eCQM QICore Content Implementation Guide
2023.0.0 - CI Build

eCQM QICore Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2023.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/ecqm-content-qicore-2023/ and changes regularly. See the Directory of published versions

## Library: AppropriateTreatmentforSTEMIFHIR

Official URL: http://ecqi.healthit.gov/ecqms/Library/AppropriateTreatmentforSTEMIFHIR | Version: 0.0.008
Active as of 2023-08-17 | Computable Name: AppropriateTreatmentforSTEMIFHIR
Other Identifiers: https://madie.cms.gov/login#AppropriateTreatmentforSTEMIFHIR (use: official, )

AppropriateTreatmentforSTEMIFHIR

Id: | AppropriateTreatmentforSTEMIFHIR
Url: | http://ecqi.healthit.gov/ecqms/Library/AppropriateTreatmentforSTEMIFHIR
Version: | 0.0.008
Identifier: | value: AppropriateTreatmentforSTEMIFHIR
Name: | AppropriateTreatmentforSTEMIFHIR
Title: | AppropriateTreatmentforSTEMIFHIR
Status: | active
Experimental: | false
Type: | system: http://terminology.hl7.org/CodeSystem/library-type code: logic-library
Date: | 2023-08-17T17:08:39+00:00
Description: | AppropriateTreatmentforSTEMIFHIR
Related Artifacts: | Dependencies
Data Requirements: |
Type | Profile | MS | Code Filter
--- | --- | --- | ---
Patient | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient |  |
Patient | http://hl7.org/fhir/Patient | ;;;; |
Condition | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition | ;; |
Encounter | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter | ;;;;;; | code filter: path: type value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1085
Encounter | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter | ;;;;; | code filter: path: type value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1085
Condition | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition | ;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4017
Location | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-location | ;; |
Reference | http://hl7.org/fhir/Reference | ;; |
Encounter | http://hl7.org/fhir/Encounter | ; |
| http://hl7.org/fhir/Encounter.Location | ; |
MedicationAdministration | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration | ; | code filter: path: medication value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4020
MedicationAdministration | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration | ; | code filter: path: medication value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4020
Procedure | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure | ;;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.2000.5
Patient | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient |  |
Coverage | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage | ;; | code filter: path: type value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
uri | http://hl7.org/fhir/uri | ; |
Patient | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient | ;; |
Patient | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient | ;; |
Patient | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient |  |
AllergyIntolerance | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance | ;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.4
AdverseEvent | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-adverseevent | ;;;;; | code filter: path: event value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.6
Condition | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition | ; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4036
Condition | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition | ; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.3
Condition | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition | ; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4025
Condition | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition | ; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4043
Condition | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition | ; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4055
Condition | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition | ; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.5
MedicationRequest | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest | ; | code filter: path: medication value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4045
MedicationRequest | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest | ; | code filter: path: medication value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4045
Condition | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition | ; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4028
Condition | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition | ; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.114.12.1012
Condition | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition | ; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4048
Procedure | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure | ;;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4056
Procedure | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure | ; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.69
Procedure | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure | ; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4052
Condition | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition | ; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.104.12.1024
Condition | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition | ; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4026
Condition | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition | ; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4031
Condition | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition | ; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4048
Procedure | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure | ;;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.2
Patient | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient | ;; |
Patient | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient | ;; |
Coverage | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage | ;; | code filter: path: type value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Patient | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient | ;; |
Patient | http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient | ;; |
Content: text/cql
    library AppropriateTreatmentforSTEMIFHIR version '0.0.008'

    using QICore version '4.1.1'

    /*This spec aligns with AU2023/PY2024 QDM version*/

    include SupplementalDataElements version '3.4.000' called SDE
    include QICoreCommon version '1.5.000' called QICoreCommon
    include FHIRHelpers version '4.3.000' called FHIRHelpers
    include CQMCommon version '1.4.000' called CQMCommon

    codesystem "LOINC": 'http://loinc.org'
    codesystem "HSLOC": 'https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/hsloc.html'
    codesystem "SNOMEDCT": 'http://snomed.info/sct'
    codesystem "ActCode": 'http://terminology.hl7.org/CodeSystem/v3-ActCode'

    valueset "Active Bleeding Excluding Menses or Bleeding Diathesis": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4036'
    valueset "Active Peptic Ulcer": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4031'
    valueset "Adverse reaction to thrombolytics": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.6'
    valueset "Allergy to thrombolytics": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.5'
    valueset "Oral Anticoagulant Medications": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4045'
    valueset "Aortic Dissection and Rupture": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4028'
    valueset "birth date": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.560.100.4'
    valueset "Cardiopulmonary Arrest": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4048'
    valueset "Cerebral Vascular Lesion": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4025'
    valueset "Closed Head and Facial Trauma": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4026'
    valueset "Dementia": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4043'
    valueset "Discharge To Acute Care Facility": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87'
    valueset "ED": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1085'
    valueset "Emergency Department Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292'
    valueset "Endotracheal Intubation": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.69'
    valueset "Fibrinolytic Therapy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4020'
    valueset "Intracranial or Intraspinal surgery": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.2'
    valueset "Ischemic Stroke": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.104.12.1024'
    valueset "Major Surgical Procedure": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4056'
    valueset "Malignant Intracranial Neoplasm Group": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.3'
    valueset "Insertion or Replacement of Mechanical Circulatory Assist Device": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4052'
    valueset "Neurologic impairment": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.114.12.1012'
    valueset "Patient Expired": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309'
    valueset "Percutaneous Coronary Intervention": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.2000.5'
    valueset "Pregnancy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4055'
    valueset "STEMI": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4017'
    valueset "Thrombolytic medications": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.4'

    code "Birthdate": '21112-8' from "LOINC" display 'Birthdate'
    code "Emergency Department": '1108-0' from "HSLOC" display 'Emergency Department'
    code "Patient transfer (procedure)": '107724000' from "SNOMEDCT" display 'Patient transfer (procedure)'
    code "Streptokinase adverse reaction (disorder)": '293571007' from "SNOMEDCT" display 'Streptokinase adverse reaction (disorder)'
    code "EMER": 'EMER' from "ActCode" display 'emergency'

    parameter "Measurement Period" Interval<DateTime>

    context Patient

    /***Population Criteria***/

    define "Initial Population":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        where AgeInYearsAt(date from start of(EDwithSTEMI.period)) >= 18

    define "Denominator":
      "Initial Population"

    define "Denominator Exclusions":
      "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"
        union "Adverse Effect to Thrombolytic Medications Before End of ED Encounter"
        union "Active Exclusion Diagnosis at Start of ED Encounter"
        union "Active Oral Anticoagulant Medication at the Start of ED Encounter"
        union "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"
        union "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter"
        union "Intubation or Mechanical Circulatory Assist Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"
        union "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"
        union "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"
        union "ED Encounter with Discharge Disposition as Patient Expired"

    define "Numerator":
      "Fibrinolytic Therapy within 30 Minutes of Arrival"
        union "PCI within 90 Minutes of Arrival"
        union "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival"

    /***Definitions***/

    define "Active Exclusion Diagnosis at Start of ED Encounter":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ( ["Condition": "Active Bleeding Excluding Menses or Bleeding Diathesis"]
          union ["Condition": "Malignant Intracranial Neoplasm Group"]
          union ["Condition": "Cerebral Vascular Lesion"]
          union ["Condition": "Dementia"]
          union ["Condition": "Pregnancy"]
          union ["Condition": "Allergy to thrombolytics"] ) ActiveExclusionDx
          such that /*ActiveExclusionDx.isActive ()
            and */
          ActiveExclusionDx.prevalenceInterval ( ) overlaps before ( EDwithSTEMI.period )
    /*KS 8-10-23: in CQLIT-389, discussed the impacts of requiring a clinical status of active but the condition could end before the end (during) the ED Visit, which would trigger an inactive status. Decided to not follow the Authoring Patterns and remove the requirement for a clinicalstatus of 'active'  */

    define "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter":
      "ED Encounter with STEMI Diagnosis" EDwSTEMI
        with ( ["Condition": "Ischemic Stroke"]
          union ["Condition": "Closed Head and Facial Trauma"]
          union ["Condition": "Active Peptic Ulcer"]
          union ["Condition": "Cardiopulmonary Arrest"] ) ExclusionCondition
          such that /* ExclusionCondition.isActive ()
       and */
          ExclusionCondition.prevalenceInterval ( ) starts during Interval[start of ( EDwSTEMI.period ) - 90 days, start of ( EDwSTEMI.period )]

    define "Active Oral Anticoagulant Medication at the Start of ED Encounter":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ["MedicationRequest": "Oral Anticoagulant Medications"] OralAnticoagulant
          such that OralAnticoagulant.status = 'active'
            and OralAnticoagulant.intent = 'order'
            and OralAnticoagulant.authoredOn before or on start of EDwithSTEMI.period
        /*this definition differs from QDM re: timing - cannot use overlaps for a single point in time*/

    /*define "Adverse Effect to Thrombolytic Medications Before End of ED Encounter":
    "ED Encounter with STEMI Diagnosis" EDwSTEMI
        with [AdverseEvent: event in "Thrombolytic medications"] ThrombolyticAdverseEvent
        such that ThrombolyticAdverseEvent.category in "Adverse reaction to thrombolytics"
        and ThrombolyticAdverseEvent.recordedDate before end of ( EDwSTEMI.period )
            and ThrombolyticAdverseEvent.actuality = 'actual'*/
    /*KS Note - not sure we need category in the logic - it is must support, but not sure this brings value to the measure logic*/

    define "Adverse Effect to Thrombolytic Medications Before End of ED Encounter":
      "ED Encounter with STEMI Diagnosis" EDwSTEMI
        with [AdverseEvent: event in "Adverse reaction to thrombolytics"] ThrombolyticAdverseEvent
          such that ThrombolyticAdverseEvent.recordedDate before end of ( EDwSTEMI.period )
            and ThrombolyticAdverseEvent.actuality = 'actual'

    define "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter":
      "ED Encounter with STEMI Diagnosis" EDwSTEMI
        with ["AllergyIntolerance": "Thrombolytic medications"] ThrombolyticAllergy
          such that ThrombolyticAllergy.clinicalStatus ~ QICoreCommon."allergy-active"
            and ThrombolyticAllergy.onset.toInterval ( ) overlaps ( EDwSTEMI.period )

    define "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        where ( EDwithSTEMI.period ) ends 45 minutes or less after start of ( EDwithSTEMI.period )
          and EDwithSTEMI.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"

    define "ED Encounter with Diagnosis of STEMI":
      ["Encounter": "ED"] EDEncounter
        with ["Condition": "STEMI"] DxSTEMI
          such that DxSTEMI.clinicalStatus ~ QICoreCommon."active"
            and EDEncounter.status = 'finished'
            and EDEncounter.class ~ "EMER"
            and DxSTEMI.prevalenceInterval ( ) starts during EDEncounter.period
            and EDEncounter.period during day of "Measurement Period"

    define "ED Encounter with Discharge Disposition as Patient Expired":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        where EDwithSTEMI.hospitalization.dischargeDisposition in "Patient Expired"

    define "ED Encounter with Encounter Diagnosis of STEMI":
      ["Encounter": "ED"] EDEncounter
        where EDEncounter.status = 'finished'
          and EDEncounter.class ~ "EMER"
          and ( EDEncounter.reasonCode in "STEMI"
              or exists ( ( EDEncounter.encounterDiagnosis ( ) ) EncDiagnosis
                  where EncDiagnosis.code in "STEMI"
              )
          )
          and EDEncounter.period during "Measurement Period"

    define "ED Encounter with STEMI Diagnosis":
      "ED Encounter with Encounter Diagnosis of STEMI"
        union "ED Encounter with Diagnosis of STEMI"

    define "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ( ["Condition": "Aortic Dissection and Rupture"]
          union ["Condition": "Neurologic impairment"]
          union ["Condition": "Cardiopulmonary Arrest"] ) ExclusionDiagnosis
          such that ( ExclusionDiagnosis.prevalenceInterval ( ) starts during EDwithSTEMI.period )
            or ( ExclusionDiagnosis.prevalenceInterval ( ) starts 24 hours or less before start of EDwithSTEMI.period )
    /*Did not include a status of active as any diagnosis that resolves during the ED visit would not be counted*/

    define "Fibrinolytic Therapy within 30 Minutes of Arrival":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ["MedicationAdministration": "Fibrinolytic Therapy"] Fibrinolytic
          such that Fibrinolytic.status = 'completed'
            and start of ( Fibrinolytic.effective.toInterval ( ) ) 30 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )

    define "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ["Procedure": "Intracranial or Intraspinal surgery"] CranialorSpinalSurgery
          such that CranialorSpinalSurgery.performed.toInterval ( ) starts 90 days or less before start of ( EDwithSTEMI.period )
            and CranialorSpinalSurgery.status = 'completed'

    define "Intubation or Mechanical Circulatory Assist Procedure During ED Encounter or Within 24 Hours of ED Encounter Start":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ( ["Procedure": "Endotracheal Intubation"]
          union ["Procedure": "Insertion or Replacement of Mechanical Circulatory Assist Device"] ) AirwayProcedure
          such that ( ( AirwayProcedure.performed.toInterval ( ) starts during ( EDwithSTEMI.period ) )
              or ( AirwayProcedure.performed.toInterval ( ) starts 24 hours or less before start of ( EDwithSTEMI.period ) )
          )
            and AirwayProcedure.status = 'completed'

    define "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ["Procedure": "Major Surgical Procedure"] MajorSurgery
          such that MajorSurgery.performed.toInterval ( ) starts 21 days or less before start of ( EDwithSTEMI.period )
            and MajorSurgery.status = 'completed'

    define "PCI within 90 Minutes of Arrival":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ["Procedure": "Percutaneous Coronary Intervention"] PCI
          such that PCI.performed.toInterval ( ) starts 90 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )
            and PCI.status = 'completed'

    define "SDE Ethnicity":
      SDE."SDE Ethnicity"

    define "SDE Payer":
      SDE."SDE Payer"

    define "SDE Race":
      SDE."SDE Race"

    define "SDE Sex":
      SDE."SDE Sex"

    /*
    @description: Returns the emergency department arrival time for the encounter.
    */

    define fluent function currentemergencyDepartmentArrivalTime(EDEncounter Encounter):
      start of ( singleton from ( ( ( EDEncounter.location ) ) EDLocation
            where CQMCommon.GetLocation ( EDLocation.location ).type in "Emergency Department Visit"
        )
      ).period
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