AppropriateTreatmentforSTEMIFHIR
type: Measure
node role: treeRoot
id:
  v: AppropriateTreatmentforSTEMIFHIR
meta:
  profile:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm
    l: computable-measure-cqfm
  profile:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm
    l: publishable-measure-cqfm
  profile:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm
    l: executable-measure-cqfm
text:
  status:
    v: extensions
  div:
    v: Title: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)FHIR Id: AppropriateTreatmentforSTEMIFHIR Download cql: AppropriateTreatmentforSTEMIFHIR.cql Version: 0.0.008 Url: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)FHIR short-name identifier: CMS996FHIR version-independent identifier: urn:uuid:a48685e0-4926-4ae8-9eb3-d8e8839b1704 version-specific identifier: urn:uuid:2c92808482113ece01821188a1500069 endorser (NQF) identifier: 3613e publisher (CMS) identifier: 996FHIR Effective Period: 2024-01-01 ..2024-12-31 Status: draft Date: 2023-10-27 08:12:31+0000 Approval Date: 2023-08-17 Last Review Date: 2023-08-17 Name: AppropriateTreatmentforSTEMIFHIR Publisher: Centers for Medicare & Medicaid Services (CMS) Author: Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation: https://medicine.yale.edu/core/, The Lewin Group: https://www.lewin.com/ Description: Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival Purpose: UNKNOWN Copyright: Limited proprietary coding is contained in these specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. All rights reserved. LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. ICD-10 is copyright 2022 World Health Organi…
contained: Library
  id:
    v: effective-data-requirements
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://hl7.org/fhir/v3/AdministrativeGender
        l: AdministrativeGender
      code:
        v: M
      display:
        v: Male
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://hl7.org/fhir/v3/AdministrativeGender
        l: AdministrativeGender
      code:
        v: F
      display:
        v: Female
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/v3-ActCode
        l: v3-ActCode
      code:
        v: EMER
      display:
        v: emergency
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-clinical
        l: condition-clinical
      code:
        v: active
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
        l: allergyintolerance-clinical
      code:
        v: active
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: SupplementalDataElements
    extension:
      url:
        v: name
        l: name
      value: String
        v: SDE Sex
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "SDE Sex": case when Patient.gender = 'male' then "M" when Patient.gender = 'female' then "F" else null end
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 0
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: AppropriateTreatmentforSTEMIFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: SDE Sex
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "SDE Sex": SDE."SDE Sex"
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 1
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: AppropriateTreatmentforSTEMIFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: ED Encounter with Encounter Diagnosis of STEMI
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "ED Encounter with Encounter Diagnosis of STEMI": ["Encounter": "ED"] EDEncounter where EDEncounter.status = 'finished' and EDEncounter.class ~ "EMER" and ( EDEncounter.reasonCode in "STEMI" or exists ( ( EDEncounter.encounterDiagnosis ( ) ) EncDiagnosis where EncDiagnosis.code in "STEMI" ) ) and EDEncounter.period during "Measurement Period"
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 2
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: AppropriateTreatmentforSTEMIFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: ED Encounter with Diagnosis of STEMI
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "ED Encounter with Diagnosis of STEMI": ["Encounter": "ED"] EDEncounter with ["Condition": "STEMI"] DxSTEMI such that DxSTEMI.clinicalStatus ~ QICoreCommon."active" and EDEncounter.status = 'finished' and EDEncounter.class ~ "EMER" and DxSTEMI.prevalenceInterval ( ) starts during EDEncounter.period and EDEncounter.period during day of "Measurement Period"
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 3
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
      l: cqfm-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: AppropriateTreatmentforSTEMIFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: ED Encounter with STEMI Diagnosis

url:
  v: statement
  l: statement
value: String
  v: define "ED Encounter with STEMI Diagnosis": "ED Encounter with Encounter Diagnosis of STEMI" union "ED Encounter with Diagnosis of STEMI"

url:
  v: displaySequence
  l: displaySequence
value: Integer
  v: 4

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Fibrinolytic Therapy within 30 Minutes of Arrival
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /*Did not include a status of active as any diagnosis that resolves during the ED visit would not be counted*/ define "Fibrinolytic Therapy within 30 Minutes of Arrival": "ED Encounter with STEMI Diagnosis" EDwithSTEMI with ["MedicationAdministration": "Fibrinolytic Therapy"] Fibrinolytic such that Fibrinolytic.status = 'completed' and start of ( Fibrinolytic.effective.toInterval ( ) ) 30 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 5
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: PCI within 90 Minutes of Arrival
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "PCI within 90 Minutes of Arrival": "ED Encounter with STEMI Diagnosis" EDwithSTEMI with ["Procedure": "Percutaneous Coronary Intervention"] PCI such that PCI.performed.toInterval ( ) starts 90 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( ) and PCI.status = 'completed'
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 6
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival": "ED Encounter with STEMI Diagnosis" EDwithSTEMI where ( EDwithSTEMI.period ) ends 45 minutes or less after start of ( EDwithSTEMI.period ) and EDwithSTEMI.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 7
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Numerator
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Numerator": "Fibrinolytic Therapy within 30 Minutes of Arrival" union "PCI within 90 Minutes of Arrival" union "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 8
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Initial Population
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /***Population Criteria***/ define "Initial Population": "ED Encounter with STEMI Diagnosis" EDwithSTEMI where AgeInYearsAt(date from start of(EDwithSTEMI.period)) >= 18
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 9
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Denominator
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Denominator": "Initial Population"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 10
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SupplementalDataElements
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Payer
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 11
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Payer
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Payer": SDE."SDE Payer"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 12
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SupplementalDataElements
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Ethnicity
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 13
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Ethnicity
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Ethnicity": SDE."SDE Ethnicity"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 14
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter": "ED Encounter with STEMI Diagnosis" EDwSTEMI with ["AllergyIntolerance": "Thrombolytic medications"] ThrombolyticAllergy such that ThrombolyticAllergy.clinicalStatus ~ QICoreCommon."allergy-active" and ThrombolyticAllergy.onset.toInterval ( ) overlaps ( EDwSTEMI.period )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 15
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Adverse Effect to Thrombolytic Medications Before End of ED Encounter
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /*this definition differs from QDM re: timing - cannot use overlaps for a single point in time*/ /*define "Adverse Effect to Thrombolytic Medications Before End of ED Encounter": "ED Encounter with STEMI Diagnosis" EDwSTEMI with [AdverseEvent: event in "Thrombolytic medications"] ThrombolyticAdverseEvent such that ThrombolyticAdverseEvent.category in "Adverse reaction to thrombolytics" and ThrombolyticAdverseEvent.recordedDate before end of ( EDwSTEMI.period ) and ThrombolyticAdverseEvent.actuality = 'actual'*/ /*KS Note - not sure we need category in the logic - it is must support, but not sure this brings value to the measure logic*/ define "Adverse Effect to Thrombolytic Medications Before End of ED Encounter": "ED Encounter with STEMI Diagnosis" EDwSTEMI with [AdverseEvent: event in "Adverse reaction to thrombolytics"] ThrombolyticAdverseEvent such that ThrombolyticAdverseEvent.recordedDate before end of ( EDwSTEMI.period ) and ThrombolyticAdverseEvent.actuality = 'actual'
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 16
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Active Exclusion Diagnosis at Start of ED Encounter
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /***Definitions***/ define "Active Exclusion Diagnosis at Start of ED Encounter": "ED Encounter with STEMI Diagnosis" EDwithSTEMI with ( ["Condition": "Active Bleeding Excluding Menses or Bleeding Diathesis"] union ["Condition": "Malignant Intracranial Neoplasm Group"] union ["Condition": "Cerebral Vascular Lesion"] union ["Condition": "Dementia"] union ["Condition": "Pregnancy"] union ["Condition": "Allergy to thrombolytics"] ) ActiveExclusionDx such that /*ActiveExclusionDx.isActive () and */ ActiveExclusionDx.prevalenceInterval ( ) overlaps before ( EDwithSTEMI.period )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 17
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Active Oral Anticoagulant Medication at the Start of ED Encounter
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Active Oral Anticoagulant Medication at the Start of ED Encounter": "ED Encounter with STEMI Diagnosis" EDwithSTEMI with ["MedicationRequest": "Oral Anticoagulant Medications"] OralAnticoagulant such that OralAnticoagulant.status = 'active' and OralAnticoagulant.intent = 'order' and OralAnticoagulant.authoredOn before or on start of EDwithSTEMI.period
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 18
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start": "ED Encounter with STEMI Diagnosis" EDwithSTEMI with ( ["Condition": "Aortic Dissection and Rupture"] union ["Condition": "Neurologic impairment"] union ["Condition": "Cardiopulmonary Arrest"] ) ExclusionDiagnosis such that ( ExclusionDiagnosis.prevalenceInterval ( ) starts during EDwithSTEMI.period ) or ( ExclusionDiagnosis.prevalenceInterval ( ) starts 24 hours or less before start of EDwithSTEMI.period )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 19
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter": "ED Encounter with STEMI Diagnosis" EDwithSTEMI with ["Procedure": "Major Surgical Procedure"] MajorSurgery such that MajorSurgery.performed.toInterval ( ) starts 21 days or less before start of ( EDwithSTEMI.period ) and MajorSurgery.status = 'completed'
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 20
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Intubation or Mechanical Circulatory Assist Procedure During ED Encounter or Within 24 Hours of ED Encounter Start
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Intubation or Mechanical Circulatory Assist Procedure During ED Encounter or Within 24 Hours of ED Encounter Start": "ED Encounter with STEMI Diagnosis" EDwithSTEMI with ( ["Procedure": "Endotracheal Intubation"] union ["Procedure": "Insertion or Replacement of Mechanical Circulatory Assist Device"] ) AirwayProcedure such that ( ( AirwayProcedure.performed.toInterval ( ) starts during ( EDwithSTEMI.period ) ) or ( AirwayProcedure.performed.toInterval ( ) starts 24 hours or less before start of ( EDwithSTEMI.period ) ) ) and AirwayProcedure.status = 'completed'
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 21
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /*KS 8-10-23: in CQLIT-389, discussed the impacts of requiring a clinical status of active but the condition could end before the end (during) the ED Visit, which would trigger an inactive status. Decided to not follow the Authoring Patterns and remove the requirement for a clinicalstatus of 'active' */ define "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter": "ED Encounter with STEMI Diagnosis" EDwSTEMI with ( ["Condition": "Ischemic Stroke"] union ["Condition": "Closed Head and Facial Trauma"] union ["Condition": "Active Peptic Ulcer"] union ["Condition": "Cardiopulmonary Arrest"] ) ExclusionCondition such that /* ExclusionCondition.isActive () and */ ExclusionCondition.prevalenceInterval ( ) starts during Interval[start of ( EDwSTEMI.period ) - 90 days, start of ( EDwSTEMI.period )]
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 22
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter": "ED Encounter with STEMI Diagnosis" EDwithSTEMI with ["Procedure": "Intracranial or Intraspinal surgery"] CranialorSpinalSurgery such that CranialorSpinalSurgery.performed.toInterval ( ) starts 90 days or less before start of ( EDwithSTEMI.period ) and CranialorSpinalSurgery.status = 'completed'
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 23
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: ED Encounter with Discharge Disposition as Patient Expired
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "ED Encounter with Discharge Disposition as Patient Expired": "ED Encounter with STEMI Diagnosis" EDwithSTEMI where EDwithSTEMI.hospitalization.dischargeDisposition in "Patient Expired"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 24
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Denominator Exclusions
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Denominator Exclusions": "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter" union "Adverse Effect to Thrombolytic Medications Before End of ED Encounter" union "Active Exclusion Diagnosis at Start of ED Encounter" union "Active Oral Anticoagulant Medication at the Start of ED Encounter" union "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start" union "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter" union "Intubation or Mechanical Circulatory Assist Procedure During ED Encounter or Within 24 Hours of ED Encounter Start" union "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter" union "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter" union "ED Encounter with Discharge Disposition as Patient Expired"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 25
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SupplementalDataElements
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Race
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 26
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Race
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Race": SDE."SDE Race"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 27
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToConcept
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept. */ define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 28
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: CQMCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: encounterDiagnosis
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Returns the Condition resources referenced by the diagnosis element of the Encounter */ define fluent function encounterDiagnosis(Encounter Encounter ): Encounter.diagnosis D return singleton from ([Condition] C where C.id = D.condition.reference.getId())
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 29
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: QICoreCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: getId
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Returns the tail of the given uri (i.e. everything after the last slash in the URI). @comment: This function can be used to determine the logical id of a given resource. It can be used in a single-server environment to trace references. However, this function does not attempt to resolve or distinguish the base of the given url, and so cannot be used safely in multi-server environments. */ define fluent function getId(uri String): Last(Split(uri, '/'))
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 30
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: QICoreCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: prevalenceInterval
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Returns an interval representing the normalized prevalence period of a given Condition. @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. If the condition is active, the resulting interval will have a closed ending boundary. If the condition is not active, the resulting interval will have an open ending boundary. */ define fluent function prevalenceInterval(condition Condition): if condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" then Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()] else Interval[start of condition.onset.toInterval(), end of condition.abatementInterval())
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 31
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: AppropriateTreatmentforSTEMIFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: currentemergencyDepartmentArrivalTime
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Returns the emergency department arrival time for the encounter. */ define fluent function currentemergencyDepartmentArrivalTime(EDEncounter Encounter): start of ( singleton from ( ( ( EDEncounter.location ) ) EDLocation where CQMCommon.GetLocation ( EDLocation.location ).type in "Emergency Department Visit" ) ).period
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 32
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: CQMCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: GetLocation
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Returns the Location resource specified by the given reference @deprecated: This function is deprecated. Use the fluent function `getLocation()` instead. */ define function "GetLocation"(reference Reference ): singleton from ( [Location] L where L.id = reference.reference.getId() )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 33
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToString
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value uri): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 34
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToCode
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 35
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: QICoreCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: toInterval
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval @comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible representations for timing-valued elements in QICore, allowing this function to be used across any resource. The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>. The intent of this function is to provide a clear and concise mechanism to treat single elements that have multiple possible representations as intervals so that logic doesn't have to account for the variability. More complex calculations (such as medication request period or dispense period calculation) need specific guidance and consideration. That guidance may make use of this function, but the focus of this function is on single element calculations where the semantics are unambiguous. If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime. If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age, and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later. If the input is a DateTime Interval, the result is the input. If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending immediately before one year later than the date the patient turned the age given as the end of the quantity interval. Any other input will reslt in a null DateTime Interval */ define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>>): case when choice is DateTim…
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 36
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

v: active

coding:
  system:
    v: http://terminology.hl7.org/CodeSystem/library-type
    l: library-type
  code:
    v: module-definition

type:
  v: depends-on
display:
  v: Library SDE
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/SupplementalDataElements|3.4.000
  l: http://ecqi.healthit.gov/ecqms/Library/SupplementalDataElements

type:
  v: depends-on
display:
  v: Library FHIRHelpers
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers|4.3.000
  l: http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers

type:
  v: depends-on
display:
  v: Library CQMCommon
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/CQMCommon|1.4.000
  l: http://ecqi.healthit.gov/ecqms/Library/CQMCommon

type:
  v: depends-on
display:
  v: Library QICoreCommon
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/QICoreCommon|1.5.000
  l: http://ecqi.healthit.gov/ecqms/Library/QICoreCommon

type:
  v: depends-on
display:
  v: Code system AdministrativeGender
resource:
  v: http://hl7.org/fhir/v3/AdministrativeGender
  l: AdministrativeGender

type:
  v: depends-on
display:
  v: Code system ActCode
resource:
  v: http://terminology.hl7.org/CodeSystem/v3-ActCode
  l: v3-ActCode

type:
  v: depends-on
display:
  v: Code system ConditionClinicalStatusCodes
resource:
  v: http://terminology.hl7.org/CodeSystem/condition-clinical
  l: condition-clinical

type:
  v: depends-on
display:
  v: Code system AllergyIntoleranceClinicalStatusCodes
resource:
  v: http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
  l: allergyintolerance-clinical

type:
  v: depends-on
display:
  v: Value set ED
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1085
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1085

type:
  v: depends-on
display:
  v: Value set STEMI
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4017
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4017

type:
  v: depends-on
display:
  v: Value set Fibrinolytic Therapy
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4020
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4020

type:
  v: depends-on
display:
  v: Value set Emergency Department Visit
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292

type:
  v: depends-on
display:
  v: Value set Percutaneous Coronary Intervention
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.2000.5
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.2000.5

type:
  v: depends-on
display:
  v: Value set Discharge To Acute Care Facility
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87

type:
  v: depends-on
display:
  v: Value set Payer Type
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591

type:
  v: depends-on
display:
  v: Value set Thrombolytic medications
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.4
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.4

type:
  v: depends-on
display:
  v: Value set Adverse reaction to thrombolytics
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.6
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.6

type:
  v: depends-on
display:
  v: Value set Active Bleeding Excluding Menses or Bleeding Diathesis
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4036
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4036

type:
  v: depends-on
display:
  v: Value set Malignant Intracranial Neoplasm Group
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.3
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.3

type:
  v: depends-on
display:
  v: Value set Cerebral Vascular Lesion
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4025
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4025

type:
  v: depends-on
display:
  v: Value set Dementia
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4043
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4043

type:
  v: depends-on
display:
  v: Value set Pregnancy
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4055
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4055

type:
  v: depends-on
display:
  v: Value set Allergy to thrombolytics
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.5
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.5

type:
  v: depends-on
display:
  v: Value set Oral Anticoagulant Medications
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4045
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4045

type:
  v: depends-on
display:
  v: Value set Aortic Dissection and Rupture
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4028
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4028

type:
  v: depends-on
display:
  v: Value set Neurologic impairment
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.114.12.1012
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.114.12.1012

type:
  v: depends-on
display:
  v: Value set Cardiopulmonary Arrest
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4048
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4048

type:
  v: depends-on
display:
  v: Value set Major Surgical Procedure
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4056
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4056

type:
  v: depends-on
display:
  v: Value set Endotracheal Intubation
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.69
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.69

type:
  v: depends-on
display:
  v: Value set Insertion or Replacement of Mechanical Circulatory Assist Device
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4052
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4052

type:
  v: depends-on
display:
  v: Value set Ischemic Stroke
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.104.12.1024
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.104.12.1024

type:
  v: depends-on
display:
  v: Value set Closed Head and Facial Trauma
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4026
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4026

type:
  v: depends-on
display:
  v: Value set Active Peptic Ulcer
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4031
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4031

type:
  v: depends-on
display:
  v: Value set Intracranial or Intraspinal surgery
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.2
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.2

type:
  v: depends-on
display:
  v: Value set Patient Expired
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309

name:
  v: Measurement Period
use:
  v: in
min:
  v: 0
max:
  v: 1
type:
  v: Period

name:
  v: SDE Sex
use:
  v: out
min:
  v: 0
max:
  v: 1
type:
  v: Coding

name:
  v: Numerator
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: Denominator
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: SDE Payer
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: Initial Population
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: SDE Ethnicity
use:
  v: out
min:
  v: 0
max:
  v: 1
type:
  v: Resource

name:
  v: Denominator Exclusions
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: Resource

name:
  v: SDE Race
use:
  v: out
min:
  v: 0
max:
  v: 1
type:
  v: Resource

type:
  v: Patient
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
  l: qicore-patient
must support:
  v: ethnicity
must support:
  v: race

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition
  l: qicore-condition
must support:
  v: id
must support:
  v: id.value
must support:
  v: code

type:
  v: Condition
profile:
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v: 0.0.008

v: AppropriateTreatmentforSTEMIFHIR

v: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)FHIR

v: draft

v: false

v: 2023-10-27T08:12:31+00:00

v: Centers for Medicare & Medicaid Services (CMS)

telecom:
  system:
    v: url
  value:
    v: https://www.cms.gov/

v: Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival

v: UNKNOWN

v: This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI. This FHIR-based measure has been derived from the QDM-based measure: CMS996v4. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html).

v: Limited proprietary coding is contained in these specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. All rights reserved. LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. ICD-10 is copyright 2022 World Health Organization. All Rights Reserved.

v: 2023-08-17

v: 2023-08-17

start:
  v: 2024-01-01
end:
  v: 2024-12-31

name:
  v: Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation
telecom:
  system:
    v: url
  value:
    v: https://medicine.yale.edu/core/

name:
  v: The Lewin Group
telecom:
  system:
    v: url
  value:
    v: https://www.lewin.com/

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

v: Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (Sohlpour & Yusuf, 2014; Fibrinolytic Therapy Trialists’ Collaborative Group, 1994). For patients receiving fibrinolytic therapy, the American Heart Association (AHA) estimates that 65 lives will be saved per 1,000 patients if treatment is administered within the first hour of symptom onset, and 131 lives will be saved per 1,000 patients treated if fibrinolytic therapy is delivered within the first three hours (O’Connor et al., 2010). The total ischemic time—that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy—is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O’Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O’Gara et al., 2013). Implementation of an eCQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the proposed eCQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of …

v: Primary PCI in STEMI: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration." - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact." Fibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - "In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact.” Transfer to a PCI-Capable Hospital after Fibrinolytic Therapy: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe HF, irrespective of the time delay from MI onset. - Urgent transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who demonstrate evidence of failed reperfusion or reocclusion after fibrinolytic therapy. - Transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy.

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  value: CodeableConcept
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-scoring
        l: measure-scoring
      code:
        v: proportion
      display:
        v: Proportion
extension:
  url:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis
    l: cqfm-populationBasis
  value: Code
    v: Encounter
extension:
  url:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type
    l: cqfm-type
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-type
        l: measure-type
      code:
        v: process
      display:
        v: Process
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: initial-population
      display:
        v: Initial Population
  description:
    v: All emergency department encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI)
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Initial Population
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: denominator
      display:
        v: Denominator
  description:
    v: Equals Initial Population
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Denominator
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: denominator-exclusion
      display:
        v: Denominator Exclusion
  description:
    v: Patients with the following conditions are excluded from measure denominator: • Expired in the ED • Bleeding or bleeding diathesis (excluding menses) • Intracranial or intraspinal surgery • Ischemic stroke • Known malignant intracranial neoplasm (primary or metastatic) • Known structural cerebral vascular lesion (e.g., AVM) • Significant facial and/or closed head trauma • Suspected aortic dissection • Peptic ulcer • Cardiopulmonary arrest, including: cardiac arrest, CPR, defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR • Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase • Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation • Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device • Oral anticoagulant therapy • Advanced dementia • Pregnancy • Internal bleeding • Major surgery • Severe neurologic impairment (e.g., based on Glasgow coma scale or as indicated by the patient receiving therapeutic hypothermia in the ED)
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Denominator Exclusions
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: numerator
      display:
        v: Numerator
  description:
    v: Emergency department encounters with a diagnosis of STEMI: - where time from ED arrival to fibrinolysis is 30 minutes or fewer; OR - where PCI is performed within 90 minutes of arrival for non-transfer patients; OR - where the patient is transferred within 45 minutes of ED arrival.
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Numerator
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: numerator-exclusion
      display:
        v: Numerator Exclusion
  criteria:
    language:
      v: text/cql-identifier
population:
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: denominator-exception
      display:
        v: Denominator Exception
  criteria:
    language:
      v: text/cql-identifier

id:
  v: sde-ethnicity
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
description:
  v: SDE Ethnicity
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Ethnicity

id:
  v: sde-payer
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
description:
  v: SDE Payer
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Payer

id:
  v: sde-race
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
description:
  v: SDE Race
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Race

id:
  v: sde-sex
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
description:
  v: SDE Sex
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Sex