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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
Metadata
TitlePrimary Caries Prevention Intervention as Offered by DentistsFHIR\n
Version1.0.000
Short NameCMS74FHIR
GUID (Version Independent)urn:uuid:1c99917f-438b-4cdb-ba95-d2fb32f9d715
GUID (Version Specific)urn:uuid:5005e0c6-c10b-4f16-ab18-865e3bedd809
CMS Identifier74FHIR
Effective Period2026-01-01 through 2026-12-31
Steward (Publisher)Centers for Medicare & Medicaid Services (CMS)
DeveloperAmerican Institutes for Research (AIR)
Description

Percentage of children, 1-20 years of age, who receive two or more fluoride varnish applications during the measurement period as determined by a dentist

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Copyright

This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract # 75FCMC18D0027/ Task Order #: 75FCMC24F0144) with the American Institutes for Research (AIR) to develop this electronic measure. AIR disclaims all liability for use or accuracy of any third-party codes contained in the specifications. CPT(R) codes, descriptions and other data are copyright 2024. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use. The American Dental Association ("ADA") holds a copyright to the Current Dental Terminology ("CDT") codes contained in certain measure specifications. The CDT codes in the measure specifications are included with the permission of the ADA. All uses of the CDT codes require a license from the ADA. No alteration, amendments, or modifications of the CDT or any portion thereof is allowed. Resale, transmission, or distribution of copies of the CDT or other portions of the CDT is also not allowed. To inquire about licensing, contact CDT-SNODENT@ada.org. The measure specifications contain coding from LOINC(R) (http://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. All Rights Reserved. ICD-10 copyright 2024 World Health Organization. All Rights Reserved. "HL7" is the registered trademark of Health Level Seven International.

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Disclaimer

The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

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Rationale

The literature reflects that fluoride varnish, when applied to the teeth of high-risk children, reduces, in conjunction with anticipatory guidance provided to the caregiver, the risk of the child developing caries (Weyant et al., 2013). Evidence in the literature also specifically supports the effectiveness of professionally applied fluoride varnish at preventing caries in higher risk children (Chou et al., 2014).

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Clinical Recommendation Statement

The 2013 American Dental Association (ADA) clinical recommendations for use of professionally applied or prescription-strength, home-use topical fluorides for caries prevention in patients at elevated risk of developing caries:

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    Younger Than 6 Years

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    • 2.26 percent fluoride varnish at least every three to six months.
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    6-18 Years

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    • 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF*) gel for four minutes at least every three to six months.
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    Older Than 18 Years

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    • 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF) gel for four minutes at least every three to six months (Weyant et al., 2013).
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The United States Preventive Services Taskforce (USPSTF) recommends the use of professionally applied fluoride varnish for the prevention of dental caries in high risk children under 5 years of age (Chou et al., 2014).

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The American Academy of Pediatric Dentistry (AAPD) recommends the application of topical fluoride treatments at least twice per year to reduce the incidence of dental caries, with precise timing based upon the unique needs, risks, and benefits inherent to the individual patient (AAPD, 2023).

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Citation\n \n \n \n

American Academy of Pediatric Dentistry (2023) Fluoride therapy. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 352-8.

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Citation\n \n \n \n

Chou, R., Cantor, A., Zakher, B., Mitchell, J.P., & Pappas, M. (2014). Prevention of dental caries in children younger than 5 years old: Systematic review to update the U.S. Preventive Services Task Force recommendation. Rockville (MD): Agency for Healthcare Research and Quality (US). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK202090/

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Citation\n \n \n \n

Weyant, R. J., Tracy, S. L., Anselmo, T. (Tracy), Beltrán-Aguilar, E. D., Donly, K. J., Frese, W. A., Hujoel, P. P., Iafolla, T., Kohn, W., Kumar, J., Levy, S. M., Tinanoff, N., Wright, J. T., Zero, D., Aravamudhan, K., Frantsve-Hawley, J., & Meyer, D. M. (2013). Topical fluoride for caries prevention. The Journal of the American Dental Association, 144(11), 1279--1291. https://doi.org/10.14219/jada.archive.2013.0057

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Guidance (Usage)This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible codes and requires a clinical action that cannot be conducted via telehealth. This FHIR-based measure has been derived from the QDM-based measure CMS74v15. 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)
Basisboolean
Scoring\n Proportion\n\n\n
Improvement Notation\n Increased score indicates improvement\n\n\n
Type\n Process\n\n\n
Initial Population\n \n ID: InitialPopulation_1\n
\n \n \n Description:\n

Children, 1-20 years of age at the start of the measurement period, with a clinical oral evaluation by a dentist 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

Exclude patients who are in hospice care or have a hospice care order documented during any part of the measurement period\n

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

Children who receive two or more fluoride varnish applications on different days during the measurement period\n

\n \n \n \n \n \n Criteria: Numerator \n \n \n \n \n \n \n
Stratifier\n \n ID: Stratification_1_1\n \n
\n \n \n \n \n Description: Population 1: Patients age 1-5 years at the start of the Measurement Period\n\n \n
Stratifier\n \n ID: Stratification_1_2\n \n
\n \n \n \n \n Description: Population 2: Patients age 6-12 years at the start of the Measurement Period\n\n \n
Stratifier\n \n ID: Stratification_1_3\n \n
\n \n \n \n \n Description: Population 3: Patients age 13-20 years at the start of the Measurement Period\n\n \n
Measure Logic
Primary Libraryhttps://madie.cms.gov/Library/CMS74FHIRDentalCariesPrevention
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  AgeInYearsAt(date from start of "Measurement Period") in Interval[1, 20]\n    and exists ( "Qualifying Encounters" )
\n \n \n Definition\n \n
\n \n Denominator\n \n
\n \n \n \n \n \n \n \n 
define "Denominator":\n  "Initial Population"
\n \n \n Definition\n \n
\n \n Denominator Exclusion\n \n
\n \n \n \n \n \n \n \n 
define "Denominator Exclusions":\n  Hospice."Has Hospice Services"
\n \n \n Definition\n \n
\n \n Numerator\n \n
\n \n \n \n \n \n \n \n 
define "Numerator":\n  Count((([Procedure: "Fluoride Varnish Application for Children"]).isProcedurePerformed()) FluorideApplication\n      where FluorideApplication.performed.toInterval() ends during day of "Measurement Period"\n      return distinct date from \n      end of FluorideApplication.performed.toInterval()\n  ) >= 2
\n \n \n Definition\n \n
\n \n Stratifier\n \n
\n \n \n \n \n 
define "Initial Population":\n  AgeInYearsAt(date from start of "Measurement Period") in Interval[1, 20]\n    and exists ( "Qualifying Encounters" )
\n \n \n Definition\n \n
\n \n Stratifier\n \n
\n \n \n \n \n 
define "Initial Population":\n  AgeInYearsAt(date from start of "Measurement Period") in Interval[1, 20]\n    and exists ( "Qualifying Encounters" )
\n \n \n Definition\n \n
\n \n Stratifier\n \n
\n \n \n \n \n 
define "Initial Population":\n  AgeInYearsAt(date from start of "Measurement Period") in Interval[1, 20]\n    and exists ( "Qualifying Encounters" )
\n \n \n Definition\n \n
Logic Definitions
\n Logic Definition\n Library Name: Hospice
\n \n \n \n \n \n \n 
define "Has Hospice Services":\n  exists ((([USQualityCore.Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter\n      where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"\n          or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"\n      )\n        and InpatientEncounter.period ends during day of "Measurement Period"\n  )\n    or exists ((([USQualityCore.Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter\n        where HospiceEncounter.period overlaps day of "Measurement Period"\n    )\n    // TODO: Shouldn't need to specify a code path here (see https://jira.hl7.org/browse/FHIR-53941)\n    or exists ((([USQualityCore.ObservationScreeningAssessment: code ~ "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment\n        where HospiceAssessment.value ~ "Yes (qualifier value)"\n          and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"\n    )\n    or exists ((([USQualityCore.ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder\n        where HospiceOrder.authoredOn during day of "Measurement Period"\n    )\n    or exists ((([USQualityCore.Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed\n        where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"\n    )\n    // TODO: Consider whether to keep this as the union of Problems and EncounterDiagnosis\n    or exists ((([FHIR.Condition: "Hospice Diagnosis"]).verified()) HospiceCareDiagnosis\n        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"\n    )
\n
\n Logic Definition\n Library Name: CMS74FHIRDentalCariesPrevention
\n \n \n \n \n \n \n 
define "Numerator":\n  Count((([Procedure: "Fluoride Varnish Application for Children"]).isProcedurePerformed()) FluorideApplication\n      where FluorideApplication.performed.toInterval() ends during day of "Measurement Period"\n      return distinct date from \n      end of FluorideApplication.performed.toInterval()\n  ) >= 2
\n
\n Logic Definition\n Library Name: CMS74FHIRDentalCariesPrevention
\n \n \n \n \n \n \n 
define "Qualifying Encounters":\n  ( ( [Encounter: "Clinical Oral Evaluation"] ).isEncounterPerformed ( ) ) ValidEncounter\n    where ValidEncounter.period during day of "Measurement Period"
\n
\n Logic Definition\n Library Name: CMS74FHIRDentalCariesPrevention
\n \n \n \n \n \n \n 
define "Initial Population":\n  AgeInYearsAt(date from start of "Measurement Period") in Interval[1, 20]\n    and exists ( "Qualifying Encounters" )
\n
\n Logic Definition\n Library Name: CMS74FHIRDentalCariesPrevention
\n \n \n \n \n \n \n 
define "Denominator":\n  "Initial Population"
\n
\n Logic Definition\n Library Name: CMS74FHIRDentalCariesPrevention
\n \n \n \n \n \n \n 
define "Denominator Exclusions":\n  Hospice."Has Hospice Services"
\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 ToDateTime(value dateTime): value.value
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
/*\n@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)\nvalue to a CQL DateTime Interval\n@comment: If the start value of the given period is unspecified, the starting\nboundary of the resulting interval will be open (meaning the start of the interval\nis unknown, as opposed to interpreted as the beginning of time).\n*/\ndefine function ToInterval(period FHIR.Period):\n    if period is null then\n        null\n    else\n        if period."start" is null then\n            Interval(period."start".value, period."end".value]\n        else\n            Interval[period."start".value, period."end".value]
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
define function ToDateTime(value instant): value.value
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
define function ToDate(value date): value.value
\n
\n Logic Definition\n Library Name: FHIRHelpers
\n \n \n \n \n \n \n 
/*\n@description: Converts the given FHIR [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 
/*\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 ObservationStatus): 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: Status
\n \n \n \n \n \n \n 
//Procedure, Performed\ndefine fluent function isProcedurePerformed(Proc List<FHIR.Procedure>):\n  Proc P\n    where P.status ~ 'completed'
\n
\n Logic Definition\n Library Name: Status
\n \n \n \n \n \n \n 
//Encounter, Performed\n//General usage unless required otherwise by measure intent (e.g., follow-up encounters)\ndefine fluent function isEncounterPerformed(Enc List<FHIR.Encounter>):\n  Enc E\n    where E.status = 'finished'
\n
\n Logic Definition\n Library Name: Status
\n \n \n \n \n \n \n 
//Assessment, Performed\ndefine fluent function isAssessmentPerformed(Obs List<ObservationScreeningAssessment>):\n  Obs O\n    where O.status in { 'final', 'amended', 'corrected' }
\n
\n Logic Definition\n Library Name: Status
\n \n \n \n \n \n \n 
//Intervention, Order\ndefine fluent function isInterventionOrder(ServiceRequest List<FHIR.ServiceRequest>):\n  ServiceRequest S\n    where S.status in { 'active', 'completed' }\n      and S.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}
\n
\n Logic Definition\n Library Name: Status
\n \n \n \n \n \n \n 
//Intervention, Performed\ndefine fluent function isInterventionPerformed(Proc List<FHIR.Procedure>):\n  Proc P\n    where P.status ~ 'completed'
\n
\n Logic Definition\n Library Name: FHIRCommon
\n \n \n \n \n \n \n 
/*\n@description: 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 conditions in the given list that either have no verification status or have a verification status of confirmed, unconfirmed, provisional, or differential\n*/\ndefine fluent function verified(conditions List<FHIR.Condition>):\n  conditions C\n    where C.verificationStatus is not null implies\n      (C.verificationStatus ~ "confirmed"\n        or C.verificationStatus ~ "unconfirmed"\n        or C.verificationStatus ~ "provisional"\n        or C.verificationStatus ~ "differential"\n      )
\n
\n Logic Definition\n Library Name: FHIRCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition resource.\n@comment: Uses the toInterval and toAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ "active"\n  or condition.clinicalStatus ~ "recurrence"\n  or condition.clinicalStatus ~ "relapse" then\n  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n  (end of condition.abatementInterval()) abatementDate\n    return \n\t  if abatementDate is null then\n        Interval[start of condition.onset.toInterval(), abatementDate)\n      else\n        Interval[start of condition.onset.toInterval(), abatementDate]
\n
\n Logic Definition\n Library Name: FHIRCommon
\n \n \n \n \n \n \n 
/*\n@description: Returns an interval representing the normalized Abatement of a given Condition resource.\n@comment: @comment: If the abatement element of the Condition is represented as a DateTime, the result\nis an interval beginning and ending on that DateTime.\nIf the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The\nresult is an interval from the date the patient turned that age to immediately before one year later.\nIf the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during\nwhich the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately\nbefore one year later than the date the patient turned the ending age of the quantity interval.\n\nNOTE: Due to the complexity of determining an interval from a String, this function will throw\na run-time exception if used with a Condition instance that has a String as the abatement value.\n*/\ndefine fluent function abatementInterval(condition Condition):\n  if condition.abatement is FHIR.dateTime then\n    Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)]\n  else if condition.abatement is FHIR.Period then\n    FHIRHelpers.ToInterval(condition.abatement as FHIR.Period)\n  else if condition.abatement is FHIR.string then\n    Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')\n  else if condition.abatement is FHIR.Age then\n    Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age),\n      FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year)\n  else if condition.abatement is FHIR.Range then\n    Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low),\n      FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year)\n  else if condition.abatement is FHIR.boolean then\n    Interval[end of condition.onset.toInterval(), condition.recordedDate)\n  else \n    null
\n
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 LOINC\n \n
\n \n \n \n \n \n \n Resource: Logical Observation Identifiers, Names and Codes (LOINC)\n
\n Canonical URL: http://loinc.org\n \n
Code System\n \n Description: Code system ConditionVerificationStatusCodes\n \n
\n \n \n \n \n \n \n Resource: ConditionVerificationStatus\n
\n Canonical URL: http://terminology.hl7.org/CodeSystem/condition-ver-status\n \n
Code System\n \n Description: Code system ConditionClinicalStatusCodes\n \n
\n \n \n \n \n \n \n Resource: Condition Clinical Status Codes\n
\n Canonical URL: http://terminology.hl7.org/CodeSystem/condition-clinical\n \n
Value Set\n \n Description: Value set Fluoride Varnish Application for Children\n \n
\n \n \n \n \n \n \n Resource: Fluoride Varnish Application for Children\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.125.12.1002\n \n
Value Set\n \n Description: Value set Clinical Oral Evaluation\n \n
\n \n \n \n \n \n \n Resource: Clinical Oral Evaluation\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.125.12.1003\n \n
Value Set\n \n Description: Value set Encounter Inpatient\n \n
\n \n \n \n \n \n \n Resource: Encounter Inpatient\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307\n \n
Value Set\n \n Description: Value set Hospice Encounter\n \n
\n \n \n \n \n \n \n Resource: Hospice Encounter\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003\n \n
Value Set\n \n Description: Value set Hospice Care Ambulatory\n \n
\n \n \n \n \n \n \n Resource: Hospice Care Ambulatory\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584\n \n
Value Set\n \n Description: Value set Hospice Diagnosis\n \n
\n \n \n \n \n \n \n Resource: Hospice Diagnosis\n
\n Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165\n \n
Direct Reference Code\n \n Display: Discharge to home for hospice care (procedure)\n
\n \n Code: 428361000124107\n
\n System: http://snomed.info/sct\n
Direct Reference Code\n \n Display: Discharge to healthcare facility for hospice care (procedure)\n
\n \n Code: 428371000124100\n
\n System: http://snomed.info/sct\n
Direct Reference Code\n \n Display: Yes (qualifier value)\n
\n \n Code: 373066001\n
\n System: http://snomed.info/sct\n
Direct Reference Code\n \n Display: Hospice care [Minimum Data Set]\n
\n \n Code: 45755-6\n
\n System: http://loinc.org\n
Direct Reference Code\n \n Code: confirmed\n
\n System: http://terminology.hl7.org/CodeSystem/condition-ver-status\n
Direct Reference Code\n \n Code: unconfirmed\n
\n System: http://terminology.hl7.org/CodeSystem/condition-ver-status\n
Direct Reference Code\n \n Code: provisional\n
\n System: http://terminology.hl7.org/CodeSystem/condition-ver-status\n
Direct Reference Code\n \n Code: differential\n
\n System: http://terminology.hl7.org/CodeSystem/condition-ver-status\n
Direct Reference Code\n \n Code: active\n
\n System: http://terminology.hl7.org/CodeSystem/condition-clinical\n
Direct Reference Code\n \n Code: recurrence\n
\n System: http://terminology.hl7.org/CodeSystem/condition-clinical\n
Direct Reference Code\n \n Code: relapse\n
\n System: http://terminology.hl7.org/CodeSystem/condition-clinical\n
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 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 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 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 Hospice\n \n
\n \n \n \n \n \n \n Resource: Hospice version: 7.1.000\n
\n Canonical URL: https://madie.cms.gov/Library/Hospice|7.1.000\n \n
Data Requirements
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: Procedure\n
\n \n Profile(s): \n \n Procedure\n
\n \n \n \n Must Support Elements: code, performed, status\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Fluoride Varnish Application for Children\n
\n \n \n \n \n
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 \n
Data Requirement\n Type: Encounter\n
\n \n Profile(s): \n \n Encounter\n
\n \n \n \n Must Support Elements: type, period, status\n
\n \n \n Code Filter(s): \n
\n \n \n Path: type\n
\n \n \n \n ValueSet: Clinical Oral Evaluation\n
\n \n \n \n \n
Data Requirement\n Type: Condition\n
\n \n Profile(s): \n \n Condition\n
\n \n \n \n Must Support Elements: abatement, verificationStatus, onset, recordedDate, clinicalStatus\n
\n \n \n
Data Requirement\n Type: Condition\n
\n \n Profile(s): \n \n Condition\n
\n \n \n \n Must Support Elements: code, verificationStatus\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Hospice Diagnosis\n
\n \n \n \n \n
Data Requirement\n Type: Encounter\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter\n
\n \n \n \n Must Support Elements: type, hospitalization, hospitalization.dischargeDisposition, period\n
\n \n \n Code Filter(s): \n
\n \n \n Path: type\n
\n \n \n \n ValueSet: Encounter Inpatient\n
\n \n \n \n \n
Data Requirement\n Type: Encounter\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter\n
\n \n \n \n Must Support Elements: type, period\n
\n \n \n Code Filter(s): \n
\n \n \n Path: type\n
\n \n \n \n ValueSet: Hospice Encounter\n
\n \n \n \n \n
Data Requirement\n Type: Observation\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-screening-assessment\n
\n \n \n \n Must Support Elements: code, value, effective, status\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n \n Code(s): \n \n \n LOINC: 45755-6 (Hospice care [Minimum Data Set])\n \n \n \n
\n \n \n \n Path: value\n
\n \n \n \n \n \n \n
Data Requirement\n Type: ServiceRequest\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-servicerequest\n
\n \n \n \n Must Support Elements: code, authoredOn\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Hospice Care Ambulatory\n
\n \n \n \n \n
Data Requirement\n Type: Procedure\n
\n \n Profile(s): \n \n http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-procedure\n
\n \n \n \n Must Support Elements: code, performed\n
\n \n \n Code Filter(s): \n
\n \n \n Path: code\n
\n \n \n \n ValueSet: Hospice Care Ambulatory\n
\n \n \n \n \n
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
NameUseCard.TypeDocumentation
Measurement PeriodIn0..1Period\n
NumeratorOut0..1boolean\n
DenominatorOut0..1boolean\n
Initial PopulationOut0..1boolean\n
Denominator ExclusionsOut0..1boolean\n
\n
Generated using version 0.5.4 of the sample-content-ig Liquid templates
\n
" }, "contained" : [{ "resourceType" : "Library", "id" : "effective-data-requirements", "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "428361000124107", "display" : "Discharge to home for hospice care (procedure)" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "428371000124100", "display" : "Discharge to healthcare facility for hospice care (procedure)" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "373066001", "display" : "Yes (qualifier value)" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://loinc.org", "code" : "45755-6", "display" : "Hospice care [Minimum Data Set]" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code" : "confirmed" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code" : "unconfirmed" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code" : "provisional" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status", "code" : "differential" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical", "code" : "active" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical", "code" : "recurrence" } }, { "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode", "valueCoding" : { "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical", "code" : "relapse" } }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS74FHIRDentalCariesPrevention" }, { "url" : "name", "valueString" : "Numerator" }, { "url" : "statement", "valueString" : "define \"Numerator\":\n Count((([Procedure: \"Fluoride Varnish Application for Children\"]).isProcedurePerformed()) FluorideApplication\n where FluorideApplication.performed.toInterval() ends during day of \"Measurement Period\"\n return distinct date from \n end of FluorideApplication.performed.toInterval()\n ) >= 2" }, { "url" : "displaySequence", "valueInteger" : 0 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS74FHIRDentalCariesPrevention" }, { "url" : "name", "valueString" : "Qualifying Encounters" }, { "url" : "statement", "valueString" : "define \"Qualifying Encounters\":\n ( ( [Encounter: \"Clinical Oral Evaluation\"] ).isEncounterPerformed ( ) ) ValidEncounter\n where ValidEncounter.period during day of \"Measurement Period\"" }, { "url" : "displaySequence", "valueInteger" : 1 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS74FHIRDentalCariesPrevention" }, { "url" : "name", "valueString" : "Initial Population" }, { "url" : "statement", "valueString" : "define \"Initial Population\":\n AgeInYearsAt(date from start of \"Measurement Period\") in Interval[1, 20]\n and exists ( \"Qualifying Encounters\" )" }, { "url" : "displaySequence", "valueInteger" : 2 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS74FHIRDentalCariesPrevention" }, { "url" : "name", "valueString" : "Denominator" }, { "url" : "statement", "valueString" : "define \"Denominator\":\n \"Initial Population\"" }, { "url" : "displaySequence", "valueInteger" : 3 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "Hospice" }, { "url" : "name", "valueString" : "Has Hospice Services" }, { "url" : "statement", "valueString" : "define \"Has Hospice Services\":\n exists ((([USQualityCore.Encounter: \"Encounter Inpatient\"]).isEncounterPerformed()) InpatientEncounter\n where (InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n or InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\"\n )\n and InpatientEncounter.period ends during day of \"Measurement Period\"\n )\n or exists ((([USQualityCore.Encounter: \"Hospice Encounter\"]).isEncounterPerformed()) HospiceEncounter\n where HospiceEncounter.period overlaps day of \"Measurement Period\"\n )\n // TODO: Shouldn't need to specify a code path here (see https://jira.hl7.org/browse/FHIR-53941)\n or exists ((([USQualityCore.ObservationScreeningAssessment: code ~ \"Hospice care [Minimum Data Set]\"]).isAssessmentPerformed()) HospiceAssessment\n where HospiceAssessment.value ~ \"Yes (qualifier value)\"\n and HospiceAssessment.effective.toInterval() overlaps day of \"Measurement Period\"\n )\n or exists ((([USQualityCore.ServiceRequest: \"Hospice Care Ambulatory\"]).isInterventionOrder()) HospiceOrder\n where HospiceOrder.authoredOn during day of \"Measurement Period\"\n )\n or exists ((([USQualityCore.Procedure: \"Hospice Care Ambulatory\"]).isInterventionPerformed()) HospicePerformed\n where HospicePerformed.performed.toInterval() overlaps day of \"Measurement Period\"\n )\n // TODO: Consider whether to keep this as the union of Problems and EncounterDiagnosis\n or exists ((([FHIR.Condition: \"Hospice Diagnosis\"]).verified()) HospiceCareDiagnosis\n where HospiceCareDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"\n )" }, { "url" : "displaySequence", "valueInteger" : 4 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "CMS74FHIRDentalCariesPrevention" }, { "url" : "name", "valueString" : "Denominator Exclusions" }, { "url" : "statement", "valueString" : "define \"Denominator Exclusions\":\n Hospice.\"Has Hospice Services\"" }, { "url" : "displaySequence", "valueInteger" : 5 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "Status" }, { "url" : "name", "valueString" : "isProcedurePerformed" }, { "url" : "statement", "valueString" : "//Procedure, Performed\ndefine fluent function isProcedurePerformed(Proc List):\n Proc P\n where P.status ~ 'completed'" }, { "url" : "displaySequence", "valueInteger" : 6 }], "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" : 7 }], "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" : 8 }], "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" : 9 }], "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" : 10 }], "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" : 11 }], "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" : 12 }], "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" : 13 }], "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" : 14 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "Status" }, { "url" : "name", "valueString" : "isEncounterPerformed" }, { "url" : "statement", "valueString" : "//Encounter, Performed\n//General usage unless required otherwise by measure intent (e.g., follow-up encounters)\ndefine fluent function isEncounterPerformed(Enc List):\n Enc E\n where E.status = 'finished'" }, { "url" : "displaySequence", "valueInteger" : 15 }], "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" : 16 }], "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" : 17 }], "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" : 18 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "Status" }, { "url" : "name", "valueString" : "isAssessmentPerformed" }, { "url" : "statement", "valueString" : "//Assessment, Performed\ndefine fluent function isAssessmentPerformed(Obs List):\n Obs O\n where O.status in { 'final', 'amended', 'corrected' }" }, { "url" : "displaySequence", "valueInteger" : 19 }], "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" : 20 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "Status" }, { "url" : "name", "valueString" : "isInterventionOrder" }, { "url" : "statement", "valueString" : "//Intervention, Order\ndefine fluent function isInterventionOrder(ServiceRequest List):\n ServiceRequest S\n where S.status in { 'active', 'completed' }\n and S.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}" }, { "url" : "displaySequence", "valueInteger" : 21 }], "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" : 22 }], "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" : 23 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "Status" }, { "url" : "name", "valueString" : "isInterventionPerformed" }, { "url" : "statement", "valueString" : "//Intervention, Performed\ndefine fluent function isInterventionPerformed(Proc List):\n Proc P\n where P.status ~ 'completed'" }, { "url" : "displaySequence", "valueInteger" : 24 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRCommon" }, { "url" : "name", "valueString" : "verified" }, { "url" : "statement", "valueString" : "/*\n@description: Returns conditions in the given list that either have no verification status or have a verification status of confirmed, unconfirmed, provisional, or differential\n*/\ndefine fluent function verified(conditions List):\n conditions C\n where C.verificationStatus is not null implies\n (C.verificationStatus ~ \"confirmed\"\n or C.verificationStatus ~ \"unconfirmed\"\n or C.verificationStatus ~ \"provisional\"\n or C.verificationStatus ~ \"differential\"\n )" }, { "url" : "displaySequence", "valueInteger" : 25 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRCommon" }, { "url" : "name", "valueString" : "prevalenceInterval" }, { "url" : "statement", "valueString" : "/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition resource.\n@comment: Uses the toInterval and toAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ \"active\"\n or condition.clinicalStatus ~ \"recurrence\"\n or condition.clinicalStatus ~ \"relapse\" then\n Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n (end of condition.abatementInterval()) abatementDate\n return \n\t if abatementDate is null then\n Interval[start of condition.onset.toInterval(), abatementDate)\n else\n Interval[start of condition.onset.toInterval(), abatementDate]" }, { "url" : "displaySequence", "valueInteger" : 26 }], "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition" }, { "extension" : [{ "url" : "libraryName", "valueString" : "FHIRCommon" }, { "url" : "name", "valueString" : "abatementInterval" }, { "url" : "statement", "valueString" : "/*\n@description: Returns an interval representing the normalized Abatement of a given Condition resource.\n@comment: @comment: If the abatement element of the Condition is represented as a DateTime, the result\nis an interval beginning and ending on that DateTime.\nIf the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The\nresult is an interval from the date the patient turned that age to immediately before one year later.\nIf the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during\nwhich the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately\nbefore one year later than the date the patient turned the ending age of the quantity interval.\n\nNOTE: Due to the complexity of determining an interval from a String, this function will throw\na run-time exception if used with a Condition instance that has a String as the abatement value.\n*/\ndefine fluent function abatementInterval(condition Condition):\n if condition.abatement is FHIR.dateTime then\n Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)]\n else if condition.abatement is FHIR.Period then\n FHIRHelpers.ToInterval(condition.abatement as FHIR.Period)\n else if condition.abatement is FHIR.string then\n Message(null as Interval, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')\n else if condition.abatement is FHIR.Age then\n Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age),\n FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year)\n else if condition.abatement is FHIR.Range then\n Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low),\n FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year)\n else if condition.abatement is FHIR.boolean then\n Interval[end of condition.onset.toInterval(), condition.recordedDate)\n else \n null" }, { "url" : "displaySequence", "valueInteger" : 27 }], "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 Status", "resource" : "https://madie.cms.gov/Library/Status|2.1.000" }, { "type" : "depends-on", "display" : "Library FHIRHelpers", "resource" : "http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1" }, { "type" : "depends-on", "display" : "Library FHIRCommon", "resource" : "http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0" }, { "type" : "depends-on", "display" : "Library Hospice", "resource" : "https://madie.cms.gov/Library/Hospice|7.1.000" }, { "type" : "depends-on", "display" : "Code system SNOMEDCT", "resource" : "http://snomed.info/sct" }, { "type" : "depends-on", "display" : "Code system LOINC", "resource" : "http://loinc.org" }, { "type" : "depends-on", "display" : "Code system ConditionVerificationStatusCodes", "resource" : "http://terminology.hl7.org/CodeSystem/condition-ver-status" }, { "type" : "depends-on", "display" : "Code system ConditionClinicalStatusCodes", "resource" : "http://terminology.hl7.org/CodeSystem/condition-clinical" }, { "type" : "depends-on", "display" : "Value set Fluoride Varnish Application for Children", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.125.12.1002" }, { "type" : "depends-on", "display" : "Value set Clinical Oral Evaluation", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.125.12.1003" }, { "type" : "depends-on", "display" : "Value set Encounter Inpatient", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307" }, { "type" : "depends-on", "display" : "Value set Hospice Encounter", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003" }, { "type" : "depends-on", "display" : "Value set Hospice Care Ambulatory", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584" }, { "type" : "depends-on", "display" : "Value set Hospice Diagnosis", "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165" }], "parameter" : [{ "name" : "Measurement Period", "use" : "in", "min" : 0, "max" : "1", "type" : "Period" }, { "name" : "Numerator", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "Denominator", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "Initial Population", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }, { "name" : "Denominator Exclusions", "use" : "out", "min" : 0, "max" : "1", "type" : "boolean" }], "dataRequirement" : [{ "type" : "Patient", "profile" : ["http://hl7.org/fhir/StructureDefinition/Patient"], "mustSupport" : ["birthDate"] }, { "type" : "Procedure", "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"], "mustSupport" : ["code", "performed", "status"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.125.12.1002" }], "dateFilter" : [{ "path" : "performed", "valuePeriod" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression", "valueExpression" : { "language" : "text/cql-identifier", "expression" : "Measurement Period" } }] } }] }, { "type" : "Patient", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient"] }, { "type" : "Encounter", "profile" : ["http://hl7.org/fhir/StructureDefinition/Encounter"], "mustSupport" : ["type", "period", "status"], "codeFilter" : [{ "path" : "type", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.125.12.1003" }] }, { "type" : "Condition", "profile" : ["http://hl7.org/fhir/StructureDefinition/Condition"], "mustSupport" : ["abatement", "verificationStatus", "onset", "recordedDate", "clinicalStatus"] }, { "type" : "Condition", "profile" : ["http://hl7.org/fhir/StructureDefinition/Condition"], "mustSupport" : ["code", "verificationStatus"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165" }] }, { "type" : "Encounter", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter"], "mustSupport" : ["type", "hospitalization", "hospitalization.dischargeDisposition", "period"], "codeFilter" : [{ "path" : "type", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307" }] }, { "type" : "Encounter", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter"], "mustSupport" : ["type", "period"], "codeFilter" : [{ "path" : "type", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003" }] }, { "type" : "Observation", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-screening-assessment"], "mustSupport" : ["code", "value", "effective", "status"], "codeFilter" : [{ "path" : "code", "code" : [{ "system" : "http://loinc.org", "code" : "45755-6", "display" : "Hospice care [Minimum Data Set]" }] }, { "path" : "value" }] }, { "type" : "ServiceRequest", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-servicerequest"], "mustSupport" : ["code", "authoredOn"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584" }], "dateFilter" : [{ "path" : "authoredOn", "valuePeriod" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression", "valueExpression" : { "language" : "text/cql-identifier", "expression" : "Measurement Period" } }] } }] }, { "type" : "Procedure", "profile" : ["http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-procedure"], "mustSupport" : ["code", "performed"], "codeFilter" : [{ "path" : "code", "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584" }] }] }], "extension" : [{ "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/CMS74FHIRDentalCariesPrevention", "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" : "CMS74FHIR" }, { "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:1c99917f-438b-4cdb-ba95-d2fb32f9d715" }, { "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:5005e0c6-c10b-4f16-ab18-865e3bedd809" }, { "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" : "74FHIR", "assigner" : { "display" : "CMS" } }], "version" : "1.0.000", "name" : "CMS74FHIRDentalCariesPrevention", "title" : "Primary Caries Prevention Intervention as Offered by DentistsFHIR\n", "status" : "active", "experimental" : false, "date" : "2026-01-16T18:18:14+00:00", "publisher" : "Centers for Medicare & Medicaid Services (CMS)", "contact" : [{ "telecom" : [{ "system" : "url", "value" : "https://www.cms.gov/" }] }], "description" : "Percentage of children, 1-20 years of age, who receive two or more fluoride varnish applications during the measurement period as determined by a dentist\n", "usage" : "This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible codes and requires a clinical action that cannot be conducted via telehealth. This FHIR-based measure has been derived from the QDM-based measure CMS74v15. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).\n", "copyright" : "This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare \\& Medicaid Services (CMS). CMS contracted (Contract # 75FCMC18D0027/ Task Order #: 75FCMC24F0144) with the American Institutes for Research (AIR) to develop this electronic measure. AIR disclaims all liability for use or accuracy of any third-party codes contained in the specifications. CPT(R) codes, descriptions and other data are copyright 2024. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use. The American Dental Association (\"ADA\") holds a copyright to the Current Dental Terminology (\"CDT\") codes contained in certain measure specifications. The CDT codes in the measure specifications are included with the permission of the ADA. All uses of the CDT codes require a license from the ADA. No alteration, amendments, or modifications of the CDT or any portion thereof is allowed. Resale, transmission, or distribution of copies of the CDT or other portions of the CDT is also not allowed. To inquire about licensing, contact CDT-SNODENT@ada.org. The measure specifications contain coding from LOINC(R) (http://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use. This material contains SNOMED Clinical Terms(R) (SNOMED CT\\[R\\]) copyright 2004-2024 International Health Terminology Standards Development Organisation. All Rights Reserved. ICD-10 copyright 2024 World Health Organization. All Rights Reserved. \"HL7\" is the registered trademark of Health Level Seven International.\n", "effectivePeriod" : { "start" : "2026-01-01", "end" : "2026-12-31" }, "author" : [{ "name" : "American Institutes for Research (AIR)", "telecom" : [{ "system" : "url", "value" : "https://www.air.org" }] }], "relatedArtifact" : [{ "type" : "citation", "citation" : "American Academy of Pediatric Dentistry (2023) Fluoride therapy. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 352-8.\n" }, { "type" : "citation", "citation" : "Chou, R., Cantor, A., Zakher, B., Mitchell, J.P., \\& Pappas, M. (2014). Prevention of dental caries in children younger than 5 years old: Systematic review to update the U.S. Preventive Services Task Force recommendation. Rockville (MD): Agency for Healthcare Research and Quality (US). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK202090/\n" }, { "type" : "citation", "citation" : "Weyant, R. J., Tracy, S. L., Anselmo, T. (Tracy), Beltrán-Aguilar, E. D., Donly, K. J., Frese, W. A., Hujoel, P. P., Iafolla, T., Kohn, W., Kumar, J., Levy, S. M., Tinanoff, N., Wright, J. T., Zero, D., Aravamudhan, K., Frantsve-Hawley, J., \\& Meyer, D. M. (2013). Topical fluoride for caries prevention. The Journal of the American Dental Association, 144(11), 1279--1291. https://doi.org/10.14219/jada.archive.2013.0057\n" }], "library" : ["https://madie.cms.gov/Library/CMS74FHIRDentalCariesPrevention"], "disclaimer" : "The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or \\[R\\] and unregistered trademarks are indicated by (TM) or \\[TM\\].\n", "rationale" : "The literature reflects that fluoride varnish, when applied to the teeth of high-risk children, reduces, in conjunction with anticipatory guidance provided to the caregiver, the risk of the child developing caries (Weyant et al., 2013). Evidence in the literature also specifically supports the effectiveness of professionally applied fluoride varnish at preventing caries in higher risk children (Chou et al., 2014).\n", "clinicalRecommendationStatement" : "The 2013 American Dental Association (ADA) clinical recommendations for use of professionally applied or prescription-strength, home-use topical fluorides for caries prevention in patients at elevated risk of developing caries:\n\n* Younger Than 6 Years\n\n * 2.26 percent fluoride varnish at least every three to six months.\n\n* 6-18 Years\n\n * 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF\\*) gel for four minutes at least every three to six months.\n\n* Older Than 18 Years\n\n * 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF) gel for four minutes at least every three to six months (Weyant et al., 2013).\n\nThe United States Preventive Services Taskforce (USPSTF) recommends the use of professionally applied fluoride varnish for the prevention of dental caries in high risk children under 5 years of age (Chou et al., 2014).\n\nThe American Academy of Pediatric Dentistry (AAPD) recommends the application of topical fluoride treatments at least twice per year to reduce the incidence of dental caries, with precise timing based upon the unique needs, risks, and benefits inherent to the individual patient (AAPD, 2023).\n", "group" : [{ "id" : "Group_1", "extension" : [{ "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring", "code" : "proportion", "display" : "Proportion" }] } }, { "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis", "valueCode" : "boolean" }, { "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-type", "code" : "process", "display" : "Process" }] } }, { "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation", "code" : "increase", "display" : "Increased score indicates improvement" }] } }], "population" : [{ "id" : "InitialPopulation_1", "code" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "initial-population", "display" : "Initial Population" }] }, "description" : "Children, 1-20 years of age at the start of the measurement period, with a clinical oral evaluation by a dentist 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" : "Exclude patients who are in hospice care or have a hospice care order documented during any part of the measurement period\n", "criteria" : { "language" : "text/cql-identifier", "expression" : "Denominator Exclusions" } }, { "id" : "Numerator_1", "code" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "numerator", "display" : "Numerator" }] }, "description" : "Children who receive two or more fluoride varnish applications on different days during the measurement period\n", "criteria" : { "language" : "text/cql-identifier", "expression" : "Numerator" } }], "stratifier" : [{ "id" : "Stratification_1_1", "extension" : [{ "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "initial-population", "display" : "Initial Population" }] } }, { "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "denominator", "display" : "Denominator" }] } }, { "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "denominator-exclusion", "display" : "Denominator Exclusion" }] } }, { "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "numerator", "display" : "Numerator" }] } }], "description" : "Population 1: Patients age 1-5 years at the start of the Measurement Period\n", "criteria" : { "language" : "text/cql-identifier", "expression" : "Initial Population" } }, { "id" : "Stratification_1_2", "extension" : [{ "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "initial-population", "display" : "Initial Population" }] } }, { "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "denominator", "display" : "Denominator" }] } }, { "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "denominator-exclusion", "display" : "Denominator Exclusion" }] } }, { "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "numerator", "display" : "Numerator" }] } }], "description" : "Population 2: Patients age 6-12 years at the start of the Measurement Period\n", "criteria" : { "language" : "text/cql-identifier", "expression" : "Initial Population" } }, { "id" : "Stratification_1_3", "extension" : [{ "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "initial-population", "display" : "Initial Population" }] } }, { "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "denominator", "display" : "Denominator" }] } }, { "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "denominator-exclusion", "display" : "Denominator Exclusion" }] } }, { "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo", "valueCodeableConcept" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/measure-population", "code" : "numerator", "display" : "Numerator" }] } }], "description" : "Population 3: Patients age 13-20 years at the start of the Measurement Period\n", "criteria" : { "language" : "text/cql-identifier", "expression" : "Initial Population" } }] }] }