UseofHighRiskMedicationsintheElderlyFHIR
type: Measure
node role: treeRoot
id:
  v: UseofHighRiskMedicationsintheElderlyFHIR
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: Use of High-Risk Medications in Older AdultsFHIR Id: UseofHighRiskMedicationsintheElderlyFHIR Download cql: UseofHighRiskMedicationsintheElderlyFHIR.cql Version: 0.0.001 Url: Use of High-Risk Medications in Older AdultsFHIR short-name identifier: CMS156FHIR version-independent identifier: urn:uuid:fa08c5d7-5345-4e0b-aa2d-d937099db108 version-specific identifier: urn:uuid:2c928084808a958901809a8b347f0755 publisher (CMS) identifier: 156FHIR Effective Period: 2024-01-01 ..2024-12-31 Status: draft Date: 2023-10-27 08:12:32+0000 Approval Date: 2023-08-28 Last Review Date: 2023-08-28 Name: UseofHighRiskMedicationsintheElderlyFHIR Publisher: National Committee for Quality Assurance Author: National Committee for Quality Assurance: https://www.ncqa.org/ Description: Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators). Use Context: code value program Purpose: UNKNOWN Copyright: This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract HHSM-500-2011-00079C) with the National Committee for Quality Assurance (NCQA) to develop this electronic measure. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. Limited proprietary cod…
contained: Library
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      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://www.nlm.nih.gov/research/umls/rxnorm
        l: rxnorm
      code:
        v: 198196
      display:
        v: reserpine 0.1 MG Oral Tablet
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://www.nlm.nih.gov/research/umls/rxnorm
        l: rxnorm
      code:
        v: 198197
      display:
        v: reserpine 0.25 MG Oral Tablet
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    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://www.nlm.nih.gov/research/umls/rxnorm
        l: rxnorm
      code:
        v: 393245
      display:
        v: digoxin 0.05 MG/ML Oral Solution
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://www.nlm.nih.gov/research/umls/rxnorm
        l: rxnorm
      code:
        v: 245273
      display:
        v: digoxin 0.0625 MG Oral Tablet
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://www.nlm.nih.gov/research/umls/rxnorm
        l: rxnorm
      code:
        v: 204504
      display:
        v: 1 ML digoxin 0.1 MG/ML Injection
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://www.nlm.nih.gov/research/umls/rxnorm
        l: rxnorm
      code:
        v: 197604
      display:
        v: digoxin 0.125 MG Oral Tablet
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://www.nlm.nih.gov/research/umls/rxnorm
        l: rxnorm
      code:
        v: 1441565
      display:
        v: digoxin 0.1875 MG Oral Tablet
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    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://www.nlm.nih.gov/research/umls/rxnorm
        l: rxnorm
      code:
        v: 197606
      display:
        v: digoxin 0.25 MG Oral Tablet
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    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://www.nlm.nih.gov/research/umls/rxnorm
        l: rxnorm
      code:
        v: 104208
      display:
        v: 2 ML digoxin 0.25 MG/ML Injection
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://www.nlm.nih.gov/research/umls/rxnorm
        l: rxnorm
      code:
        v: 966787
      display:
        v: doxepin 3 MG Oral Tablet
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://www.nlm.nih.gov/research/umls/rxnorm
        l: rxnorm
      code:
        v: 966793
      display:
        v: doxepin 6 MG Oral Tablet
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    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://www.nlm.nih.gov/research/umls/rxnorm
        l: rxnorm
      code:
        v: 1000048
      display:
        v: doxepin hydrochloride 10 MG Oral Capsule
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://www.nlm.nih.gov/research/umls/rxnorm
        l: rxnorm
      code:
        v: 1000054
      display:
        v: doxepin hydrochloride 10 MG/ML Oral Solution
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://www.nlm.nih.gov/research/umls/rxnorm
        l: rxnorm
      code:
        v: 1000070
      display:
        v: doxepin hydrochloride 25 MG Oral Capsule
  extension:
    url:
      v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
      l: cqfm-directReferenceCode
    value: Coding
      system:
        v: http://www.nlm.nih.gov/research/umls/rxnorm
        l: rxnorm
      code:
        v: 1000076
      display:
        v: doxepin hydrochloride 50 MG Oral Capsule

url:
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  l: cqfm-directReferenceCode
value: Coding
  system:
    v: http://www.nlm.nih.gov/research/umls/rxnorm
    l: rxnorm
  code:
    v: 1000097
  display:
    v: doxepin hydrochloride 75 MG Oral Capsule

url:
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  l: cqfm-directReferenceCode
value: Coding
  system:
    v: http://www.nlm.nih.gov/research/umls/rxnorm
    l: rxnorm
  code:
    v: 1000058
  display:
    v: doxepin hydrochloride 100 MG Oral Capsule

url:
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  l: cqfm-directReferenceCode
value: Coding
  system:
    v: http://www.nlm.nih.gov/research/umls/rxnorm
    l: rxnorm
  code:
    v: 1000064
  display:
    v: doxepin hydrochloride 150 MG Oral Capsule

url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
  l: cqfm-directReferenceCode
value: Coding
  system:
    v: http://www.ama-assn.org/go/cpt
    l: cpt
  code:
    v: 99211
  display:
    v: Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.

url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
  l: cqfm-directReferenceCode
value: Coding
  type: http://snomed.info/id/428361000124107
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 428361000124107
  display:
    v: Discharge to home for hospice care (procedure)

url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
  l: cqfm-directReferenceCode
value: Coding
  type: http://snomed.info/id/428371000124100
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 428371000124100
  display:
    v: Discharge to healthcare facility for hospice care (procedure)

url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
  l: cqfm-directReferenceCode
value: Coding
  system:
    v: http://terminology.hl7.org/CodeSystem/observation-category
    l: observation-category
  code:
    v: survey
  display:
    v: survey

url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
  l: cqfm-directReferenceCode
value: Coding
  type: https://loinc.org/rdf/45755-6
  system:
    v: http://loinc.org
    l: loinc.org
  code:
    v: 45755-6
  display:
    v: Hospice care [Minimum Data Set]

url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
  l: cqfm-directReferenceCode
value: Coding
  type: http://snomed.info/id/373066001
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 373066001
  display:
    v: Yes (qualifier value)

url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode
  l: cqfm-directReferenceCode
value: Coding
  type: https://loinc.org/rdf/71007-9
  system:
    v: http://loinc.org
    l: loinc.org
  code:
    v: 71007-9
  display:
    v: Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: UseofHighRiskMedicationsintheElderlyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: More than One Antipsychotic Order
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "More than One Antipsychotic Order": exists ( "More Than One Order"([MedicationRequest: "Antipsychotic"]) )
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:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: UseofHighRiskMedicationsintheElderlyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Antipsychotic Index Prescription Start Date
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Antipsychotic Index Prescription Start Date": First((Status."Active or Completed Medication Request"([MedicationRequest: "Antipsychotic"])) AntipsychoticMedication where AntipsychoticMedication.authoredOn during "Measurement Period" return AntipsychoticMedication.authoredOn sort asc )
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:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: UseofHighRiskMedicationsintheElderlyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: More than One Benzodiazepine Order
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "More than One Benzodiazepine Order": exists ( "More Than One Order"([MedicationRequest: "Benzodiazepine"]) )
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:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: UseofHighRiskMedicationsintheElderlyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Benzodiazepine Index Prescription Start Date
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Benzodiazepine Index Prescription Start Date": First((Status."Active or Completed Medication Request"([MedicationRequest: "Benzodiazepine"])) BenzodiazepineMedication where BenzodiazepineMedication.authoredOn during "Measurement Period" return BenzodiazepineMedication.authoredOn sort asc )
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:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: UseofHighRiskMedicationsintheElderlyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Numerator 2
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Numerator 2": ( "More than One Antipsychotic Order" and ( not exists ( ( [Condition: "Schizophrenia"] union [Condition: "Bipolar Disorder"] ) AntipsychoticTreatedDiagnoses where QICoreCommon."ToPrevalenceInterval" ( AntipsychoticTreatedDiagnoses ) overlaps Interval[start of "Measurement Period" - 1 year, "Antipsychotic Index Prescription Start Date"] ) ) ) or ( "More than One Benzodiazepine Order" and ( not exists ( ( [Condition: "Seizure Disorder"] union [Condition: "REM Sleep Behavior Disorder"] union [Condition: "Benzodiazepine Withdrawal"] union [Condition: "Alcohol Withdrawal"] union [Condition: "Generalized Anxiety Disorder"] ) BenzodiazepineTreatedDiagnoses where QICoreCommon."ToPrevalenceInterval" ( BenzodiazepineTreatedDiagnoses ) overlaps Interval[start of "Measurement Period" - 1 year, "Benzodiazepine Index Prescription Start Date"] ) ) )
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: UseofHighRiskMedicationsintheElderlyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Same High Risk Medications Ordered on Different Days
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Same High Risk Medications Ordered on Different Days": "More Than One Order"(["MedicationRequest": "Anticholinergics, first generation antihistamines"]) union "More Than One Order"(["MedicationRequest": "Anticholinergics, anti Parkinson agents"]) union "More Than One Order"(["MedicationRequest": "Antispasmodics"]) union "More Than One Order"(["MedicationRequest": "Antithrombotic"]) union "More Than One Order"(["MedicationRequest": "Cardiovascular, alpha agonists, central"]) union "More Than One Order"(["MedicationRequest": "Cardiovascular, other"]) union "More Than One Order"(["MedicationRequest": "Central nervous system, antidepressants"]) union "More Than One Order"(["MedicationRequest": "Central nervous system, barbiturates"]) union "More Than One Order"(["MedicationRequest": "Central nervous system, vasodilators"]) union "More Than One Order"(["MedicationRequest": "Central nervous system, other"]) union "More Than One Order"(["MedicationRequest": "Endocrine system, estrogens with or without progestins"]) union "More Than One Order"(["MedicationRequest": "Endocrine system, sulfonylureas, long duration"]) union "More Than One Order"(["MedicationRequest": "Endocrine system, other"]) union "More Than One Order"(["MedicationRequest": "Nonbenzodiazepine hypnotics"]) union "More Than One Order"(["MedicationRequest": "Pain medications, skeletal muscle relaxants"]) union "More Than One Order"(["MedicationRequest": "Pain medications, other"])
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: UseofHighRiskMedicationsintheElderlyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Two High Risk Medications with Prolonged Duration
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Two High Risk Medications with Prolonged Duration": Sum(("More Than One Order"([MedicationRequest: "Anti Infectives, other"])) AntiInfectives let DaysSupply: AntiInfectives.MedicationRequestPeriodInDays() return all DaysSupply ) > 90
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: UseofHighRiskMedicationsintheElderlyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: High Risk Medications with Average Daily Dose Criteria
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "High Risk Medications with Average Daily Dose Criteria": exists ( "More Than One Order"([MedicationRequest: "Reserpine"] ReserpineOrdered where "Average Daily Dose"(ReserpineOrdered) > 0.1 'mg/d' ) ) or exists ( "More Than One Order"([MedicationRequest: "Digoxin"] DigoxinOrdered where "Average Daily Dose"(DigoxinOrdered) > 0.125 'mg/d' ) ) or exists ( "More Than One Order"([MedicationRequest: "Doxepin"] DoxepinOrdered where "Average Daily Dose"(DoxepinOrdered) > 6 'mg/d' ) )
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: UseofHighRiskMedicationsintheElderlyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Numerator 1
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Numerator 1": exists ( "Same High Risk Medications Ordered on Different Days" ) or ( "Two High Risk Medications with Prolonged Duration" ) or ( "High Risk Medications with Average Daily Dose Criteria" )
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: UseofHighRiskMedicationsintheElderlyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Numerator 3
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Numerator 3": "Numerator 2" or ( "Numerator 1" and not "Numerator 2" )
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: UseofHighRiskMedicationsintheElderlyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Qualifying Encounters
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Qualifying Encounters": ( ["Encounter": "Office Visit"] union ["Encounter": "Ophthalmologic Services"] union ["Encounter": "Preventive Care Services Established Office Visit, 18 and Up"] union ["Encounter": "Discharge Services Nursing Facility"] union ["Encounter": "Nursing Facility Visit"] union ["Encounter": "Care Services in Long Term Residential Facility"] union ["Encounter": "Preventive Care Services Initial Office Visit, 18 and Up"] union ["Encounter": "Annual Wellness Visit"] union ["Encounter": "Home Healthcare Services"] union ["Encounter": "Telephone Visits"] union ["Encounter": "Online Assessments"] union ( [Encounter] E where exists ( ( E.type ) T where T ~ "Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal." ) ) ) ValidEncounters where ValidEncounters.period during "Measurement Period"
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: UseofHighRiskMedicationsintheElderlyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Initial Population
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Initial Population": AgeInYearsAt(date from end of "Measurement Period" ) >= 65 and exists ( "Qualifying Encounters" )
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: UseofHighRiskMedicationsintheElderlyFHIR
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: 12
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: Hospice
extension:
  url:
    v: name
    l: name
  value: String
    v: Has Hospice Services
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Has Hospice Services": exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)" or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)" ) and InpatientEncounter.period.toInterval() ends during day of "Measurement Period" ) or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period" ) or exists ((([Observation: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment where HospiceAssessment.value ~ "Yes (qualifier value)" and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period" ) or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period" ) or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period" ) or exists (([Condition: "Hospice Diagnosis"]) HospiceCareDiagnosis where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" )
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: PalliativeCare
extension:
  url:
    v: name
    l: name
  value: String
    v: Has Palliative Care in the Measurement Period
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Has Palliative Care in the Measurement Period": exists ((([Observation: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period" ) or exists ([Condition: "Palliative Care Diagnosis"] PalliativeDiagnosis where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" ) or exists ((([Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter where PalliativeEncounter.period.toInterval() overlaps day of "Measurement Period" ) or exists ((([Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement 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: UseofHighRiskMedicationsintheElderlyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Denominator Exclusions
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Denominator Exclusions": Hospice."Has Hospice Services" or PalliativeCare."Has Palliative Care in the Measurement 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: UseofHighRiskMedicationsintheElderlyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: More Than One Order
extension:
  url:
    v: statement
    l: statement
  value: String
    v: //Functions define function "More Than One Order"(Medication List<"MedicationRequest">): ( Status."Active or Completed Medication Request" ( "Medication" ) ) OrderMedication1 with ( Status."Active or Completed Medication Request" ( "Medication" ) ) OrderMedication2 such that ( OrderMedication1.authoredOn during "Measurement Period" and OrderMedication1.dispenseRequest.numberOfRepeatsAllowed >= 1 ) or ( date from OrderMedication1.authoredOn !~ date from OrderMedication2.authoredOn and OrderMedication1.authoredOn during "Measurement Period" and OrderMedication2.authoredOn during "Measurement Period" ) or ( date from OrderMedication1.authoredOn ~ date from OrderMedication2.authoredOn and OrderMedication1.authoredOn during "Measurement Period" and date from start of CMD."MedicationRequestPeriod" ( OrderMedication1 ) !~ date from start of CMD."MedicationRequestPeriod" ( OrderMedication2 ) and start of CMD."MedicationRequestPeriod" ( OrderMedication1 ) during "Measurement Period" and start of CMD."MedicationRequestPeriod" ( OrderMedication2 ) during "Measurement Period" ) return OrderMedication1
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: Status
extension:
  url:
    v: name
    l: name
  value: String
    v: Active or Completed Medication Request
extension:
  url:
    v: statement
    l: statement
  value: String
    v: //Medication, Order: active and completed only define function "Active or Completed Medication Request"(MedicationRequest List<MedicationRequest>): MedicationRequest M where M.status in { 'active', 'completed' } and M.intent = 'order'
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: CumulativeMedicationDuration
extension:
  url:
    v: name
    l: name
  value: String
    v: MedicationRequestPeriod
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* Now that we have a ToDaily function, we can approach calculation of the duration of medication for an order. First, consider the definitions for each element: * 1 and only 1 dosageInstruction * 1 and only 1 doseAndRate * 1 timing with 1 repeat * frequency, frequencyMax, defaulting to 1 * period, periodUnit, defaulting to 1 'd' * doseQuantity or doseRange * timeOfDay * authoredOn: The date the prescription was written * dispenseRequest.validityPeriod: Time period supply is authorized for * dispenseRequest.quantity: amount of medication supplied per dispense * dispenseRequest.numberOfRepeatsAllowed: number of refills authorized * dispenseRequest.expectedSupplyDuration: number of days supply per dispense * dosageInstruction.timing.repeat.boundsDuration: total duration of the repeat * dosageInstruction.timing.repeat.boundsRange: range of durations of the repeat * dosageInstruction.timing.repeat.boundsPeriod: period bounds of the repeat * dosageInstruction.timing.repeat.count: number of times to repeat * dosageInstruction.timing.repeat.countMax: maximum number of times to repeat * dosageInstruction.timing.repeat.frequency: event occurs frequency times per period * dosageInstruction.timing.repeat.frequencyMax: event occurs up to frequencyMax times per period * dosageInstruction.timing.repeat.period: event occurs frequency times per period * dosageInstruction.timing.repeat.periodMax: upper limit of period * dosageInstruction.timing.repeat.periodUnit: period duration (s | min | h | d | wk | mo | a) * dosageInstruction.timing.repeat.timeOfDay: time of day for the event (0..*) * dosageInstruction.timing.repeat.when: event timing (HS | WAKE | C | CM | CD | CV | AC | ACM...) * dosageInstruction.timing.code: BID | TID | QID | AM | PM | QD | QOD... * dosageInstruction.asNeeded * dosageInstruction.doseAndRate.doseQuantity * dosageInstruction.doseAndRate.doseRange If expectedSupplyDuration is present, then the duration is expectedSupplyDuration * (1 + numberOfRepeatsAllowed) If …
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: CumulativeMedicationDuration
extension:
  url:
    v: name
    l: name
  value: String
    v: Quantity
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /**********************************************************************/ /* Functions in this region are copied from opioid-mme-r4 */ /**********************************************************************/ define function Quantity(value Decimal, unit String): if value is not null then System.Quantity { value: value, unit: unit } else null
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: CumulativeMedicationDuration
extension:
  url:
    v: name
    l: name
  value: String
    v: ToDaily
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* Goal is to get to number of days Two broad approaches to the calculation: 1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered 2) Based on relevant period, determine a covered interval and calculate the length of that interval in days This topic covers several use cases and illustrates how to calculate Cumulative Medication Duration for each type of medication resource using the supply and frequency approach. */ /* For the first approach, we need to get from frequency to a frequency/day So we define ToDaily */ /* Calculates daily frequency given frequency within a period */ define function ToDaily(frequency System.Integer, period System.Quantity): case period.unit when 'h' then frequency * (24.0 / period.value) when 'min' then frequency * (24.0 / period.value) * 60 when 's' then frequency * (24.0 / period.value) * 60 * 60 when 'd' then frequency * (24.0 / period.value) / 24 when 'wk' then frequency * (24.0 / period.value) / (24 * 7) when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ when 'hour' then frequency * (24.0 / period.value) when 'minute' then frequency * (24.0 / period.value) * 60 when 'second' then frequency * (24.0 / period.value) * 60 * 60 when 'day' then frequency * (24.0 / period.value) / 24 when 'week' then frequency * (24.0 / period.value) / (24 * 7) when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ when 'hours' then frequency * (24.0 / period.value) when 'minutes' then frequency * (24.0 / period.value) * 60 when 'seconds' then frequency * (24.0 / period.value) * 60 * 60 when 'days' then frequency * (24.0 / period.value) / 24 when 'weeks' then frequency * (24.0 / period.value) / (24 * 7) when 'months' then frequency * (…
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: QICoreCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: ToPrevalenceInterval
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. @deprecated: This function is deprecated. Use the `prevalenceInterval()` fluent function instead */ define function ToPrevalenceInterval(condition Condition): if condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" then Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition)] else Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition))
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: UseofHighRiskMedicationsintheElderlyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: MedicationRequestPeriodInDays
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define fluent function MedicationRequestPeriodInDays(Request "MedicationRequest"): Request R let dosage: singleton from R.dosageInstruction, doseAndRate: singleton from dosage.doseAndRate, timing: dosage.timing, frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency), period: CMD."Quantity" ( timing.repeat.period, timing.repeat.periodUnit ), doseRange: doseAndRate.dose, doseQuantity: doseAndRate.dose, dose: Coalesce( end of doseRange, doseQuantity ), dosesPerDay: Coalesce((CMD."ToDaily"(frequency, period)), Count(timing.repeat.timeOfDay), 1.0), boundsPeriod: timing.repeat.bounds as Interval<DateTime>, daysSupply: ( convert R.dispenseRequest.expectedSupplyDuration to days ).value, quantity: R.dispenseRequest.quantity, refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0), startDate: Coalesce(date from start of boundsPeriod, date from R.authoredOn, date from start of R.dispenseRequest.validityPeriod), totalDaysSupplied: Coalesce(daysSupply, quantity.value /(dose.value * dosesPerDay)) * ( 1 + refills ) return totalDaysSupplied
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: UseofHighRiskMedicationsintheElderlyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: Average Daily Dose
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function "Average Daily Dose"(MedicationRequest "MedicationRequest"): MedicationRequest Order let MedicationStrength: Order.getMedicationCode ( ).MedicationStrengthPerUnit ( ), DaysSupplied: Order.MedicationRequestPeriodInDays ( ) return if DaysSupplied is not null and ( MedicationStrength.unit = 'mg' or ( MedicationStrength.unit = 'mg/mL' and Order.dispenseRequest.quantity.unit = 'mL' ) ) then ( ( Order.dispenseRequest.quantity * MedicationStrength ) / Quantity { value: DaysSupplied, unit: 'd' } ) else null
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: UseofHighRiskMedicationsintheElderlyFHIR
extension:
  url:
    v: name
    l: name
  value: String
    v: MedicationStrengthPerUnit
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define fluent function MedicationStrengthPerUnit(Strength Concept): case when Strength ~ "reserpine 0.1 MG Oral Tablet" then 0.1 'mg' when Strength ~ "reserpine 0.25 MG Oral Tablet" then 0.25 'mg' when Strength ~ "digoxin 0.05 MG/ML Oral Solution" then 0.05 'mg/mL' when Strength ~ "digoxin 0.0625 MG Oral Tablet" then 0.0625 'mg' when Strength ~ "1 ML digoxin 0.1 MG/ML Injection" then 0.1 'mg/mL' when Strength ~ "digoxin 0.125 MG Oral Tablet" then 0.125 'mg' when Strength ~ "digoxin 0.1875 MG Oral Tablet" then 0.1875 'mg' when Strength ~ "digoxin 0.25 MG Oral Tablet" then 0.25 'mg' when Strength ~ "2 ML digoxin 0.25 MG/ML Injection" then 0.25 'mg/mL' when Strength ~ "doxepin 3 MG Oral Tablet" then 3 'mg' when Strength ~ "doxepin 6 MG Oral Tablet" then 6 'mg' when Strength ~ "doxepin hydrochloride 10 MG Oral Capsule" then 10 'mg' when Strength ~ "doxepin hydrochloride 10 MG/ML Oral Solution" then 10 'mg/mL' when Strength ~ "doxepin hydrochloride 25 MG Oral Capsule" then 25 'mg' when Strength ~ "doxepin hydrochloride 50 MG Oral Capsule" then 50 'mg' when Strength ~ "doxepin hydrochloride 75 MG Oral Capsule" then 75 'mg' when Strength ~ "doxepin hydrochloride 100 MG Oral Capsule" then 100 'mg' when Strength ~ "doxepin hydrochloride 150 MG Oral Capsule" then 150 'mg' else null end
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: CQMCommon
extension:
  url:
    v: name
    l: name
  value: String
    v: getMedicationCode
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Returns the medication code for the given MedicationRequest */ define fluent function getMedicationCode(request MedicationRequest ): if request.medication is Concept then request.medication as Concept else (singleton from ([Medication] M where M.id = (request.medication as Reference).reference.getId())).code
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: 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: 26
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: Status
extension:
  url:
    v: name
    l: name
  value: String
    v: isEncounterPerformed
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define fluent function isEncounterPerformed(Enc List<Encounter>): Enc E where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}
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: 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: 28
url:
  v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition
  l: cqfm-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: Status
extension:
  url:
    v: name
    l: name
  value: String
    v: isAssessmentPerformed
extension:
  url:
    v: statement
    l: statement
  value: String
    v: //Similar but different from QICoreCommon.isSurvey, which does not have status constraints define fluent function isAssessmentPerformed(Obs List<Observation>): Obs O where O.status in { 'final', 'amended', 'corrected' } and exists ( O.category ObservationCategory where ( ObservationCategory ) ~ "survey" )
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: Status
extension:
  url:
    v: name
    l: name
  value: String
    v: isInterventionOrder
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>): ServiceRequest S where S.status in { 'active', 'completed' } and S.intent = 'order'
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: Status
extension:
  url:
    v: name
    l: name
  value: String
    v: isInterventionPerformed
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define fluent function isInterventionPerformed(Proc List<Procedure>): Proc P where P.status ~ 'completed'
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: 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: 32
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 Status
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/Status|1.6.000
  l: http://ecqi.healthit.gov/ecqms/Library/Status

type:
  v: depends-on
display:
  v: Library CMD
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/CumulativeMedicationDuration|3.3.000
  l: http://ecqi.healthit.gov/ecqms/Library/CumulativeMedicationDuration

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 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: Library CQMCommon
resource:
  v: http://ecqi.healthit.gov/ecqms/Library/CQMCommon|1.4.000
  l: http://ecqi.healthit.gov/ecqms/Library/CQMCommon

type:
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  v: id

type:
  v: Medication
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication
  l: qicore-medication
must support:
  v: id

type:
  v: Medication
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication
  l: qicore-medication
must support:
  v: id

type:
  v: Medication
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication
  l: qicore-medication
must support:
  v: id

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition
  l: qicore-condition
must support:
  v: code
code filter:
  path:
    v: code
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    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1205

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition
  l: qicore-condition
must support:
  v: code
code filter:
  path:
    v: code
  value set:
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    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1157

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition
  l: qicore-condition
must support:
  v: code
code filter:
  path:
    v: code
  value set:
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    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1206

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition
  l: qicore-condition
must support:
  v: code
code filter:
  path:
    v: code
  value set:
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    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1207

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition
  l: qicore-condition
must support:
  v: code
code filter:
  path:
    v: code
  value set:
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    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1208

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition
  l: qicore-condition
must support:
  v: code
code filter:
  path:
    v: code
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    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1209

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition
  l: qicore-condition
must support:
  v: code
code filter:
  path:
    v: code
  value set:
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    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1210

type:
  v: Condition
profile:
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  l: qicore-condition
must support:
  v: code
code filter:
  path:
    v: code
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    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165

type:
  v: Condition
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition
  l: qicore-condition
must support:
  v: code
code filter:
  path:
    v: code
  value set:
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    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167

type:
  v: Patient
profile:
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  l: qicore-patient

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: period
must support:
  v: status
must support:
  v: status.value

type:
  v: Encounter
profile:
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  l: qicore-encounter
must support:
  v: type
must support:
  v: period
must support:
  v: status
must support:
  v: status.value
code filter:
  path:
    v: type
  value set:
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    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: period
must support:
  v: status
must support:
  v: status.value
code filter:
  path:
    v: type
  value set:
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    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.11.1206

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: period
must support:
  v: status
must support:
  v: status.value
code filter:
  path:
    v: type
  value set:
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    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: period
must support:
  v: status
must support:
  v: status.value
code filter:
  path:
    v: type
  value set:
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    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1013

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: period
must support:
  v: status
must support:
  v: status.value
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: period
must support:
  v: status
must support:
  v: status.value
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: period
must support:
  v: status
must support:
  v: status.value
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: period
must support:
  v: status
must support:
  v: status.value
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: period
must support:
  v: status
must support:
  v: status.value
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: period
must support:
  v: status
must support:
  v: status.value
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: period
must support:
  v: status
must support:
  v: status.value
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: hospitalization
must support:
  v: hospitalization.dischargeDisposition
must support:
  v: period
must support:
  v: status
must support:
  v: status.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

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: period
must support:
  v: status
must support:
  v: status.value
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003

type:
  v: Encounter
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
  l: qicore-encounter
must support:
  v: type
must support:
  v: period
must support:
  v: status
must support:
  v: status.value
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090

type:
  v: Observation
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation
  l: qicore-observation
must support:
  v: code
must support:
  v: value
must support:
  v: effective
must support:
  v: status
must support:
  v: status.value
must support:
  v: category
code filter:
  path:
    v: code
  code: https://loinc.org/rdf/45755-6
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 45755-6
    display:
      v: Hospice care [Minimum Data Set]
code filter:
  path:
    v: value

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: category
code filter:
  path:
    v: code
  code: https://loinc.org/rdf/71007-9
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 71007-9
    display:
      v: Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)

type:
  v: ServiceRequest
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest
  l: qicore-servicerequest
must support:
  v: code
must support:
  v: authoredOn
must support:
  v: authoredOn.value
must support:
  v: status
must support:
  v: status.value
must support:
  v: intent
must support:
  v: intent.value
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584

type:
  v: Procedure
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
  l: qicore-procedure
must support:
  v: code
must support:
  v: performed
must support:
  v: status
must support:
  v: status.value
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584

type:
  v: Procedure
profile:
  v: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
  l: qicore-procedure
must support:
  v: code
must support:
  v: performed
must support:
  v: status
must support:
  v: status.value
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135

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: CMS156FHIR

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: publisher
system:
  v: https://madie.cms.gov/measure/cmsId
  l: cmsId
value:
  v: 156FHIR
assigner:
  display:
    v: CMS

v: 0.0.001

v: UseofHighRiskMedicationsintheElderlyFHIR

v: Use of High-Risk Medications in Older AdultsFHIR

v: draft

v: false

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

v: National Committee for Quality Assurance

telecom:
  system:
    v: url
  value:
    v: https://www.ncqa.org/

v: Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported. 1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. 2. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses. 3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators).

code:
  system:
    v: http://terminology.hl7.org/CodeSystem/usage-context-type
    l: usage-context-type
  code:
    v: program
value: CodeableConcept
  coding:
    system:
      v: http://hl7.org/fhir/us/cqfmeasures/CodeSystem/quality-programs
      l: quality-programs
    code:
      v: ep-ec
    display:
      v: EP/EC

v: UNKNOWN

v: The intent of the measure is to assess if the patient has been ordered at least two high-risk medication prescriptions from the same drug class on different days. The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication from the same drug class for them. Calculate average daily dose for each prescription event. To calculate average daily dose, multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a prescription for the 30-days supply of digoxin containing 15 pills, 0.25 mg each pill, has an average daily dose of 0.125 mg. To calculate average daily dose for elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS156v12. 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: This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract HHSM-500-2011-00079C) with the National Committee for Quality Assurance (NCQA) to develop this electronic measure. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) codes, descriptions and other data are copyright 2022. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. LOINC(R) 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 copyright 2022 World Health Organization. All Rights Reserved.

v: 2023-08-28

v: 2023-08-28

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

name:
  v: National Committee for Quality Assurance
telecom:
  system:
    v: url
  value:
    v: https://www.ncqa.org/

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

v: Certain medications (MacKinnon & Hepler, 2003) are associated with increased risk of harm from drug side-effects and drug toxicity and pose a concern for patient safety. There is clinical consensus that these drugs pose increased risks in older adults (Kaufman, Brodin, & Sarafian, 2005). Potentially inappropriate medication use in older adults has been connected to significantly longer hospital stay lengths and increased hospitalization costs (Hagstrom et al., 2015) as well as increased risk of death (Lau et al., 2004). Use of specific high-risk medications such as hypnotics, including benzodiazepine receptor agonists, and nonsteroidal anti-inflammatory drugs (NSAIDS) can result in increased risk of delirium, falls, fractures, gastrointestinal bleeding and acute kidney injury (Merel et al., 2017). Long-term use of benzodiazepines in older adults has been associated with increased risk of dementia (Zhong et al., 2015; Takada et al., 2016). Additionally, the use of antipsychotics can lead to increased risk of stroke and greater cognitive decline in older adults with dementia (Tampi et al., 2016). Older adults receiving inappropriate medications are more likely to report poorer health status at follow-up, compared to those who receive appropriate medications (Fu, Liu, & Christensen, 2004). A study of the prevalence of potentially inappropriate medication use in older adults found that 40 percent of individuals 65 and older filled at least one prescription for a potentially inappropriate medication and 13 percent filled two or more (Fick et al., 2008). While some adverse drug events (ADEs) are unavoidable, studies estimate that between 30 and 80 percent of ADEs in older adults are preventable (MacKinnon & Hepler, 2003). More recently with the onset of the COVID-19 pandemic, several studies have shown an increase in anxiety, insomnia and depression rates, which could result in an increase in the use of high-risk medications in order to treat these conditions (Agrawal, 20…

v: The measure is based on recommendations from the American Geriatrics Society Beers Criteria[R] for Potentially Inappropriate Medication Use in Older Adults (2019 Update). The criteria were developed through key clinical expert consensus processes by Beers in 1997, Zhan in 2001, and an updated process by Fick et al. in 2003, 2012, 2015, and 2019. The Beers Criteria identifies lists of drugs that are potentially inappropriate for all older adults, except for those with certain conditions for which some high-risk medications may be warranted, and drugs that are potentially inappropriate in older adults based on various high-risk factors such as dosage, days supply and underlying diseases or conditions. NCQA's Geriatric Measurement Advisory Panel recommended a subset of drugs that should be used with caution in older adults for inclusion in the measure based upon the recommendations in the Beers Criteria.

id:
  v: 649c8b4a4c79454c026f7495
extension:
  url:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring
    l: cqfm-scoring
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    coding:
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        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: boolean
extension:
  url:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type
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    coding:
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      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: Patients 65 years and older at the end of the measurement period who had a visit during the measurement period
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Initial Population
population:
  code:
    coding:
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        v: http://terminology.hl7.org/CodeSystem/measure-population
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        v: denominator
      display:
        v: Denominator
  description:
    v: Equals Initial Population
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Denominator
population:
  code:
    coding:
      system:
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        l: measure-population
      code:
        v: denominator-exclusion
      display:
        v: Denominator Exclusion
  description:
    v: Exclude patients who are in hospice care for any part of the measurement period. Exclude patients receiving palliative care for any part of the measurement period.
  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:
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  description:
    v: Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days. a. At least two orders of high-risk medications from the same drug class. b. At least two orders of high-risk medications from the same drug class with summed days supply greater than 90 days. c. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria.
  criteria:
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    expression:
      v: Numerator 1
population:
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    coding:
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        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: 649c8b4a4c79454c026f7496
extension:
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      code:
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      display:
        v: Proportion
extension:
  url:
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    l: cqfm-populationBasis
  value: Code
    v: boolean
extension:
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  value: CodeableConcept
    coding:
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      display:
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population:
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    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: initial-population
      display:
        v: Initial Population
  description:
    v: Patients 65 years and older at the end of the measurement period who had a visit during the measurement period
  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: Exclude patients who are in hospice care for any part of the measurement period. Exclude patients receiving palliative care for any part of the measurement period.
  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: Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines) on different days except for appropriate diagnoses. a. Patients with two or more antipsychotic prescriptions ordered on different days, and who did not have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the IPSD for antipsychotics. b. Patients with two or more benzodiazepine prescriptions ordered on different days, and who did not have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines.
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Numerator 2
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: 649c8b4a4c79454c026f7497
extension:
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    coding:
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      code:
        v: proportion
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extension:
  url:
    v: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis
    l: cqfm-populationBasis
  value: Code
    v: boolean
extension:
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  value: CodeableConcept
    coding:
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        v: http://terminology.hl7.org/CodeSystem/measure-type
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      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: Patients 65 years and older at the end of the measurement period who had a visit during the measurement period
  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: Exclude patients who are in hospice care for any part of the measurement period. Exclude patients receiving palliative care for any part of the measurement period.
  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: Total rate (the sum of the two previous numerators, deduplicated).
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Numerator 3
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