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

## : Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract SurgeryFHIR - XML Representation

Draft as of 2023-10-27

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    <Measure xmlns="http://hl7.org/fhir">
      <id value="Cataracts2040BCVAwithin90DaysFHIR"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"/>
        <profile
                 value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"/>
        <profile
                 value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"/>
      </meta>
      <text>
        <status value="extensions"/>
        <div xmlns="http://www.w3.org/1999/xhtml">
        <table class="grid dict">

                <tr>
                    <th scope="row"><b>Title: </b></th>
                    <td style="padding-left: 4px;">Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract SurgeryFHIR</td>
                </tr>

                <tr>
                    <th scope="row"><b>Id: </b></th>
                    <td style="padding-left: 4px;">Cataracts2040BCVAwithin90DaysFHIR</td>
                </tr>

                    <tr>
                        <th scope="row"><b>Download cql: </b></th>
                        <td style="padding-left: 4px;"><a href="Library-Cataracts2040BCVAwithin90DaysFHIR.cql">Cataracts2040BCVAwithin90DaysFHIR.cql</a></td>
                    </tr>

                <tr>
                    <th scope="row"><b>Version: </b></th>
                    <td style="padding-left: 4px;">0.0.007</td>
                </tr>

                <tr>
                    <th scope="row"><b>Url: </b></th>
                    <td style="padding-left: 4px;"><a href="Measure-Cataracts2040BCVAwithin90DaysFHIR.html">Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract SurgeryFHIR</a></td>
                </tr>

                <tr>
                    <th scope="row">
                        <b>

                                    short-name identifier:

                        </b>
                    </th>

                    <td style="padding-left: 4px;">

                            <p style="margin-bottom: 5px;">
                                <span>CMS133FHIR</span>
                            </p>

                    </td>
                </tr>

                <tr>
                    <th scope="row">
                        <b>

                                    version-independent identifier:

                        </b>
                    </th>

                    <td style="padding-left: 4px;">

                            <p style="margin-bottom: 5px;">
                                <span>urn:uuid:84905817-706b-48a8-a8f8-a05436cd6a0e</span>
                            </p>

                    </td>
                </tr>

                <tr>
                    <th scope="row">
                        <b>

                                    version-specific identifier:

                        </b>
                    </th>

                    <td style="padding-left: 4px;">

                            <p style="margin-bottom: 5px;">
                                <span>urn:uuid:71bb8dc6-ca81-48a4-aa82-af4a0df0e92c</span>
                            </p>

                    </td>
                </tr>

                <tr>
                    <th scope="row">
                        <b>

                                    endorser (NQF) identifier:

                        </b>
                    </th>

                    <td style="padding-left: 4px;">

                            <p style="margin-bottom: 5px;">
                                <span>0565e</span>
                            </p>

                    </td>
                </tr>

                <tr>
                    <th scope="row">
                        <b>

                                    publisher (CMS) identifier:

                        </b>
                    </th>

                    <td style="padding-left: 4px;">

                            <p style="margin-bottom: 5px;">
                                <span>133FHIR</span>
                            </p>

                    </td>
                </tr>

                <tr>
                    <th scope="row"><b>Effective Period: </b></th>
                    <td style="padding-left: 4px;">2024-01-01
                        ..2024-12-31</td>
                </tr>

                <tr>
                    <th scope="row"><b>Status: </b></th>
                    <td style="padding-left: 4px;">draft</td>
                </tr>

                <tr>
                    <th scope="row"><b>Date: </b></th>
                    <td style="padding-left: 4px;">2023-10-27 08:12:31+0000</td>
                </tr>

                <tr>
                    <th scope="row"><b>Approval Date: </b></th>
                    <td style="padding-left: 4px;">2023-08-14</td>
                </tr>

                <tr>
                    <th scope="row"><b>Last Review Date: </b></th>
                    <td style="padding-left: 4px;">2023-08-14</td>
                </tr>

                <tr>
                    <th scope="row"><b>Name: </b></th>
                    <td style="padding-left: 4px;">Cataracts2040BCVAwithin90DaysFHIR</td>
                </tr>

                <tr>
                    <th scope="row"><b>Publisher: </b></th>
                    <td style="padding-left: 4px;">American Academy of Ophthalmology</td>
                </tr>

            <tr>
                <th scope="row"><b>Author: </b></th>
                <td style="padding-left: 4px;">American Academy of Ophthalmology: <a href="www.aao.org">www.aao.org</a>, American Medical Association (AMA): <a href="https://www.ama-assn.org/">https://www.ama-assn.org/</a></td>
            </tr>

                <tr>
                    <th scope="row"><b>Description: </b></th>
                    <td style="padding-left: 4px;"><div><p>Percentage of cataract surgeries for patients aged 18 and older with a diagnosis of uncomplicated cataract and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following the cataract surgery</p>
    </div></td>
                </tr>

                <tr>
                    <th scope="row"><b>Use Context: </b></th>
                    <td style="padding-left: 4px;">
                        <table class="grid-dict">
                            <tr>
                                <th><b>code</b></th>
                                <th><b>value</b></th>
                            </tr>

                                <tr>
                                    <td>program</td>
                                    <td/>
                                </tr>

                        </table>
                    </td>
                </tr>

                <tr>
                    <th scope="row"><b>Purpose: </b></th>
                    <td style="padding-left: 4px;"><div><p>UNKNOWN</p>
    </div></td>
                </tr>

                <tr>
                    <th scope="row"><b>Copyright: </b></th>
                    <td style="padding-left: 4px;"><div><p>Copyright 2023 American Academy of Ophthalmology. All Rights Reserved.</p>
    </div></td>
                </tr>

                <tr>
                    <th scope="row"><b>Disclaimer: </b></th>
                    <td style="padding-left: 4px;"><div><p>The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.</p>
    <p>The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain.</p>
    <p>Commercial uses of the Measure require a license agreement between the user and the American Academy of Ophthalmology (Academy). Neither the Academy, PCPI, nor the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor their members shall be responsible for any use of the Measure.</p>
    <p>The PCPI’s and AMA’s significant past efforts and contributions to the development and updating of the Measures are acknowledged. The National Committee for Quality Assurance’s significant past efforts and contributions to the development and updating of the Measure is acknowledged.</p>
    <p>THE MEASURE AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.</p>
    <p>Limited proprietary coding is contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party’s use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measures. Any other use of CPT or other coding by the third party is strictly prohibited. The Academy, its members, the AMA, and former members of the PCPI disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications.</p>
    <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>
    <p>Due to technical limitations, registered trademarks are indicated by (R) or [R].</p>
    </div></td>
                </tr>

            <tr>
                <th scope="row"><b>Rationale: </b></th>
                <td style="padding-left: 4px;"><div><p>In the United States, cataracts affect more than 24 million adults over 40 years (National Eye Institute, 2019). According to the American Academy of Ophthalmology (2021), cataract surgery has a substantial beneficial impact on visual function and on quality of life.</p>
    <ol>
    <li>Scientific basis for measuring visual acuity outcomes after cataract surgery
    The only reason to perform cataract surgery (other than for a limited set of medical indications) is to improve a patient's vision and associated functioning. The use of a 20/40 visual acuity threshold is based on several considerations. First, it is the level for unrestricted operation of a motor vehicle in the US. Second, it has been consistently used by the FDA in its assessment for approval of intraocular lens (IOL) and other vision devices. Third, it is the literature standard to denote success in cataract surgery. Fourth, work by West et al. in the Salisbury Eye Study suggests that 20/40 is a useful threshold for 50th percentile functioning for several vision-related tasks.</li>
    </ol>
    <p>Most patients achieve excellent visual acuity after cataract surgery (20/40 or better). This outcome is achieved consistently through careful attention through the accurate measurement of axial length and corneal power and the appropriate selection of an IOL power calculation formula. As such, it reflects the care and diligence with which the surgery is assessed, planned and executed. Failure to achieve this after surgery in eyes without comorbid ocular conditions that would impact the success of the surgery would reflect care that should be assessed for opportunities for improvement.</p>
    <p>The exclusion of patients with other ocular and systemic conditions known to increase the risk of an adverse outcome reflects the findings of the two published prediction rule papers for cataract surgery outcomes, by Mangione et al. (1995) and Steinberg et al. (1994). In both papers, the presence of comorbid glaucoma and macular degeneration negatively impacted the likelihood of successful outcomes of surgery. Further, as noted in the prior indicator, exclusion of eyes with ocular conditions that could impact the success of the surgery would NOT eliminate the large majority of eyes undergoing surgery while also minimizing the potential adverse selection that might otherwise occur relative to those patients with the most complex situations who might benefit the most from having surgery to maximize their remaining vision.</p>
    <ol start="2">
    <li>Evidence of a gap in care
    Cataract surgery successfully restores vision in the majority of people who have the procedure.</li>
    </ol>
    <p>Data from a study of 368,256 cataract surgeries show that corrected visual acuity (CDVA) of 0.5 (20/40) or better was achieved in 94.3% and CDVA of 1.0 (20/20) or better was achieved in 61.3% of cases (Lundstrom, Barry, Henry, Rosen &amp; Stenevi, 2013).</p>
    <p>Additionally, data from a UK multi-center Cataract National Dataset found a postoperative visual acuity of 6/12 (20/40) or better was achieved for 94.7% of eyes with no co-pathologies and in 79.9% of eyes with one or more co-pathologies (Jaycock et al., 2009).</p>
    <p>A rate of 85.5-94.7% of patients achieving a 20/40 or better visual acuity in the context of approximately 3 million cataract surgeries in the US annually would mean that between 160,000 to 435,000 individuals would not achieve a 20/40 or better visual acuity which suggests an opportunity for improvement.</p>
    </div></td>
            </tr>

            <tr>
                <th scope="row"><b>Clinical recommendation statement: </b></th>
                <td style="padding-left: 4px;"><div><p>This is an outcome measure. As such, there is no statement in the guideline specific to this measurement topic.</p>
    </div></td>
            </tr>

                <tr>
                    <th scope="row"><b>Guidance (Usage): </b></th>
                    <td style="padding-left: 4px;">This eCQM is an episode-based measure. An episode for this measure is defined as each cataract surgery during the measurement period, including instances where more than one cataract procedure was performed during the measurement period. Every cataract surgery during the measurement period should be counted as a measurable denominator event for the measure calculation.

    Only procedures performed during January 1 - September 30 of the reporting period will be considered for this measure, in order to determine if 20/40 or better visual acuity has been achieved within the 90 days following the cataract procedure. Cataract procedures performed during October 1 - December 31 are excluded from the initial population.

    The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional or eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality.

    This measure is to be reported by the clinician performing the cataract surgery procedure. Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure.

    Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible encounter codes.

    This FHIR-based measure has been derived from the QDM-based measure: CMS133v12.

    Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html).</td>
                </tr>

                    <tr>
                        <th scope="row"><b>Population Criteria: </b></th>
                        <td style="padding-left: 4px;">

                                <table class="grid-dict">

                                        <tr>
                                            <th><b>64529e07beb771640fc4cc00</b></th>
                                        </tr>

                                        <tr>
                                            <td>Initial Population:</td>

                                                <td>All cataract surgeries performed between January and September of the measurement period for patients 18 years and older</td>

                                        </tr>

                                        <tr>
                                            <td>Denominator:</td>

                                                <td>Equals Initial Population</td>

                                        </tr>

                                        <tr>
                                            <td>Denominator Exclusion:</td>

                                                <td>Cataract surgeries in patients with significant ocular conditions impacting the visual outcome of surgery</td>

                                        </tr>

                                        <tr>
                                            <td>Numerator:</td>

                                                <td>Cataract surgeries with best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following cataract surgery</td>

                                        </tr>

                                        <tr>
                                            <td>Numerator Exclusion:</td>

                                                <td>None</td>

                                        </tr>

                                        <tr>
                                            <td>Denominator Exception:</td>

                                                <td>None</td>

                                        </tr>

                                </table>

                        </td>
                    </tr>

                <tr>
                    <th scope="row">
                        <b> Supplemental Data Guidance
                            : </b></th>
                    <td style="padding-left: 4px;">  </td>
                </tr>

                <tr>
                    <th scope="row"><b> Supplemental Data Elements: </b></th>
                    <td style="padding-left: 4px;">

                                    SDE Payer

                                    SDE Ethnicity

                                    SDE Race

                                    SDE Sex

                    </td>
                </tr>

                <tr>
                    <th scope="row"><b>Libraries: </b></th>
                    <td style="padding-left: 4px;">
                        <table class="grid-dict">

                                <tr>
                                    <td><a href="Library-Cataracts2040BCVAwithin90DaysFHIR.html">Cataracts2040BCVAwithin90DaysFHIR</a></td>
                                </tr>

                        </table>
                    </td>
                </tr>

                    <tr>
                        <th scope="row"><b>Related Artifact Dependencies: </b></th>
                        <td style="padding-left: 4px;">

                                <li><a href="Library-SupplementalDataElements.html">SupplementalDataElements</a> version: 3.4.000</li>

                                <li><a href="Library-QICoreCommon.html">QICoreCommon</a> version: 1.5.000</li>

                                <li><a href="Library-FHIRHelpers.html">FHIRHelpers</a> version: 4.3.000</li>

                                <li><code>http://hl7.org/fhir/v3/AdministrativeGender</code></li>

                                <li><a href="http://hl7.org/fhir/R4/codesystem-snomedct.html">SNOMED CT (all versions)</a></li>

                                <li><a href="http://terminology.hl7.org/7.1.0/CodeSystem-condition-clinical.html">Condition Clinical Status Codes</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1411/expansion">Cataract Surgery</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1560/expansion">Best Corrected Visual Acuity Exam Using Snellen Chart</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1483/expansion">Visual Acuity 20/40 or Better</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1241/expansion">Acute and Subacute Iridocyclitis</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1448/expansion">Amblyopia</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1409/expansion">Burn Confined to Eye and Adnexa</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1410/expansion">Cataract Secondary to Ocular Disorders</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1412/expansion">Cataract, Congenital</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1413/expansion">Cataract, Mature or Hypermature</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1414/expansion">Cataract, Posterior Polar</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1428/expansion">Central Corneal Ulcer</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1415/expansion">Certain Types of Iridocyclitis</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1450/expansion">Choroidal Degenerations</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1451/expansion">Choroidal Detachment</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1452/expansion">Choroidal Hemorrhage and Rupture</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1416/expansion">Chronic Iridocyclitis</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1417/expansion">Cloudy Cornea</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1418/expansion">Corneal Edema</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1419/expansion">Corneal Opacity and Other Disorders of Cornea</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1453/expansion">Degeneration of Macula and Posterior Pole</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1454/expansion">Degenerative Disorders of Globe</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1455/expansion">Diabetic Macular Edema</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.327/expansion">Diabetic Retinopathy</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1457/expansion">Disorders of Optic Chiasm</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1458/expansion">Disorders of Visual Cortex</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1459/expansion">Disseminated Chorioretinitis and Disseminated Retinochoroiditis</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1460/expansion">Focal Chorioretinitis and Focal Retinochoroiditis</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1423/expansion">Glaucoma</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1461/expansion">Glaucoma Associated with Congenital Anomalies, Dystrophies, and Systemic Syndromes</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1462/expansion">Hereditary Choroidal Dystrophies</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1424/expansion">Hereditary Corneal Dystrophies</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1463/expansion">Hereditary Retinal Dystrophies</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1426/expansion">Hypotony of Eye</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1427/expansion">Injury to Optic Nerve and Pathways</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1559/expansion">Macular Scar of Posterior Polar</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1558/expansion">Morgagnian Cataract</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1465/expansion">Nystagmus and Other Irregular Eye Movements</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1430/expansion">Open Wound of Eyeball</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1466/expansion">Optic Atrophy</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1467/expansion">Optic Neuritis</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1468/expansion">Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1469/expansion">Other Background Retinopathy and Retinal Vascular Changes</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1471/expansion">Other Disorders of Optic Nerve</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1473/expansion">Other Endophthalmitis</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1480/expansion">Other Proliferative Retinopathy</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1432/expansion">Pathologic Myopia</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1433/expansion">Posterior Lenticonus</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1475/expansion">Prior Penetrating Keratoplasty</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1477/expansion">Purulent Endophthalmitis</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1478/expansion">Retinal Detachment with Retinal Defect</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1479/expansion">Retinal Vascular Occlusion</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1438/expansion">Retrolental Fibroplasias</a></li>

                                <li><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113762.1.4.1226.1-20210308">Scleritis</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1482/expansion">Separation of Retinal Layers</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1443/expansion">Traumatic Cataract</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1444/expansion">Uveitis</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1445/expansion">Vascular Disorders of Iris and Ciliary Body</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1446/expansion">Visual Field Defects</a></li>

                        </td>
                    </tr>
                    <tr>
                        <th scope="row"><b>Parameters:</b></th>
                        <td style="padding-left: 4px;">
                            <table class="grid-dict">
                                <tr>
                                    <th><b>name</b></th>
                                    <th><b>use</b></th>
                                    <th><b>min</b></th>
                                    <th><b>max</b></th>
                                    <th><b>type</b></th>
                                </tr>

                                    <tr>
                                        <td>Measurement Period</td>
                                        <td>In</td>
                                        <td>0</td>
                                        <td>1</td>
                                        <td>Period</td>
                                    </tr>

                                    <tr>
                                        <td>SDE Sex</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>1</td>
                                        <td>Coding</td>
                                    </tr>

                                    <tr>
                                        <td>Numerator</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>*</td>
                                        <td>Resource</td>
                                    </tr>

                                    <tr>
                                        <td>Denominator</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>*</td>
                                        <td>Resource</td>
                                    </tr>

                                    <tr>
                                        <td>SDE Payer</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>*</td>
                                        <td>Resource</td>
                                    </tr>

                                    <tr>
                                        <td>Initial Population</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>*</td>
                                        <td>Resource</td>
                                    </tr>

                                    <tr>
                                        <td>SDE Ethnicity</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>1</td>
                                        <td>Resource</td>
                                    </tr>

                                    <tr>
                                        <td>Denominator Exclusions</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>*</td>
                                        <td>Resource</td>
                                    </tr>

                                    <tr>
                                        <td>SDE Race</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>1</td>
                                        <td>Resource</td>
                                    </tr>

                            </table>
                        </td>
                    </tr>

                    <tr>
                        <th scope="row"><b>DataRequirements:</b></th>
                        <td style="padding-left: 4px;">
                            <table class="grid-dict">
                                <tr>
                                    <th><b>Type</b></th>
                                    <th><b>Elements</b></th>
                                    <th><b>Valueset Name</b></th>
                                    <th><b>Valueset</b></th>
                                </tr>

                                    <tr>
                                        <td>Patient(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a>)</td>
                                        <td>

                                                ethnicity

                                                race

                                        </td>
                                        <td>

                                        </td>
                                        <td/>
                                    </tr>

                                    <tr>
                                        <td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
                                        <td>

                                                code

                                                performed

                                                status

                                                status.value

                                        </td>
                                        <td>

                                                     Cataract Surgery

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1411/expansion">Cataract Surgery</a></td>
                                    </tr>

                                    <tr>
                                        <td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
                                        <td>

                                                code

                                                effective

                                                status

                                                status.value

                                                value

                                        </td>
                                        <td>

                                        </td>
                                        <td/>
                                    </tr>

                                    <tr>
                                        <td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
                                        <td>

                                                code

                                                effective

                                                status

                                                status.value

                                                value

                                        </td>
                                        <td>

                                                     Best Corrected Visual Acuity Exam Using Snellen Chart

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1560/expansion">Best Corrected Visual Acuity Exam Using Snellen Chart</a></td>
                                    </tr>

                                    <tr>
                                        <td>Coverage(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html">QICoreCoverage</a>)</td>
                                        <td>

                                                type

                                                period

                                        </td>
                                        <td>

                                                     Payer Type

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Acute and Subacute Iridocyclitis

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1241/expansion">Acute and Subacute Iridocyclitis</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Amblyopia

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1448/expansion">Amblyopia</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Burn Confined to Eye and Adnexa

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1409/expansion">Burn Confined to Eye and Adnexa</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Cataract Secondary to Ocular Disorders

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1410/expansion">Cataract Secondary to Ocular Disorders</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Cataract Congenital

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1412/expansion">Cataract, Congenital</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Cataract Mature or Hypermature

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1413/expansion">Cataract, Mature or Hypermature</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Cataract Posterior Polar

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1414/expansion">Cataract, Posterior Polar</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Central Corneal Ulcer

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1428/expansion">Central Corneal Ulcer</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Certain Types of Iridocyclitis

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1415/expansion">Certain Types of Iridocyclitis</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Choroidal Degenerations

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1450/expansion">Choroidal Degenerations</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Choroidal Detachment

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1451/expansion">Choroidal Detachment</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Choroidal Hemorrhage and Rupture

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1452/expansion">Choroidal Hemorrhage and Rupture</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Chronic Iridocyclitis

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1416/expansion">Chronic Iridocyclitis</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Cloudy Cornea

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1417/expansion">Cloudy Cornea</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Corneal Edema

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1418/expansion">Corneal Edema</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Disorders of Cornea Including Corneal Opacity

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1419/expansion">Corneal Opacity and Other Disorders of Cornea</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Degeneration of Macula and Posterior Pole

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1453/expansion">Degeneration of Macula and Posterior Pole</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Degenerative Disorders of Globe

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1454/expansion">Degenerative Disorders of Globe</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Diabetic Macular Edema

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1455/expansion">Diabetic Macular Edema</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Diabetic Retinopathy

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.327/expansion">Diabetic Retinopathy</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Disorders of Optic Chiasm

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1457/expansion">Disorders of Optic Chiasm</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Disorders of Visual Cortex

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1458/expansion">Disorders of Visual Cortex</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Disseminated Chorioretinitis and Disseminated Retinochoroiditis

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1459/expansion">Disseminated Chorioretinitis and Disseminated Retinochoroiditis</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Focal Chorioretinitis and Focal Retinochoroiditis

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1460/expansion">Focal Chorioretinitis and Focal Retinochoroiditis</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Glaucoma

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1423/expansion">Glaucoma</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1461/expansion">Glaucoma Associated with Congenital Anomalies, Dystrophies, and Systemic Syndromes</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Hereditary Choroidal Dystrophies

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1462/expansion">Hereditary Choroidal Dystrophies</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Hereditary Corneal Dystrophies

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1424/expansion">Hereditary Corneal Dystrophies</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Hereditary Retinal Dystrophies

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1463/expansion">Hereditary Retinal Dystrophies</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Hypotony of Eye

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1426/expansion">Hypotony of Eye</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Injury to Optic Nerve and Pathways

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1427/expansion">Injury to Optic Nerve and Pathways</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Macular Scar of Posterior Polar

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1559/expansion">Macular Scar of Posterior Polar</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Morgagnian Cataract

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1558/expansion">Morgagnian Cataract</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Nystagmus and Other Irregular Eye Movements

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1465/expansion">Nystagmus and Other Irregular Eye Movements</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Open Wound of Eyeball

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1430/expansion">Open Wound of Eyeball</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Optic Atrophy

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1466/expansion">Optic Atrophy</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Optic Neuritis

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1467/expansion">Optic Neuritis</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1468/expansion">Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Other Background Retinopathy and Retinal Vascular Changes

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1469/expansion">Other Background Retinopathy and Retinal Vascular Changes</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Other Disorders of Optic Nerve

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1471/expansion">Other Disorders of Optic Nerve</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Other Endophthalmitis

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1473/expansion">Other Endophthalmitis</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Other Proliferative Retinopathy

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1480/expansion">Other Proliferative Retinopathy</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Pathologic Myopia

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1432/expansion">Pathologic Myopia</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Posterior Lenticonus

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1433/expansion">Posterior Lenticonus</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Prior Penetrating Keratoplasty

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1475/expansion">Prior Penetrating Keratoplasty</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Purulent Endophthalmitis

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1477/expansion">Purulent Endophthalmitis</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Retinal Detachment with Retinal Defect

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1478/expansion">Retinal Detachment with Retinal Defect</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Retinal Vascular Occlusion

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1479/expansion">Retinal Vascular Occlusion</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Retrolental Fibroplasias

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1438/expansion">Retrolental Fibroplasias</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Scleritis

                                        </td>
                                        <td><a href="https://tx.fhir.org/r4/ValueSet/2.16.840.1.113762.1.4.1226.1-20210308">Scleritis</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Separation of Retinal Layers

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1482/expansion">Separation of Retinal Layers</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Traumatic Cataract

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1443/expansion">Traumatic Cataract</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Uveitis

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1444/expansion">Uveitis</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Vascular Disorders of Iris and Ciliary Body

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1445/expansion">Vascular Disorders of Iris and Ciliary Body</a></td>
                                    </tr>

                                    <tr>
                                        <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                        <td>

                                                code

                                        </td>
                                        <td>

                                                     Visual Field Defects

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1446/expansion">Visual Field Defects</a></td>
                                    </tr>

                            </table>
                        </td>
                    </tr>

                        <tr>
                            <th scope="row"><b>Direct Reference Codes:</b></th>
                            <td style="padding-left: 4px;">
                                <table class="grid-dict">
                                    <tr>
                                        <th><b>display</b></th>
                                        <th><b>code</b></th>
                                        <th><b>system</b></th>
                                    </tr>

                                        <tr>
                                            <td>Male</td>
                                            <td>M</td>
                                            <td><a href="http://hl7.org/fhir/v3/AdministrativeGender">http://hl7.org/fhir/v3/AdministrativeGender</a></td>
                                        </tr>

                                        <tr>
                                            <td>Female</td>
                                            <td>F</td>
                                            <td><a href="http://hl7.org/fhir/v3/AdministrativeGender">http://hl7.org/fhir/v3/AdministrativeGender</a></td>
                                        </tr>

                                        <tr>
                                            <td>Best corrected visual acuity (observable entity)</td>
                                            <td>419775003</td>
                                            <td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
                                        </tr>

                                        <tr>
                                            <td/>
                                            <td>active</td>
                                            <td><a href="http://terminology.hl7.org/7.1.0/CodeSystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
                                        </tr>

                                        <tr>
                                            <td/>
                                            <td>recurrence</td>
                                            <td><a href="http://terminology.hl7.org/7.1.0/CodeSystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
                                        </tr>

                                        <tr>
                                            <td/>
                                            <td>relapse</td>
                                            <td><a href="http://terminology.hl7.org/7.1.0/CodeSystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
                                        </tr>

                                </table>
                            </td>
                        </tr>

                    <tr>
                        <th scope="row"><b>Logic Definitions:</b></th>
                        <td style="padding-left: 4px;">

                            <table class="grid-dict">
                                <tr>
                                    <th><b>Group</b></th>
                                    <th><b>Scoring</b></th>
                                    <th><b>Population Criteria</b></th>
                                    <th><b>Expression</b></th>
                                </tr>
                                <tr>

                                    <td> 64529e07beb771640fc4cc00 </td>
                                    <td>

                                            <b>Group scoring:</b>

                                                <span>  proportion </span>

                                    </td>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Initial Population</td>
                                        <td>

                                                <pre><code class="language-cql">define &quot;Initial Population&quot;:
      &quot;Cataract Surgery Between January and September of Measurement Period&quot; CataractSurgeryPerformed
        where AgeInYearsAt(date from start of &quot;Measurement Period&quot;) &gt;= 18</code></pre>

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Denominator</td>
                                        <td>

                                                <pre><code class="language-cql">define &quot;Denominator&quot;:
      &quot;Initial Population&quot;</code></pre>

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Denominator Exclusion</td>
                                        <td>

                                                <pre><code class="language-cql">define &quot;Denominator Exclusions&quot;:
      &quot;Cataract Surgery Between January and September of Measurement Period&quot; CataractSurgeryPerformed
        with ( [Condition: &quot;Acute and Subacute Iridocyclitis&quot;]
          union [Condition: &quot;Amblyopia&quot;]
          union [Condition: &quot;Burn Confined to Eye and Adnexa&quot;]
          union [Condition: &quot;Cataract Secondary to Ocular Disorders&quot;]
          union [Condition: &quot;Cataract Congenital&quot;]
          union [Condition: &quot;Cataract Mature or Hypermature&quot;]
          union [Condition: &quot;Cataract Posterior Polar&quot;]
          union [Condition: &quot;Central Corneal Ulcer&quot;]
          union [Condition: &quot;Certain Types of Iridocyclitis&quot;]
          union [Condition: &quot;Choroidal Degenerations&quot;]
          union [Condition: &quot;Choroidal Detachment&quot;]
          union [Condition: &quot;Choroidal Hemorrhage and Rupture&quot;]
          union [Condition: &quot;Chronic Iridocyclitis&quot;]
          union [Condition: &quot;Cloudy Cornea&quot;]
          union [Condition: &quot;Corneal Edema&quot;]
          union [Condition: &quot;Disorders of Cornea Including Corneal Opacity&quot;]
          union [Condition: &quot;Degeneration of Macula and Posterior Pole&quot;]
          union [Condition: &quot;Degenerative Disorders of Globe&quot;]
          union [Condition: &quot;Diabetic Macular Edema&quot;]
          union [Condition: &quot;Diabetic Retinopathy&quot;]
          union [Condition: &quot;Disorders of Optic Chiasm&quot;]
          union [Condition: &quot;Disorders of Visual Cortex&quot;]
          union [Condition: &quot;Disseminated Chorioretinitis and Disseminated Retinochoroiditis&quot;]
          union [Condition: &quot;Focal Chorioretinitis and Focal Retinochoroiditis&quot;]
          union [Condition: &quot;Glaucoma&quot;]
          union [Condition: &quot;Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes&quot;]
          union [Condition: &quot;Hereditary Choroidal Dystrophies&quot;]
          union [Condition: &quot;Hereditary Corneal Dystrophies&quot;]
          union [Condition: &quot;Hereditary Retinal Dystrophies&quot;]
          union [Condition: &quot;Hypotony of Eye&quot;]
          union [Condition: &quot;Injury to Optic Nerve and Pathways&quot;]
          union [Condition: &quot;Macular Scar of Posterior Polar&quot;]
          union [Condition: &quot;Morgagnian Cataract&quot;]
          union [Condition: &quot;Nystagmus and Other Irregular Eye Movements&quot;]
          union [Condition: &quot;Open Wound of Eyeball&quot;]
          union [Condition: &quot;Optic Atrophy&quot;]
          union [Condition: &quot;Optic Neuritis&quot;]
          union [Condition: &quot;Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis&quot;]
          union [Condition: &quot;Other Background Retinopathy and Retinal Vascular Changes&quot;]
          union [Condition: &quot;Other Disorders of Optic Nerve&quot;]
          union [Condition: &quot;Other Endophthalmitis&quot;]
          union [Condition: &quot;Other Proliferative Retinopathy&quot;]
          union [Condition: &quot;Pathologic Myopia&quot;]
          union [Condition: &quot;Posterior Lenticonus&quot;]
          union [Condition: &quot;Prior Penetrating Keratoplasty&quot;]
          union [Condition: &quot;Purulent Endophthalmitis&quot;]
          union [Condition: &quot;Retinal Detachment with Retinal Defect&quot;]
          union [Condition: &quot;Retinal Vascular Occlusion&quot;]
          union [Condition: &quot;Retrolental Fibroplasias&quot;]
          union [Condition: &quot;Scleritis&quot;]
          union [Condition: &quot;Separation of Retinal Layers&quot;]
          union [Condition: &quot;Traumatic Cataract&quot;]
          union [Condition: &quot;Uveitis&quot;]
          union [Condition: &quot;Vascular Disorders of Iris and Ciliary Body&quot;]
          union [Condition: &quot;Visual Field Defects&quot;] ) ComorbidDiagnosis
          such that ComorbidDiagnosis.prevalenceInterval ( ) overlaps before CataractSurgeryPerformed.performed.toInterval ( )
            and ComorbidDiagnosis.isActive ( )</code></pre>

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Numerator</td>
                                        <td>

                                                <pre><code class="language-cql">define &quot;Numerator&quot;:
      &quot;Cataract Surgery Between January and September of Measurement Period&quot; CataractSurgeryPerformed
        with ( [Observation: &quot;Best corrected visual acuity (observable entity)&quot;]
          union [Observation: &quot;Best Corrected Visual Acuity Exam Using Snellen Chart&quot;] ) VisualAcuityExamPerformed
          such that VisualAcuityExamPerformed.effective.toInterval ( ) 90 days or less after day of end of CataractSurgeryPerformed.performed.toInterval ( )
            and VisualAcuityExamPerformed.status in { 'final', 'amended', 'corrected', 'preliminary' }
            and VisualAcuityExamPerformed.value as Concept in &quot;Visual Acuity 20/40 or Better&quot;</code></pre>

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Numerator Exclusion</td>
                                        <td>

                                                None

                                        </td>
                                    </tr>

                                    <tr>
                                        <td/>
                                        <td/>
                                        <td>Denominator Exception</td>
                                        <td>

                                                None

                                        </td>
                                    </tr>

                                </tr>
                            </table>

                    <table class="grid-dict">

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>SupplementalDataElements</td>

                                    <td>SDE Sex</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Sex&quot;:
      case
          when Patient.gender = 'male' then &quot;M&quot;
          when Patient.gender = 'female' then &quot;F&quot;
          else null
        end</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>Cataracts2040BCVAwithin90DaysFHIR</td>

                                    <td>SDE Sex</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Sex&quot;:
      SDE.&quot;SDE Sex&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>Cataracts2040BCVAwithin90DaysFHIR</td>

                                    <td>Cataract Surgery Between January and September of Measurement Period</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Cataract Surgery Between January and September of Measurement Period&quot;:
      [Procedure: &quot;Cataract Surgery&quot;] CataractSurgery
        where CataractSurgery.performed.toInterval ( ) during &quot;Measurement Period&quot;
          and CataractSurgery.performed.toInterval ( ) starts 92 days or more before end of &quot;Measurement Period&quot;
          and CataractSurgery.status = 'completed'</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>Cataracts2040BCVAwithin90DaysFHIR</td>

                                    <td>Numerator</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Numerator&quot;:
      &quot;Cataract Surgery Between January and September of Measurement Period&quot; CataractSurgeryPerformed
        with ( [Observation: &quot;Best corrected visual acuity (observable entity)&quot;]
          union [Observation: &quot;Best Corrected Visual Acuity Exam Using Snellen Chart&quot;] ) VisualAcuityExamPerformed
          such that VisualAcuityExamPerformed.effective.toInterval ( ) 90 days or less after day of end of CataractSurgeryPerformed.performed.toInterval ( )
            and VisualAcuityExamPerformed.status in { 'final', 'amended', 'corrected', 'preliminary' }
            and VisualAcuityExamPerformed.value as Concept in &quot;Visual Acuity 20/40 or Better&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>Cataracts2040BCVAwithin90DaysFHIR</td>

                                    <td>Initial Population</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Initial Population&quot;:
      &quot;Cataract Surgery Between January and September of Measurement Period&quot; CataractSurgeryPerformed
        where AgeInYearsAt(date from start of &quot;Measurement Period&quot;) &gt;= 18</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>Cataracts2040BCVAwithin90DaysFHIR</td>

                                    <td>Denominator</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Denominator&quot;:
      &quot;Initial Population&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>SupplementalDataElements</td>

                                    <td>SDE Payer</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Payer&quot;:
      [Coverage: type in &quot;Payer Type&quot;] Payer
        return {
          code: Payer.type,
          period: Payer.period
        }</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>Cataracts2040BCVAwithin90DaysFHIR</td>

                                    <td>SDE Payer</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Payer&quot;:
      SDE.&quot;SDE Payer&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>SupplementalDataElements</td>

                                    <td>SDE Ethnicity</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Ethnicity&quot;:
      Patient.ethnicity E
        return Tuple {
          codes: { E.ombCategory } union E.detailed,
          display: E.text
        }</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>Cataracts2040BCVAwithin90DaysFHIR</td>

                                    <td>SDE Ethnicity</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Ethnicity&quot;:
      SDE.&quot;SDE Ethnicity&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>Cataracts2040BCVAwithin90DaysFHIR</td>

                                    <td>Denominator Exclusions</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Denominator Exclusions&quot;:
      &quot;Cataract Surgery Between January and September of Measurement Period&quot; CataractSurgeryPerformed
        with ( [Condition: &quot;Acute and Subacute Iridocyclitis&quot;]
          union [Condition: &quot;Amblyopia&quot;]
          union [Condition: &quot;Burn Confined to Eye and Adnexa&quot;]
          union [Condition: &quot;Cataract Secondary to Ocular Disorders&quot;]
          union [Condition: &quot;Cataract Congenital&quot;]
          union [Condition: &quot;Cataract Mature or Hypermature&quot;]
          union [Condition: &quot;Cataract Posterior Polar&quot;]
          union [Condition: &quot;Central Corneal Ulcer&quot;]
          union [Condition: &quot;Certain Types of Iridocyclitis&quot;]
          union [Condition: &quot;Choroidal Degenerations&quot;]
          union [Condition: &quot;Choroidal Detachment&quot;]
          union [Condition: &quot;Choroidal Hemorrhage and Rupture&quot;]
          union [Condition: &quot;Chronic Iridocyclitis&quot;]
          union [Condition: &quot;Cloudy Cornea&quot;]
          union [Condition: &quot;Corneal Edema&quot;]
          union [Condition: &quot;Disorders of Cornea Including Corneal Opacity&quot;]
          union [Condition: &quot;Degeneration of Macula and Posterior Pole&quot;]
          union [Condition: &quot;Degenerative Disorders of Globe&quot;]
          union [Condition: &quot;Diabetic Macular Edema&quot;]
          union [Condition: &quot;Diabetic Retinopathy&quot;]
          union [Condition: &quot;Disorders of Optic Chiasm&quot;]
          union [Condition: &quot;Disorders of Visual Cortex&quot;]
          union [Condition: &quot;Disseminated Chorioretinitis and Disseminated Retinochoroiditis&quot;]
          union [Condition: &quot;Focal Chorioretinitis and Focal Retinochoroiditis&quot;]
          union [Condition: &quot;Glaucoma&quot;]
          union [Condition: &quot;Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes&quot;]
          union [Condition: &quot;Hereditary Choroidal Dystrophies&quot;]
          union [Condition: &quot;Hereditary Corneal Dystrophies&quot;]
          union [Condition: &quot;Hereditary Retinal Dystrophies&quot;]
          union [Condition: &quot;Hypotony of Eye&quot;]
          union [Condition: &quot;Injury to Optic Nerve and Pathways&quot;]
          union [Condition: &quot;Macular Scar of Posterior Polar&quot;]
          union [Condition: &quot;Morgagnian Cataract&quot;]
          union [Condition: &quot;Nystagmus and Other Irregular Eye Movements&quot;]
          union [Condition: &quot;Open Wound of Eyeball&quot;]
          union [Condition: &quot;Optic Atrophy&quot;]
          union [Condition: &quot;Optic Neuritis&quot;]
          union [Condition: &quot;Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis&quot;]
          union [Condition: &quot;Other Background Retinopathy and Retinal Vascular Changes&quot;]
          union [Condition: &quot;Other Disorders of Optic Nerve&quot;]
          union [Condition: &quot;Other Endophthalmitis&quot;]
          union [Condition: &quot;Other Proliferative Retinopathy&quot;]
          union [Condition: &quot;Pathologic Myopia&quot;]
          union [Condition: &quot;Posterior Lenticonus&quot;]
          union [Condition: &quot;Prior Penetrating Keratoplasty&quot;]
          union [Condition: &quot;Purulent Endophthalmitis&quot;]
          union [Condition: &quot;Retinal Detachment with Retinal Defect&quot;]
          union [Condition: &quot;Retinal Vascular Occlusion&quot;]
          union [Condition: &quot;Retrolental Fibroplasias&quot;]
          union [Condition: &quot;Scleritis&quot;]
          union [Condition: &quot;Separation of Retinal Layers&quot;]
          union [Condition: &quot;Traumatic Cataract&quot;]
          union [Condition: &quot;Uveitis&quot;]
          union [Condition: &quot;Vascular Disorders of Iris and Ciliary Body&quot;]
          union [Condition: &quot;Visual Field Defects&quot;] ) ComorbidDiagnosis
          such that ComorbidDiagnosis.prevalenceInterval ( ) overlaps before CataractSurgeryPerformed.performed.toInterval ( )
            and ComorbidDiagnosis.isActive ( )</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>SupplementalDataElements</td>

                                    <td>SDE Race</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Race&quot;:
      Patient.race R
        return Tuple {
          codes: R.ombCategory union R.detailed,
          display: R.text
        }</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>Cataracts2040BCVAwithin90DaysFHIR</td>

                                    <td>SDE Race</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Race&quot;:
      SDE.&quot;SDE Race&quot;</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>QICoreCommon</td>

                                    <td>toInterval</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">/*
    @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
    @comment: Normalizes a choice type of DateTime, Quanitty, Interval&lt;DateTime&gt;, or Interval&lt;Quantity&gt; types
    to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
    representations for timing-valued elements in QICore, allowing this function to be used across any resource.
    The input can be provided as a DateTime, Quantity, Interval&lt;DateTime&gt; or Interval&lt;Quantity&gt;.
    The intent of this function is to provide a clear and concise mechanism to treat single
    elements that have multiple possible representations as intervals so that logic doesn't have to account
    for the variability. More complex calculations (such as medication request period or dispense period
    calculation) need specific guidance and consideration. That guidance may make use of this function, but
    the focus of this function is on single element calculations where the semantics are unambiguous.
    If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
    If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
    and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
    If the input is a DateTime Interval, the result is the input.
    If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
    is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
    immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
    Any other input will reslt in a null DateTime Interval
    */
    define fluent function toInterval(choice Choice&lt;DateTime, Quantity, Interval&lt;DateTime&gt;, Interval&lt;Quantity&gt;&gt;):
      case
    	  when choice is DateTime then
        	Interval[choice as DateTime, choice as DateTime]
    		when choice is Interval&lt;DateTime&gt; then
      		choice as Interval&lt;DateTime&gt;
    		when choice is Quantity then
    		  Interval[Patient.birthDate + (choice as Quantity),
    			  Patient.birthDate + (choice as Quantity) + 1 year)
    		when choice is Interval&lt;Quantity&gt; then
    		  Interval[Patient.birthDate + (choice.low as Quantity),
    			  Patient.birthDate + (choice.high as Quantity) + 1 year)
    		else
    			null as Interval&lt;DateTime&gt;
    	end</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>FHIRHelpers</td>

                                    <td>ToString</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define function ToString(value uri): value.value</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>FHIRHelpers</td>

                                    <td>ToCode</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">/*
    @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
    */
    define function ToCode(coding FHIR.Coding):
        if coding is null then
            null
        else
            System.Code {
              code: coding.code.value,
              system: coding.system.value,
              version: coding.version.value,
              display: coding.display.value
            }</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>QICoreCommon</td>

                                    <td>prevalenceInterval</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">/*
    @description: Returns an interval representing the normalized prevalence period of a given Condition.
    @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
    onset to abatement as specified in the given Condition. If the condition is active, the resulting interval will have
    a closed ending boundary. If the condition is not active, the resulting interval will have an open ending boundary.
    */
    define fluent function prevalenceInterval(condition Condition):
    if condition.clinicalStatus ~ &quot;active&quot;
      or condition.clinicalStatus ~ &quot;recurrence&quot;
      or condition.clinicalStatus ~ &quot;relapse&quot; then
      Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
    else
      Interval[start of condition.onset.toInterval(), end of condition.abatementInterval())</code></pre>
                                    </td>

                            </tr>

                            <tr>
                                <th><b>Library Name</b></th>
                                <th><b>Name</b></th>
                            </tr>
                            <tr>

                                    <td>QICoreCommon</td>

                                    <td>isActive</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">/* Candidates for FHIRCommon */

    /*
    @description: Returns true if the given condition has a clinical status of active, recurrence, or relapse
    */
    define fluent function isActive(condition Condition):
      condition.clinicalStatus ~ &quot;active&quot;
        or condition.clinicalStatus ~ &quot;recurrence&quot;
        or condition.clinicalStatus ~ &quot;relapse&quot;</code></pre>
                                    </td>

                            </tr>

                        </table>
                    </td>
                </tr>

        </table>
    </div>
      </text>
      <contained>
        <Library>
          <id value="effective-data-requirements"/>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system value="http://hl7.org/fhir/v3/AdministrativeGender"/>
              <code value="M"/>
              <display value="Male"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system value="http://hl7.org/fhir/v3/AdministrativeGender"/>
              <code value="F"/>
              <display value="Female"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system value="http://snomed.info/sct"/>
              <code value="419775003"/>
              <display value="Best corrected visual acuity (observable entity)"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
              <code value="active"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
              <code value="recurrence"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
              <code value="relapse"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="SupplementalDataElements"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Sex"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Sex&quot;:
      case
          when Patient.gender = 'male' then &quot;M&quot;
          when Patient.gender = 'female' then &quot;F&quot;
          else null
        end"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="0"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="Cataracts2040BCVAwithin90DaysFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Sex"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Sex&quot;:
      SDE.&quot;SDE Sex&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="1"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="Cataracts2040BCVAwithin90DaysFHIR"/>
            </extension>
            <extension url="name">
              <valueString
                           value="Cataract Surgery Between January and September of Measurement Period"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Cataract Surgery Between January and September of Measurement Period&quot;:
      [Procedure: &quot;Cataract Surgery&quot;] CataractSurgery
        where CataractSurgery.performed.toInterval ( ) during &quot;Measurement Period&quot;
          and CataractSurgery.performed.toInterval ( ) starts 92 days or more before end of &quot;Measurement Period&quot;
          and CataractSurgery.status = 'completed'"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="2"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="Cataracts2040BCVAwithin90DaysFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Numerator"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Numerator&quot;:
      &quot;Cataract Surgery Between January and September of Measurement Period&quot; CataractSurgeryPerformed
        with ( [Observation: &quot;Best corrected visual acuity (observable entity)&quot;]
          union [Observation: &quot;Best Corrected Visual Acuity Exam Using Snellen Chart&quot;] ) VisualAcuityExamPerformed
          such that VisualAcuityExamPerformed.effective.toInterval ( ) 90 days or less after day of end of CataractSurgeryPerformed.performed.toInterval ( )
            and VisualAcuityExamPerformed.status in { 'final', 'amended', 'corrected', 'preliminary' }
            and VisualAcuityExamPerformed.value as Concept in &quot;Visual Acuity 20/40 or Better&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="3"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="Cataracts2040BCVAwithin90DaysFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Initial Population"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Initial Population&quot;:
      &quot;Cataract Surgery Between January and September of Measurement Period&quot; CataractSurgeryPerformed
        where AgeInYearsAt(date from start of &quot;Measurement Period&quot;) &gt;= 18"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="4"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="Cataracts2040BCVAwithin90DaysFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Denominator"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Denominator&quot;:
      &quot;Initial Population&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="5"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="SupplementalDataElements"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Payer"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Payer&quot;:
      [Coverage: type in &quot;Payer Type&quot;] Payer
        return {
          code: Payer.type,
          period: Payer.period
        }"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="6"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="Cataracts2040BCVAwithin90DaysFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Payer"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Payer&quot;:
      SDE.&quot;SDE Payer&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="7"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="SupplementalDataElements"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Ethnicity"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Ethnicity&quot;:
      Patient.ethnicity E
        return Tuple {
          codes: { E.ombCategory } union E.detailed,
          display: E.text
        }"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="8"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="Cataracts2040BCVAwithin90DaysFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Ethnicity"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Ethnicity&quot;:
      SDE.&quot;SDE Ethnicity&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="9"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="Cataracts2040BCVAwithin90DaysFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Denominator Exclusions"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Denominator Exclusions&quot;:
      &quot;Cataract Surgery Between January and September of Measurement Period&quot; CataractSurgeryPerformed
        with ( [Condition: &quot;Acute and Subacute Iridocyclitis&quot;]
          union [Condition: &quot;Amblyopia&quot;]
          union [Condition: &quot;Burn Confined to Eye and Adnexa&quot;]
          union [Condition: &quot;Cataract Secondary to Ocular Disorders&quot;]
          union [Condition: &quot;Cataract Congenital&quot;]
          union [Condition: &quot;Cataract Mature or Hypermature&quot;]
          union [Condition: &quot;Cataract Posterior Polar&quot;]
          union [Condition: &quot;Central Corneal Ulcer&quot;]
          union [Condition: &quot;Certain Types of Iridocyclitis&quot;]
          union [Condition: &quot;Choroidal Degenerations&quot;]
          union [Condition: &quot;Choroidal Detachment&quot;]
          union [Condition: &quot;Choroidal Hemorrhage and Rupture&quot;]
          union [Condition: &quot;Chronic Iridocyclitis&quot;]
          union [Condition: &quot;Cloudy Cornea&quot;]
          union [Condition: &quot;Corneal Edema&quot;]
          union [Condition: &quot;Disorders of Cornea Including Corneal Opacity&quot;]
          union [Condition: &quot;Degeneration of Macula and Posterior Pole&quot;]
          union [Condition: &quot;Degenerative Disorders of Globe&quot;]
          union [Condition: &quot;Diabetic Macular Edema&quot;]
          union [Condition: &quot;Diabetic Retinopathy&quot;]
          union [Condition: &quot;Disorders of Optic Chiasm&quot;]
          union [Condition: &quot;Disorders of Visual Cortex&quot;]
          union [Condition: &quot;Disseminated Chorioretinitis and Disseminated Retinochoroiditis&quot;]
          union [Condition: &quot;Focal Chorioretinitis and Focal Retinochoroiditis&quot;]
          union [Condition: &quot;Glaucoma&quot;]
          union [Condition: &quot;Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes&quot;]
          union [Condition: &quot;Hereditary Choroidal Dystrophies&quot;]
          union [Condition: &quot;Hereditary Corneal Dystrophies&quot;]
          union [Condition: &quot;Hereditary Retinal Dystrophies&quot;]
          union [Condition: &quot;Hypotony of Eye&quot;]
          union [Condition: &quot;Injury to Optic Nerve and Pathways&quot;]
          union [Condition: &quot;Macular Scar of Posterior Polar&quot;]
          union [Condition: &quot;Morgagnian Cataract&quot;]
          union [Condition: &quot;Nystagmus and Other Irregular Eye Movements&quot;]
          union [Condition: &quot;Open Wound of Eyeball&quot;]
          union [Condition: &quot;Optic Atrophy&quot;]
          union [Condition: &quot;Optic Neuritis&quot;]
          union [Condition: &quot;Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis&quot;]
          union [Condition: &quot;Other Background Retinopathy and Retinal Vascular Changes&quot;]
          union [Condition: &quot;Other Disorders of Optic Nerve&quot;]
          union [Condition: &quot;Other Endophthalmitis&quot;]
          union [Condition: &quot;Other Proliferative Retinopathy&quot;]
          union [Condition: &quot;Pathologic Myopia&quot;]
          union [Condition: &quot;Posterior Lenticonus&quot;]
          union [Condition: &quot;Prior Penetrating Keratoplasty&quot;]
          union [Condition: &quot;Purulent Endophthalmitis&quot;]
          union [Condition: &quot;Retinal Detachment with Retinal Defect&quot;]
          union [Condition: &quot;Retinal Vascular Occlusion&quot;]
          union [Condition: &quot;Retrolental Fibroplasias&quot;]
          union [Condition: &quot;Scleritis&quot;]
          union [Condition: &quot;Separation of Retinal Layers&quot;]
          union [Condition: &quot;Traumatic Cataract&quot;]
          union [Condition: &quot;Uveitis&quot;]
          union [Condition: &quot;Vascular Disorders of Iris and Ciliary Body&quot;]
          union [Condition: &quot;Visual Field Defects&quot;] ) ComorbidDiagnosis
          such that ComorbidDiagnosis.prevalenceInterval ( ) overlaps before CataractSurgeryPerformed.performed.toInterval ( )
            and ComorbidDiagnosis.isActive ( )"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="10"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="SupplementalDataElements"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Race"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Race&quot;:
      Patient.race R
        return Tuple {
          codes: R.ombCategory union R.detailed,
          display: R.text
        }"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="11"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="Cataracts2040BCVAwithin90DaysFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Race"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Race&quot;:
      SDE.&quot;SDE Race&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="12"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="QICoreCommon"/>
            </extension>
            <extension url="name">
              <valueString value="toInterval"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="/*
    @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
    @comment: Normalizes a choice type of DateTime, Quanitty, Interval&lt;DateTime&gt;, or Interval&lt;Quantity&gt; types
    to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
    representations for timing-valued elements in QICore, allowing this function to be used across any resource.
    The input can be provided as a DateTime, Quantity, Interval&lt;DateTime&gt; or Interval&lt;Quantity&gt;.
    The intent of this function is to provide a clear and concise mechanism to treat single
    elements that have multiple possible representations as intervals so that logic doesn't have to account
    for the variability. More complex calculations (such as medication request period or dispense period
    calculation) need specific guidance and consideration. That guidance may make use of this function, but
    the focus of this function is on single element calculations where the semantics are unambiguous.
    If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
    If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
    and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
    If the input is a DateTime Interval, the result is the input.
    If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
    is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
    immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
    Any other input will reslt in a null DateTime Interval
    */
    define fluent function toInterval(choice Choice&lt;DateTime, Quantity, Interval&lt;DateTime&gt;, Interval&lt;Quantity&gt;&gt;):
      case
    	  when choice is DateTime then
        	Interval[choice as DateTime, choice as DateTime]
    		when choice is Interval&lt;DateTime&gt; then
      		choice as Interval&lt;DateTime&gt;
    		when choice is Quantity then
    		  Interval[Patient.birthDate + (choice as Quantity),
    			  Patient.birthDate + (choice as Quantity) + 1 year)
    		when choice is Interval&lt;Quantity&gt; then
    		  Interval[Patient.birthDate + (choice.low as Quantity),
    			  Patient.birthDate + (choice.high as Quantity) + 1 year)
    		else
    			null as Interval&lt;DateTime&gt;
    	end"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="13"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="FHIRHelpers"/>
            </extension>
            <extension url="name">
              <valueString value="ToString"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define function ToString(value uri): value.value"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="14"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="FHIRHelpers"/>
            </extension>
            <extension url="name">
              <valueString value="ToCode"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="/*
    @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
    */
    define function ToCode(coding FHIR.Coding):
        if coding is null then
            null
        else
            System.Code {
              code: coding.code.value,
              system: coding.system.value,
              version: coding.version.value,
              display: coding.display.value
            }"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="15"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="QICoreCommon"/>
            </extension>
            <extension url="name">
              <valueString value="prevalenceInterval"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="/*
    @description: Returns an interval representing the normalized prevalence period of a given Condition.
    @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
    onset to abatement as specified in the given Condition. If the condition is active, the resulting interval will have
    a closed ending boundary. If the condition is not active, the resulting interval will have an open ending boundary.
    */
    define fluent function prevalenceInterval(condition Condition):
    if condition.clinicalStatus ~ &quot;active&quot;
      or condition.clinicalStatus ~ &quot;recurrence&quot;
      or condition.clinicalStatus ~ &quot;relapse&quot; then
      Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
    else
      Interval[start of condition.onset.toInterval(), end of condition.abatementInterval())"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="16"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="QICoreCommon"/>
            </extension>
            <extension url="name">
              <valueString value="isActive"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="/* Candidates for FHIRCommon */

    /*
    @description: Returns true if the given condition has a clinical status of active, recurrence, or relapse
    */
    define fluent function isActive(condition Condition):
      condition.clinicalStatus ~ &quot;active&quot;
        or condition.clinicalStatus ~ &quot;recurrence&quot;
        or condition.clinicalStatus ~ &quot;relapse&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="17"/>
            </extension>
          </extension>
          <status value="active"/>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/library-type"/>
              <code value="module-definition"/>
            </coding>
          </type>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Library SDE"/>
            <resource
                      value="http://ecqi.healthit.gov/ecqms/Library/SupplementalDataElements|3.4.000"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Library QICoreCommon"/>
            <resource
                      value="http://ecqi.healthit.gov/ecqms/Library/QICoreCommon|1.5.000"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Library FHIRHelpers"/>
            <resource
                      value="http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers|4.3.000"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Code system AdministrativeGender"/>
            <resource value="http://hl7.org/fhir/v3/AdministrativeGender"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Code system SNOMEDCT"/>
            <resource value="http://snomed.info/sct"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Code system ConditionClinicalStatusCodes"/>
            <resource
                      value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Cataract Surgery"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1411"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display
                     value="Value set Best Corrected Visual Acuity Exam Using Snellen Chart"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1560"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Visual Acuity 20/40 or Better"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1483"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Payer Type"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Acute and Subacute Iridocyclitis"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1241"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Amblyopia"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1448"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Burn Confined to Eye and Adnexa"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1409"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Cataract Secondary to Ocular Disorders"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1410"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Cataract Congenital"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1412"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Cataract Mature or Hypermature"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1413"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Cataract Posterior Polar"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1414"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Central Corneal Ulcer"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1428"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Certain Types of Iridocyclitis"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1415"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Choroidal Degenerations"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1450"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Choroidal Detachment"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1451"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Choroidal Hemorrhage and Rupture"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1452"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Chronic Iridocyclitis"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1416"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Cloudy Cornea"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1417"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Corneal Edema"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1418"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display
                     value="Value set Disorders of Cornea Including Corneal Opacity"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1419"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Degeneration of Macula and Posterior Pole"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1453"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Degenerative Disorders of Globe"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1454"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Diabetic Macular Edema"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1455"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Diabetic Retinopathy"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.327"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Disorders of Optic Chiasm"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1457"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Disorders of Visual Cortex"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1458"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display
                     value="Value set Disseminated Chorioretinitis and Disseminated Retinochoroiditis"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1459"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display
                     value="Value set Focal Chorioretinitis and Focal Retinochoroiditis"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1460"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Glaucoma"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1423"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display
                     value="Value set Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1461"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Hereditary Choroidal Dystrophies"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1462"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Hereditary Corneal Dystrophies"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1424"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Hereditary Retinal Dystrophies"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1463"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Hypotony of Eye"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1426"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Injury to Optic Nerve and Pathways"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1427"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Macular Scar of Posterior Polar"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1559"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Morgagnian Cataract"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1558"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display
                     value="Value set Nystagmus and Other Irregular Eye Movements"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1465"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Open Wound of Eyeball"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1430"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Optic Atrophy"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1466"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Optic Neuritis"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1467"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display
                     value="Value set Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1468"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display
                     value="Value set Other Background Retinopathy and Retinal Vascular Changes"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1469"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Other Disorders of Optic Nerve"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1471"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Other Endophthalmitis"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1473"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Other Proliferative Retinopathy"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1480"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Pathologic Myopia"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1432"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
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        <value value="133FHIR"/>
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      <name value="Cataracts2040BCVAwithin90DaysFHIR"/>
      <title
             value="Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract SurgeryFHIR"/>
      <status value="draft"/>
      <experimental value="false"/>
      <date value="2023-10-27T08:12:31+00:00"/>
      <publisher value="American Academy of Ophthalmology"/>
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      <description
                   value="Percentage of cataract surgeries for patients aged 18 and older with a diagnosis of uncomplicated cataract and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following the cataract surgery"/>
      <useContext>
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                  value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
          <code value="program"/>
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      <purpose value="UNKNOWN"/>
      <usage
             value="This eCQM is an episode-based measure. An episode for this measure is defined as each cataract surgery during the measurement period, including instances where more than one cataract procedure was performed during the measurement period. Every cataract surgery during the measurement period should be counted as a measurable denominator event for the measure calculation.

    Only procedures performed during January 1 - September 30 of the reporting period will be considered for this measure, in order to determine if 20/40 or better visual acuity has been achieved within the 90 days following the cataract procedure. Cataract procedures performed during October 1 - December 31 are excluded from the initial population.

    The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional or eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality.

    This measure is to be reported by the clinician performing the cataract surgery procedure. Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure.

    Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible encounter codes.

    This FHIR-based measure has been derived from the QDM-based measure: CMS133v12.

    Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html)."/>
      <copyright
                 value="Copyright 2023 American Academy of Ophthalmology. All Rights Reserved."/>
      <approvalDate value="2023-08-14"/>
      <lastReviewDate value="2023-08-14"/>
      <effectivePeriod>
        <start value="2024-01-01"/>
        <end value="2024-12-31"/>
      </effectivePeriod>
      <author>
        <name value="American Academy of Ophthalmology"/>
        <telecom>
          <system value="url"/>
          <value value="www.aao.org"/>
        </telecom>
      </author>
      <author>
        <name value="American Medical Association (AMA)"/>
        <telecom>
          <system value="url"/>
          <value value="https://www.ama-assn.org/"/>
        </telecom>
      </author>
      <library
               value="http://ecqi.healthit.gov/ecqms/Library/Cataracts2040BCVAwithin90DaysFHIR"/>
      <disclaimer
                  value="The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.

    The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain.

    Commercial uses of the Measure require a license agreement between the user and the American Academy of Ophthalmology (Academy). Neither the Academy, PCPI, nor the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor their members shall be responsible for any use of the Measure.

    The PCPI’s and AMA’s significant past efforts and contributions to the development and updating of the Measures are acknowledged. The National Committee for Quality Assurance’s significant past efforts and contributions to the development and updating of the Measure is acknowledged.

    THE MEASURE AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.

    Limited proprietary coding is contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party’s use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measures. Any other use of CPT or other coding by the third party is strictly prohibited. The Academy, its members, the AMA, and former members of the PCPI disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications.

    CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) is copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2022 World Health Organization. All Rights Reserved.

    Due to technical limitations, registered trademarks are indicated by (R) or [R]."/>
      <rationale
                 value="In the United States, cataracts affect more than 24 million adults over 40 years (National Eye Institute, 2019). According to the American Academy of Ophthalmology (2021), cataract surgery has a substantial beneficial impact on visual function and on quality of life.

    1. Scientific basis for measuring visual acuity outcomes after cataract surgery
    The only reason to perform cataract surgery (other than for a limited set of medical indications) is to improve a patient's vision and associated functioning. The use of a 20/40 visual acuity threshold is based on several considerations. First, it is the level for unrestricted operation of a motor vehicle in the US. Second, it has been consistently used by the FDA in its assessment for approval of intraocular lens (IOL) and other vision devices. Third, it is the literature standard to denote success in cataract surgery. Fourth, work by West et al. in the Salisbury Eye Study suggests that 20/40 is a useful threshold for 50th percentile functioning for several vision-related tasks.

    Most patients achieve excellent visual acuity after cataract surgery (20/40 or better). This outcome is achieved consistently through careful attention through the accurate measurement of axial length and corneal power and the appropriate selection of an IOL power calculation formula. As such, it reflects the care and diligence with which the surgery is assessed, planned and executed. Failure to achieve this after surgery in eyes without comorbid ocular conditions that would impact the success of the surgery would reflect care that should be assessed for opportunities for improvement.

    The exclusion of patients with other ocular and systemic conditions known to increase the risk of an adverse outcome reflects the findings of the two published prediction rule papers for cataract surgery outcomes, by Mangione et al. (1995) and Steinberg et al. (1994). In both papers, the presence of comorbid glaucoma and macular degeneration negatively impacted the likelihood of successful outcomes of surgery. Further, as noted in the prior indicator, exclusion of eyes with ocular conditions that could impact the success of the surgery would NOT eliminate the large majority of eyes undergoing surgery while also minimizing the potential adverse selection that might otherwise occur relative to those patients with the most complex situations who might benefit the most from having surgery to maximize their remaining vision.

    2. Evidence of a gap in care
    Cataract surgery successfully restores vision in the majority of people who have the procedure.

    Data from a study of 368,256 cataract surgeries show that corrected visual acuity (CDVA) of 0.5 (20/40) or better was achieved in 94.3% and CDVA of 1.0 (20/20) or better was achieved in 61.3% of cases (Lundstrom, Barry, Henry, Rosen &amp; Stenevi, 2013).

    Additionally, data from a UK multi-center Cataract National Dataset found a postoperative visual acuity of 6/12 (20/40) or better was achieved for 94.7% of eyes with no co-pathologies and in 79.9% of eyes with one or more co-pathologies (Jaycock et al., 2009).

    A rate of 85.5-94.7% of patients achieving a 20/40 or better visual acuity in the context of approximately 3 million cataract surgeries in the US annually would mean that between 160,000 to 435,000 individuals would not achieve a 20/40 or better visual acuity which suggests an opportunity for improvement."/>
      <clinicalRecommendationStatement
                                       value="This is an outcome measure. As such, there is no statement in the guideline specific to this measurement topic."/>
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