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hl7.fhir.us.hai: Healthcare Associated Infection Implementation Guide ®© HL7 | CC0 ( src )

/* @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept. */ define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value } ( src )

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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. ( src )

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This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2022 National Committee for Quality Assurance. All Rights Reserved. ( src )

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 ( src )

library CumulativeMedicationDuration version '3.3.000' using QICore version '4.1.1' include FHIRHelpers version '4.3.000' include QICoreCommon version '1.5.000' // These code systems are not known to the MAT environment yet, request to have them added submitted codesystem "V3TimingEvent": 'http://terminology.hl7.org/CodeSystem/v3-TimingEvent' codesystem "EventTiming": 'http://hl7.org/fhir/event-timing' code "HS": 'HS' from "V3TimingEvent" // event occurs [offset] before the hour of sleep (or trying to) code "WAKE": 'WAKE' from "V3TimingEvent" // event occurs [offset] after waking code "C": 'C' from "V3TimingEvent" // event occurs at a meal (from the Latin cibus) code "CM": 'CM' from "V3TimingEvent" // event occurs at breakfast (from the Latin cibus matutinus) code "CD": 'CD' from "V3TimingEvent" // event occurs at lunch (from the Latin cibus diurnus) code "CV": 'CV' from "V3TimingEvent" // event occurs at dinner (from the Latin ante cibus vespertinus) code "AC": 'AC' from "V3TimingEvent" // event occurs [offset] before a meal (from the Latin ante cibus) code "ACM": 'ACM' from "V3TimingEvent" // event occurs [offset] before breakfast (from the Latin ante cibus matutinus) code "ACD": 'ACD' from "V3TimingEvent" // event occurs [offset] before lunch (from the Latin ante cibus diurnus) code "ACV": 'ACV' from "V3TimingEvent" // event occurs [offset] before dinner (from the Latin ante cibus vespertinus) code "PC": 'PC' from "V3TimingEvent" // event occurs [offset] after a meal (from the Latin post cibus) code "PCM": 'PCM' from "V3TimingEvent" // event occurs [offset] after breakfast (from the Latin post cibus matutinus) code "PCD": 'PCD' from "V3TimingEvent" // event occurs [offset] after lunch (from the Latin post cibus diurnus) code "PCV": 'PCV' from "V3TimingEvent" // event occurs [offset] after dinner (from the Latin post cibus vespertinus) code "MORN": 'MORN' from EventTiming // Event occurs during the morning. The exact time is unspecified and established by institution convention or patient interpretation. code "MORN.early": 'MORN.early' from EventTiming // Early Morning Event occurs during the early morning. The exact time is unspecified and established by institution convention or patient interpretation. code "MORN.late": 'MORN.late' from EventTiming // Late Morning Event occurs during the late morning. The exact time is unspecified and established by institution convention or patient interpretation. code "NOON": 'NOON' from EventTiming // Noon Event occurs around 12:00pm. The exact time is unspecified and established by institution convention or patient interpretation. code "AFT": 'AFT' from EventTiming // Afternoon Event occurs during the afternoon. The exact time is unspecified and established by institution convention or patient interpretation. code "AFT.early": 'AFT.early' from EventTiming // Early Afternoon Event occurs during the early afternoon. The exact time is unspecified and established by institution convention or patient interpretation. code "AFT.late": 'AFT.late' from EventTiming // Late Afternoon Event occurs during the late afternoon. The exact time is unspecified and established by institution convention or patient interpretation. code "EVE": 'EVE' from EventTiming // Evening Event occurs during the evening. The exact time is unspecified and established by institution convention or patient interpretation. code "EVE.early": 'EVE.early' from EventTiming // Early Evening Event occurs during the early evening. The exact time is unspecified and established by institution convention or patient interpretation. code "EVE.late": 'EVE.late' from EventTiming // Late Evening Event occurs during the late evening. The exact time is unspecified and established by institution convention or patient interpretation. code "NIGHT": 'NIGHT' from EventTiming // Night Event occurs during the night. The exact time is unspecified and established by institution convention or patient interpretation. code "PHS": 'PHS' from EventTiming // After Sleep Event occurs [offset] after subject goes to sleep. The exact time is unspecified and established by institution convention or patient interpretation. code "Every eight hours (qualifier value)": '307469008' from QICoreCommon."SNOMEDCT" display 'Every eight hours (qualifier value)' code "Every eight to twelve hours (qualifier value)": '396140003' from QICoreCommon."SNOMEDCT" display 'Every eight to twelve hours (qualifier value)' code "Every forty eight hours (qualifier value)": '396131002' from QICoreCommon."SNOMEDCT" display 'Every forty eight hours (qualifier value)' code "Every forty hours (qualifier value)": '396130001' from QICoreCommon."SNOMEDCT" display 'Every forty hours (qualifier value)' code "Every four hours (qualifier value)": '225756002' from QICoreCommon."SNOMEDCT" display 'Every four hours (qualifier value)' code "Every seventy two hours (qualifier value)": '396143001' from QICoreCommon."SNOMEDCT" display 'Every seventy two hours (qualifier value)' code "Every six hours (qualifier value)": '307468000' from QICoreCommon."SNOMEDCT" display 'Every six hours (qualifier value)' code "Every six to eight hours (qualifier value)": '396139000' from QICoreCommon."SNOMEDCT" display 'Every six to eight hours (qualifier value)' code "Every thirty six hours (qualifier value)": '396126004' from QICoreCommon."SNOMEDCT" display 'Every thirty six hours (qualifier value)' code "Every three to four hours (qualifier value)": '225754004' from QICoreCommon."SNOMEDCT" display 'Every three to four hours (qualifier value)' code "Every three to six hours (qualifier value)": '396127008' from QICoreCommon."SNOMEDCT" display 'Every three to six hours (qualifier value)' code "Every twelve hours (qualifier value)": '307470009' from QICoreCommon."SNOMEDCT" display 'Every twelve hours (qualifier value)' code "Every twenty four hours (qualifier value)": '396125000' from QICoreCommon."SNOMEDCT" display 'Every twenty four hours (qualifier value)' code "Every two to four hours (qualifier value)": '225752000' from QICoreCommon."SNOMEDCT" display 'Every two to four hours (qualifier value)' code "Four times daily (qualifier value)": '307439001' from QICoreCommon."SNOMEDCT" display 'Four times daily (qualifier value)' code "Once daily (qualifier value)": '229797004' from QICoreCommon."SNOMEDCT" display 'Once daily (qualifier value)' code "One to four times a day (qualifier value)": '396109005' from QICoreCommon."SNOMEDCT" display 'One to four times a day (qualifier value)' code "One to three times a day (qualifier value)": '396108002' from QICoreCommon."SNOMEDCT" display 'One to three times a day (qualifier value)' code "One to two times a day (qualifier value)": '396107007' from QICoreCommon."SNOMEDCT" display 'One to two times a day (qualifier value)' code "Three times daily (qualifier value)": '229798009' from QICoreCommon."SNOMEDCT" display 'Three times daily (qualifier value)' code "Twice a day (qualifier value)": '229799001' from QICoreCommon."SNOMEDCT" display 'Twice a day (qualifier value)' code "Two to four times a day (qualifier value)": '396111001' from QICoreCommon."SNOMEDCT" display 'Two to four times a day (qualifier value)' parameter ErrorLevel String default 'Warning' context Patient /* Goal is to get to number of days Two broad approaches to the calculation: 1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered 2) Based on relevant period, determine a covered interval and calculate the length of that interval in days This topic covers several use cases and illustrates how to calculate Cumulative Medication Duration for each type of medication resource using the supply and frequency approach. */ /* For the first approach, we need to get from frequency to a frequency/day So we define ToDaily */ /* Calculates daily frequency given frequency within a period */ define function ToDaily(frequency System.Integer, period System.Quantity): case period.unit when 'h' then frequency * (24.0 / period.value) when 'min' then frequency * (24.0 / period.value) * 60 when 's' then frequency * (24.0 / period.value) * 60 * 60 when 'd' then frequency * (24.0 / period.value) / 24 when 'wk' then frequency * (24.0 / period.value) / (24 * 7) when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ when 'hour' then frequency * (24.0 / period.value) when 'minute' then frequency * (24.0 / period.value) * 60 when 'second' then frequency * (24.0 / period.value) * 60 * 60 when 'day' then frequency * (24.0 / period.value) / 24 when 'week' then frequency * (24.0 / period.value) / (24 * 7) when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ when 'hours' then frequency * (24.0 / period.value) when 'minutes' then frequency * (24.0 / period.value) * 60 when 'seconds' then frequency * (24.0 / period.value) * 60 * 60 when 'days' then frequency * (24.0 / period.value) / 24 when 'weeks' then frequency * (24.0 / period.value) / (24 * 7) when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit) end /* Returns a daily frequency for the given code representation of frequency. The function expects codes from the [EventTiming](http://hl7.org/fhir/codesystem-event-timing.html) or [V3TimingEvent](http://hl7.org/fhir/v3/TimingEvent/cs.html) code systems. // TODO: Determine whether or not we should use timing.code at all.... */ define function ToDaily(frequency Code): case when frequency ~ "HS" then 1 // event occurs [offset] before the hour of sleep (or trying to) when frequency ~ "WAKE" then 1 // event occurs [offset] after waking when frequency ~ "C" then 3 // event occurs at a meal (from the Latin cibus) when frequency ~ "CM" then 1 // event occurs at breakfast (from the Latin cibus matutinus) when frequency ~ "CD" then 1 // event occurs at lunch (from the Latin cibus diurnus) when frequency ~ "CV" then 1 // event occurs at dinner (from the Latin ante cibus vespertinus) when frequency ~ "AC" then 3 // event occurs [offset] before a meal (from the Latin ante cibus) when frequency ~ "ACM" then 1 // event occurs [offset] before breakfast (from the Latin ante cibus matutinus) when frequency ~ "ACD" then 1 // event occurs [offset] before lunch (from the Latin ante cibus diurnus) when frequency ~ "ACV" then 1 // event occurs [offset] before dinner (from the Latin ante cibus vespertinus) when frequency ~ "PC" then 3 // event occurs [offset] after a meal (from the Latin post cibus) when frequency ~ "PCM" then 1 // event occurs [offset] after breakfast (from the Latin post cibus matutinus) when frequency ~ "PCD" then 1 // event occurs [offset] after lunch (from the Latin post cibus diurnus) when frequency ~ "PCV" then 1 // event occurs [offset] after dinner (from the Latin post cibus vespertinus) when frequency ~ "MORN" then 1 // Event occurs during the morning. The exact time is unspecified and established by institution convention or patient interpretation. when frequency ~ "MORN.early" then 1 // Early Morning Event occurs during the early morning. The exact time is unspecified and established by institution convention or patient interpretation. when frequency ~ "MORN.late" then 1 // Late Morning Event occurs during the late morning. The exact time is unspecified and established by institution convention or patient interpretation. when frequency ~ "NOON" then 1 // Noon Event occurs around 12:00pm. The exact time is unspecified and established by institution convention or patient interpretation. when frequency ~ "AFT" then 1 // Afternoon Event occurs during the afternoon. The exact time is unspecified and established by institution convention or patient interpretation. when frequency ~ "AFT.early" then 1 // Early Afternoon Event occurs during the early afternoon. The exact time is unspecified and established by institution convention or patient interpretation. when frequency ~ "AFT.late" then 1 // Late Afternoon Event occurs during the late afternoon. The exact time is unspecified and established by institution convention or patient interpretation. when frequency ~ "EVE" then 1 // Evening Event occurs during the evening. The exact time is unspecified and established by institution convention or patient interpretation. when frequency ~ "EVE.early" then 1 // Early Evening Event occurs during the early evening. The exact time is unspecified and established by institution convention or patient interpretation. when frequency ~ "EVE.late" then 1 // Late Evening Event occurs during the late evening. The exact time is unspecified and established by institution convention or patient interpretation. when frequency ~ "NIGHT" then 1 // Night Event occurs during the night. The exact time is unspecified and established by institution convention or patient interpretation. when frequency ~ "PHS" then 1 // After Sleep Event occurs [offset] after subject goes to sleep. The exact time is unspecified and established by institution convention or patient interpretation. when frequency ~ "Once daily (qualifier value)" then 1.0 when frequency ~ "Twice a day (qualifier value)" then 2.0 when frequency ~ "Three times daily (qualifier value)" then 3.0 when frequency ~ "Four times daily (qualifier value)" then 4.0 when frequency ~ "Every twenty four hours (qualifier value)" then 1.0 when frequency ~ "Every twelve hours (qualifier value)" then 2.0 when frequency ~ "Every thirty six hours (qualifier value)" then 0.67 when frequency ~ "Every eight hours (qualifier value)" then 3.0 when frequency ~ "Every four hours (qualifier value)" then 6.0 when frequency ~ "Every six hours (qualifier value)" then 4.0 when frequency ~ "Every seventy two hours (qualifier value)" then 0.33 when frequency ~ "Every forty eight hours (qualifier value)" then 0.5 when frequency ~ "Every eight to twelve hours (qualifier value)" then 3.0 when frequency ~ "Every six to eight hours (qualifier value)" then 4.0 when frequency ~ "Every three to four hours (qualifier value)" then 8.0 when frequency ~ "Every three to six hours (qualifier value)" then 8.0 when frequency ~ "Every two to four hours (qualifier value)" then 12.0 when frequency ~ "One to four times a day (qualifier value)" then 4.0 when frequency ~ "One to three times a day (qualifier value)" then 3.0 when frequency ~ "One to two times a day (qualifier value)" then 2.0 when frequency ~ "Two to four times a day (qualifier value)" then 4.0 else Message(null, true, 'CMDLogic.ToDaily.UnknownFrequencyCode', ErrorLevel, 'Unknown frequency code ' & frequency.code) end /* Now that we have a ToDaily function, we can approach calculation of the duration of medication for an order. First, consider the definitions for each element: * 1 and only 1 dosageInstruction * 1 and only 1 doseAndRate * 1 timing with 1 repeat * frequency, frequencyMax, defaulting to 1 * period, periodUnit, defaulting to 1 'd' * doseQuantity or doseRange * timeOfDay * authoredOn: The date the prescription was written * dispenseRequest.validityPeriod: Time period supply is authorized for * dispenseRequest.quantity: amount of medication supplied per dispense * dispenseRequest.numberOfRepeatsAllowed: number of refills authorized * dispenseRequest.expectedSupplyDuration: number of days supply per dispense * dosageInstruction.timing.repeat.boundsDuration: total duration of the repeat * dosageInstruction.timing.repeat.boundsRange: range of durations of the repeat * dosageInstruction.timing.repeat.boundsPeriod: period bounds of the repeat * dosageInstruction.timing.repeat.count: number of times to repeat * dosageInstruction.timing.repeat.countMax: maximum number of times to repeat * dosageInstruction.timing.repeat.frequency: event occurs frequency times per period * dosageInstruction.timing.repeat.frequencyMax: event occurs up to frequencyMax times per period * dosageInstruction.timing.repeat.period: event occurs frequency times per period * dosageInstruction.timing.repeat.periodMax: upper limit of period * dosageInstruction.timing.repeat.periodUnit: period duration (s | min | h | d | wk | mo | a) * dosageInstruction.timing.repeat.timeOfDay: time of day for the event (0..*) * dosageInstruction.timing.repeat.when: event timing (HS | WAKE | C | CM | CD | CV | AC | ACM...) * dosageInstruction.timing.code: BID | TID | QID | AM | PM | QD | QOD... * dosageInstruction.asNeeded * dosageInstruction.doseAndRate.doseQuantity * dosageInstruction.doseAndRate.doseRange If expectedSupplyDuration is present, then the duration is expectedSupplyDuration * (1 + numberOfRepeatsAllowed) If expectedSupplyDuration is not present, then it must be calculated based on the quantity, dosage, and frequency: (quantity / (dosage * frequency)) * (1 + numberOfRepeatsAllowed) dosage: Coalesce(end of doseAndRate.doseRange, doseAndRate.doseQuantity) frequency: Coalesce(frequencyMax, frequency) period: Quantity(period, periodUnit) If expectedSupplyDuration is not present and cannot be calculated, and the boundsPeriod is present (and completely specified), we can use that directly dosage.timing.repeat.boundsPeriod This calculation results in a number of days, which can then be turned into a period by anchoring that to the start of the validityPeriod or the authoredOn: Interval[earliestDispensable, earliestDispensable + expectedSupplyDuration - 1] earliestDispensable: Coalesce(start of validityPeriod, authoredOn) The following function illustrates this completely: */ /* Calculates the Medication Period for a single MedicationRequest. MedicationRequest instances provided to this function are expected to conform to the [MMEMedicationRequest](http://build.fhir.org/ig/cqframework/opioid-mme-r4/StructureDefinition-mmemedicationrequest.html) profile, which expects: * 1 and only 1 dosageInstruction, multiple dosageInstruction elements will result in an error * 1 and only 1 doseAndRate, multiple doseAndRate elements will result in an error * 1 timing with 1 repeat, missing timing or repeat elements will result in a null * frequency, frequencyMax, defaulting to 1 * period, periodUnit, defaulting to 1 'd' * timeOfDay * doseQuantity or doseRange, missing doseQuantity and doseRange will result in a null Note that MedicationRequest status is not considered by this calculation, as the list of MedicationRequest instances provided to this function should already have considered appropriate statuses, depending on the use case, typically `completed`. */ define function MedicationRequestPeriod(Request "MedicationRequest"): Request R let dosage: singleton from R.dosageInstruction, doseAndRate: singleton from dosage.doseAndRate, timing: dosage.timing, frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency), period: Quantity(timing.repeat.period, timing.repeat.periodUnit), doseRange: doseAndRate.dose, doseQuantity: doseAndRate.dose, dose: Coalesce(end of doseRange, doseQuantity), dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0), boundsPeriod: timing.repeat.bounds as Interval<DateTime>, daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value, quantity: R.dispenseRequest.quantity, refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0), startDate: Coalesce( date from start of boundsPeriod, date from R.authoredOn, date from start of R.dispenseRequest.validityPeriod ), totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills) return if startDate is not null and totalDaysSupplied is not null then Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ] else if startDate is not null and boundsPeriod."high" is not null then Interval[startDate, date from end of boundsPeriod] else null /* Next, consider the MedicationDispense case: * whenPrepared: When product was prepared * whenHandedOver: When product was given out * quantity: Amount dispensed * daysSupply: Amount of medication expressed as a timing amount * dosageInstruction.timing.repeat.boundsDuration: total duration of the repeat * dosageInstruction.timing.repeat.boundsRange: range of durations of the repeat * dosageInstruction.timing.repeat.boundsPeriod: period bounds of the repeat * dosageInstruction.timing.repeat.count: number of times to repeat * dosageInstruction.timing.repeat.countMax: maximum number of times to repeat * dosageInstruction.timing.repeat.frequency: event occurs frequency times per period * dosageInstruction.timing.repeat.frequencyMax: event occurs up to frequencyMax times per period * dosageInstruction.timing.repeat.period: event occurs frequency times per period * dosageInstruction.timing.repeat.periodMax: upper limit of period * dosageInstruction.timing.repeat.periodUnit: period duration (s | min | h | d | wk | mo | a) * dosageInstruction.timing.repeat.timeOfDay: time of day for the event (0..*) * dosageInstruction.timing.repeat.when: event timing (HS | WAKE | C | CM | CD | CV | AC | ACM...) * dosageInstruction.timing.code: BID | TID | QID | AM | PM | QD | QOD... * dosageInstruction.asNeeded * dosageInstruction.doseAndRate.doseQuantity * dosageInstruction.doseAndRate.doseRange We have effectively the same elements, with the same meanings, with the exception that the event is documenting a single dispense, and does not contain refill information. In addition, multiple dispense events would typically be present, and those would all have to be considered as part of an overall calculation. That will be considered when we combine results, but for this function, we'll focus on calculating the duration of a single dispense. With a MedicationDispense, dosage information is expected to be the same as the related MedicationRequest, so boundsPeriod would still cover the entire prescription (including refills) and so cannot be used to calculate the interval covered by the dispense. If the daysSupply element is present, then the duration in days is simply daysSupply Note specifically that we are not considering refills, as those would be covered by subsequent dispense records. If daysSupplied is not present, then daysSupplied must be calculated based on the quantity, dosage, and frequency: (quantity / (dosage * frequency)) This calculation results in a number of days, which can then be turned into a period by anchoring that to the startDate, as determined by the first available value of the start of the boundsPeriod, whenHandedOver, and whenPrepared. Interval[startDate, startDate + totalDaysSupplied - 1 day] */ /* Calculates Medication Period for a given MedicationDispense MedicationDispense instances provided to this function are expected to conform to the [TODO: MMEMedicationDispense](http://build.fhir.org/ig/cqframework/opioid-mme-r4/StructureDefinition-mmemedicationdispense.html) profile, which expects: * 1 and only 1 dosageInstruction, multiple dosageInstruction elements will result in an error * 1 and only 1 doseAndRate, multiple doseAndRate elements will result in an error * 1 timing with 1 repeat, missing timing or repeat elements will result in a null * frequency, frequencyMax, defaulting to 1 * period, periodUnit, defaulting to 1 'd' * timeOfDay * doseQuantity or doseRange, missing doseQuantity and doseRange will result in a null * whenHandedOver or whenPrepared, if missing both whenHandedOver and whenPrepared will result in a null Note that MedicationDispense status is not considered by this calculation, as the list of MedicationDispense instances provided to this function should already have considered appropriate statuses, depending on the use case, typically `completed`, especially since whenHandedOver would be expected to be present for a completed MedicationDispense. Note also that the dosage information recorded in a dispense is expected to be a copy of the dispense information from the related medication request. As such, the boundsPeriod would be expected to cover the entire range, and should _not_ be used for timing of the event. There is also active discussion in the Pharmacy WG about what date should be used if whenPrepared/whenHandedOver is not present. This may take the form of an "original creation date", but may also be a "status change date" for dispense events that are updating status of an existing dispense. That discussion is ongoing, so until that is resolved, this logic will return null if whenPrepared/whenHandedOver are not available. */ define function MedicationDispensePeriod(Dispense "MedicationDispense"): Dispense D let dosage: singleton from D.dosageInstruction, doseAndRate: singleton from dosage.doseAndRate, timing: dosage.timing, frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency), period: Quantity(timing.repeat.period, timing.repeat.periodUnit), doseRange: doseAndRate.dose, doseQuantity: doseAndRate.dose, dose: Coalesce(end of doseRange, doseQuantity), daysSupply: (convert D.daysSupply to days).value, dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0), startDate: Coalesce( date from D.whenHandedOver, date from D.whenPrepared ), totalDaysSupplied: Coalesce(daysSupply, D.quantity.value / (dose.value * dosesPerDay)) return if startDate is not null and totalDaysSupplied is not null then Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day')] else null /* Returns the established therapeutic duration for a given medication. This is likely measure specific, though could potentially be established for any drug and distributed as a CodeSystem supplement. Defaulting to 14 days here for illustration. */ define function TherapeuticDuration(medication Concept): 14 days /* Next we consider MedicationAdministration. This data type is typically used to capture specific administration, with the relevantPeriod capturing start and stop time of the administration event: * effective[x]: Start and end time of administration However, when calculating cumulative medication duration, it is typically the therapeutic period of the medication that should be considered. Currently neither the Medication nor MedicationKnowledge resources provide this information, so we model it here as a function that can potentially be implemented in a variety of ways, including measure-specific values, as well as distribution as an RxNorm code system supplement. However it is obtained, if therapeutic duration can be obtained, and the effective period has a start, the result will be Interval[startDate, startDate + therapeuticDuration - 1 day] NOTE: Therapeutic duration needs to be established and until a way is implemented to do that based on the medication, this logic is incomplete and should not be used. */ define function MedicationAdministrationPeriod(Administration "MedicationAdministration"): Administration M let therapeuticDuration: TherapeuticDuration(Administration.medication), startDate: date from start of Administration.effective return if startDate is not null and therapeuticDuration is not null then Interval[startDate, startDate + therapeuticDuration - 1] else null /* Now that we have functions for determining the medication period for individual prescriptions, administrations, and dispenses, we can combine those using an overall cumulative medication duration calculation. There are two broad approaches to calculating cumulative duration, one that _collapses_ overlapping intervals so that calculations are not duplicated, and one that _rolls out_ overlapping intervals so that the durations are laid end-to-end. First, we define a function that simply calculates CumulativeDuration of a set of intervals: */ define function CumulativeDuration(Intervals List<Interval<Date>>): if Intervals is not null then ( Sum((collapse Intervals per day)X return all(difference in days between start of X and end of X )+ 1 ) ) else null /* Next, we define a function that rolls out intervals: */ define function RolloutIntervals(intervals List<Interval<Date>>): intervals I aggregate all R starting ( null as List<Interval<Date>>): R union ( { I X let S: Max({ end of Last(R)+ 1 day, start of X } ), E: S + Quantity(Coalesce(duration in days of X, 0), 'day') return Interval[S, E]} ) /* Then, we define a function that allows us to calculate based on the various medication types: */ define function MedicationPeriod( medication Choice<"MedicationRequest", "MedicationDispense" >): case when medication is MedicationRequest then MedicationRequestPeriod(medication) when medication is MedicationDispense then MedicationDispensePeriod(medication) else null end /* We can then use this function, combined with the MedicationDuration functions above to calculate Cumulative Medication Duration: Generally speaking, we want to _roll out_ intervals from dispense and administration events, and then collapse across that result and intervals from prescriptions. Note also that the separation of medications by type should already be done by this stage as well. Calculations that combine dosages from different types of medications (such as Morphine Milligram Equivalent (MME) or Average MME) require further consideration. */ define function CumulativeMedicationDuration( Medications List<Choice<"MedicationRequest", "MedicationDispense" >>): CumulativeDuration(( Medications M where M is MedicationRequest return MedicationRequestPeriod(M) ) union ( RolloutIntervals( Medications M where M is MedicationDispense return MedicationDispensePeriod(M) ) ) ) /**********************************************************************/ /* Functions in this region are copied from opioid-mme-r4 */ /**********************************************************************/ define function Quantity(value Decimal, unit String): if value is not null then System.Quantity { value: value, unit: unit } else null ( src )

library FHIRHelpers version '4.3.000' using FHIR version '4.0.1' /* @description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period) value to a CQL DateTime Interval @comment: If the start value of the given period is unspecified, the starting boundary of the resulting interval will be open (meaning the start of the interval is unknown, as opposed to interpreted as the beginning of time). */ define function ToInterval(period FHIR.Period): if period is null then null else if period."start" is null then Interval(period."start".value, period."end".value] else Interval[period."start".value, period."end".value] /* @description: Converts a UCUM definite duration unit to a CQL calendar duration unit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities) topic of the CQL specification. @comment: Note that for durations above days (or weeks), the conversion is understood to be approximate */ define function ToCalendarUnit(unit System.String): case unit when 'ms' then 'millisecond' when 's' then 'second' when 'min' then 'minute' when 'h' then 'hour' when 'd' then 'day' when 'wk' then 'week' when 'mo' then 'month' when 'a' then 'year' else unit end /* @description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) value to a CQL Quantity @comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity has a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`) an error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used. @seealso: ToCalendarUnit */ define function ToQuantity(quantity FHIR.Quantity): case when quantity is null then null when quantity.value is null then null when quantity.comparator is not null then Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.') when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org' or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) } else Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')') end /* @description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) value to a CQL Quantity, ignoring the comparator element. This function should only be used when an application is justified in ignoring the comparator value (i.e. the context is looking for boundary). @comment: If the given quantity has a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`) an error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used. @seealso: ToCalendarUnit */ define function ToQuantityIgnoringComparator(quantity FHIR.Quantity): case when quantity is null then null when quantity.value is null then null when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org' or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) } else Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')') end /* @description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) value to a CQL Interval of Quantity. @comment: If the given quantity has a comparator, it is used to construct an interval based on the value of the comparator. If the comparator is less than, the resulting interval will start with a null closed boundary and end with an open boundary on the quantity. If the comparator is less than or equal, the resulting interval will start with a null closed boundary and end with a closed boundary on the quantity. If the comparator is greater or equal, the resulting interval will start with a closed boundary on the quantity and end with a closed null boundary. If the comparator is greatter than, the resulting interval will start with an open boundary on the quantity and end with a closed null boundary. If no comparator is specified, the resulting interval will start and end with a closed boundary on the quantity. */ define function ToInterval(quantity FHIR.Quantity): if quantity is null then null else case quantity.comparator.value when '<' then Interval[ null, ToQuantityIgnoringComparator(quantity) ) when '<=' then Interval[ null, ToQuantityIgnoringComparator(quantity) ] when '>=' then Interval[ ToQuantityIgnoringComparator(quantity), null ] when '>' then Interval( ToQuantityIgnoringComparator(quantity), null ] else Interval[ToQuantity(quantity), ToQuantity(quantity)] end /* @description: Converts the given FHIR [Ratio](https://hl7.org/fhir/datatypes.html#Ratio) value to a CQL Ratio. */ define function ToRatio(ratio FHIR.Ratio): if ratio is null then null else System.Ratio { numerator: ToQuantity(ratio.numerator), denominator: ToQuantity(ratio.denominator) } /* @description: Converts the given FHIR [Range](https://hl7.org/fhir/datatypes.html#Range) value to a CQL Interval of Quantity */ define function ToInterval(range FHIR.Range): if range is null then null else Interval[ToQuantity(range.low), ToQuantity(range.high)] /* @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 } /* @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept. */ define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value } /* @description: Converts the given value (assumed to be a URI) to a CQL [ValueSet](https://cql.hl7.org/09-b-cqlreference.html#valueset) */ define function ToValueSet(uri String): if uri is null then null else System.ValueSet { id: uri } /* @description: Constructs a FHIR [Reference](https://hl7.org/fhir/datatypes.html#Reference) from the given reference (assumed to be a FHIR resource URL) */ define function reference(reference String): if reference is null then null else Reference { reference: string { value: reference } } /* @description: Converts the given value to a CQL value using the appropriate accessor or conversion function. @comment: TODO: document conversion */ define function ToValue(value Choice<base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta>): case when value is base64Binary then (value as base64Binary).value when value is boolean then (value as boolean).value when value is canonical then (value as canonical).value when value is code then (value as code).value when value is date then (value as date).value when value is dateTime then (value as dateTime).value when value is decimal then (value as decimal).value when value is id then (value as id).value when value is instant then (value as instant).value when value is integer then (value as integer).value when value is markdown then (value as markdown).value when value is oid then (value as oid).value when value is positiveInt then (value as positiveInt).value when value is string then (value as string).value when value is time then (value as time).value when value is unsignedInt then (value as unsignedInt).value when value is uri then (value as uri).value when value is url then (value as url).value when value is uuid then (value as uuid).value when value is Age then ToQuantity(value as Age) when value is CodeableConcept then ToConcept(value as CodeableConcept) when value is Coding then ToCode(value as Coding) when value is Count then ToQuantity(value as Count) when value is Distance then ToQuantity(value as Distance) when value is Duration then ToQuantity(value as Duration) when value is Quantity then ToQuantity(value as Quantity) when value is Range then ToInterval(value as Range) when value is Period then ToInterval(value as Period) when value is Ratio then ToRatio(value as Ratio) else value as Choice<Address, Annotation, Attachment, ContactPoint, HumanName, Identifier, Money, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta> end /* @description: Resolve the given reference as a url to a resource. If the item resolves, the Resource is returned, otherwise the result is null. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function resolve(reference String) returns Resource: external /* @description: Resolve the reference element of the given Reference. If the item resolves, the Resource is returned, otherwise the result is null. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function resolve(reference Reference) returns Resource: external /* @description: Constructs a Reference to the given Resource. The resulting reference will typically be relative, but implementations may provide a base URL if one can be unambiguously determined. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function reference(resource Resource) returns Reference: external /* @description: Returns any extensions with the given url defined on the given element. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function extension(element Element, url String) returns List<Extension>: external /* @description: Returns any extensions with the given url defined on the given resource. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function extension(resource DomainResource, url String) returns List<Extension>: external /* @description: Returns any modifier extensions with the given url defined on the given element. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function modifierExtension(element BackboneElement, url String) returns List<Extension>: external /* @description: Returns any modifier extensions with the given url defined on the given resource. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function modifierExtension(resource DomainResource, url String) returns List<Extension>: external /* @description: Returns true if the element is a FHIR primitive type with a value element (as opposed to having only extensions); false otherwise @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function hasValue(element Element) returns Boolean: external /* @description: Returns the value of the FHIR primitive; null otherwise @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function getValue(element Element) returns Any: external /* @description: Returns a list containing only those elements in the input that are of the given type, specified as a string. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function ofType(identifier String) returns List<Any>: external /* @description: Returns true if the input is of the given type; false otherwise @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function is(identifier String) returns Boolean: external /* @description: If the input is of the given type; returns the value as that type; null otherwise. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function as(identifier String) returns Any: external /* @description: Returns the FHIR element definition for the given element @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function elementDefinition(element Element) returns ElementDefinition: external /* @description: Returns the given slice as defined in the given structure definition. The structure argument is a uri that resolves to the structure definition, and the name must be the name of a slice within that structure definition. If the structure cannot be resolved, or the name of the slice within the resolved structure is not present, an error is thrown. @comment: For every element in the input collection, if the resolved slice is present on the element, it will be returned. If the slice does not match any element in the input collection, or if the input collection is empty, the result is an empty collection ({ }). @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function slice(element Element, url String, name String) returns List<Element>: external /* @description: For each element in the input collection, verifies that there are no modifying extensions defined other than the ones given by the modifier argument. If the check passes, the input collection is returned. Otherwise, an error is thrown. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function checkModifiers(resource Resource) returns Resource: external /* @description: For each element in the input collection, verifies that there are no modifying extensions defined other than the ones given by the modifier argument. If the check passes, the input collection is returned. Otherwise, an error is thrown. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function checkModifiers(resource Resource, modifier String) returns Resource: external /* @description: For each element in the input collection, verifies that there are no modifying extensions defined other than the ones given by the modifier argument. If the check passes, the input collection is returned. Otherwise, an error is thrown. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function checkModifiers(element Element) returns Element: external /* @description: For each element in the input collection, verifies that there are no modifying extensions defined other than the ones given by the modifier argument. If the check passes, the input collection is returned. Otherwise, an error is thrown. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function checkModifiers(element Element, modifier String) returns Element: external /* @description: Returns true if the single input element conforms to the profile specified by the structure argument, and false otherwise. If the structure cannot be resolved to a valid profile, an error is thrown. If the input contains more than one element, an error is thrown. If the input is empty, the result is empty. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function conformsTo(resource Resource, structure String) returns Boolean: external /* @description: Returns true if the given code is equal to a code in the valueset, so long as the valueset only contains one codesystem. If the valueset contains more than one codesystem, an error is thrown. @comment: If the valueset cannot be resolved as a uri to a value set, an error is thrown. Note that implementations are encouraged to make use of a terminology service to provide this functionality. For example: ```fhirpath Observation.component.where(code.memberOf('http://hl7.org/fhir/ValueSet/observation-vitalsignresult')) ``` This expression returns components that have a code that is a member of the observation-vitalsignresult valueset. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function memberOf(code code, valueSet String) returns Boolean: external /* @description: Returns true if the code is a member of the given valueset. @comment: If the valueset cannot be resolved as a uri to a value set, an error is thrown. Note that implementations are encouraged to make use of a terminology service to provide this functionality. For example: ```fhirpath Observation.component.where(code.memberOf('http://hl7.org/fhir/ValueSet/observation-vitalsignresult')) ``` This expression returns components that have a code that is a member of the observation-vitalsignresult valueset. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function memberOf(coding Coding, valueSet String) returns Boolean: external /* @description: Returns true if any code in the concept is a member of the given valueset. @comment: If the valueset cannot be resolved as a uri to a value set, an error is thrown. Note that implementations are encouraged to make use of a terminology service to provide this functionality. For example: ```fhirpath Observation.component.where(code.memberOf('http://hl7.org/fhir/ValueSet/observation-vitalsignresult')) ``` This expression returns components that have a code that is a member of the observation-vitalsignresult valueset. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function memberOf(concept CodeableConcept, valueSet String) returns Boolean: external /* @description: Returns true if the source code is equivalent to the given code, or if the source code subsumes the given code (i.e. the source code is an ancestor of the given code in a subsumption hierarchy), and false otherwise. @comment: If the Codings are from different code systems, the relationships between the code systems must be well-defined or a run-time error is thrown. Note that implementations are encouraged to make use of a terminology service to provide this functionality. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function subsumes(coding Coding, subsumedCoding Coding) returns Boolean: external /* @description: Returns true if any Coding in the source or given elements is equivalent to or subsumes the given code. @comment: If the Codings are from different code systems, the relationships between the code systems must be well-defined or a run-time error is thrown. Note that implementations are encouraged to make use of a terminology service to provide this functionality. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function subsumes(concept CodeableConcept, subsumedConcept CodeableConcept) returns Boolean: external /* @description: Returns true if the source code is equivalent to the given code, or if the source code is subsumed by the given code (i.e. the source code is a descendant of the given code in a subsumption hierarchy), and false otherwise. @comment: If the Codings are from different code systems, the relationships between the code systems must be well-defined or a run-time error is thrown. Note that implementations are encouraged to make use of a terminology service to provide this functionality. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function subsumedBy(coding Coding, subsumingCoding Coding) returns Boolean: external /* @description: Returns true if any Coding in the source or given elements is equivalent to or subsumed by the given code. @comment: If the Codings are from different code systems, the relationships between the code systems must be well-defined or a run-time error is thrown. Note that implementations are encouraged to make use of a terminology service to provide this functionality. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function subsumedBy(concept CodeableConcept, subsumingConcept CodeableConcept) returns Boolean: external /* @description: When invoked on an xhtml element, returns true if the rules around HTML usage are met, and false if they are not. The return value is undefined (null) on any other kind of element. @seealso: https://hl7.org/fhir/fhirpath.html#functions */ define function htmlChecks(element Element) returns Boolean: external define function ToString(value AccountStatus): value.value define function ToString(value ActionCardinalityBehavior): value.value define function ToString(value ActionConditionKind): value.value define function ToString(value ActionGroupingBehavior): value.value define function ToString(value ActionParticipantType): value.value define function ToString(value ActionPrecheckBehavior): value.value define function ToString(value ActionRelationshipType): value.value define function ToString(value ActionRequiredBehavior): value.value define function ToString(value ActionSelectionBehavior): value.value define function ToString(value ActivityDefinitionKind): value.value define function ToString(value ActivityParticipantType): value.value define function ToString(value AddressType): value.value define function ToString(value AddressUse): value.value define function ToString(value AdministrativeGender): value.value define function ToString(value AdverseEventActuality): value.value define function ToString(value AggregationMode): value.value define function ToString(value AllergyIntoleranceCategory): value.value define function ToString(value AllergyIntoleranceCriticality): value.value define function ToString(value AllergyIntoleranceSeverity): value.value define function ToString(value AllergyIntoleranceType): value.value define function ToString(value AppointmentStatus): value.value define function ToString(value AssertionDirectionType): value.value define function ToString(value AssertionOperatorType): value.value define function ToString(value AssertionResponseTypes): value.value define function ToString(value AuditEventAction): value.value define function ToString(value AuditEventAgentNetworkType): value.value define function ToString(value AuditEventOutcome): value.value define function ToString(value BindingStrength): value.value define function ToString(value BiologicallyDerivedProductCategory): value.value define function ToString(value BiologicallyDerivedProductStatus): value.value define function ToString(value BiologicallyDerivedProductStorageScale): value.value define function ToString(value BundleType): value.value define function ToString(value CapabilityStatementKind): value.value define function ToString(value CarePlanActivityKind): value.value define function ToString(value CarePlanActivityStatus): value.value define function ToString(value CarePlanIntent): value.value define function ToString(value CarePlanStatus): value.value define function ToString(value CareTeamStatus): value.value define function ToString(value CatalogEntryRelationType): value.value define function ToString(value ChargeItemDefinitionPriceComponentType): value.value define function ToString(value ChargeItemStatus): value.value define function ToString(value ClaimResponseStatus): value.value define function ToString(value ClaimStatus): value.value define function ToString(value ClinicalImpressionStatus): value.value define function ToString(value CodeSearchSupport): value.value define function ToString(value CodeSystemContentMode): value.value define function ToString(value CodeSystemHierarchyMeaning): value.value define function ToString(value CommunicationPriority): value.value define function ToString(value CommunicationRequestStatus): value.value define function ToString(value CommunicationStatus): value.value define function ToString(value CompartmentCode): value.value define function ToString(value CompartmentType): value.value define function ToString(value CompositionAttestationMode): value.value define function ToString(value CompositionStatus): value.value define function ToString(value ConceptMapEquivalence): value.value define function ToString(value ConceptMapGroupUnmappedMode): value.value define function ToString(value ConditionalDeleteStatus): value.value define function ToString(value ConditionalReadStatus): value.value define function ToString(value ConsentDataMeaning): value.value define function ToString(value ConsentProvisionType): value.value define function ToString(value ConsentState): value.value define function ToString(value ConstraintSeverity): value.value define function ToString(value ContactPointSystem): value.value define function ToString(value ContactPointUse): value.value define function ToString(value ContractPublicationStatus): value.value define function ToString(value ContractStatus): value.value define function ToString(value ContributorType): value.value define function ToString(value CoverageStatus): value.value define function ToString(value CurrencyCode): value.value define function ToString(value DayOfWeek): value.value define function ToString(value DaysOfWeek): value.value define function ToString(value DetectedIssueSeverity): value.value define function ToString(value DetectedIssueStatus): value.value define function ToString(value DeviceMetricCalibrationState): value.value define function ToString(value DeviceMetricCalibrationType): value.value define function ToString(value DeviceMetricCategory): value.value define function ToString(value DeviceMetricColor): value.value define function ToString(value DeviceMetricOperationalStatus): value.value define function ToString(value DeviceNameType): value.value define function ToString(value DeviceRequestStatus): value.value define function ToString(value DeviceUseStatementStatus): value.value define function ToString(value DiagnosticReportStatus): value.value define function ToString(value DiscriminatorType): value.value define function ToString(value DocumentConfidentiality): value.value define function ToString(value DocumentMode): value.value define function ToString(value DocumentReferenceStatus): value.value define function ToString(value DocumentRelationshipType): value.value define function ToString(value EligibilityRequestPurpose): value.value define function ToString(value EligibilityRequestStatus): value.value define function ToString(value EligibilityResponsePurpose): value.value define function ToString(value EligibilityResponseStatus): value.value define function ToString(value EnableWhenBehavior): value.value define function ToString(value EncounterLocationStatus): value.value define function ToString(value EncounterStatus): value.value define function ToString(value EndpointStatus): value.value define function ToString(value EnrollmentRequestStatus): value.value define function ToString(value EnrollmentResponseStatus): value.value define function ToString(value EpisodeOfCareStatus): value.value define function ToString(value EventCapabilityMode): value.value define function ToString(value EventTiming): value.value define function ToString(value EvidenceVariableType): value.value define function ToString(value ExampleScenarioActorType): value.value define function ToString(value ExplanationOfBenefitStatus): value.value define function ToString(value ExposureState): value.value define function ToString(value ExtensionContextType): value.value define function ToString(value FHIRAllTypes): value.value define function ToString(value FHIRDefinedType): value.value define function ToString(value FHIRDeviceStatus): value.value define function ToString(value FHIRResourceType): value.value define function ToString(value FHIRSubstanceStatus): value.value define function ToString(value FHIRVersion): value.value define function ToString(value FamilyHistoryStatus): value.value define function ToString(value FilterOperator): value.value define function ToString(value FlagStatus): value.value define function ToString(value GoalLifecycleStatus): value.value define function ToString(value GraphCompartmentRule): value.value define function ToString(value GraphCompartmentUse): value.value define function ToString(value GroupMeasure): value.value define function ToString(value GroupType): value.value define function ToString(value GuidanceResponseStatus): value.value define function ToString(value GuidePageGeneration): value.value define function ToString(value GuideParameterCode): value.value define function ToString(value HTTPVerb): value.value define function ToString(value IdentifierUse): value.value define function ToString(value IdentityAssuranceLevel): value.value define function ToString(value ImagingStudyStatus): value.value define function ToString(value ImmunizationEvaluationStatus): value.value define function ToString(value ImmunizationStatus): value.value define function ToString(value InvoicePriceComponentType): value.value define function ToString(value InvoiceStatus): value.value define function ToString(value IssueSeverity): value.value define function ToString(value IssueType): value.value define function ToString(value LinkType): value.value define function ToString(value LinkageType): value.value define function ToString(value ListMode): value.value define function ToString(value ListStatus): value.value define function ToString(value LocationMode): value.value define function ToString(value LocationStatus): value.value define function ToString(value MeasureReportStatus): value.value define function ToString(value MeasureReportType): value.value define function ToString(value MediaStatus): value.value define function ToString(value MedicationAdministrationStatus): value.value define function ToString(value MedicationDispenseStatus): value.value define function ToString(value MedicationKnowledgeStatus): value.value define function ToString(value MedicationRequestIntent): value.value define function ToString(value MedicationRequestPriority): value.value define function ToString(value MedicationRequestStatus): value.value define function ToString(value MedicationStatementStatus): value.value define function ToString(value MedicationStatus): value.value define function ToString(value MessageSignificanceCategory): value.value define function ToString(value Messageheader_Response_Request): value.value define function ToString(value MimeType): value.value define function ToString(value NameUse): value.value define function ToString(value NamingSystemIdentifierType): value.value define function ToString(value NamingSystemType): value.value define function ToString(value NarrativeStatus): value.value define function ToString(value NoteType): value.value define function ToString(value NutritiionOrderIntent): value.value define function ToString(value NutritionOrderStatus): value.value define function ToString(value ObservationDataType): value.value define function ToString(value ObservationRangeCategory): value.value define function ToString(value ObservationStatus): value.value define function ToString(value OperationKind): value.value define function ToString(value OperationParameterUse): value.value define function ToString(value OrientationType): value.value define function ToString(value ParameterUse): value.value define function ToString(value ParticipantRequired): value.value define function ToString(value ParticipantStatus): value.value define function ToString(value ParticipationStatus): value.value define function ToString(value PaymentNoticeStatus): value.value define function ToString(value PaymentReconciliationStatus): value.value define function ToString(value ProcedureStatus): value.value define function ToString(value PropertyRepresentation): value.value define function ToString(value PropertyType): value.value define function ToString(value ProvenanceEntityRole): value.value define function ToString(value PublicationStatus): value.value define function ToString(value QualityType): value.value define function ToString(value QuantityComparator): value.value define function ToString(value QuestionnaireItemOperator): value.value define function ToString(value QuestionnaireItemType): value.value define function ToString(value QuestionnaireResponseStatus): value.value define function ToString(value ReferenceHandlingPolicy): value.value define function ToString(value ReferenceVersionRules): value.value define function ToString(value ReferredDocumentStatus): value.value define function ToString(value RelatedArtifactType): value.value define function ToString(value RemittanceOutcome): value.value define function ToString(value RepositoryType): value.value define function ToString(value RequestIntent): value.value define function ToString(value RequestPriority): value.value define function ToString(value RequestStatus): value.value define function ToString(value ResearchElementType): value.value define function ToString(value ResearchStudyStatus): value.value define function ToString(value ResearchSubjectStatus): value.value define function ToString(value ResourceType): value.value define function ToString(value ResourceVersionPolicy): value.value define function ToString(value ResponseType): value.value define function ToString(value RestfulCapabilityMode): value.value define function ToString(value RiskAssessmentStatus): value.value define function ToString(value SPDXLicense): value.value define function ToString(value SearchComparator): value.value define function ToString(value SearchEntryMode): value.value define function ToString(value SearchModifierCode): value.value define function ToString(value SearchParamType): value.value define function ToString(value SectionMode): value.value define function ToString(value SequenceType): value.value define function ToString(value ServiceRequestIntent): value.value define function ToString(value ServiceRequestPriority): value.value define function ToString(value ServiceRequestStatus): value.value define function ToString(value SlicingRules): value.value define function ToString(value SlotStatus): value.value define function ToString(value SortDirection): value.value define function ToString(value SpecimenContainedPreference): value.value define function ToString(value SpecimenStatus): value.value define function ToString(value Status): value.value define function ToString(value StrandType): value.value define function ToString(value StructureDefinitionKind): value.value define function ToString(value StructureMapContextType): value.value define function ToString(value StructureMapGroupTypeMode): value.value define function ToString(value StructureMapInputMode): value.value define function ToString(value StructureMapModelMode): value.value define function ToString(value StructureMapSourceListMode): value.value define function ToString(value StructureMapTargetListMode): value.value define function ToString(value StructureMapTransform): value.value define function ToString(value SubscriptionChannelType): value.value define function ToString(value SubscriptionStatus): value.value define function ToString(value SupplyDeliveryStatus): value.value define function ToString(value SupplyRequestStatus): value.value define function ToString(value SystemRestfulInteraction): value.value define function ToString(value TaskIntent): value.value define function ToString(value TaskPriority): value.value define function ToString(value TaskStatus): value.value define function ToString(value TestReportActionResult): value.value define function ToString(value TestReportParticipantType): value.value define function ToString(value TestReportResult): value.value define function ToString(value TestReportStatus): value.value define function ToString(value TestScriptRequestMethodCode): value.value define function ToString(value TriggerType): value.value define function ToString(value TypeDerivationRule): value.value define function ToString(value TypeRestfulInteraction): value.value define function ToString(value UDIEntryType): value.value define function ToString(value UnitsOfTime): value.value define function ToString(value Use): value.value define function ToString(value VariableType): value.value define function ToString(value VisionBase): value.value define function ToString(value VisionEyes): value.value define function ToString(value VisionStatus): value.value define function ToString(value XPathUsageType): value.value define function ToString(value base64Binary): value.value define function ToBoolean(value boolean): value.value define function ToDate(value date): value.value define function ToDateTime(value dateTime): value.value define function ToDecimal(value decimal): value.value define function ToDateTime(value instant): value.value define function ToInteger(value integer): value.value define function ToString(value string): value.value define function ToTime(value time): value.value define function ToString(value uri): value.value define function ToString(value xhtml): value.value ( src )

External References

Type	Reference	Content
web	snomed.info	http://snomed.info/sct/900000000000207008
web	www.mathematica.org	Mathematica: https://www.mathematica.org/ , American Medical Association (AMA): https://www.ama-assn.org/
web	www.ama-assn.org	Mathematica: https://www.mathematica.org/ , American Medical Association (AMA): https://www.ama-assn.org/
web	browser.ihtsdotools.org	http://snomed.info/sct
web	medicine.yale.edu	Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation: https://medicine.yale.edu/core/ , The Lewin Group: https://www.lewin.com/
web	www.lewin.com	Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation: https://medicine.yale.edu/core/ , The Lewin Group: https://www.lewin.com/
web	www.ama-assn.org	American Academy of Ophthalmology: www.aao.org , American Medical Association (AMA): https://www.ama-assn.org/
web	www.ncqa.org	National Committee for Quality Assurance: https://www.ncqa.org/
web	www.ama-assn.org	American Academy of Neurology: www.aan.com , American Medical Association (AMA): https://www.ama-assn.org/
web	www.telligen.com	Telligen: https://www.telligen.com/
web	www.jointcommission.org	The Joint Commission: https://www.jointcommission.org/
web	www.mathematica.org	Mathematica: https://www.mathematica.org/
web	www.mathematica.org	Mathematica: https://www.mathematica.org/ , Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation: https://medicine.yale.edu/core/
web	medicine.yale.edu	Mathematica: https://www.mathematica.org/ , Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation: https://medicine.yale.edu/core/
web	medicine.yale.edu	Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation: https://medicine.yale.edu/core/
web	www.jointcommission.org	The Joint Commission: https://www.jointcommission.org/ , Centers for Medicare & Medicaid Services (CMS): https://www.cms.gov/ , Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation: https://medicine.yale.edu/core/
web	medicine.yale.edu	The Joint Commission: https://www.jointcommission.org/ , Centers for Medicare & Medicaid Services (CMS): https://www.cms.gov/ , Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation: https://medicine.yale.edu/core/
web	github.com
web	github.com	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
web	github.com	IG © 2023+ cqframework . Package gov.healthit.ecqi.ecqms#2023.0.0 based on FHIR 4.0.1 . Generated 2026-05-13 Links: Table of Contents \| QA Report \| Version History \|
web	www.mathematica.org	Responsible: Mathematica
web	www.ncqa.org	Responsible: National Committee for Quality Assurance
web	www.jointcommission.org	Responsible: The Joint Commission

Type

Reference

Content

web

snomed.info

http://snomed.info/sct/900000000000207008

web

www.mathematica.org

Mathematica: https://www.mathematica.org/ , American Medical Association (AMA): https://www.ama-assn.org/

web

www.ama-assn.org

Mathematica: https://www.mathematica.org/ , American Medical Association (AMA): https://www.ama-assn.org/

web

browser.ihtsdotools.org

http://snomed.info/sct

web

medicine.yale.edu

Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation: https://medicine.yale.edu/core/ , The Lewin Group: https://www.lewin.com/

web

www.lewin.com

Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation: https://medicine.yale.edu/core/ , The Lewin Group: https://www.lewin.com/

web

www.ama-assn.org

American Academy of Ophthalmology: www.aao.org , American Medical Association (AMA): https://www.ama-assn.org/

web

www.ncqa.org

National Committee for Quality Assurance: https://www.ncqa.org/

web

www.ama-assn.org

American Academy of Neurology: www.aan.com , American Medical Association (AMA): https://www.ama-assn.org/

web

www.telligen.com

Telligen: https://www.telligen.com/

web

www.jointcommission.org

The Joint Commission: https://www.jointcommission.org/

web

www.mathematica.org

Mathematica: https://www.mathematica.org/

web

www.mathematica.org

Mathematica: https://www.mathematica.org/ , Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation: https://medicine.yale.edu/core/

web

medicine.yale.edu

Mathematica: https://www.mathematica.org/ , Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation: https://medicine.yale.edu/core/

web

medicine.yale.edu

Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation: https://medicine.yale.edu/core/

web

www.jointcommission.org

The Joint Commission: https://www.jointcommission.org/ , Centers for Medicare & Medicaid Services (CMS): https://www.cms.gov/ , Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation: https://medicine.yale.edu/core/

web

medicine.yale.edu

web

github.com

web

github.com

web

github.com

IG © 2023+ cqframework . Package gov.healthit.ecqi.ecqms#2023.0.0 based on FHIR 4.0.1 . Generated 2026-05-13
Links: Table of Contents | QA Report | Version History external

web

www.mathematica.org

Responsible: Mathematica

web

www.ncqa.org

Responsible: National Committee for Quality Assurance

web

www.jointcommission.org

Responsible: The Joint Commission

Unattributed Code Systems

Copyright Fragment

Copyright and Registered Trademark Uses

External References

Internal Images