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

## : HIV ScreeningFHIR - XML Representation

Draft as of 2023-10-27

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    <Measure xmlns="http://hl7.org/fhir">
      <id value="HIVScreeningFHIR"/>
      <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;">HIV ScreeningFHIR</td>
                </tr>

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

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

                <tr>
                    <th scope="row"><b>Version: </b></th>
                    <td style="padding-left: 4px;">0.0.001</td>
                </tr>

                <tr>
                    <th scope="row"><b>Url: </b></th>
                    <td style="padding-left: 4px;"><a href="Measure-HIVScreeningFHIR.html">HIV ScreeningFHIR</a></td>
                </tr>

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

                                    short-name identifier:

                        </b>
                    </th>

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

                            <p style="margin-bottom: 5px;">
                                <span>CMS349FHIR</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:40b617bf-3054-4663-bf9c-a15417c9a7dc</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:2c928085806c39a2018085c0e0570593</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>349FHIR</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 08:12:32+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;">HIVScreeningFHIR</td>
                </tr>

                <tr>
                    <th scope="row"><b>Publisher: </b></th>
                    <td style="padding-left: 4px;">Centers for Disease Control and Prevention (CDC)</td>
                </tr>

            <tr>
                <th scope="row"><b>Author: </b></th>
                <td style="padding-left: 4px;">Mathematica: <a href="https://www.mathematica.org/">https://www.mathematica.org/</a></td>
            </tr>

                <tr>
                    <th scope="row"><b>Description: </b></th>
                    <td style="padding-left: 4px;"><div><p>Percentage of patients aged 15-65 at the start of the measurement period who were between 15-65 years old when tested for Human immunodeficiency virus (HIV)</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>Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Mathematica disclaims all liability for use or accuracy of any third party codes contained in the specifications.</p>
    <p>CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2022 World Health Organization. All Rights Reserved.</p>
    </div></td>
                </tr>

                <tr>
                    <th scope="row"><b>Disclaimer: </b></th>
                    <td style="padding-left: 4px;"><div><p>The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.</p>
    <p>THE MEASURES AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.</p>
    <p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>
    </div></td>
                </tr>

            <tr>
                <th scope="row"><b>Rationale: </b></th>
                <td style="padding-left: 4px;"><div><p>Human immunodeficiency virus (HIV) is a communicable infection that leads to a progressive disease with a long asymptomatic period. There were an estimated 34,800 new HIV infections in the United States in 2019 (Centers for Disease Control and Prevention, 2021a). Without treatment, most persons develop acquired immunodeficiency syndrome (AIDS) within 10 years of HIV infection. Antiretroviral therapy (ART) delays this progression and increases the length of survival, but it is most effective when initiated during the asymptomatic phase. Persons living with HIV who use ART and achieve viral suppression can have a nearly normal life expectancy (Samji et al., 2013). DHHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents recommends immediate antiretroviral therapy for all HIV-infected individuals, regardless of CD4 count at diagnosis, to reduce the risk of disease progression (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2019).</p>
    <p>CDC estimates that, at the end of 2016, approximately 14% of the 1.1 million adults and adolescents living with HIV infection in the United States were unaware of their infection (Centers for Disease Control and Prevention, 2018b). Among persons diagnosed with HIV in 2017, approximately 21% were diagnosed with Stage 3 HIV (AIDS) at the time of HIV diagnosis (Centers for Disease Control and Prevention, 2019c), which is when the median CD4 count at diagnosis is less than 200 cells/mm3 for persons aged greater than or equal to 6 years (Centers for Disease Control and Prevention, 2019a). HIV screening identifies infected persons who were previously unaware of their infection, which enables them to seek medical and social services that can improve their health and the quality and length of their lives. Additionally, using ART with high levels of medication adherence has been shown to substantially reduce risk for HIV transmission (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2019).</p>
    <p>Based on the Behavioral Risk Factor Surveillance System (BRFSS), the percentage of ever tested for HIV increased from 42.9% in 2011 to 45.9% in 2017. Despite this increase, less than half of US adults have ever been tested for HIV over ten years after CDC’s recommendations (Patel et al., 2019).</p>
    </div></td>
            </tr>

            <tr>
                <th scope="row"><b>Clinical recommendation statement: </b></th>
                <td style="padding-left: 4px;"><div><p>The US Preventive Services Task Force recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened (A Recommendation) (Owens, et al., 2019).</p>
    <p>Since 2006, the CDC has recommended routine opt-out HIV screening (i.e., patient is notified that testing will be performed unless the patient declines) in healthcare facilities of adolescents and adults 13-64 years of age and HIV diagnostic testing of adolescents and adults with clinical signs or symptoms consistent with HIV infection (Centers for Disease Control and Prevention, 2006).</p>
    </div></td>
            </tr>

                <tr>
                    <th scope="row"><b>Guidance (Usage): </b></th>
                    <td style="padding-left: 4px;">This measure evaluates the proportion of patients aged 15 to 65 at the start of the measurement period who have documentation of having received an HIV test at least once on or after their 15th birthday and before their 66th birthday. In order to satisfy the measure, the reporting provider must have documentation of the administration of the laboratory test present in the patient's medical record. In cases where the HIV test was performed elsewhere, providers cannot rely on patient attestation or self-report to meet the measure requirements, as previous research has shown that patient self-report is an unreliable indicator of previous HIV testing history. Rather, providers must request documentation of those test results. If such documentation is not available, the patient should be considered still eligible for HIV screening. If such documentation is available, but cannot be provided in a standardized, structured format (such that the lab test and results can be readily incorporated as structured data within the EHR), providers should enter the information into their EHR as a laboratory test in a manner consistent with the EHR in use. If the specific Human Immunodeficiency Virus (HIV) Laboratory Test LOINC code of the test is not known, the entry should use the more generic code LOINC panel code [75622-1].

    This eCQM is a patient-based measure.

    This FHIR-based measure has been derived from the QDM-based measure: CMS349v6.

    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>6385057e4ba3d47c885c02cc</b></th>
                                        </tr>

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

                                                <td>Patients 15 to 65 years of age at the start of the measurement period AND who had at least one outpatient visit during the measurement period</td>

                                        </tr>

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

                                                <td>Equals Initial Population</td>

                                        </tr>

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

                                                <td>Patients diagnosed with HIV prior to the start of the measurement period</td>

                                        </tr>

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

                                                <td>None</td>

                                        </tr>

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

                                                <td>Patients with documentation of an HIV test performed on or after their 15th birthday and before their 66th birthday</td>

                                        </tr>

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

                                    SDE Payer

                                    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-HIVScreeningFHIR.html">HIVScreeningFHIR</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://tx.fhir.org/r4/ValueSet/x-loinc2.82">LOINC</a></li>

                                <li><a href="http://terminology.hl7.org/7.1.0/CodeSystem-v3-ActCode.html">ActCode</a></li>

                                <li><a href="http://terminology.hl7.org/7.1.0/CodeSystem-condition-ver-status.html">ConditionVerificationStatus</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1056.50/expansion">Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag)</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1022/expansion">Preventive Care Services, Initial Office Visit, 0 to 17</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion">Preventive Care Services-Initial Office Visit, 18 and Up</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1024/expansion">Preventive Care, Established Office Visit, 0 to 17</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion">Preventive Care Services - Established Office Visit, 18 and Up</a></li>

                                <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion">Office Visit</a></li>

                                <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/2.16.840.1.113883.3.464.1003.120.12.1003/expansion">HIV</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>1</td>
                                        <td>boolean</td>
                                    </tr>

                                    <tr>
                                        <td>Denominator</td>
                                        <td>Out</td>
                                        <td>0</td>
                                        <td>1</td>
                                        <td>boolean</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>1</td>
                                        <td>boolean</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>1</td>
                                        <td>boolean</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>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

                                        </td>
                                        <td>

                                                     Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag)

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1056.50/expansion">Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag)</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

                                        </td>
                                        <td>

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

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

                                                type

                                                period

                                                class

                                                status

                                                status.value

                                        </td>
                                        <td>

                                                     Preventive Care Services, Initial Office Visit, 0 to 17

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1022/expansion">Preventive Care Services, Initial Office Visit, 0 to 17</a></td>
                                    </tr>

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

                                                type

                                                period

                                                class

                                                status

                                                status.value

                                        </td>
                                        <td>

                                                     Preventive Care Services-Initial Office Visit, 18 and Up

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion">Preventive Care Services-Initial Office Visit, 18 and Up</a></td>
                                    </tr>

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

                                                type

                                                period

                                                class

                                                status

                                                status.value

                                        </td>
                                        <td>

                                                     Preventive Care, Established Office Visit, 0 to 17

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1024/expansion">Preventive Care, Established Office Visit, 0 to 17</a></td>
                                    </tr>

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

                                                type

                                                period

                                                class

                                                status

                                                status.value

                                        </td>
                                        <td>

                                                     Preventive Care Services - Established Office Visit, 18 and Up

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion">Preventive Care Services - Established Office Visit, 18 and Up</a></td>
                                    </tr>

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

                                                type

                                                period

                                                class

                                                status

                                                status.value

                                        </td>
                                        <td>

                                                     Office Visit

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion">Office Visit</a></td>
                                    </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

                                                verificationStatus

                                        </td>
                                        <td>

                                                     HIV

                                        </td>
                                        <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.120.12.1003/expansion">HIV</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>HIV 1 and 2 tests - Meaningful Use set</td>
                                            <td>75622-1</td>
                                            <td><a href="https://loinc.org/">http://loinc.org</a></td>
                                        </tr>

                                        <tr>
                                            <td>Ambulatory</td>
                                            <td>AMB</td>
                                            <td><a href="http://terminology.hl7.org/7.1.0/CodeSystem-v3-ActCode.html">http://terminology.hl7.org/CodeSystem/v3-ActCode</a></td>
                                        </tr>

                                        <tr>
                                            <td/>
                                            <td>refuted</td>
                                            <td><a href="http://terminology.hl7.org/7.1.0/CodeSystem-condition-ver-status.html">http://terminology.hl7.org/CodeSystem/condition-ver-status</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> 6385057e4ba3d47c885c02cc </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;:
      AgeInYearsAt(date from start of &quot;Measurement Period&quot;) in Interval[15, 65]
        and exists &quot;Qualifying Encounters&quot;</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;:
      exists ( [&quot;Condition&quot;: &quot;HIV&quot;] HIV
          where QICoreCommon.&quot;ToPrevalenceInterval&quot; ( HIV Indicators ) starts before start of &quot;Measurement Period&quot;
            and HIV.verificationStatus !~ &quot;refuted&quot;
      )</code></pre>

                                        </td>
                                    </tr>

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

                                                None

                                        </td>
                                    </tr>

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

                                                <pre><code class="language-cql">define &quot;Numerator&quot;:
      ( &quot;Has HIV Test Performed&quot; )</code></pre>

                                        </td>
                                    </tr>

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

                                    <td>Has HIV Test Performed</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Has HIV Test Performed&quot;:
      exists ( [&quot;Observation&quot;: &quot;Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag)&quot;]
        union [&quot;Observation&quot;: &quot;HIV 1 and 2 tests - Meaningful Use set&quot;] ) HIVTest
        where AgeInYearsAt(date from start of QICoreCommon.&quot;ToInterval&quot;(HIVTest.effective)) in Interval[15, 65]
          and QICoreCommon.&quot;ToInterval&quot; ( HIVTest.effective ) starts before end of &quot;Measurement Period&quot;
          and ( HIVTest.status = 'final'
              or HIVTest.status = 'amended'
              or HIVTest.status = 'corrected'
          )</code></pre>
                                    </td>

                            </tr>

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

                                    <td>HIVScreeningFHIR</td>

                                    <td>Numerator</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Numerator&quot;:
      ( &quot;Has HIV Test Performed&quot; )</code></pre>
                                    </td>

                            </tr>

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

                                    <td>HIVScreeningFHIR</td>

                                    <td>Qualifying Encounters</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Qualifying Encounters&quot;:
      ( [&quot;Encounter&quot;: &quot;Preventive Care Services, Initial Office Visit, 0 to 17&quot;]
        union [&quot;Encounter&quot;: &quot;Preventive Care Services-Initial Office Visit, 18 and Up&quot;]
        union [&quot;Encounter&quot;: &quot;Preventive Care, Established Office Visit, 0 to 17&quot;]
        union [&quot;Encounter&quot;: &quot;Preventive Care Services - Established Office Visit, 18 and Up&quot;]
        union [&quot;Encounter&quot;: &quot;Office Visit&quot;] ) Encounter
        where Encounter.period during &quot;Measurement Period&quot;
          and Encounter.class ~ &quot;AMB&quot;
          and Encounter.status = 'finished'</code></pre>
                                    </td>

                            </tr>

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

                                    <td>HIVScreeningFHIR</td>

                                    <td>Initial Population</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Initial Population&quot;:
      AgeInYearsAt(date from start of &quot;Measurement Period&quot;) in Interval[15, 65]
        and exists &quot;Qualifying Encounters&quot;</code></pre>
                                    </td>

                            </tr>

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

                                    <td>HIVScreeningFHIR</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>HIVScreeningFHIR</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>HIVScreeningFHIR</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>HIVScreeningFHIR</td>

                                    <td>Denominator Exclusions</td>

                            </tr>
                            <tr>

                                    <td/>
                                    <td>
                                        <pre class="highlight language-cql"><code class="language-cql">define &quot;Denominator Exclusions&quot;:
      exists ( [&quot;Condition&quot;: &quot;HIV&quot;] HIV
          where QICoreCommon.&quot;ToPrevalenceInterval&quot; ( HIV Indicators ) starts before start of &quot;Measurement Period&quot;
            and HIV.verificationStatus !~ &quot;refuted&quot;
      )</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>HIVScreeningFHIR</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
    @deprecated: This function is deprecated. Use the fluent function `toInterval()` instead
    */
    define 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)
    		when choice is QICore.Timing then
                null as Interval&lt;DateTime&gt;
    		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>ToPrevalenceInterval</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.
    @deprecated: This function is deprecated. Use the `prevalenceInterval()` fluent function instead
    */
    define function ToPrevalenceInterval(condition Condition):
    if condition.clinicalStatus ~ &quot;active&quot;
      or condition.clinicalStatus ~ &quot;recurrence&quot;
      or condition.clinicalStatus ~ &quot;relapse&quot; then
      Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition)]
    else
      Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition))</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://loinc.org"/>
              <code value="75622-1"/>
              <display value="HIV 1 and 2 tests - Meaningful Use set"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
              <code value="AMB"/>
              <display value="Ambulatory"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
            <valueCoding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
              <code value="refuted"/>
            </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="HIVScreeningFHIR"/>
            </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="HIVScreeningFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Has HIV Test Performed"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Has HIV Test Performed&quot;:
      exists ( [&quot;Observation&quot;: &quot;Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag)&quot;]
        union [&quot;Observation&quot;: &quot;HIV 1 and 2 tests - Meaningful Use set&quot;] ) HIVTest
        where AgeInYearsAt(date from start of QICoreCommon.&quot;ToInterval&quot;(HIVTest.effective)) in Interval[15, 65]
          and QICoreCommon.&quot;ToInterval&quot; ( HIVTest.effective ) starts before end of &quot;Measurement Period&quot;
          and ( HIVTest.status = 'final'
              or HIVTest.status = 'amended'
              or HIVTest.status = 'corrected'
          )"/>
            </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="HIVScreeningFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Numerator"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Numerator&quot;:
      ( &quot;Has HIV Test Performed&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="HIVScreeningFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Qualifying Encounters"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Qualifying Encounters&quot;:
      ( [&quot;Encounter&quot;: &quot;Preventive Care Services, Initial Office Visit, 0 to 17&quot;]
        union [&quot;Encounter&quot;: &quot;Preventive Care Services-Initial Office Visit, 18 and Up&quot;]
        union [&quot;Encounter&quot;: &quot;Preventive Care, Established Office Visit, 0 to 17&quot;]
        union [&quot;Encounter&quot;: &quot;Preventive Care Services - Established Office Visit, 18 and Up&quot;]
        union [&quot;Encounter&quot;: &quot;Office Visit&quot;] ) Encounter
        where Encounter.period during &quot;Measurement Period&quot;
          and Encounter.class ~ &quot;AMB&quot;
          and Encounter.status = 'finished'"/>
            </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="HIVScreeningFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Initial Population"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Initial Population&quot;:
      AgeInYearsAt(date from start of &quot;Measurement Period&quot;) in Interval[15, 65]
        and exists &quot;Qualifying Encounters&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="HIVScreeningFHIR"/>
            </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="6"/>
            </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="7"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="HIVScreeningFHIR"/>
            </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="8"/>
            </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="9"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="HIVScreeningFHIR"/>
            </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="10"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="HIVScreeningFHIR"/>
            </extension>
            <extension url="name">
              <valueString value="Denominator Exclusions"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Denominator Exclusions&quot;:
      exists ( [&quot;Condition&quot;: &quot;HIV&quot;] HIV
          where QICoreCommon.&quot;ToPrevalenceInterval&quot; ( HIV Indicators ) starts before start of &quot;Measurement Period&quot;
            and HIV.verificationStatus !~ &quot;refuted&quot;
      )"/>
            </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="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="12"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
            <extension url="libraryName">
              <valueString value="HIVScreeningFHIR"/>
            </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="13"/>
            </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
    @deprecated: This function is deprecated. Use the fluent function `toInterval()` instead
    */
    define 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)
    		when choice is QICore.Timing then
                null as Interval&lt;DateTime&gt;
    		else
    			null as Interval&lt;DateTime&gt;
    	end"/>
            </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="ToString"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define function ToString(value uri): value.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="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="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="ToPrevalenceInterval"/>
            </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.
    @deprecated: This function is deprecated. Use the `prevalenceInterval()` fluent function instead
    */
    define function ToPrevalenceInterval(condition Condition):
    if condition.clinicalStatus ~ &quot;active&quot;
      or condition.clinicalStatus ~ &quot;recurrence&quot;
      or condition.clinicalStatus ~ &quot;relapse&quot; then
      Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition)]
    else
      Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition))"/>
            </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 LOINC"/>
            <resource value="http://loinc.org"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Code system ActCode"/>
            <resource value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Code system ConditionVerificationStatus"/>
            <resource
                      value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display
                     value="Value set Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag)"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1056.50"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display
                     value="Value set Preventive Care Services, Initial Office Visit, 0 to 17"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display
                     value="Value set Preventive Care Services-Initial Office Visit, 18 and Up"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display
                     value="Value set Preventive Care, Established Office Visit, 0 to 17"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display
                     value="Value set Preventive Care Services - Established Office Visit, 18 and Up"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Office Visit"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
          </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 HIV"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003"/>
          </relatedArtifact>
          <parameter>
            <name value="Measurement Period"/>
            <use value="in"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Period"/>
          </parameter>
          <parameter>
            <name value="SDE Sex"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Coding"/>
          </parameter>
          <parameter>
            <name value="Numerator"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="boolean"/>
          </parameter>
          <parameter>
            <name value="Denominator"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="boolean"/>
          </parameter>
          <parameter>
            <name value="SDE Payer"/>
            <use value="out"/>
            <min value="0"/>
            <max value="*"/>
            <type value="Resource"/>
          </parameter>
          <parameter>
            <name value="Initial Population"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="boolean"/>
          </parameter>
          <parameter>
            <name value="SDE Ethnicity"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Resource"/>
          </parameter>
          <parameter>
            <name value="Denominator Exclusions"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="boolean"/>
          </parameter>
          <parameter>
            <name value="SDE Race"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Resource"/>
          </parameter>
          <dataRequirement>
            <type value="Patient"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
            <mustSupport value="ethnicity"/>
            <mustSupport value="race"/>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="effective"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1056.50"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="effective"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <codeFilter>
              <path value="code"/>
              <code>
                <system value="http://loinc.org"/>
                <code value="75622-1"/>
                <display value="HIV 1 and 2 tests - Meaningful Use set"/>
              </code>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <mustSupport value="class"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <mustSupport value="class"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <mustSupport value="class"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <mustSupport value="class"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <mustSupport value="class"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Coverage"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Condition"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
            <mustSupport value="code"/>
            <mustSupport value="verificationStatus"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003"/>
            </codeFilter>
            <codeFilter>
              <path value="verificationStatus"/>
            </codeFilter>
          </dataRequirement>
        </Library>
      </contained>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" id="supplementalDataGuidance">
        <extension url="guidance"/>
        <extension url="usage">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
              <code value="supplemental-data"/>
              <display value="Supplemental Data"/>
            </coding>
            <text value="Supplemental Data Guidance"/>
          </valueCodeableConcept>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem">
        <valueReference>
          <reference value="Device/cqf-tooling"/>
        </valueReference>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements" id="effective-data-requirements">
        <valueReference>
          <reference value="#effective-data-requirements"/>
        </valueReference>
      </extension>
      <url value="http://ecqi.healthit.gov/ecqms/Measure/HIVScreeningFHIR"/>
      <identifier>
        <use value="usual"/>
        <type>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
            <code value="short-name"/>
          </coding>
        </type>
        <system value="https://madie.cms.gov/measure/shortName"/>
        <value value="CMS349FHIR"/>
      </identifier>
      <identifier>
        <use value="official"/>
        <type>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
            <code value="version-independent"/>
          </coding>
        </type>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:uuid:40b617bf-3054-4663-bf9c-a15417c9a7dc"/>
      </identifier>
      <identifier>
        <use value="official"/>
        <type>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
            <code value="version-specific"/>
          </coding>
        </type>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:uuid:2c928085806c39a2018085c0e0570593"/>
      </identifier>
      <identifier>
        <use value="official"/>
        <type>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
            <code value="publisher"/>
          </coding>
        </type>
        <system value="https://madie.cms.gov/measure/cmsId"/>
        <value value="349FHIR"/>
        <assigner>
          <display value="CMS"/>
        </assigner>
      </identifier>
      <version value="0.0.001"/>
      <name value="HIVScreeningFHIR"/>
      <title value="HIV ScreeningFHIR"/>
      <status value="draft"/>
      <experimental value="false"/>
      <date value="2023-10-27T08:12:32+00:00"/>
      <publisher value="Centers for Disease Control and Prevention (CDC)"/>
      <contact>
        <telecom>
          <system value="url"/>
          <value value="www.cdc.gov/hiv/"/>
        </telecom>
      </contact>
      <description
                   value="Percentage of patients aged 15-65 at the start of the measurement period who were between 15-65 years old when tested for Human immunodeficiency virus (HIV)"/>
      <useContext>
        <code>
          <system
                  value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
          <code value="program"/>
        </code>
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/quality-programs"/>
            <code value="ep-ec"/>
            <display value="EP/EC"/>
          </coding>
        </valueCodeableConcept>
      </useContext>
      <purpose value="UNKNOWN"/>
      <usage
             value="This measure evaluates the proportion of patients aged 15 to 65 at the start of the measurement period who have documentation of having received an HIV test at least once on or after their 15th birthday and before their 66th birthday. In order to satisfy the measure, the reporting provider must have documentation of the administration of the laboratory test present in the patient's medical record. In cases where the HIV test was performed elsewhere, providers cannot rely on patient attestation or self-report to meet the measure requirements, as previous research has shown that patient self-report is an unreliable indicator of previous HIV testing history. Rather, providers must request documentation of those test results. If such documentation is not available, the patient should be considered still eligible for HIV screening. If such documentation is available, but cannot be provided in a standardized, structured format (such that the lab test and results can be readily incorporated as structured data within the EHR), providers should enter the information into their EHR as a laboratory test in a manner consistent with the EHR in use. If the specific Human Immunodeficiency Virus (HIV) Laboratory Test LOINC code of the test is not known, the entry should use the more generic code LOINC panel code [75622-1].

    This eCQM is a patient-based measure.

    This FHIR-based measure has been derived from the QDM-based measure: CMS349v6.

    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="Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Mathematica disclaims all liability for use or accuracy of any third party codes contained in the specifications.

    CPT(R) contained in the Measure specifications is copyright 2004-2022 American Medical Association. LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2022 World Health Organization. All Rights Reserved."/>
      <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="Mathematica"/>
        <telecom>
          <system value="url"/>
          <value value="https://www.mathematica.org/"/>
        </telecom>
      </author>
      <library value="http://ecqi.healthit.gov/ecqms/Library/HIVScreeningFHIR"/>
      <disclaimer
                  value="The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.

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

    Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]."/>
      <rationale
                 value="Human immunodeficiency virus (HIV) is a communicable infection that leads to a progressive disease with a long asymptomatic period. There were an estimated 34,800 new HIV infections in the United States in 2019 (Centers for Disease Control and Prevention, 2021a). Without treatment, most persons develop acquired immunodeficiency syndrome (AIDS) within 10 years of HIV infection. Antiretroviral therapy (ART) delays this progression and increases the length of survival, but it is most effective when initiated during the asymptomatic phase. Persons living with HIV who use ART and achieve viral suppression can have a nearly normal life expectancy (Samji et al., 2013). DHHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents recommends immediate antiretroviral therapy for all HIV-infected individuals, regardless of CD4 count at diagnosis, to reduce the risk of disease progression (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2019).

    CDC estimates that, at the end of 2016, approximately 14% of the 1.1 million adults and adolescents living with HIV infection in the United States were unaware of their infection (Centers for Disease Control and Prevention, 2018b). Among persons diagnosed with HIV in 2017, approximately 21% were diagnosed with Stage 3 HIV (AIDS) at the time of HIV diagnosis (Centers for Disease Control and Prevention, 2019c), which is when the median CD4 count at diagnosis is less than 200 cells/mm3 for persons aged greater than or equal to 6 years (Centers for Disease Control and Prevention, 2019a). HIV screening identifies infected persons who were previously unaware of their infection, which enables them to seek medical and social services that can improve their health and the quality and length of their lives. Additionally, using ART with high levels of medication adherence has been shown to substantially reduce risk for HIV transmission (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2019).

    Based on the Behavioral Risk Factor Surveillance System (BRFSS), the percentage of ever tested for HIV increased from 42.9% in 2011 to 45.9% in 2017. Despite this increase, less than half of US adults have ever been tested for HIV over ten years after CDC’s recommendations (Patel et al., 2019)."/>
      <clinicalRecommendationStatement
                                       value="The US Preventive Services Task Force recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened (A Recommendation) (Owens, et al., 2019).

    Since 2006, the CDC has recommended routine opt-out HIV screening (i.e., patient is notified that testing will be performed unless the patient declines) in healthcare facilities of adolescents and adults 13-64 years of age and HIV diagnostic testing of adolescents and adults with clinical signs or symptoms consistent with HIV infection (Centers for Disease Control and Prevention, 2006)."/>
      <group id="6385057e4ba3d47c885c02cc">
        <extension
                   url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
              <code value="proportion"/>
              <display value="Proportion"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
          <valueCode value="boolean"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
          <valueCodeableConcept>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
              <code value="process"/>
              <display value="Process"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <population id="C2A7E87A-490A-499A-8963-64BA2572F8E8">
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="initial-population"/>
              <display value="Initial Population"/>
            </coding>
          </code>
          <description
                       value="Patients 15 to 65 years of age at the start of the measurement period AND who had at least one outpatient visit during the measurement period"/>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Initial Population"/>
          </criteria>
        </population>
        <population id="7BA5ADB3-C957-4597-92B1-F524798034AA">
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="denominator"/>
              <display value="Denominator"/>
            </coding>
          </code>
          <description value="Equals Initial Population"/>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Denominator"/>
          </criteria>
        </population>
        <population id="2FB4D48E-45CA-45E4-BF78-1A9A74E74E36">
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="denominator-exclusion"/>
              <display value="Denominator Exclusion"/>
            </coding>
          </code>
          <description
                       value="Patients diagnosed with HIV prior to the start of the measurement period"/>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Denominator Exclusions"/>
          </criteria>
        </population>
        <population id="3e6e8d24-ab85-45ad-b5a7-2be3f7bdccaa">
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="denominator-exception"/>
              <display value="Denominator Exception"/>
            </coding>
          </code>
          <criteria>
            <language value="text/cql-identifier"/>
          </criteria>
        </population>
        <population id="5EB2EB7D-F782-4660-886D-665CE94169AC">
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="numerator"/>
              <display value="Numerator"/>
            </coding>
          </code>
          <description
                       value="Patients with documentation of an HIV test performed on or after their 15th birthday and before their 66th birthday"/>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Numerator"/>
          </criteria>
        </population>
        <population id="0d9973ab-5ee2-477f-a7fd-a4332d0255ca">
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="numerator-exclusion"/>
              <display value="Numerator Exclusion"/>
            </coding>
          </code>
          <criteria>
            <language value="text/cql-identifier"/>
          </criteria>
        </population>
      </group>
      <supplementalData id="sde-ethnicity">
        <usage>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
            <code value="supplemental-data"/>
          </coding>
        </usage>
        <description value="SDE Ethnicity"/>
        <criteria>
          <language value="text/cql-identifier"/>
          <expression value="SDE Ethnicity"/>
        </criteria>
      </supplementalData>
      <supplementalData id="sde-payer">
        <usage>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
            <code value="supplemental-data"/>
          </coding>
        </usage>
        <description value="SDE Payer"/>
        <criteria>
          <language value="text/cql-identifier"/>
          <expression value="SDE Payer"/>
        </criteria>
      </supplementalData>
      <supplementalData id="sde-race">
        <usage>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
            <code value="supplemental-data"/>
          </coding>
        </usage>
        <description value="SDE Race"/>
        <criteria>
          <language value="text/cql-identifier"/>
          <expression value="SDE Race"/>
        </criteria>
      </supplementalData>
      <supplementalData id="sde-sex">
        <usage>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
            <code value="supplemental-data"/>
          </coding>
        </usage>
        <description value="SDE Sex"/>
        <criteria>
          <language value="text/cql-identifier"/>
          <expression value="SDE Sex"/>
        </criteria>
      </supplementalData>
    </Measure>