : "depends-on", "display" : "Value set Thrombolytic tPA Therapy", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.226" }, { "type" : "depends-on", "display" : "Value set Intravenous or Intraarterial Thrombolytic tPA Therapy", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.21" }, { "type" : "depends-on", "display" : "Value set Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.21" }, { "type" : "depends-on", "display" : "Value set Medical Reason for Not Providing Treatment", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473" }, { "type" : "depends-on", "display" : "Value set Patient Refusal", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93" }, { "type" : "depends-on", "display" : "Value set Pharmacological Contraindications For Antithrombotic Therapy", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52" }, { "type" : "depends-on", "display" : "Value set INR", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.213" }], "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" : "*", "type" : "Encounter" }, { "name" : "Denominator", "use" : "out", "min" : 0, "max" : "*", "type" : "Encounter" }, { "name" : "SDE Payer", "use" : "out", "min" : 0, "max" : "*", "type" : "Resource" }, { "name" : "Initial Population", "use" : "out", "min" : 0, "max" : "*", "type" : "Encounter" }, { "name" : "SDE Ethnicity", "use" : "out", "min" : 0, "max" : "1", "type" : "Resource" }, { "name" : "Denominator Exclusions", "use" : "out", "min" : 0, "max" : "*", "type" : "Encounter" }, { "name" : "SDE Race", "use" : "out", "min" : 0, "max" : "1", "type" : "Resource" }, { "name" : "Denominator Exceptions", "use" : "out", "min" : 0, "max" : "*", "type" : "Encounter" }], "dataRequirement" : [{ "type" : "Patient", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient"], "mustSupport" : ["ombCategory", "detailed", "text"] }, { "type" : "Encounter", "profile" : ["http://hl7.org/fhir/StructureDefinition/Encounter"], "mustSupport" : ["type", "status", "period", "diagnosis", "diagnosis.code"], "codeFilter" : [{ "path" : "type", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143" }, { "path" : "status", "code" : [{ "code" : "finished" }] }] }, { "type" : "Encounter", "profile" : ["http://hl7.org/fhir/StructureDefinition/Encounter"], "mustSupport" : ["type", "status", "period", "diagnosis", "diagnosis.code"], "codeFilter" : [{ "path" : "type", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292" }, { "path" : "status", "code" : [{ "code" : "finished" }] }], "dateFilter" : [{ "path" : "period", "valuePeriod" : { "extension" : [{ "url" : "http://hl7.org/fhir/uv/crmi-analysisException", "valueString" : "Error attempting to determine filter value: toFhirValue not implemented for Subtract" }] } }] }, { "type" : "Encounter", "profile" : ["http://hl7.org/fhir/StructureDefinition/Encounter"], "mustSupport" : ["type", "period", "diagnosis", "diagnosis.code"], "codeFilter" : [{ "path" : "type", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424" }], "dateFilter" : [{ "path" : "period", "valuePeriod" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression", "valueExpression" : { "language" : "text/cql-identifier", "expression" : "Measurement Period" } }] } }] }, { "type" : "Resource", "profile" : ["http://hl7.org/fhir/StructureDefinition/Resource"], "mustSupport" : ["id"] }, { "type" : "Claim", "profile" : ["http://hl7.org/fhir/StructureDefinition/Claim"], "mustSupport" : ["status", "use", "item"], "codeFilter" : [{ "path" : "status", "code" : [{ "code" : "active" }] }, { "path" : "use", "code" : [{ "code" : "claim" }] }] }, { "type" : "Condition", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis"] }, { "type" : "Condition", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns"] }, { "type" : "Condition", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns"], "mustSupport" : ["code", "recordedDate", "verificationStatus"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.21" }] }, { "type" : "Patient", "profile" : ["http://hl7.org/fhir/StructureDefinition/Patient"], "mustSupport" : ["birthDate"] }, { "type" : "Medication", "profile" : ["http://hl7.org/fhir/StructureDefinition/Medication"], "mustSupport" : ["id", "code"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62" }] }, { "type" : "Medication", "profile" : ["http://hl7.org/fhir/StructureDefinition/Medication"], "mustSupport" : ["id", "code"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.226" }] }, { "extension" : [{ "extension" : [{ "url" : "targetId", "valueString" : "1531" }, { "url" : "targetProperty", "valueString" : "medication" }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-relatedRequirement" }], "type" : "Medication", "profile" : ["http://hl7.org/fhir/StructureDefinition/Medication"], "mustSupport" : ["id", "code"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62" }] }, { "type" : "Medication", "profile" : ["http://hl7.org/fhir/StructureDefinition/Medication"], "mustSupport" : ["id", "code"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52" }] }, { "type" : "MedicationAdministration", "profile" : ["http://hl7.org/fhir/StructureDefinition/MedicationAdministration"], "mustSupport" : ["medication", "status", "effective", "id"], "codeFilter" : [{ "path" : "medication", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62" }] }, { "type" : "MedicationAdministration", "profile" : ["http://hl7.org/fhir/StructureDefinition/MedicationAdministration"], "mustSupport" : ["medication", "status", "effective", "id"], "codeFilter" : [{ "path" : "medication", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.226" }] }, { "type" : "MedicationAdministration", "profile" : ["http://hl7.org/fhir/StructureDefinition/MedicationAdministration"], "mustSupport" : ["medication.reference", "status", "effective", "id"] }, { "type" : "MedicationAdministration", "profile" : ["http://hl7.org/fhir/StructureDefinition/MedicationAdministration"], "mustSupport" : ["medication", "status", "effective", "id"], "codeFilter" : [{ "path" : "medication", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52" }] }, { "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" : "ServiceRequest", "profile" : ["http://hl7.org/fhir/StructureDefinition/ServiceRequest"], "mustSupport" : ["code", "status", "intent"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45" }] }, { "type" : "Procedure", "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"], "mustSupport" : ["code", "status"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45" }] }, { "type" : "Procedure", "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"], "mustSupport" : ["code", "status", "id", "performed"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.21" }, { "path" : "status", "code" : [{ "code" : "completed" }] }] }, { "type" : "MedicationRequest", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-medicationnotrequested"], "mustSupport" : ["medication", "reasonCode", "status", "intent", "id", "authoredOn"], "codeFilter" : [{ "path" : "medication", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62" }] }, { "id" : "1531", "type" : "MedicationRequest", "profile" : ["http://hl7.org/fhir/StructureDefinition/MedicationRequest"], "mustSupport" : ["medication.reference", "status", "id", "authoredOn"] }, { "type" : "MedicationRequest", "profile" : ["http://hl7.org/fhir/StructureDefinition/MedicationRequest"], "mustSupport" : ["medication", "status", "id", "authoredOn"], "codeFilter" : [{ "path" : "medication", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62" }] }, { "type" : "Task", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-taskrejected"], "mustSupport" : ["focus", "statusReason", "code"], "codeFilter" : [{ "path" : "code" }] }, { "type" : "MedicationAdministration", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-medicationadministrationnotdone"], "mustSupport" : ["medication", "statusReason", "id", "effective"], "codeFilter" : [{ "path" : "medication", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62" }] }, { "type" : "Observation", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-lab"], "mustSupport" : ["code", "value", "status", "issued"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.213" }] }] }], "extension" : [{ "id" : "supplementalDataGuidance", "extension" : [{ "url" : "guidance", "valueString" : "

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

" }, { "url" : "usage", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage", "code" : "supplemental-data", "display" : "Supplemental Data" }], "text" : "Supplemental Data Guidance" } }], "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" }, { "url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem", "valueReference" : { "reference" : "Device/cqf-tooling" } }, { "url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements", "valueCanonical" : "#effective-data-requirements" }], "url" : "https://madie.cms.gov/Measure/CMS72FHIRSTKAntithromboticDay2", "identifier" : [{ "use" : "usual", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/artifact-identifier-type", "code" : "short-name", "display" : "Short Name" }] }, "system" : "https://madie.cms.gov/measure/shortName", "value" : "CMS72FHIR" }, { "use" : "official", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/artifact-identifier-type", "code" : "version-independent", "display" : "Version Independent" }] }, "system" : "urn:ietf:rfc:3986", "value" : "urn:uuid:b6ae4357-9baa-4195-a9cd-50391b7d0dab" }, { "use" : "official", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/artifact-identifier-type", "code" : "version-specific", "display" : "Version Specific" }] }, "system" : "urn:ietf:rfc:3986", "value" : "urn:uuid:5de3156a-7293-40aa-9ec3-f3df76d3579c" }, { "use" : "official", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/artifact-identifier-type", "code" : "publisher", "display" : "Publisher" }] }, "system" : "https://madie.cms.gov/measure/cmsId", "value" : "72FHIR", "assigner" : { "display" : "CMS" } }], "version" : "1.0.000", "name" : "CMS72FHIRSTKAntithromboticDay2", "title" : "Antithrombotic Therapy by End of Hospital Day 2FHIR\n", "status" : "active", "experimental" : false, "date" : "2026-01-16T18:18:14+00:00", "publisher" : "The Joint Commission", "contact" : [{ "telecom" : [{ "system" : "url", "value" : "https://www.jointcommission.org/" }] }], "description" : "Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2\n", "usage" : "The \"Nonelective Inpatient Encounter\" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the \"Inpatient Encounter\" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective Inpatient Encounters include emergency, urgent, and unplanned admissions.\n\nNPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e., rectal or intravenous).\n\nIn the denominator exclusions, the intent is to only exclude patients with a total length of stay of \\<2 days, including Emergency Department (ED) visit (if there is one). For the dQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits.\n\nThe denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.\n\nThis dQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS72v14. 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" : "Measure specifications are in the Public Domain\n\nLOINC(R) 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 copyright 2024 World Health Organization. All Rights Reserved.\n", "effectivePeriod" : { "start" : "2026-01-01", "end" : "2026-12-31" }, "author" : [{ "name" : "The Joint Commission", "telecom" : [{ "system" : "url", "value" : "https://www.jointcommission.org/" }] }], "relatedArtifact" : [{ "type" : "citation", "citation" : "Adams, H. P., Jr., del Zoppo, G., Alberts, M. J., et al. (2007, May). Guidelines for the early management of adults with ischemic stroke: A guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Stroke, 38(5), 1655-1711.\n" }, { "type" : "citation", "citation" : "Adams, H., Adams, R., del Zoppo, G., et al. (2005, April). Guidelines for the early management of patients with ischemic stroke: 2005 guidelines update-A scientific statement from the Stroke Council of the American Heart Association/American Stroke Association. Stroke, 36(4): 916-923.\n" }, { "type" : "citation", "citation" : "Albers, G. W, Amarenco, P., Easton, J. D., et al. (2001). Antithrombotic and thrombolytic therapy for ischemic stroke. Chest, 119, 300-320.\n" }, { "type" : "citation", "citation" : "Antithrombotic Trialists' Collaboration. (2002, January 12). Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high-risk patients. BMJ, 324(7329), 71-86.\n" }, { "type" : "citation", "citation" : "Brott, T. G., Clark, W. M., Fagan, S. C., et al. (2000). Stroke: The first hours. Guidelines for acute treatment. Washington, DC: National Stroke Association.\n" }, { "type" : "citation", "citation" : "Centers for Disease Control and Prevention. (2009, May 1). Prevalence and most common causes of disability among adults-United States, 2005. Morbidity and Mortality Weekly Report, 58(16), 421-426.\n" }, { "type" : "citation", "citation" : "Chen, Z. M., Sandercock, P., Pan, H. C., et al. (2000, June). Indications for early aspirin use in acute ischemic stroke: A combined analysis of 40,000 randomized patients from the Chinese Acute Stroke Trial and the International Stroke Trial. Stroke, 31(6), 1240-1249.\n" }, { "type" : "citation", "citation" : "Coull, B. M., Williams, L. S., Goldstein, L. B., et al. (2002, July). Anticoagulants and antiplatelet agents in acute ischemic stroke: Report of the Joint Stroke Guideline Development Committee of the American Academy of Neurology and the American Stroke Association (a Division of the American Heart Association). Stroke, 33(7), 1934-1942.\n" }, { "type" : "citation", "citation" : "Eccles, M., Freemantle, N., \\& Mason, J. (1998, April 25). North of England Evidence-Based Guideline Development Project: Guideline on the use of aspirin as secondary prophylaxis for vascular disease in primary care. BMJ, 316(7140), 1303-1309.\n" }, { "type" : "citation", "citation" : "ESPS Group. (1987, December 12). The European Stroke Prevention Study (ESPS): Principal end-points. Lancet, 2(8572), 1351-1354.\n" }, { "type" : "citation", "citation" : "Furie, K. L., Kasner, S. E., Adams, R. J., et al. (2011, January). Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: A guideline for health care professionals from the American Heart Association/American Stroke Association. Stroke, 42(1), 227-276.\n" }, { "type" : "citation", "citation" : "Gaspoz, J. M., Coxson, P. G., Goldman, P. A., et al. (2002, June 6). Cost effectiveness of aspirin, clopidogrel, or both for secondary prevention of coronary heart disease. New England Journal of Medicine, 346(23), 1800-1806.\n" }, { "type" : "citation", "citation" : "Guyatt, G. H., Akl, E. A., Crowther, M., et al. (2012, February). Executive summary: Antithrombotic therapy and prevention of thrombosis, 9th ed.: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2 Suppl.), 7S-47S.\n" }, { "type" : "citation", "citation" : "International Stroke Trial Collaborative Group. (1997, May 31). The International Stroke Trial (IST): A randomised trial of aspirin, subcutaneous heparin, both, or neither among 19,435 patients with acute ischaemic stroke. Lancet, 349(9065), 1569-1581.\n" }, { "type" : "citation", "citation" : "Jauch, E. C., Saver, J. L., Adams, H. P., Jr., et al. (2013). Guidelines for the early management of patients with acute ischemic stroke: A guideline for health care professionals from the American Heart Association/American Stroke Association. Stroke, 44(3), 870-947.\n" }, { "type" : "citation", "citation" : "Johnson, E. S., Lanes, S. F., Wentworth, C. E., III, et al. (1999, June 14). A metaregression analysis of the dose-response effect of aspirin on stroke. Archives of Internal Medicine, 159(11), 1248-1253.\n" }, { "type" : "citation", "citation" : "Powers, W. J., Rabinstein, A. A., Ackerson, T., et al. (2018, January). 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for health care professionals from the American Heart Association/American Stroke Association. Stroke, 49,\n" }, { "type" : "citation", "citation" : "Roger, V. L., Go, A. S., Lloyd-Jones, D. M., et al. (2012, January 3). Heart disease and stroke statistics-2012 update: A report from the American Heart Association. Circulation, 125(1), e2-e220.\n" }, { "type" : "citation", "citation" : "Sacco, R. L., Adams, R., Albers, G., et al. (2006, February). Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: A statement for health care professionals from the American Heart Association/American Stroke Association Council on Stroke: Co-sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke, 37(2), 577-617.\n" }], "library" : ["https://madie.cms.gov/Library/CMS72FHIRSTKAntithromboticDay2"], "disclaimer" : "These performance measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.\n", "rationale" : "The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks (TIA) continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist.\n\nAspirin is the recommended antithrombotic medication for early antithrombotic therapy and most frequently administered unless contraindicated. Anticoagulants at doses to prevent venous thromboembolism (VTE) are insufficient. Subcutaneous Lovenox (enoxaparin) and unfractionated heparin (UFH) SQ at lower dosages used for VTE prophylaxis (i.e., enoxaparin SQ 40 mg once daily; enoxaparin SQ 30 mg Q12 hours; UFH 5,000 units or less two or three times daily) are not sufficient for early antithrombotic therapy.\n\nAnticoagulants at doses to prevent VTE are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA.\n", "clinicalRecommendationStatement" : "Antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist\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" : "Encounter" }, { "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-rateAggregation", "valueString" : "None\n" }, { "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" }] } }], "population" : [{ "id" : "InitialPopulation_1", "code" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "initial-population", "display" : "Initial Population" }] }, "description" : "Inpatient hospitalization (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke that ends 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" : "* Inpatient hospitalization for patients who have a duration of stay less than 2 days.\n\n* Inpatient hospitalization for patients with comfort measures documented day of or the day after arrival.\n\n* Inpatient hospitalization for patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy administered within 24 hours prior to arrival or anytime during hospitalization.\n\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" : "Inpatient hospitalization for patients who had antithrombotic therapy administered the day of or day after hospital arrival\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" : "* Inpatient hospitalization for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival\n\n* Inpatient hospitalization for patients who receive Prasugrel as an antithrombotic therapy the day of or day after hospital arrival\n\n* Inpatient hospitalization for patients with an international normalized ratio (INR) greater than 3.5\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" } }] }