Title: Primary Open-Angle Glaucoma (POAG): Optic Nerve EvaluationFHIR Id: POAGOpticNerveEvaluationFHIR Download cql: POAGOpticNerveEvaluationFHIR.cql Version: 0.0.004 Url: Primary Open-Angle Glaucoma (POAG): Optic Nerve EvaluationFHIR short-name identifier: CMS143FHIR version-independent identifier: urn:uuid:7b41a49e-61af-4a73-8dfd-a6a76e8e7c49 version-specific identifier: urn:uuid:dad4363e-52b2-4add-9740-fb79aaf65e74 endorser (NQF) identifier: 0086e publisher (CMS) identifier: 143FHIR Effective Period: 2024-01-01 ..2024-12-31 Status: draft Date: 2023-10-27 08:12:32+0000 Approval Date: 2023-08-14 Last Review Date: 2023-08-14 Name: POAGOpticNerveEvaluationFHIR Publisher: American Academy of Ophthalmology Author: American Academy of Ophthalmology: www.aao.org, American Medical Association (AMA): https://www.ama-assn.org/ Description: Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more visits within 12 months Purpose: UNKNOWN Copyright: Copyright 2023 American Academy of Ophthalmology. All Rights Reserved. Disclaimer: The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measure require a license agreement between the user and the American Academy of Ophthalmology (Academy). Neither the Academy, its members, the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor PCPI, nor their members shall be responsible for any use of the Measure. The PCPI’s and AMA’s significant past efforts and contributions to the development and updating of the Measures are acknowledged. The National Committee for Quality Assurance's significant past efforts and contributions to the development and updating of the Measure is acknowledged. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party’s use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measures. Any other use of CPT or other coding by the third party is strictly prohibited. The Academy, its members, the AMA, and former members of the PCPI disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) is copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2022 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R]. Rationale: Glaucoma is a group of diseases that damage the eye’s optic nerve and can result in vision loss and blindness. In 2011, 2.71 million persons in the U.S. had primary open-angle glaucoma (POAG) and in 2050, an estimated 7.32 million persons will have POAG (Vajaranant, Wu, Torres, & Varma, 2012). Furthermore, a study by Rein, Zhang, & Wirth (2006) estimated that the total financial burden of major visual disorders among U.S. residents aged 40 years or older was $35.4 billion in 2004: $16.2 billion in direct medical costs, $11.1 billion in other direct costs, and $8 billion in productivity losses. Of the direct medical costs, approximately $2.9 billion was attributable to glaucoma (Rein, Zhang, & Wirth, 2006). It is imperative that evidence-based care be delivered to all glaucoma patients. According to recent guidelines, optic nerve changes are one of the characteristics which reflect progression of glaucoma (the other characteristic is visual field). Examination of the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) provides valuable structural information about optic nerve damage from glaucoma. Visible structural alterations of the ONH or RNFL may precede the onset of visual field defects. Careful study of the optic disc neural rim for small hemorrhages is important because these hemorrhages sometimes signal focal disc damage and visual field loss, and they may signify ongoing optic nerve damage in patients with glaucoma (Gedde et al., 2021). Despite evidence emphasizing the value of an optic nerve evaluation, there is a gap in documentation patterns of the optic nerve for both initial and follow-up care. This measure is intended to promote examination and documentation of the structure and function of the optic nerve, and to monitor and detect disease progression among patients diagnosed with POAG. Clinical recommendation statement: Ophthalmic Evaluation The ophthalmic evaluation specifically focuses on the following elements in the comprehensive adult medical eye evaluation: Visual acuity measurement Pupil examination Anterior segment examination IOP measurement Gonioscopy Optic nerve head (ONH) and retinal nerve fiber layer (RNFL) examination Fundus examination (Gedde et al., 2021) The optic nerve should be carefully examined for the signs of glaucoma damage, and its appearance should be serially documented (I+, moderate quality, strong recommendation) (Gedde et al., 2021). Guidance (Usage): Optic nerve head evaluation includes examination of the cup to disc ratio and identification of optic disc or retinal nerve abnormalities. Both of these components of the optic nerve head evaluation are examined using ophthalmoscopy. The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional or eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality. This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth. This FHIR-based measure has been derived from the QDM-based measure: CMS143v12. 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). Population Criteria: 6467cfd1be9def4e0b01b112 Initial Population: All patients aged 18 years and older with a diagnosis of primary open-angle glaucoma Denominator: Equals Initial Population Denominator Exclusion: None Numerator: Patients who have an optic nerve head evaluation during one or more visits within 12 months Numerator Exclusion: None Denominator Exception: Documentation of medical reason(s) for not performing an optic nerve head evaluation Supplemental Data Guidance : Supplemental Data Elements: SDE Ethnicity SDE Payer SDE Race SDE Sex Libraries: POAGOpticNerveEvaluationFHIR Related Artifact Dependencies: SupplementalDataElements version: 3.4.000 FHIRHelpers version: 4.3.000 QICoreCommon version: 1.5.000 http://hl7.org/fhir/v3/AdministrativeGender ActCode Condition Clinical Status Codes ConditionVerificationStatus Cup to Disc Ratio Office Visit Ophthalmological Services Outpatient Consultation Nursing Facility Visit Care Services in Long-Term Residential Facility Primary Open-Angle Glaucoma Optic Disc Exam for Structural Abnormalities Payer Medical Reason Parameters: name use min max type Measurement Period In 0 1 Period SDE Sex Out 0 1 Coding Numerator Out 0 1 boolean Denominator Out 0 1 boolean SDE Payer Out 0 * Resource Initial Population Out 0 1 boolean SDE Ethnicity Out 0 1 Resource SDE Race Out 0 1 Resource Denominator Exceptions Out 0 1 boolean DataRequirements: Type Elements Valueset Name Valueset Patient(QICorePatient) ethnicity race Encounter(QICoreEncounter) type period class status status.value Office Visit Office Visit Encounter(QICoreEncounter) type period class status status.value Ophthalmological Services Ophthalmological Services Encounter(QICoreEncounter) type period class status status.value Outpatient Consultation Outpatient Consultation Encounter(QICoreEncounter) type period class status status.value Nursing Facility Visit Nursing Facility Visit Encounter(QICoreEncounter) type period class status status.value Care Services in Long-Term Residential Facility Care Services in Long-Term Residential Facility Condition(QICoreCondition) code verificationStatus Primary Open-Angle Glaucoma Primary Open-Angle Glaucoma Observation(QICoreObservation) code effective value status status.value Cup to Disc Ratio Cup to Disc Ratio Observation(QICoreObservation) code effective value status status.value Optic Disc Exam for Structural Abnormalities Optic Disc Exam for Structural Abnormalities Coverage(QICoreCoverage) type period Payer Type Payer Observation(QICoreObservationNotDone) code issued issued.value status status.value extension Cup to Disc Ratio Cup to Disc Ratio Observation(QICoreObservationNotDone) code issued issued.value status status.value extension Cup to Disc Ratio Cup to Disc Ratio Observation(QICoreObservationNotDone) code issued issued.value status status.value extension Optic Disc Exam for Structural Abnormalities Optic Disc Exam for Structural Abnormalities Observation(QICoreObservationNotDone) code issued issued.value status status.value extension Optic Disc Exam for Structural Abnormalities Optic Disc Exam for Structural Abnormalities Direct Reference Codes: display code system Male M http://hl7.org/fhir/v3/AdministrativeGender Female F http://hl7.org/fhir/v3/AdministrativeGender virtual VR http://terminology.hl7.org/CodeSystem/v3-ActCode Ambulatory AMB http://terminology.hl7.org/CodeSystem/v3-ActCode active http://terminology.hl7.org/CodeSystem/condition-clinical recurrence http://terminology.hl7.org/CodeSystem/condition-clinical relapse http://terminology.hl7.org/CodeSystem/condition-clinical unconfirmed http://terminology.hl7.org/CodeSystem/condition-ver-status refuted http://terminology.hl7.org/CodeSystem/condition-ver-status entered-in-error http://terminology.hl7.org/CodeSystem/condition-ver-status Logic Definitions: Group Scoring Population Criteria Expression 6467cfd1be9def4e0b01b112 Group scoring: proportion Initial Population define "Initial Population": AgeInYearsAt(date from start of "Measurement Period") >= 18 and exists "Primary Open Angle Glaucoma Encounter" Denominator define "Denominator": "Initial Population" Denominator Exclusion None Numerator define "Numerator": exists "Cup to Disc Ratio Performed with Result" and exists "Optic Disc Exam Performed with Result" Numerator Exclusion None Denominator Exception define "Denominator Exceptions": exists "Medical Reason for Not Performing Cup to Disc Ratio" or exists "Medical Reason for Not Performing Optic Disc Exam" Library Name Name SupplementalDataElements SDE Sex define "SDE Sex": case when Patient.gender = 'male' then "M" when Patient.gender = 'female' then "F" else null end Library Name Name POAGOpticNerveEvaluationFHIR SDE Sex define "SDE Sex": SDE."SDE Sex" Library Name Name POAGOpticNerveEvaluationFHIR Qualifying Encounter During Measurement Period define "Qualifying Encounter During Measurement Period": ( ["Encounter": "Office Visit"] union ["Encounter": "Ophthalmological Services"] union ["Encounter": "Outpatient Consultation"] union ["Encounter": "Nursing Facility Visit"] union ["Encounter": "Care Services in Long-Term Residential Facility"] ) QualifyingEncounter where QualifyingEncounter.period during "Measurement Period" and QualifyingEncounter.class !~ "virtual" and QualifyingEncounter.class ~ "AMB" and QualifyingEncounter.status = 'finished' Library Name Name POAGOpticNerveEvaluationFHIR Primary Open Angle Glaucoma Encounter define "Primary Open Angle Glaucoma Encounter": "Qualifying Encounter During Measurement Period" ValidQualifyingEncounter with ["Condition": "Primary Open-Angle Glaucoma"] PrimaryOpenAngleGlaucoma such that PrimaryOpenAngleGlaucoma.prevalenceInterval ( ) overlaps ValidQualifyingEncounter.period and PrimaryOpenAngleGlaucoma.isActive ( ) and not ( PrimaryOpenAngleGlaucoma.verificationStatus ~ QICoreCommon."unconfirmed" or PrimaryOpenAngleGlaucoma.verificationStatus ~ QICoreCommon."refuted" or PrimaryOpenAngleGlaucoma.verificationStatus ~ QICoreCommon."entered-in-error" ) Library Name Name POAGOpticNerveEvaluationFHIR Cup to Disc Ratio Performed with Result define "Cup to Disc Ratio Performed with Result": ["Observation": "Cup to Disc Ratio"] CupToDiscExamPerformed with "Primary Open Angle Glaucoma Encounter" EncounterWithPOAG such that CupToDiscExamPerformed.effective.toInterval ( ) during EncounterWithPOAG.period where CupToDiscExamPerformed.value is not null and CupToDiscExamPerformed.status in { 'final', 'amended', 'corrected' } Library Name Name POAGOpticNerveEvaluationFHIR Optic Disc Exam Performed with Result define "Optic Disc Exam Performed with Result": ["Observation": "Optic Disc Exam for Structural Abnormalities"] OpticDiscExamPerformed with "Primary Open Angle Glaucoma Encounter" EncounterWithPOAG such that OpticDiscExamPerformed.effective.toInterval ( ) during EncounterWithPOAG.period where OpticDiscExamPerformed.value is not null and OpticDiscExamPerformed.status in { 'final', 'amended', 'corrected' } Library Name Name POAGOpticNerveEvaluationFHIR Numerator define "Numerator": exists "Cup to Disc Ratio Performed with Result" and exists "Optic Disc Exam Performed with Result" Library Name Name POAGOpticNerveEvaluationFHIR Initial Population define "Initial Population": AgeInYearsAt(date from start of "Measurement Period") >= 18 and exists "Primary Open Angle Glaucoma Encounter" Library Name Name POAGOpticNerveEvaluationFHIR Denominator define "Denominator": "Initial Population" Library Name Name SupplementalDataElements SDE Payer define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period } Library Name Name POAGOpticNerveEvaluationFHIR SDE Payer define "SDE Payer": SDE."SDE Payer" Library Name Name SupplementalDataElements SDE Ethnicity define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text } Library Name Name POAGOpticNerveEvaluationFHIR SDE Ethnicity define "SDE Ethnicity": SDE."SDE Ethnicity" Library Name Name SupplementalDataElements SDE Race define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text } Library Name Name POAGOpticNerveEvaluationFHIR SDE Race define "SDE Race": SDE."SDE Race" Library Name Name POAGOpticNerveEvaluationFHIR Medical Reason for Not Performing Cup to Disc Ratio define "Medical Reason for Not Performing Cup to Disc Ratio": ["ObservationNotDone": "Cup to Disc Ratio"] CupToDiscExamNotPerformed with "Primary Open Angle Glaucoma Encounter" EncounterWithPOAG such that CupToDiscExamNotPerformed.issued.toInterval ( ) during EncounterWithPOAG.period where CupToDiscExamNotPerformed.status = 'cancelled' and CupToDiscExamNotPerformed.notDoneReason in "Medical Reason" Library Name Name POAGOpticNerveEvaluationFHIR Medical Reason for Not Performing Optic Disc Exam define "Medical Reason for Not Performing Optic Disc Exam": ["ObservationNotDone": "Optic Disc Exam for Structural Abnormalities"] OpticDiscExamNotPerformed with "Primary Open Angle Glaucoma Encounter" EncounterWithPOAG such that OpticDiscExamNotPerformed.issued.toInterval ( ) during EncounterWithPOAG.period where OpticDiscExamNotPerformed.status = 'cancelled' and OpticDiscExamNotPerformed.notDoneReason in "Medical Reason" Library Name Name POAGOpticNerveEvaluationFHIR Denominator Exceptions define "Denominator Exceptions": exists "Medical Reason for Not Performing Cup to Disc Ratio" or exists "Medical Reason for Not Performing Optic Disc Exam" Library Name Name QICoreCommon prevalenceInterval /* @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()) Library Name Name QICoreCommon isActive /* Candidates for FHIRCommon */ /* @description: Returns true if the given condition has a clinical status of active, recurrence, or relapse */ define fluent function isActive(condition Condition): condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" Library Name Name QICoreCommon toInterval /* @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 DateTime then Interval[choice as DateTime, choice as DateTime] when choice is Interval<DateTime> then choice as Interval<DateTime> when choice is Quantity then Interval[Patient.birthDate + (choice as Quantity), Patient.birthDate + (choice as Quantity) + 1 year) when choice is Interval<Quantity> then Interval[Patient.birthDate + (choice.low as Quantity), Patient.birthDate + (choice.high as Quantity) + 1 year) else null as Interval<DateTime> end Library Name Name FHIRHelpers ToString define function ToString(value uri): value.value Library Name Name FHIRHelpers ToCode /* @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 }
define "SDE Sex": case when Patient.gender = 'male' then "M" when Patient.gender = 'female' then "F" else null end
Qualifying Encounter During Measurement Period
define "Qualifying Encounter During Measurement Period": ( ["Encounter": "Office Visit"] union ["Encounter": "Ophthalmological Services"] union ["Encounter": "Outpatient Consultation"] union ["Encounter": "Nursing Facility Visit"] union ["Encounter": "Care Services in Long-Term Residential Facility"] ) QualifyingEncounter where QualifyingEncounter.period during "Measurement Period" and QualifyingEncounter.class !~ "virtual" and QualifyingEncounter.class ~ "AMB" and QualifyingEncounter.status = 'finished'
define "Primary Open Angle Glaucoma Encounter": "Qualifying Encounter During Measurement Period" ValidQualifyingEncounter with ["Condition": "Primary Open-Angle Glaucoma"] PrimaryOpenAngleGlaucoma such that PrimaryOpenAngleGlaucoma.prevalenceInterval ( ) overlaps ValidQualifyingEncounter.period and PrimaryOpenAngleGlaucoma.isActive ( ) and not ( PrimaryOpenAngleGlaucoma.verificationStatus ~ QICoreCommon."unconfirmed" or PrimaryOpenAngleGlaucoma.verificationStatus ~ QICoreCommon."refuted" or PrimaryOpenAngleGlaucoma.verificationStatus ~ QICoreCommon."entered-in-error" )
define "Cup to Disc Ratio Performed with Result": ["Observation": "Cup to Disc Ratio"] CupToDiscExamPerformed with "Primary Open Angle Glaucoma Encounter" EncounterWithPOAG such that CupToDiscExamPerformed.effective.toInterval ( ) during EncounterWithPOAG.period where CupToDiscExamPerformed.value is not null and CupToDiscExamPerformed.status in { 'final', 'amended', 'corrected' }
define "Optic Disc Exam Performed with Result": ["Observation": "Optic Disc Exam for Structural Abnormalities"] OpticDiscExamPerformed with "Primary Open Angle Glaucoma Encounter" EncounterWithPOAG such that OpticDiscExamPerformed.effective.toInterval ( ) during EncounterWithPOAG.period where OpticDiscExamPerformed.value is not null and OpticDiscExamPerformed.status in { 'final', 'amended', 'corrected' }
define "Numerator": exists "Cup to Disc Ratio Performed with Result" and exists "Optic Disc Exam Performed with Result"
define "Initial Population": AgeInYearsAt(date from start of "Measurement Period") >= 18 and exists "Primary Open Angle Glaucoma Encounter"
define "Denominator": "Initial Population"
define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period }
define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text }
define "SDE Ethnicity": SDE."SDE Ethnicity"
define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text }
Medical Reason for Not Performing Cup to Disc Ratio
define "Medical Reason for Not Performing Cup to Disc Ratio": ["ObservationNotDone": "Cup to Disc Ratio"] CupToDiscExamNotPerformed with "Primary Open Angle Glaucoma Encounter" EncounterWithPOAG such that CupToDiscExamNotPerformed.issued.toInterval ( ) during EncounterWithPOAG.period where CupToDiscExamNotPerformed.status = 'cancelled' and CupToDiscExamNotPerformed.notDoneReason in "Medical Reason"
Medical Reason for Not Performing Optic Disc Exam
define "Medical Reason for Not Performing Optic Disc Exam": ["ObservationNotDone": "Optic Disc Exam for Structural Abnormalities"] OpticDiscExamNotPerformed with "Primary Open Angle Glaucoma Encounter" EncounterWithPOAG such that OpticDiscExamNotPerformed.issued.toInterval ( ) during EncounterWithPOAG.period where OpticDiscExamNotPerformed.status = 'cancelled' and OpticDiscExamNotPerformed.notDoneReason in "Medical Reason"
define "Denominator Exceptions": exists "Medical Reason for Not Performing Cup to Disc Ratio" or exists "Medical Reason for Not Performing Optic Disc Exam"
/* @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())
/* Candidates for FHIRCommon */ /* @description: Returns true if the given condition has a clinical status of active, recurrence, or relapse */ define fluent function isActive(condition Condition): condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse"
/* @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 DateTime then Interval[choice as DateTime, choice as DateTime] when choice is Interval<DateTime> then choice as Interval<DateTime> when choice is Quantity then Interval[Patient.birthDate + (choice as Quantity), Patient.birthDate + (choice as Quantity) + 1 year) when choice is Interval<Quantity> then Interval[Patient.birthDate + (choice.low as Quantity), Patient.birthDate + (choice.high as Quantity) + 1 year) else null as Interval<DateTime> end
define function ToString(value uri): value.value
/* @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 }
Code system ConditionClinicalStatusCodes
Code system ConditionVerificationStatusCodes
Value set Care Services in Long-Term Residential Facility
Value set Optic Disc Exam for Structural Abnormalities
Primary Open-Angle Glaucoma (POAG): Optic Nerve EvaluationFHIR
Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more visits within 12 months
Optic nerve head evaluation includes examination of the cup to disc ratio and identification of optic disc or retinal nerve abnormalities. Both of these components of the optic nerve head evaluation are examined using ophthalmoscopy. The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional or eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality. This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth. This FHIR-based measure has been derived from the QDM-based measure: CMS143v12. 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).
Copyright 2023 American Academy of Ophthalmology. All Rights Reserved.
The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measure require a license agreement between the user and the American Academy of Ophthalmology (Academy). Neither the Academy, its members, the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor PCPI, nor their members shall be responsible for any use of the Measure. The PCPI’s and AMA’s significant past efforts and contributions to the development and updating of the Measures are acknowledged. The National Committee for Quality Assurance's significant past efforts and contributions to the development and updating of the Measure is acknowledged. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party’s use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measures. Any other use of CPT or other coding by the third party is strictly prohibited. The Academy, its members, the AMA, and former members of the PCPI disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) is copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2022 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R].
Glaucoma is a group of diseases that damage the eye’s optic nerve and can result in vision loss and blindness. In 2011, 2.71 million persons in the U.S. had primary open-angle glaucoma (POAG) and in 2050, an estimated 7.32 million persons will have POAG (Vajaranant, Wu, Torres, & Varma, 2012). Furthermore, a study by Rein, Zhang, & Wirth (2006) estimated that the total financial burden of major visual disorders among U.S. residents aged 40 years or older was $35.4 billion in 2004: $16.2 billion in direct medical costs, $11.1 billion in other direct costs, and $8 billion in productivity losses. Of the direct medical costs, approximately $2.9 billion was attributable to glaucoma (Rein, Zhang, & Wirth, 2006). It is imperative that evidence-based care be delivered to all glaucoma patients. According to recent guidelines, optic nerve changes are one of the characteristics which reflect progression of glaucoma (the other characteristic is visual field). Examination of the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) provides valuable structural information about optic nerve damage from glaucoma. Visible structural alterations of the ONH or RNFL may precede the onset of visual field defects. Careful study of the optic disc neural rim for small hemorrhages is important because these hemorrhages sometimes signal focal disc damage and visual field loss, and they may signify ongoing optic nerve damage in patients with glaucoma (Gedde et al., 2021). Despite evidence emphasizing the value of an optic nerve evaluation, there is a gap in documentation patterns of the optic nerve for both initial and follow-up care. This measure is intended to promote examination and documentation of the structure and function of the optic nerve, and to monitor and detect disease progression among patients diagnosed with POAG.
Ophthalmic Evaluation The ophthalmic evaluation specifically focuses on the following elements in the comprehensive adult medical eye evaluation: Visual acuity measurement Pupil examination Anterior segment examination IOP measurement Gonioscopy Optic nerve head (ONH) and retinal nerve fiber layer (RNFL) examination Fundus examination (Gedde et al., 2021) The optic nerve should be carefully examined for the signs of glaucoma damage, and its appearance should be serially documented (I+, moderate quality, strong recommendation) (Gedde et al., 2021).
All patients aged 18 years and older with a diagnosis of primary open-angle glaucoma
Patients who have an optic nerve head evaluation during one or more visits within 12 months
Documentation of medical reason(s) for not performing an optic nerve head evaluation