HybridHospitalWideMortalityFHIR
type: Measure
node role: treeRoot
id:
  v: HybridHospitalWideMortalityFHIR
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: Core Clinical Data Elements for the Hybrid Hospital-Wide (All-Condition, All-Procedure) Risk-Standardized Mortality Measure (HWM) FHIR Id: HybridHospitalWideMortalityFHIR Download cql: HybridHospitalWideMortalityFHIR.cql Version: 0.0.001 Url: Core Clinical Data Elements for the Hybrid Hospital-Wide (All-Condition, All-Procedure) Risk-Standardized Mortality Measure (HWM) FHIR short-name identifier: CMS844FHIR version-independent identifier: urn:uuid:965255e9-dfeb-42d0-8416-2c4b7ecc5109 version-specific identifier: urn:uuid:2c92808482113ece0182c5d4fc662f1a endorser (NQF) identifier: 3502 publisher (CMS) identifier: 844FHIR Effective Period: 2024-07-01 ..2025-06-30 Status: draft Date: 2023-10-27 08:12:32+0000 Approval Date: 2023-08-14 Last Review Date: 2023-08-14 Name: HybridHospitalWideMortalityFHIR Publisher: Centers for Medicare & Medicaid Services (CMS) Author: Mathematica: https://www.mathematica.org/, Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation: https://medicine.yale.edu/core/ Description: This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from encounters for adult Medicare Fee-For-Service patients admitted to acute care short stay hospitals. 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 2004-2021 International Health Terminology Standards Development Organisation. All rights reserved. LOINC(R) copyright 2004-2021 Regenstrief …
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: IMP
      display:
        v: Inpatient
  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: ACUTE
      display:
        v: Acute
  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: NONAC
      display:
        v: Nonacute
  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: OBSENC
      display:
        v: Observation Encounter
  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: HybridHospitalWideMortalityFHIR
    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: HybridHospitalWideMortalityFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: Inpatient Encounters
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "Inpatient Encounters": from ["Encounter": "Encounter Inpatient"] InpatientEncounter, ["Coverage": "Medicare payer"] Payer where InpatientEncounter.status = 'finished' and ( InpatientEncounter.class ~ "IMP" or InpatientEncounter.class ~ "ACUTE" or InpatientEncounter.class ~ "NONAC" or InpatientEncounter.class ~ "OBSENC" ) and AgeInYearsAt(date from start of InpatientEncounter.period) in Interval[65, 94] and InpatientEncounter.hospitalizationWithObservationLengthofStay ( ) < 365 and InpatientEncounter.period ends during day of "Measurement Period" return InpatientEncounter
    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: HybridHospitalWideMortalityFHIR
    extension:
      url:
        v: name
        l: name
      value: String
        v: Results
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: /*Inpatient encounter initially listed as AMB class; changed this to inpatient classes as discussed with CORE team- AM*/ define "Results": flatten { //First physical exams (vital signs) "FirstPhysicalExamWithEncounterId"([Observation: "Heart Rate"], 'FirstHeartRate'), "FirstPhysicalExamWithEncounterId"([Observation: "Systolic Blood Pressure"], 'FirstSystolicBP'), "FirstPhysicalExamWithEncounterId"([Observation: "Body temperature"], 'FirstTemperature'), "FirstPhysicalExamWithEncounterId"([Observation: "Oxygen Saturation by Pulse Oximetry"], 'FirstO2Saturation'), //First lab tests "FirstLabTestWithEncounterId"([Observation: "Hematocrit lab test"], 'FirstHematocrit'), "FirstLabTestWithEncounterId"([Observation: "Platelet count lab test"], 'FirstPlateletCount'), "FirstLabTestWithEncounterId"([Observation: "White blood cells count lab test"], 'FirstWhiteBloodCell'), "FirstLabTestWithEncounterId"([Observation: "Sodium lab test"], 'FirstSodium'), "FirstLabTestWithEncounterId"([Observation: "Bicarbonate lab test"], 'FirstBicarbonate'), "FirstLabTestWithEncounterId"([Observation: "Creatinine lab test"], 'FirstCreatinine') }
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 3

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: 4
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: HybridHospitalWideMortalityFHIR
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: 5
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: HybridHospitalWideMortalityFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Initial Population
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Initial Population": "Inpatient Encounters"
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: 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: 7
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: HybridHospitalWideMortalityFHIR
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: 8
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: 9
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: HybridHospitalWideMortalityFHIR
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: 10
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: HybridHospitalWideMortalityFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: FirstPhysicalExamWithEncounterId
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function "FirstPhysicalExamWithEncounterId"(ExamList List<Observation>, CCDE String): "Inpatient Encounters" Encounter let firstexam: First(ExamList Exam where start of QICoreCommon."ToInterval"(Exam.effective) is not null and start of QICoreCommon."ToInterval"(Exam.effective) during Interval[start of Encounter.period - 1440 minutes, start of Encounter.period + 120 minutes] and Exam.status in { 'final', 'amended', 'preliminary' } and Exam.value is not null sort by start of QICoreCommon."ToInterval"(effective) ) return '\r\n' & CCDE & ',' & Encounter.id & ' , ' & ( ToString(firstexam.value as Quantity) ) & ',' & ToString(start of QICoreCommon."ToInterval"(firstexam.effective))
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: CQMCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: hospitalizationWithObservationLengthofStay
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Hospitalization with Observation Length of Stay returns the length in days from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter */ define fluent function hospitalizationWithObservationLengthofStay(TheEncounter "Encounter" ): ((TheEncounter."hospitalizationWithObservation"(). "lengthInDays"()))
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: CQMCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: lengthInDays
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Calculates the difference in calendar days between the start and end of the given interval. */ define fluent function lengthInDays(Value Interval<DateTime> ): difference in days between start of Value and end of Value
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: CQMCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: hospitalizationWithObservation
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter */ define fluent function hospitalizationWithObservation(TheEncounter Encounter ): TheEncounter Visit let ObsVisit: Last([Encounter: "Observation Services"] LastObs where LastObs.status = 'finished' and LastObs.period ends 1 hour or less on or before start of Visit.period sort by end of period ), VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period), EDVisit: Last([Encounter: "Emergency Department Visit"] LastED where LastED.status = 'finished' and LastED.period ends 1 hour or less on or before VisitStart sort by end of period ) return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]
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: 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 @deprecated: This function is deprecated. Use the fluent function `toInterval()` instead */ define function ToInterval(choice Choice<DateTim…
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: HybridHospitalWideMortalityFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: FirstLabTestWithEncounterId
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function "FirstLabTestWithEncounterId"(LabList List<Observation>, CCDE String): "Inpatient Encounters" Encounter let firstlab: First(LabList Lab where Lab.issued is not null and Lab.issued during Interval[start of Encounter.period - 1440 minutes, start of Encounter.period + 1440 minutes] and Lab.status in { 'final', 'amended', 'preliminary' } and Lab.value is not null sort by issued ) return '\r\n' & CCDE & ',' & Encounter.id & ',' & ( ToString(firstlab.value as Quantity) ) & ',' & ToString(firstlab.issued)
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: 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: 17
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: 18
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: Value set Encounter Inpatient
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307

type:
  v: depends-on
display:
  v: Value set Medicare payer
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.10
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.10

type:
  v: depends-on
display:
  v: Value set Observation Services
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143

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 Heart Rate
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.149
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.149

type:
  v: depends-on
display:
  v: Value set Systolic Blood Pressure
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.163
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.163

type:
  v: depends-on
display:
  v: Value set Body temperature
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.152
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.152

type:
  v: depends-on
display:
  v: Value set Oxygen Saturation by Pulse Oximetry
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.151
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.151

type:
  v: depends-on
display:
  v: Value set Hematocrit lab test
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.114
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.114

type:
  v: depends-on
display:
  v: Value set Platelet count lab test
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.127
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.127

type:
  v: depends-on
display:
  v: Value set White blood cells count lab test
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.129
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.129

type:
  v: depends-on
display:
  v: Value set Sodium lab test
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.119
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.119

type:
  v: depends-on
display:
  v: Value set Bicarbonate lab test
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.139
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.139

type:
  v: depends-on
display:
  v: Value set Creatinine lab test
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.2363
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.2363

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

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: Results
use:
  v: out
min:
  v: 0
max:
  v: *
type:
  v: string

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: 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: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: status
must support:
  v: status.value
must support:
  v: period
must support:
  v: id
must support:
  v: id.value
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
code filter:
  path:
    v: status.value
  code:
    code:
      v: finished

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: status
must support:
  v: status.value
must support:
  v: period
must support:
  v: id
must support:
  v: id.value
code filter:
  path:
    v: type
  value set:
    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
code filter:
  path:
    v: status.value
  code:
    code:
      v: finished
date filter:
  path:
    v: period
  value: Period
    extension:
      url:
        v: http://hl7.org/fhir/uv/crmi-analysisException
        l: crmi-analysisException
      value: String
        v: Error attempting to determine filter value: toFhirValue not implemented for Subtract

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: status
must support:
  v: status.value
must support:
  v: class
must support:
  v: period
must support:
  v: id
must support:
  v: id.value
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
date filter:
  path:
    v: period
  value: Period
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/cqf-expression
        l: cqf-expression
      value: Expression

v: text/cql-identifier

v: Measurement Period

type:
  v: Coverage
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage
  l: qicore-coverage
must support:
  v: type
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.10
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.10

type:
  v: Coverage
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage
  l: qicore-coverage
must support:
  v: type
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    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: Observation
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation
  l: qicore-observation
must support:
  v: code
must support:
  v: effective
must support:
  v: status
must support:
  v: status.value
must support:
  v: value
must support:
  v: issued
must support:
  v: issued.value
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.149
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.149

type:
  v: Observation
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation
  l: qicore-observation
must support:
  v: code
must support:
  v: effective
must support:
  v: status
must support:
  v: status.value
must support:
  v: value
must support:
  v: issued
must support:
  v: issued.value
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.163
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.163

type:
  v: Observation
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation
  l: qicore-observation
must support:
  v: code
must support:
  v: effective
must support:
  v: status
must support:
  v: status.value
must support:
  v: value
must support:
  v: issued
must support:
  v: issued.value
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.152
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.152

type:
  v: Observation
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation
  l: qicore-observation
must support:
  v: code
must support:
  v: effective
must support:
  v: status
must support:
  v: status.value
must support:
  v: value
must support:
  v: issued
must support:
  v: issued.value
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.151
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.151

type:
  v: Observation
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation
  l: qicore-observation
must support:
  v: code
must support:
  v: effective
must support:
  v: status
must support:
  v: status.value
must support:
  v: value
must support:
  v: issued
must support:
  v: issued.value
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.114
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.114

type:
  v: Observation
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation
  l: qicore-observation
must support:
  v: code
must support:
  v: effective
must support:
  v: status
must support:
  v: status.value
must support:
  v: value
must support:
  v: issued
must support:
  v: issued.value
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.127
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.127

type:
  v: Observation
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation
  l: qicore-observation
must support:
  v: code
must support:
  v: effective
must support:
  v: status
must support:
  v: status.value
must support:
  v: value
must support:
  v: issued
must support:
  v: issued.value
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.129
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.129

type:
  v: Observation
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation
  l: qicore-observation
must support:
  v: code
must support:
  v: effective
must support:
  v: status
must support:
  v: status.value
must support:
  v: value
must support:
  v: issued
must support:
  v: issued.value
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.119
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.119

type:
  v: Observation
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation
  l: qicore-observation
must support:
  v: code
must support:
  v: effective
must support:
  v: status
must support:
  v: status.value
must support:
  v: value
must support:
  v: issued
must support:
  v: issued.value
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.139
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.139

type:
  v: Observation
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation
  l: qicore-observation
must support:
  v: code
must support:
  v: effective
must support:
  v: status
must support:
  v: status.value
must support:
  v: value
must support:
  v: issued
must support:
  v: issued.value
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.2363
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.2363

id:
  v: supplementalDataGuidance
extension:
  url:
    v: guidance
    l: guidance
extension:
  url:
    v: usage
    l: usage
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-data-usage
        l: measure-data-usage
      code:
        v: supplemental-data
      display:
        v: Supplemental Data
    text:
      v: Supplemental Data Guidance
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance
  l: cqfm-supplementalDataGuidance

url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem
  l: cqfm-softwaresystem
value: Reference
  l: cqf-tooling
  reference:
    v: Device/cqf-tooling

id:
  v: effective-data-requirements
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements
  l: cqfm-effectiveDataRequirements
value: Reference
  l: effective-data-requirements
  reference:
    v: #effective-data-requirements

use:
  v: usual
type:
  coding:
    system:
      v: http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type
      l: identifier-type
    code:
      v: short-name
system:
  v: https://madie.cms.gov/measure/shortName
  l: shortName
value:
  v: CMS844FHIR

use:
  v: official
type:
  coding:
    system:
      v: http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type
      l: identifier-type
    code:
      v: version-independent
system:
  v: urn:ietf:rfc:3986
  l: 3986

use:
  v: official
type:
  coding:
    system:
      v: http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type
      l: identifier-type
    code:
      v: version-specific
system:
  v: urn:ietf:rfc:3986
  l: 3986

use:
  v: official
type:
  coding:
    system:
      v: http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type
      l: identifier-type
    code:
      v: endorser
system:
  v: https://madie.cms.gov/measure/nqfId
  l: nqfId
value:
  v: 3502
assigner:
  display:
    v: NQF

use:
  v: official
type:
  coding:
    system:
      v: http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type
      l: identifier-type
    code:
      v: publisher
system:
  v: https://madie.cms.gov/measure/cmsId
  l: cmsId
value:
  v: 844FHIR
assigner:
  display:
    v: CMS

v: 0.0.001

v: HybridHospitalWideMortalityFHIR

v: Core Clinical Data Elements for the Hybrid Hospital-Wide (All-Condition, All-Procedure) Risk-Standardized Mortality Measure (HWM) FHIR

v: draft

v: false

v: 2023-10-27T08:12:32+00:00

v: Centers for Medicare & Medicaid Services (CMS)

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

v: This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from encounters for adult Medicare Fee-For-Service patients admitted to acute care short stay hospitals.

v: UNKNOWN

v: This FHIR-based measure has been derived from the QDM-based measure: CMS844v3.1 (QDM 5.6). 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). These specifications are for use for data with discharges that occur between July 1, 2023 and June 30, 2024. This logic guides the user to extract the FIRST resulted HWM-specific core clinical data elements for all Medicare Fee-For-Service encounters for patients age 65 to 94 (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area, such as the emergency department or hospital outpatient location. The logic supports extraction of the FIRST set of HWM-specific core clinical data elements in two different ways, depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility: 1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission. 2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for core clinical data element values related to a patient who is subsequently admitted. Value set…

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 2004-2021 International Health Terminology Standards Development Organisation. All rights reserved. LOINC(R) copyright 2004-2021 Regenstrief Institute, Inc.

v: 2023-08-14

v: 2023-08-14

start:
  v: 2024-07-01
end:
  v: 2025-06-30

name:
  v: Mathematica
telecom:
  system:
    v: url
  value:
    v: https://www.mathematica.org/

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/

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: The intent of this logic is to extract the FIRST set of clinical data elements from hospital electronic health records (EHRs) for all qualifying encounters. The data will be linked with administrative claims to risk adjust the Hybrid HWM outcome measure. This work addresses stakeholder concerns that clinical data garnered from patients, and used by clinicians to guide diagnostic decisions and treatment, are preferable to administrative claims data when profiling hospitals’ case mix. We are calling the list of data elements for extraction the "HWM-specific core clinical data elements". The core clinical data elements are the first set of vital signs and basic laboratory tests resulted from encounters for adult Medicare Fee-For-Service patients, age 65 to 94 (Initial Population), after they arrive at the hospital to which they are subsequently admitted. For example, this first set of data values are often captured in the emergency department or in the pre-operative area, sometimes hours before a patient is admitted to that same facility. Encounters over the age of 94 are not included to avoid holding hospitals responsible for the survival of the oldest elderly patients, who may be less likely to have survival as a primary goal. While we acknowledge that many elderly patients do have survival beyond 30 days as a primary goal for their hospitalization, with input from our Technical Expert Panel and work groups, we decided to only include encounters between 65 and 94 years of age. These core clinical data elements were selected because they: 1. reflect patients' clinical status when they first present to the hospital; 2. are clinically and statistically relevant to patient outcomes; 3. are consistently obtained on adult inpatient encounters based on current clinical practice; 4. are captured with a standard definition and recorded in a standard format across providers; and 5. are entered in structured fields that are feasibly retrieved from current EHR systems (YNHHSC/CO…

v: The logic is not meant to guide or alter the care patients receive. The purpose of this core clinical data elements logic is to extract clinical data that are already routinely captured in EHRs from encounters for hospitalized adult patients. It is not intended to require that clinical staff perform additional measurements or tests that are not needed for diagnostic assessment or treatment of patients.

id:
  v: 6385011c4ba3d47c885c02aa
extension:
  url:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring
    l: cqfm-scoring
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-scoring
        l: measure-scoring
      code:
        v: cohort
      display:
        v: Cohort
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: outcome
      display:
        v: Outcome
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 Medicare Fee-For-Service encounters age 65 to 94 years at the start of an inpatient admission, who are discharged during the measurement period (length of stay <365 days). NOTE: All Medicare Fee-For-Service encounters meeting the above criteria should be included, regardless if Medicare Fee-For-Service is the primary, secondary, or tertiary payer.
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Initial Population

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

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