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

## : Sexually Transmitted Infection (STI) Testing for People with HIVFHIR - JSON Representation

Draft as of 2023-10-27

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    {
      "resourceType" : "Measure",
      "id" : "HIVSTITestingFHIR",
      "meta" : {
        "profile" : [
          🔗 "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"🔗 ,
          "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"🔗 ,
          "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"
        ]
      },
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n    <table class=\"grid dict\">\n        \n            <tr>\n                <th scope=\"row\"><b>Title: </b></th>\n                <td style=\"padding-left: 4px;\">Sexually Transmitted Infection (STI) Testing for People with HIVFHIR</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Id: </b></th>\n                <td style=\"padding-left: 4px;\">HIVSTITestingFHIR</td>\n            </tr>\n            \n                <tr>\n                    <th scope=\"row\"><b>Download cql: </b></th>\n                    <td style=\"padding-left: 4px;\"><a href=\"Library-HIVSTITestingFHIR.cql\">HIVSTITestingFHIR.cql</a></td>\n                </tr>\n            \n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Version: </b></th>\n                <td style=\"padding-left: 4px;\">0.1.000</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Url: </b></th>\n                <td style=\"padding-left: 4px;\"><a href=\"Measure-HIVSTITestingFHIR.html\">Sexually Transmitted Infection (STI) Testing for People with HIVFHIR</a></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                short-name identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>CMS1188FHIR</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                version-independent identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>urn:uuid:6f66ca77-1a2c-489c-b0d8-730da6e5a763</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                version-specific identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>urn:uuid:2c92808287dd6f640188b07c4a8a1f35</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                publisher (CMS) identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>1188FHIR</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Effective Period: </b></th>\n                <td style=\"padding-left: 4px;\">2024-01-01\n                    ..2024-12-31</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Status: </b></th>\n                <td style=\"padding-left: 4px;\">draft</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Date: </b></th>\n                <td style=\"padding-left: 4px;\">2023-10-27 08:12:32+0000</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Approval Date: </b></th>\n                <td style=\"padding-left: 4px;\">2023-08-11</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Last Review Date: </b></th>\n                <td style=\"padding-left: 4px;\">2023-08-11</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Name: </b></th>\n                <td style=\"padding-left: 4px;\">HIVSTITestingFHIR</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Publisher: </b></th>\n                <td style=\"padding-left: 4px;\">Health Resources &amp; Services Administration</td>\n            </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Author: </b></th>\n            <td style=\"padding-left: 4px;\">Health Resources &amp; Services Administration: <a href=\" https://www.hrsa.gov/\"> https://www.hrsa.gov/</a></td>\n        </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Description: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>Percentage of patients 13 years of age and older with a diagnosis of HIV who had tests for syphilis, gonorrhea, and chlamydia performed within the measurement period</p>\n</div></td>\n            </tr>\n        \n\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Use Context: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    <table class=\"grid-dict\">\n                        <tr>\n                            <th><b>code</b></th>\n                            <th><b>value</b></th>\n                        </tr>\n                        \n                            <tr>\n                                <td>program</td>\n                                <td/>\n                            </tr>\n                        \n                    </table>\n                </td>\n            </tr>\n        \n\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Purpose: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>UNKNOWN</p>\n</div></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Copyright: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>This measure was developed by the Health Resources &amp; Services Administration (HRSA) of the U.S. Department of Health &amp; Human Services (HHS). It is in the public domain.</p>\n<p>Citation of HRSA as the source of the original measure is appreciated. Any modified versions may not be represented as approved, endorsed, or authorized by HRSA or HHS. 42 U.S.C. Section 1320b-10. Users of modified versions should clearly explain how they deviate from HRSA's original measure.</p>\n<p>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.</p>\n<p>CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) is copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2022 World Health Organization. All Rights Reserved.</p>\n<p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>\n</div></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Disclaimer: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.</p>\n<p>THE MEASURES AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.</p>\n<p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>\n</div></td>\n            </tr>\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Rationale: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>The rates of syphilis, gonorrhea, and chlamydia cases per 100,000 in the United States have steadily risen over the last decade and increased 11.2%, 5.9%, and 2.8%, respectively, from 2018 to 2019 (DHHS, 2021). People with HIV are at an increased risk of bacterial sexually transmitted infections (STIs), including chlamydia, gonorrhea, and syphilis (CDC, 2004). However, early detection and treatment of bacterial STIs in people with HIV can lead to a reduction in HIV transmission (CDC, 2004). Despite guidelines for at least annual screening among sexually active persons with HIV, only an estimated 55% received a syphilis test in the past year, 23% received a gonorrhea test in the past year, and 24% received a chlamydia test in the past year based on a nationally-representative survey of adults with HIV receiving medical care in the United States (Flagg et al., 2015). This measure will help providers focus their attention and quality improvement efforts towards testing and treating sexually transmitted infections in patients with HIV, thus reducing the complications to long-term syphilis infection and reducing STI incidence (Patel et al., 2012).</p>\n</div></td>\n        </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Clinical recommendation statement: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>&quot;Routine serologic screening for syphilis is recommended at least annually for all persons with HIV infection who are sexually active, with more frequent screening (i.e., every 3-6 months) for those who have multiple or anonymous partners&quot; (Panel on Opportunistic Infections in Adults and Adolescents with HIV, 2022, p. Y-3).</p>\n<p>&quot;Patients undergoing screening or treatment for syphilis also should be evaluated for other sexually transmitted diseases such as chlamydia and gonorrhea at anatomic sites of exposure in men and for chlamydia, gonorrhea, and trichomonas in women&quot; (Panel on Opportunistic Infections in Adults and Adolescents with HIV, 2022, p. Y-3).</p>\n<p>&quot;The USPSTF recommends screening for syphilis in persons who are at increased risk for infection. When deciding which persons to screen for syphilis, clinicians should consider the prevalence of infection in the communities they serve, as well as other sociodemographic and behavioral factors that may be associated with increased risk of syphilis infection. For example, prevalence of syphilis is higher in men, men who have sex with men, persons with HIV infection, young adults, and persons with a history of incarceration, sex work, or military service…. Optimal screening frequency for persons who are at increased risk for syphilis infection is not well established. Men who have sex with men or persons with HIV infection may benefit from screening at least annually or more frequently (e.g., every 3 to 6 months) if they continue to be at high risk&quot; (USPSTF, 2022, p. 1244-1246).</p>\n<p>&quot;At the initial HIV care visit, providers should screen all sexually active persons for syphilis, gonorrhea, and chlamydia, and perform screening for these infections at least annually during the course of HIV care. Specific testing includes syphilis serology and [a nucleic acid amplification test] NAAT for N. gonorrhoeae and C. trachomatis at the anatomic site of exposure&quot; (Workowski et al., 2021, p. 26).</p>\n</div></td>\n        </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Guidance (Usage): </b></th>\n                <td style=\"padding-left: 4px;\">This eCQM is a patient-based measure.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS1188v1.\n\nPlease 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).</td>\n            </tr>\n        \n\n        \n            \n                <tr>\n                    <th scope=\"row\"><b>Population Criteria: </b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                            <table class=\"grid-dict\">\n                                \n                                    <tr>\n                                        <th><b>64998bd84c79454c026f7483</b></th>\n                                    </tr>\n                                \n                                \n                                    <tr>\n                                        <td>Initial Population:</td>\n                                        \n                                            <td>All patients 13 years of age and older at the start of the measurement period with a diagnosis of HIV before the end of the measurement period with an eligible encounter during the measurement period</td>\n                                        \n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator:</td>\n                                        \n                                            <td>Equals Initial Population</td>\n                                        \n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator Exclusion:</td>\n                                        \n                                            <td>None</td>\n                                        \n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Numerator:</td>\n                                        \n                                            <td>Patients who were tested for each of the following at least once during the measurement period: syphilis, gonorrhea, and chlamydia</td>\n                                        \n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Numerator Exclusion:</td>\n                                        \n                                            <td>None</td>\n                                        \n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator Exception:</td>\n                                        \n                                            <td>None</td>\n                                        \n                                    </tr>\n                                \n                                \n                            </table>\n                        \n                    </td>\n                </tr>\n            \n        \n\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Libraries: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    <table class=\"grid-dict\">\n                        \n                            <tr>\n                                <td><a href=\"Library-HIVSTITestingFHIR.html\">HIVSTITestingFHIR</a></td>\n                            </tr>\n                        \n                    </table>\n                </td>\n            </tr>\n        \n\n        \n\n        \n            \n                <tr>\n                    <th scope=\"row\"><b>Related Artifact Dependencies: </b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                            <li><a href=\"Library-FHIRHelpers.html\">FHIRHelpers</a> version: 4.3.000</li>\n                        \n                            <li><a href=\"Library-QICoreCommon.html\">QICoreCommon</a> version: 1.5.000</li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1052/expansion\">Chlamydia Screening</a></li>\n                        \n                            <li><a href=\"https://tx.fhir.org/r4/ValueSet/2.16.840.1.113762.1.4.1258.1-20250208\">Gonorrhea Screening</a></li>\n                        \n                            <li><a href=\"https://tx.fhir.org/r4/ValueSet/2.16.840.1.113762.1.4.1166.117-20230708\">Syphilis Tests</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion\">Office Visit</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1008/expansion\">Outpatient Consultation</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion\">Annual Wellness Visit</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1048/expansion\">Face-to-Face Interaction</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion\">Home Healthcare Services</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion\">Preventive Care Services - Established Office Visit, 18 and Up</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion\">Preventive Care Services-Initial Office Visit, 18 and Up</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1022/expansion\">Preventive Care Services, Initial Office Visit, 0 to 17</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1024/expansion\">Preventive Care, Established Office Visit, 0 to 17</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion\">Telephone Visits</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.11.1150/expansion\">Preventive Care Services - Other</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.120.12.1003/expansion\">HIV</a></li>\n                        \n                    </td>\n                </tr>\n                <tr>\n                    <th scope=\"row\"><b>Parameters:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>name</b></th>\n                                <th><b>use</b></th>\n                                <th><b>min</b></th>\n                                <th><b>max</b></th>\n                                <th><b>type</b></th>\n                            </tr>\n                            \n                                <tr>\n                                    <td>Measurement Period</td>\n                                    <td>In</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Period</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Numerator</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Denominator</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Initial Population</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                        </table>\n                    </td>\n                </tr>\n\n                <tr>\n                    <th scope=\"row\"><b>DataRequirements:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>Type</b></th>\n                                <th><b>Elements</b></th>\n                                <th><b>Valueset Name</b></th>\n                                <th><b>Valueset</b></th>\n                            </tr>\n                            \n                                <tr>\n                                    <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            value\n                                        \n                                            effective\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Chlamydia Screening\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1052/expansion\">Chlamydia Screening</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            value\n                                        \n                                            effective\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Gonorrhea Screening\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://tx.fhir.org/r4/ValueSet/2.16.840.1.113762.1.4.1258.1-20250208\">Gonorrhea Screening</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            value\n                                        \n                                            effective\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Syphilis Tests\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://tx.fhir.org/r4/ValueSet/2.16.840.1.113762.1.4.1166.117-20230708\">Syphilis Tests</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Office Visit\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion\">Office Visit</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Outpatient Consultation\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1008/expansion\">Outpatient Consultation</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Annual Wellness Visit\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion\">Annual Wellness Visit</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Face-to-Face Interaction\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1048/expansion\">Face-to-Face Interaction</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Home Healthcare Services\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion\">Home Healthcare Services</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Preventive Care Services Established Office Visit, 18 and Up\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion\">Preventive Care Services - Established Office Visit, 18 and Up</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Preventive Care Services Initial Office Visit, 18 and Up\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion\">Preventive Care Services-Initial Office Visit, 18 and Up</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Preventive Care Services, Initial Office Visit, 0 to 17\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1022/expansion\">Preventive Care Services, Initial Office Visit, 0 to 17</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Preventive Care, Established Office Visit, 0 to 17\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1024/expansion\">Preventive Care, Established Office Visit, 0 to 17</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Telephone Visits\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion\">Telephone Visits</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Preventive Care Services - Other\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.11.1150/expansion\">Preventive Care Services - Other</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 HIV\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.120.12.1003/expansion\">HIV</a></td>\n                                </tr>\n                            \n                        </table>\n                    </td>\n                </tr>\n\n                \n\n                \n                <tr>\n                    <th scope=\"row\"><b>Logic Definitions:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>Group</b></th>\n                                <th><b>Scoring</b></th>\n                                <th><b>Population Criteria</b></th>\n                                <th><b>Expression</b></th>\n                            </tr>\n                            <tr>\n                                \n                                <td> 64998bd84c79454c026f7483 </td>\n                                <td>\n                                    \n                                        <b>Group scoring:</b>\n                                        \n                                            <span>  proportion </span>\n                                        \n                                    \n\n                                    \n\n                                    \n\n                                    \n\n                                    \n\n                                    \n\n                                    \n\n                                    \n\n                                </td>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Initial Population</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  AgeInYearsAt(date from start of &quot;Measurement Period&quot;) &gt;= 13\n    and &quot;Has Qualifying Encounter During Measurement Period&quot;\n    and &quot;Has HIV Diagnosis Before End of Measurement Period&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Denominator&quot;:\n  &quot;Initial Population&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator Exclusion</td>\n                                    <td>\n                                        \n                                            None\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Numerator</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Numerator&quot;:\n  &quot;Has Chlamydia Testing&quot;\n    and &quot;Has Gonorrhea Testing&quot;\n    and &quot;Has Syphilis Testing&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Numerator Exclusion</td>\n                                    <td>\n                                        \n                                            None\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator Exception</td>\n                                    <td>\n                                        \n                                            None\n                                        \n                                    </td>\n                                </tr>\n                                \n                                \n                            \n                            </tr>\n                        </table>\n                \n\n                <table class=\"grid-dict\">\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>HIVSTITestingFHIR</td>\n                            \n                            \n                                <td>Has Chlamydia Testing</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Has Chlamydia Testing&quot;:\n  exists [&quot;Observation&quot;: &quot;Chlamydia Screening&quot;] ChlamydiaTest\n    where ChlamydiaTest.value is not null\n      and QICoreCommon.&quot;Latest&quot; ( ChlamydiaTest.effective ) during day of &quot;Measurement Period&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>HIVSTITestingFHIR</td>\n                            \n                            \n                                <td>Has Gonorrhea Testing</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Has Gonorrhea Testing&quot;:\n  exists [&quot;Observation&quot;: &quot;Gonorrhea Screening&quot;] GonorrheaTest\n    where GonorrheaTest.value is not null\n      and QICoreCommon.&quot;Latest&quot; ( GonorrheaTest.effective ) during day of &quot;Measurement Period&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>HIVSTITestingFHIR</td>\n                            \n                            \n                                <td>Has Syphilis Testing</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Has Syphilis Testing&quot;:\n  exists [&quot;Observation&quot;: &quot;Syphilis Tests&quot;] SyphilisTest\n    where SyphilisTest.value is not null\n      and QICoreCommon.&quot;Latest&quot; ( SyphilisTest.effective ) during day of &quot;Measurement Period&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>HIVSTITestingFHIR</td>\n                            \n                            \n                                <td>Numerator</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Numerator&quot;:\n  &quot;Has Chlamydia Testing&quot;\n    and &quot;Has Gonorrhea Testing&quot;\n    and &quot;Has Syphilis Testing&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>HIVSTITestingFHIR</td>\n                            \n                            \n                                <td>Has Qualifying Encounter During Measurement Period</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Has Qualifying Encounter During Measurement Period&quot;:\n  exists ( ( [&quot;Encounter&quot;: &quot;Office Visit&quot;]\n      union [&quot;Encounter&quot;: &quot;Outpatient Consultation&quot;]\n      union [&quot;Encounter&quot;: &quot;Annual Wellness Visit&quot;]\n      union [&quot;Encounter&quot;: &quot;Face-to-Face Interaction&quot;]\n      union [&quot;Encounter&quot;: &quot;Home Healthcare Services&quot;]\n      union [&quot;Encounter&quot;: &quot;Preventive Care Services Established Office Visit, 18 and Up&quot;]\n      union [&quot;Encounter&quot;: &quot;Preventive Care Services Initial Office Visit, 18 and Up&quot;]\n      union [&quot;Encounter&quot;: &quot;Preventive Care Services, Initial Office Visit, 0 to 17&quot;]\n      union [&quot;Encounter&quot;: &quot;Preventive Care, Established Office Visit, 0 to 17&quot;]\n      union [&quot;Encounter&quot;: &quot;Telephone Visits&quot;]\n      union [&quot;Encounter&quot;: &quot;Preventive Care Services - Other&quot;] ) QualifyingEncounter\n      where QualifyingEncounter.period during day of &quot;Measurement Period&quot;\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>HIVSTITestingFHIR</td>\n                            \n                            \n                                <td>Has HIV Diagnosis Before End of Measurement Period</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Has HIV Diagnosis Before End of Measurement Period&quot;:\n  exists [&quot;Condition&quot;: &quot;HIV&quot;] HIVDx\n    where QICoreCommon.&quot;ToPrevalenceInterval&quot; ( HIVDx ) starts on or before day of end of &quot;Measurement Period&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>HIVSTITestingFHIR</td>\n                            \n                            \n                                <td>Initial Population</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  AgeInYearsAt(date from start of &quot;Measurement Period&quot;) &gt;= 13\n    and &quot;Has Qualifying Encounter During Measurement Period&quot;\n    and &quot;Has HIV Diagnosis Before End of Measurement Period&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>HIVSTITestingFHIR</td>\n                            \n                            \n                                <td>Denominator</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator&quot;:\n  &quot;Initial Population&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>QICoreCommon</td>\n                            \n                            \n                                <td>Latest</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Given an interval, returns the ending point if the interval has an ending boundary specified,\notherwise, returns the starting point\n@deprecated: This function is deprecated. Use the fluent function `latest()` instead\n*/\ndefine function &quot;Latest&quot;(choice Choice&lt;DateTime, Quantity, Interval&lt;DateTime&gt;, Interval&lt;Quantity&gt;&gt; ):\n  (choice.toInterval()) period\n    return\n      if (HasEnd(period)) then end of period\n      else start of period</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>QICoreCommon</td>\n                            \n                            \n                                <td>toInterval</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of DateTime, Quanitty, Interval&lt;DateTime&gt;, or Interval&lt;Quantity&gt; types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in QICore, allowing this function to be used across any resource.\nThe input can be provided as a DateTime, Quantity, Interval&lt;DateTime&gt; or Interval&lt;Quantity&gt;.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.\nIf the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,\nand the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.\nIf the input is a DateTime Interval, the result is the input.\nIf the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result\nis a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending\nimmediately before one year later than the date the patient turned the age given as the end of the quantity interval.\nAny other input will reslt in a null DateTime Interval\n*/\ndefine fluent function toInterval(choice Choice&lt;DateTime, Quantity, Interval&lt;DateTime&gt;, Interval&lt;Quantity&gt;&gt;):\n  case\n\t  when choice is DateTime then\n    \tInterval[choice as DateTime, choice as DateTime]\n\t\twhen choice is Interval&lt;DateTime&gt; then\n  \t\tchoice as Interval&lt;DateTime&gt;\n\t\twhen choice is Quantity then\n\t\t  Interval[Patient.birthDate + (choice as Quantity),\n\t\t\t  Patient.birthDate + (choice as Quantity) + 1 year)\n\t\twhen choice is Interval&lt;Quantity&gt; then\n\t\t  Interval[Patient.birthDate + (choice.low as Quantity),\n\t\t\t  Patient.birthDate + (choice.high as Quantity) + 1 year)\n\t\telse\n\t\t\tnull as Interval&lt;DateTime&gt;\n\tend</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>QICoreCommon</td>\n                            \n                            \n                                <td>ToPrevalenceInterval</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition. If the condition is active, the resulting interval will have\na closed ending boundary. If the condition is not active, the resulting interval will have an open ending boundary.\n@deprecated: This function is deprecated. Use the `prevalenceInterval()` fluent function instead\n*/\ndefine function ToPrevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ &quot;active&quot;\n  or condition.clinicalStatus ~ &quot;recurrence&quot;\n  or condition.clinicalStatus ~ &quot;relapse&quot; then\n  Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition)]\nelse\n  Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition))</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                    </table>\n                </td>\n            </tr>\n            \n        \n    \n\n    </table>\n</div>"
      },
      "contained" : [
        {
          "resourceType" : "Library",
          "id" : "effective-data-requirements",
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "HIVSTITestingFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has Chlamydia Testing"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Has Chlamydia Testing\":\n  exists [\"Observation\": \"Chlamydia Screening\"] ChlamydiaTest\n    where ChlamydiaTest.value is not null\n      and QICoreCommon.\"Latest\" ( ChlamydiaTest.effective ) during day of \"Measurement Period\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 0
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "HIVSTITestingFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has Gonorrhea Testing"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Has Gonorrhea Testing\":\n  exists [\"Observation\": \"Gonorrhea Screening\"] GonorrheaTest\n    where GonorrheaTest.value is not null\n      and QICoreCommon.\"Latest\" ( GonorrheaTest.effective ) during day of \"Measurement Period\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 1
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "HIVSTITestingFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has Syphilis Testing"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Has Syphilis Testing\":\n  exists [\"Observation\": \"Syphilis Tests\"] SyphilisTest\n    where SyphilisTest.value is not null\n      and QICoreCommon.\"Latest\" ( SyphilisTest.effective ) during day of \"Measurement Period\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 2
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "HIVSTITestingFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Numerator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Numerator\":\n  \"Has Chlamydia Testing\"\n    and \"Has Gonorrhea Testing\"\n    and \"Has Syphilis Testing\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 3
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "HIVSTITestingFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has Qualifying Encounter During Measurement Period"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Has Qualifying Encounter During Measurement Period\":\n  exists ( ( [\"Encounter\": \"Office Visit\"]\n      union [\"Encounter\": \"Outpatient Consultation\"]\n      union [\"Encounter\": \"Annual Wellness Visit\"]\n      union [\"Encounter\": \"Face-to-Face Interaction\"]\n      union [\"Encounter\": \"Home Healthcare Services\"]\n      union [\"Encounter\": \"Preventive Care Services Established Office Visit, 18 and Up\"]\n      union [\"Encounter\": \"Preventive Care Services Initial Office Visit, 18 and Up\"]\n      union [\"Encounter\": \"Preventive Care Services, Initial Office Visit, 0 to 17\"]\n      union [\"Encounter\": \"Preventive Care, Established Office Visit, 0 to 17\"]\n      union [\"Encounter\": \"Telephone Visits\"]\n      union [\"Encounter\": \"Preventive Care Services - Other\"] ) QualifyingEncounter\n      where QualifyingEncounter.period during day of \"Measurement Period\"\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 4
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "HIVSTITestingFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has HIV Diagnosis Before End of Measurement Period"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Has HIV Diagnosis Before End of Measurement Period\":\n  exists [\"Condition\": \"HIV\"] HIVDx\n    where QICoreCommon.\"ToPrevalenceInterval\" ( HIVDx ) starts on or before day of end of \"Measurement Period\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 5
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "HIVSTITestingFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Initial Population"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Initial Population\":\n  AgeInYearsAt(date from start of \"Measurement Period\") >= 13\n    and \"Has Qualifying Encounter During Measurement Period\"\n    and \"Has HIV Diagnosis Before End of Measurement Period\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 6
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "HIVSTITestingFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Denominator\":\n  \"Initial Population\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 7
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "Latest"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Given an interval, returns the ending point if the interval has an ending boundary specified,\notherwise, returns the starting point\n@deprecated: This function is deprecated. Use the fluent function `latest()` instead\n*/\ndefine function \"Latest\"(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):\n  (choice.toInterval()) period\n    return\n      if (HasEnd(period)) then end of period\n      else start of period"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 8
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "toInterval"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in QICore, allowing this function to be used across any resource.\nThe input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.\nIf the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,\nand the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.\nIf the input is a DateTime Interval, the result is the input.\nIf the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result\nis a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending\nimmediately before one year later than the date the patient turned the age given as the end of the quantity interval.\nAny other input will reslt in a null DateTime Interval\n*/\ndefine fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>>):\n  case\n\t  when choice is DateTime then\n    \tInterval[choice as DateTime, choice as DateTime]\n\t\twhen choice is Interval<DateTime> then\n  \t\tchoice as Interval<DateTime>\n\t\twhen choice is Quantity then\n\t\t  Interval[Patient.birthDate + (choice as Quantity),\n\t\t\t  Patient.birthDate + (choice as Quantity) + 1 year)\n\t\twhen choice is Interval<Quantity> then\n\t\t  Interval[Patient.birthDate + (choice.low as Quantity),\n\t\t\t  Patient.birthDate + (choice.high as Quantity) + 1 year)\n\t\telse\n\t\t\tnull as Interval<DateTime>\n\tend"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 9
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "ToPrevalenceInterval"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition. If the condition is active, the resulting interval will have\na closed ending boundary. If the condition is not active, the resulting interval will have an open ending boundary.\n@deprecated: This function is deprecated. Use the `prevalenceInterval()` fluent function instead\n*/\ndefine function ToPrevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ \"active\"\n  or condition.clinicalStatus ~ \"recurrence\"\n  or condition.clinicalStatus ~ \"relapse\" then\n  Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition)]\nelse\n  Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition))"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 10
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            }
          ],
          "status" : "active",
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/library-type",
                "code" : "module-definition"
              }
            ]
          },
          "relatedArtifact" : [
            {
              "type" : "depends-on",
              "display" : "Library FHIRHelpers",
              "resource" : "http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers|4.3.000"
            },
            {
              "type" : "depends-on",
              "display" : "Library QICoreCommon",
              "resource" : "http://ecqi.healthit.gov/ecqms/Library/QICoreCommon|1.5.000"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Chlamydia Screening",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1052"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Gonorrhea Screening",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1258.1"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Syphilis Tests",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1166.117"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Office Visit",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Outpatient Consultation",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Annual Wellness Visit",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Face-to-Face Interaction",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1048"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Home Healthcare Services",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Preventive Care Services Established Office Visit, 18 and Up",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Preventive Care Services Initial Office Visit, 18 and Up",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Preventive Care Services, Initial Office Visit, 0 to 17",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Preventive Care, Established Office Visit, 0 to 17",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Telephone Visits",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Preventive Care Services - Other",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.11.1150"
            },
            {
              "type" : "depends-on",
              "display" : "Value set HIV",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003"
            }
          ],
          "parameter" : [
            {
              "name" : "Measurement Period",
              "use" : "in",
              "min" : 0,
              "max" : "1",
              "type" : "Period"
            },
            {
              "name" : "Numerator",
              "use" : "out",
              "min" : 0,
              "max" : "1",
              "type" : "boolean"
            },
            {
              "name" : "Denominator",
              "use" : "out",
              "min" : 0,
              "max" : "1",
              "type" : "boolean"
            },
            {
              "name" : "Initial Population",
              "use" : "out",
              "min" : 0,
              "max" : "1",
              "type" : "boolean"
            }
          ],
          "dataRequirement" : [
            {
              "type" : "Patient",
              "profile" : [
                🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
              ]
            },
            {
              "type" : "Observation",
              "profile" : [
                🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"
              ],
              "mustSupport" : [
                "code",
                "value",
                "effective"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1052"
                }
              ]
            },
            {
              "type" : "Observation",
              "profile" : [
                🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"
              ],
              "mustSupport" : [
                "code",
                "value",
                "effective"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1258.1"
                }
              ]
            },
            {
              "type" : "Observation",
              "profile" : [
                🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"
              ],
              "mustSupport" : [
                "code",
                "value",
                "effective"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1166.117"
                }
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "period"
              ],
              "codeFilter" : [
                {
                  "path" : "type",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
                }
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "period"
              ],
              "codeFilter" : [
                {
                  "path" : "type",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"
                }
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "period"
              ],
              "codeFilter" : [
                {
                  "path" : "type",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"
                }
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "period"
              ],
              "codeFilter" : [
                {
                  "path" : "type",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1048"
                }
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "period"
              ],
              "codeFilter" : [
                {
                  "path" : "type",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"
                }
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "period"
              ],
              "codeFilter" : [
                {
                  "path" : "type",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"
                }
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "period"
              ],
              "codeFilter" : [
                {
                  "path" : "type",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"
                }
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "period"
              ],
              "codeFilter" : [
                {
                  "path" : "type",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022"
                }
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "period"
              ],
              "codeFilter" : [
                {
                  "path" : "type",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024"
                }
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "period"
              ],
              "codeFilter" : [
                {
                  "path" : "type",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"
                }
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "period"
              ],
              "codeFilter" : [
                {
                  "path" : "type",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.11.1150"
                }
              ]
            },
            {
              "type" : "Condition",
              "profile" : [
                🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"
              ],
              "mustSupport" : [
                "code"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003"
                }
              ]
            }
          ]
        }
      ],
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem",
          "valueReference" : {
            "reference" : "Device/cqf-tooling"
          }
        },
        {
          "id" : "effective-data-requirements",
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
          "valueReference" : {
            "reference" : "#effective-data-requirements"
          }
        }
      ],
      "url" : "http://ecqi.healthit.gov/ecqms/Measure/HIVSTITestingFHIR",
      "identifier" : [
        {
          "use" : "usual",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
                "code" : "short-name"
              }
            ]
          },
          "system" : "https://madie.cms.gov/measure/shortName",
          "value" : "CMS1188FHIR"
        },
        {
          "use" : "official",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
                "code" : "version-independent"
              }
            ]
          },
          "system" : "urn:ietf:rfc:3986",
          "value" : "urn:uuid:6f66ca77-1a2c-489c-b0d8-730da6e5a763"
        },
        {
          "use" : "official",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
                "code" : "version-specific"
              }
            ]
          },
          "system" : "urn:ietf:rfc:3986",
          "value" : "urn:uuid:2c92808287dd6f640188b07c4a8a1f35"
        },
        {
          "use" : "official",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
                "code" : "publisher"
              }
            ]
          },
          "system" : "https://madie.cms.gov/measure/cmsId",
          "value" : "1188FHIR",
          "assigner" : {
            "display" : "CMS"
          }
        }
      ],
      "version" : "0.1.000",
      "name" : "HIVSTITestingFHIR",
      "title" : "Sexually Transmitted Infection (STI) Testing for People with HIVFHIR",
      "status" : "draft",
      "experimental" : false,
      "date" : "2023-10-27T08:12:32+00:00",
      "publisher" : "Health Resources & Services Administration",
      "contact" : [
        {
          "telecom" : [
            {
              "system" : "url",
              "value" : " https://www.hrsa.gov/"
            }
          ]
        }
      ],
      "description" : "Percentage of patients 13 years of age and older with a diagnosis of HIV who had tests for syphilis, gonorrhea, and chlamydia performed within the measurement period",
      "useContext" : [
        {
          "code" : {
            "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
            "code" : "program"
          },
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/quality-programs",
                "code" : "ep-ec",
                "display" : "EP/EC"
              }
            ]
          }
        }
      ],
      "purpose" : "UNKNOWN",
      "usage" : "This eCQM is a patient-based measure.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS1188v1.\n\nPlease refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html).",
      "copyright" : "This measure was developed by the Health Resources & Services Administration (HRSA) of the U.S. Department of Health & Human Services (HHS). It is in the public domain.\n \nCitation of HRSA as the source of the original measure is appreciated. Any modified versions may not be represented as approved, endorsed, or authorized by HRSA or HHS. 42 U.S.C. Section 1320b-10. Users of modified versions should clearly explain how they deviate from HRSA's original measure.\n\nLimited 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. \n\nCPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) is copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2022 World Health Organization. All Rights Reserved.\n\nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
      "approvalDate" : "2023-08-11",
      "lastReviewDate" : "2023-08-11",
      "effectivePeriod" : {
        "start" : "2024-01-01",
        "end" : "2024-12-31"
      },
      "author" : [
        {
          "name" : "Health Resources & Services Administration",
          "telecom" : [
            {
              "system" : "url",
              "value" : " https://www.hrsa.gov/"
            }
          ]
        }
      ],
      "library" : [
        🔗 "http://ecqi.healthit.gov/ecqms/Library/HIVSTITestingFHIR"
      ],
      "disclaimer" : "These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.\n\nTHE MEASURES AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.\n\nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
      "rationale" : "The rates of syphilis, gonorrhea, and chlamydia cases per 100,000 in the United States have steadily risen over the last decade and increased 11.2%, 5.9%, and 2.8%, respectively, from 2018 to 2019 (DHHS, 2021). People with HIV are at an increased risk of bacterial sexually transmitted infections (STIs), including chlamydia, gonorrhea, and syphilis (CDC, 2004). However, early detection and treatment of bacterial STIs in people with HIV can lead to a reduction in HIV transmission (CDC, 2004). Despite guidelines for at least annual screening among sexually active persons with HIV, only an estimated 55% received a syphilis test in the past year, 23% received a gonorrhea test in the past year, and 24% received a chlamydia test in the past year based on a nationally-representative survey of adults with HIV receiving medical care in the United States (Flagg et al., 2015). This measure will help providers focus their attention and quality improvement efforts towards testing and treating sexually transmitted infections in patients with HIV, thus reducing the complications to long-term syphilis infection and reducing STI incidence (Patel et al., 2012).",
      "clinicalRecommendationStatement" : "\"Routine serologic screening for syphilis is recommended at least annually for all persons with HIV infection who are sexually active, with more frequent screening (i.e., every 3-6 months) for those who have multiple or anonymous partners\" (Panel on Opportunistic Infections in Adults and Adolescents with HIV, 2022, p. Y-3).\n\n\"Patients undergoing screening or treatment for syphilis also should be evaluated for other sexually transmitted diseases such as chlamydia and gonorrhea at anatomic sites of exposure in men and for chlamydia, gonorrhea, and trichomonas in women\" (Panel on Opportunistic Infections in Adults and Adolescents with HIV, 2022, p. Y-3).\n\n\"The USPSTF recommends screening for syphilis in persons who are at increased risk for infection. When deciding which persons to screen for syphilis, clinicians should consider the prevalence of infection in the communities they serve, as well as other sociodemographic and behavioral factors that may be associated with increased risk of syphilis infection. For example, prevalence of syphilis is higher in men, men who have sex with men, persons with HIV infection, young adults, and persons with a history of incarceration, sex work, or military service…. Optimal screening frequency for persons who are at increased risk for syphilis infection is not well established. Men who have sex with men or persons with HIV infection may benefit from screening at least annually or more frequently (e.g., every 3 to 6 months) if they continue to be at high risk\" (USPSTF, 2022, p. 1244-1246).\n\n\"At the initial HIV care visit, providers should screen all sexually active persons for syphilis, gonorrhea, and chlamydia, and perform screening for these infections at least annually during the course of HIV care. Specific testing includes syphilis serology and [a nucleic acid amplification test] NAAT for N. gonorrhoeae and C. trachomatis at the anatomic site of exposure\" (Workowski et al., 2021, p. 26).",
      "group" : [
        {
          "id" : "64998bd84c79454c026f7483",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
                    "code" : "proportion",
                    "display" : "Proportion"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
              "valueCode" : "boolean"
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-type",
                    "code" : "process",
                    "display" : "Process"
                  }
                ]
              }
            }
          ],
          "population" : [
            {
              "id" : "250DDEF3-2C5A-44DA-BFB9-69734554ACF4",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "initial-population",
                    "display" : "Initial Population"
                  }
                ]
              },
              "description" : "All patients 13 years of age and older at the start of the measurement period with a diagnosis of HIV before the end of the measurement period with an eligible encounter during the measurement period",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Initial Population"
              }
            },
            {
              "id" : "10249168-FCAB-4E5C-AE8E-3D94C9E5BEE7",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "denominator",
                    "display" : "Denominator"
                  }
                ]
              },
              "description" : "Equals Initial Population",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Denominator"
              }
            },
            {
              "id" : "5e85b046-832f-4cea-9d3c-f7d35dda4faf",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "denominator-exclusion",
                    "display" : "Denominator Exclusion"
                  }
                ]
              },
              "criteria" : {
                "language" : "text/cql-identifier"
              }
            },
            {
              "id" : "3C47B2A0-999A-43F1-AF6E-359AC843FD67",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "numerator",
                    "display" : "Numerator"
                  }
                ]
              },
              "description" : "Patients who were tested for each of the following at least once during the measurement period: syphilis, gonorrhea, and chlamydia",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Numerator"
              }
            },
            {
              "id" : "192f31c2-58e6-4192-8d4d-eb0dc07a1cfd",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "numerator-exclusion",
                    "display" : "Numerator Exclusion"
                  }
                ]
              },
              "criteria" : {
                "language" : "text/cql-identifier"
              }
            },
            {
              "id" : "3e946d98-08c5-4a41-a3fc-cba39eaabda7",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "denominator-exception",
                    "display" : "Denominator Exception"
                  }
                ]
              },
              "criteria" : {
                "language" : "text/cql-identifier"
              }
            }
          ]
        }
      ]
    }