Metadata Title Core Clinical Data Elements for the Hybrid Hospital-Wide (All-Condition, All-Procedure) Risk-Standardized Mortality Measure (HWM) FHIR Example Version 0.5.3 Short Name CMS844FHIR GUID (Version Independent) urn:uuid:965255e9-dfeb-42d0-8416-2c4b7ecc5109 GUID (Version Specific) urn:uuid:2c92808482113ece0182c5d4fc662f1a CMS Identifier 844FHIR NQF Identifier 3502 Effective Period 2024-07-01 through 2025-06-30 Approval Date 2023-08-14 Last Review Date 2023-08-14 Status Draft Jurisdiction 001 from http://unstats.un.org/unsd/methods/m49/m49.htm Steward (Publisher) HL7 International - [Some] Work Group Developer Mathematica Developer Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation Description This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from encounters for adult Medicare Fee-For-Service patients admitted to acute care short stay hospitals. Copyright Limited proprietary coding is contained in these specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2021 International Health Terminology Standards Development Organisation. All rights reserved. LOINC(R) copyright 2004-2021 Regenstrief Institute, Inc. Disclaimer These performance specifications are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” 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 The intent of this logic is to extract the FIRST set of clinical data elements from hospital electronic health records (EHRs) for all qualifying encounters. The data will be linked with administrative claims to risk adjust the Hybrid HWM outcome measure. This work addresses stakeholder concerns that clinical data garnered from patients, and used by clinicians to guide diagnostic decisions and treatment, are preferable to administrative claims data when profiling hospitals’ case mix. We are calling the list of data elements for extraction the "HWM-specific core clinical data elements". The core clinical data elements are the first set of vital signs and basic laboratory tests resulted from encounters for adult Medicare Fee-For-Service patients, age 65 to 94 (Initial Population), after they arrive at the hospital to which they are subsequently admitted. For example, this first set of data values are often captured in the emergency department or in the pre-operative area, sometimes hours before a patient is admitted to that same facility. Encounters over the age of 94 are not included to avoid holding hospitals responsible for the survival of the oldest elderly patients, who may be less likely to have survival as a primary goal. While we acknowledge that many elderly patients do have survival beyond 30 days as a primary goal for their hospitalization, with input from our Technical Expert Panel and work groups, we decided to only include encounters between 65 and 94 years of age. These core clinical data elements were selected because they: 1. reflect patients' clinical status when they first present to the hospital; 2. are clinically and statistically relevant to patient outcomes; 3. are consistently obtained on adult inpatient encounters based on current clinical practice; 4. are captured with a standard definition and recorded in a standard format across providers; and 5. are entered in structured fields that are feasibly retrieved from current EHR systems (YNHHSC/CORE, 2015). Additional data called Linking Variables are used to link EHR data files with administrative claims data for CMS to calculate results for the Hybrid HWM measure, which are: CMS Certification Number; Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI); date of birth; sex; admission date; and discharge date. Clinical Recommendation Statement The logic is not meant to guide or alter the care patients receive. The purpose of this core clinical data elements logic is to extract clinical data that are already routinely captured in EHRs from encounters for hospitalized adult patients. It is not intended to require that clinical staff perform additional measurements or tests that are not needed for diagnostic assessment or treatment of patients. Guidance (Usage) This FHIR-based measure has been derived from the QDM-based measure: CMS844v3.1 (QDM 5.6). 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). These specifications are for use for data with discharges that occur between July 1, 2023 and June 30, 2024. This logic guides the user to extract the FIRST resulted HWM-specific core clinical data elements for all Medicare Fee-For-Service encounters for patients age 65 to 94 (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area, such as the emergency department or hospital outpatient location. The logic supports extraction of the FIRST set of HWM-specific core clinical data elements in two different ways, depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility: 1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission. 2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for core clinical data element values related to a patient who is subsequently admitted. Value sets for the laboratory tests represent the LOINC codes currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements. NOTE: Do not report ALL values on an encounter during their entire admission. Only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. For each core clinical data element, please report values using one of the appropriate units of measurement listed below, which represent valid UCUM codes: Core Clinical Data Element UCUM Unit Bicarbonate-----------------------------------meq/L mmol/L Creatinine-------------------------------------mg/dL umol/L Heart rate------------------------------------{Beats}/min Hematocrit -----------------------------------% Oxygen saturation (by pulse oximetry)-----%{Oxygen} Platelet----------------------------------------10*3/uL 10*9/L /mm3 Sodium----------------------------------------meq/L mmol/L Systolic blood pressure----------------------mm[Hg] Temperature----------------------------------Cel [degF] White blood cell count ----------------------{Cells}/uL 10*3/uL 10*9/L /mm3 For each encounter please also submit the following Linking Variables: CMS Certification Number; Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI); Date of Birth; Sex; Inpatient Admission Date; and, Discharge Date. The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. Measure Group (Rate) (ID: 6385011c4ba3d47c885c02aa) Basis Encounter Scoring Cohort Type Outcome Initial Population ID: 24BB5BA9-820F-4958-B8AA-AA8962E9E398 Description: All Medicare Fee-For-Service encounters age 65 to 94 years at the start of an inpatient admission, who are discharged during the measurement period (length of stay <365 days). NOTE: All Medicare Fee-For-Service encounters meeting the above criteria should be included, regardless if Medicare Fee-For-Service is the primary, secondary, or tertiary payer. Criteria: Initial Population Supplemental Data Elements Supplemental Data Element ID: results Usage Code: Supplemental Data Description: Results Logic Definition: Results Supplemental Data Element ID: sde-ethnicity Usage Code: Supplemental Data Description: SDE Ethnicity Logic Definition: SDE Ethnicity Supplemental Data Element ID: sde-payer Usage Code: Supplemental Data Description: SDE Payer Logic Definition: SDE Payer Supplemental Data Element ID: sde-race Usage Code: Supplemental Data Description: SDE Race Logic Definition: SDE Race Supplemental Data Element ID: sde-sex Usage Code: Supplemental Data Description: SDE Sex Logic Definition: SDE Sex Measure Logic Primary Library HybridHospitalWideMortalityFHIRExample Contents Population Criteria Logic Definitions Terminology Dependencies Data Requirements Parameters Population Criteria Measure Group (Rate) (ID: 6385011c4ba3d47c885c02aa) Initial Population define "Initial Population": "Inpatient Encounters" Definition Logic Definitions Logic Definition Library Name: SupplementalDataElementsExample define "SDE Sex": case when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' } when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' } else null end Logic Definition Library Name: SupplementalDataElementsExample define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period } Logic Definition Library Name: SupplementalDataElementsExample define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text } Logic Definition Library Name: SupplementalDataElementsExample define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text } Logic Definition Library Name: CQMCommonExample /* @description: Hospitalization with Observation Length of Stay returns the length in days from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter */ define fluent function hospitalizationWithObservationLengthofStay(TheEncounter "Encounter" ): ((TheEncounter."hospitalizationWithObservation"(). "lengthInDays"())) Logic Definition Library Name: CQMCommonExample /* @description: Calculates the difference in calendar days between the start and end of the given interval. */ define fluent function lengthInDays(Value Interval<DateTime> ): difference in days between start of Value and end of Value Logic Definition Library Name: CQMCommonExample /* @description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter */ define fluent function hospitalizationWithObservation(TheEncounter Encounter ): TheEncounter Visit let ObsVisit: Last([Encounter: "Observation Services"] LastObs where LastObs.status = 'finished' and LastObs.period ends 1 hour or less on or before start of Visit.period sort by end of period ), VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period), EDVisit: Last([Encounter: "Emergency Department Visit"] LastED where LastED.status = 'finished' and LastED.period ends 1 hour or less on or before VisitStart sort by end of period ) return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period] Logic Definition Library Name: QICoreCommonExample /* @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<DateTime>, or Interval<Quantity> 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<DateTime> or Interval<Quantity>. 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<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>>): case when choice is DateTime then Interval[choice as DateTime, choice as DateTime] when choice is Interval<DateTime> then choice as Interval<DateTime> when choice is Quantity then Interval[Patient.birthDate + (choice as Quantity), Patient.birthDate + (choice as Quantity) + 1 year) when choice is Interval<Quantity> 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<DateTime> else null as Interval<DateTime> end Logic Definition Library Name: HybridHospitalWideMortalityFHIRExample define "SDE Sex": SDE."SDE Sex" Logic Definition Library Name: HybridHospitalWideMortalityFHIRExample define "Inpatient Encounters": from ["Encounter": "Encounter Inpatient"] InpatientEncounter, ["Coverage": "Medicare payer"] Payer where InpatientEncounter.status = 'finished' and ( InpatientEncounter.class ~ "IMP" or InpatientEncounter.class ~ "ACUTE" or InpatientEncounter.class ~ "NONAC" or InpatientEncounter.class ~ "OBSENC" ) and AgeInYearsAt(date from start of InpatientEncounter.period) in Interval[65, 94] and InpatientEncounter.hospitalizationWithObservationLengthofStay ( ) < 365 and InpatientEncounter.period ends during day of "Measurement Period" return InpatientEncounter Logic Definition Library Name: HybridHospitalWideMortalityFHIRExample /*Inpatient encounter initially listed as AMB class; changed this to inpatient classes as discussed with CORE team- AM*/ define "Results": flatten { //First physical exams (vital signs) "FirstPhysicalExamWithEncounterId"([Observation: "Heart Rate"], 'FirstHeartRate'), "FirstPhysicalExamWithEncounterId"([Observation: "Systolic Blood Pressure"], 'FirstSystolicBP'), "FirstPhysicalExamWithEncounterId"([Observation: "Body temperature"], 'FirstTemperature'), "FirstPhysicalExamWithEncounterId"([Observation: "Oxygen Saturation by Pulse Oximetry"], 'FirstO2Saturation'), //First lab tests "FirstLabTestWithEncounterId"([Observation: "Hematocrit lab test"], 'FirstHematocrit'), "FirstLabTestWithEncounterId"([Observation: "Platelet count lab test"], 'FirstPlateletCount'), "FirstLabTestWithEncounterId"([Observation: "White blood cells count lab test"], 'FirstWhiteBloodCell'), "FirstLabTestWithEncounterId"([Observation: "Sodium lab test"], 'FirstSodium'), "FirstLabTestWithEncounterId"([Observation: "Bicarbonate lab test"], 'FirstBicarbonate'), "FirstLabTestWithEncounterId"([Observation: "Creatinine lab test"], 'FirstCreatinine') } Logic Definition Library Name: HybridHospitalWideMortalityFHIRExample define "SDE Payer": SDE."SDE Payer" Logic Definition Library Name: HybridHospitalWideMortalityFHIRExample define "Initial Population": "Inpatient Encounters" Logic Definition Library Name: HybridHospitalWideMortalityFHIRExample define "SDE Ethnicity": SDE."SDE Ethnicity" Logic Definition Library Name: HybridHospitalWideMortalityFHIRExample define "SDE Race": SDE."SDE Race" Logic Definition Library Name: HybridHospitalWideMortalityFHIRExample define function "FirstPhysicalExamWithEncounterId"(ExamList List<Observation>, CCDE String): "Inpatient Encounters" Encounter let firstexam: First(ExamList Exam where start of QICoreCommon."ToInterval"(Exam.effective) is not null and start of QICoreCommon."ToInterval"(Exam.effective) during Interval[start of Encounter.period - 1440 minutes, start of Encounter.period + 120 minutes] and Exam.status in { 'final', 'amended', 'preliminary' } and Exam.value is not null sort by start of QICoreCommon."ToInterval"(effective) ) return '\r\n' & CCDE & ',' & Encounter.id & ' , ' & ( ToString(firstexam.value as Quantity) ) & ',' & ToString(start of QICoreCommon."ToInterval"(firstexam.effective)) Logic Definition Library Name: HybridHospitalWideMortalityFHIRExample define function "FirstLabTestWithEncounterId"(LabList List<Observation>, CCDE String): "Inpatient Encounters" Encounter let firstlab: First(LabList Lab where Lab.issued is not null and Lab.issued during Interval[start of Encounter.period - 1440 minutes, start of Encounter.period + 1440 minutes] and Lab.status in { 'final', 'amended', 'preliminary' } and Lab.value is not null sort by issued ) return '\r\n' & CCDE & ',' & Encounter.id & ',' & ( ToString(firstlab.value as Quantity) ) & ',' & ToString(firstlab.issued) Logic Definition Library Name: FHIRHelpers 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] Logic Definition Library Name: FHIRHelpers define function ToString(value uri): value.value Logic Definition Library Name: FHIRHelpers 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 } Terminology Code System Description: Code system ActCode Resource: ActCode Canonical URL: http://terminology.hl7.org/CodeSystem/v3-ActCode Value Set Description: Value set Encounter Inpatient Resource: Encounter Inpatient Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307 Value Set Description: Value set Medicare payer Resource: Medicare payer Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.10 Value Set Description: Value set Observation Services Resource: Observation Services Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143 Value Set Description: Value set Emergency Department Visit Resource: Emergency Department Visit Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292 Value Set Description: Value set Heart Rate Resource: Heart Rate Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.149 Value Set Description: Value set Systolic Blood Pressure Resource: Systolic Blood Pressure Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.163 Value Set Description: Value set Body temperature Resource: Body temperature Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.152 Value Set Description: Value set Oxygen Saturation by Pulse Oximetry Resource: Oxygen Saturation by Pulse Oximetry Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.151 Value Set Description: Value set Hematocrit lab test Resource: Hematocrit lab test Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.114 Value Set Description: Value set Platelet count lab test Resource: Platelet count lab test Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.127 Value Set Description: Value set White blood cells count lab test Resource: White blood cells count lab test Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.129 Value Set Description: Value set Sodium lab test Resource: Sodium lab test Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.119 Value Set Description: Value set Bicarbonate lab test Resource: Bicarbonate lab test Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.139 Value Set Description: Value set Creatinine lab test Resource: Creatinine lab test Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.2363 Value Set Description: Value set Payer Type Resource: Payer Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 Direct Reference Code Display: Inpatient Code: IMP System: http://terminology.hl7.org/CodeSystem/v3-ActCode Direct Reference Code Display: Acute Code: ACUTE System: http://terminology.hl7.org/CodeSystem/v3-ActCode Direct Reference Code Display: Nonacute Code: NONAC System: http://terminology.hl7.org/CodeSystem/v3-ActCode Direct Reference Code Display: Observation Encounter Code: OBSENC System: http://terminology.hl7.org/CodeSystem/v3-ActCode Dependencies Dependency Description: Library SDE Resource: SupplementalDataElementsExample Canonical URL: http://somewhere.org/fhir/uv/mycontentig/Library/SupplementalDataElementsExample Dependency Description: Library FHIRHelpers Resource: http://somewhere.org/fhir/uv/mycontentig/Library/FHIRHelpers|4.0.1 Canonical URL: http://somewhere.org/fhir/uv/mycontentig/Library/FHIRHelpers|4.0.1 Dependency Description: Library CQMCommon Resource: CQMCommonExample Canonical URL: http://somewhere.org/fhir/uv/mycontentig/Library/CQMCommonExample Dependency Description: Library QICoreCommon Resource: QICoreCommonExample Canonical URL: http://somewhere.org/fhir/uv/mycontentig/Library/QICoreCommonExample Data Requirements Data Requirement Type: Patient Profile(s): QICore Patient Must Support Elements: url, extension Data Requirement Type: Encounter Profile(s): QICore Encounter Must Support Elements: type, status, status.value, period, id, id.value Code Filter(s): Path: type ValueSet: Observation Services Data Requirement Type: Encounter Profile(s): QICore Encounter Must Support Elements: type, status, status.value, period, id, id.value Code Filter(s): Path: type ValueSet: Emergency Department Visit Data Requirement Type: Encounter Profile(s): QICore Encounter Must Support Elements: type, status, status.value, class, period, id, id.value Code Filter(s): Path: type ValueSet: Encounter Inpatient Data Requirement Type: Coverage Profile(s): QICore Coverage Must Support Elements: type Code Filter(s): Path: type ValueSet: Medicare payer Data Requirement Type: Coverage Profile(s): QICore Coverage Must Support Elements: type, period Code Filter(s): Path: type ValueSet: Payer Data Requirement Type: Observation Profile(s): QICore Observation Must Support Elements: code, effective, status, status.value, value, issued, issued.value Code Filter(s): Path: code ValueSet: Heart Rate Data Requirement Type: Observation Profile(s): QICore Observation Must Support Elements: code, effective, status, status.value, value, issued, issued.value Code Filter(s): Path: code ValueSet: Systolic Blood Pressure Data Requirement Type: Observation Profile(s): QICore Observation Must Support Elements: code, effective, status, status.value, value, issued, issued.value Code Filter(s): Path: code ValueSet: Body temperature Data Requirement Type: Observation Profile(s): QICore Observation Must Support Elements: code, effective, status, status.value, value, issued, issued.value Code Filter(s): Path: code ValueSet: Oxygen Saturation by Pulse Oximetry Data Requirement Type: Observation Profile(s): QICore Observation Must Support Elements: code, effective, status, status.value, value, issued, issued.value Code Filter(s): Path: code ValueSet: Hematocrit lab test Data Requirement Type: Observation Profile(s): QICore Observation Must Support Elements: code, effective, status, status.value, value, issued, issued.value Code Filter(s): Path: code ValueSet: Platelet count lab test Data Requirement Type: Observation Profile(s): QICore Observation Must Support Elements: code, effective, status, status.value, value, issued, issued.value Code Filter(s): Path: code ValueSet: White blood cells count lab test Data Requirement Type: Observation Profile(s): QICore Observation Must Support Elements: code, effective, status, status.value, value, issued, issued.value Code Filter(s): Path: code ValueSet: Sodium lab test Data Requirement Type: Observation Profile(s): QICore Observation Must Support Elements: code, effective, status, status.value, value, issued, issued.value Code Filter(s): Path: code ValueSet: Bicarbonate lab test Data Requirement Type: Observation Profile(s): QICore Observation Must Support Elements: code, effective, status, status.value, value, issued, issued.value Code Filter(s): Path: code ValueSet: Creatinine lab test Parameters Name Use Card. Type Documentation Measurement Period In 0..1 Period SDE Sex Out 0..1 Coding Results Out 0..* string SDE Payer Out 0..* Resource Initial Population Out 0..* Resource SDE Ethnicity Out 0..1 Resource SDE Race Out 0..1 Resource Generated using version 0.5.3 of the sample-content-ig Liquid templates
define "SDE Sex": case when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' } when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' } else null end
define "Inpatient Encounters": from ["Encounter": "Encounter Inpatient"] InpatientEncounter, ["Coverage": "Medicare payer"] Payer where InpatientEncounter.status = 'finished' and ( InpatientEncounter.class ~ "IMP" or InpatientEncounter.class ~ "ACUTE" or InpatientEncounter.class ~ "NONAC" or InpatientEncounter.class ~ "OBSENC" ) and AgeInYearsAt(date from start of InpatientEncounter.period) in Interval[65, 94] and InpatientEncounter.hospitalizationWithObservationLengthofStay ( ) < 365 and InpatientEncounter.period ends during day of "Measurement Period" return InpatientEncounter
/*Inpatient encounter initially listed as AMB class; changed this to inpatient classes as discussed with CORE team- AM*/ define "Results": flatten { //First physical exams (vital signs) "FirstPhysicalExamWithEncounterId"([Observation: "Heart Rate"], 'FirstHeartRate'), "FirstPhysicalExamWithEncounterId"([Observation: "Systolic Blood Pressure"], 'FirstSystolicBP'), "FirstPhysicalExamWithEncounterId"([Observation: "Body temperature"], 'FirstTemperature'), "FirstPhysicalExamWithEncounterId"([Observation: "Oxygen Saturation by Pulse Oximetry"], 'FirstO2Saturation'), //First lab tests "FirstLabTestWithEncounterId"([Observation: "Hematocrit lab test"], 'FirstHematocrit'), "FirstLabTestWithEncounterId"([Observation: "Platelet count lab test"], 'FirstPlateletCount'), "FirstLabTestWithEncounterId"([Observation: "White blood cells count lab test"], 'FirstWhiteBloodCell'), "FirstLabTestWithEncounterId"([Observation: "Sodium lab test"], 'FirstSodium'), "FirstLabTestWithEncounterId"([Observation: "Bicarbonate lab test"], 'FirstBicarbonate'), "FirstLabTestWithEncounterId"([Observation: "Creatinine lab test"], 'FirstCreatinine') }
define "SDE Payer": [Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period }
define "Initial Population": "Inpatient Encounters"
define "SDE Ethnicity": Patient.ethnicity E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text }
define "SDE Ethnicity": SDE."SDE Ethnicity"
define "SDE Race": Patient.race R return Tuple { codes: R.ombCategory union R.detailed, display: R.text }
define function "FirstPhysicalExamWithEncounterId"(ExamList List<Observation>, CCDE String): "Inpatient Encounters" Encounter let firstexam: First(ExamList Exam where start of QICoreCommon."ToInterval"(Exam.effective) is not null and start of QICoreCommon."ToInterval"(Exam.effective) during Interval[start of Encounter.period - 1440 minutes, start of Encounter.period + 120 minutes] and Exam.status in { 'final', 'amended', 'preliminary' } and Exam.value is not null sort by start of QICoreCommon."ToInterval"(effective) ) return '\r\n' & CCDE & ',' & Encounter.id & ' , ' & ( ToString(firstexam.value as Quantity) ) & ',' & ToString(start of QICoreCommon."ToInterval"(firstexam.effective))
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: Hospitalization with Observation Length of Stay returns the length in days from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter */ define fluent function hospitalizationWithObservationLengthofStay(TheEncounter "Encounter" ): ((TheEncounter."hospitalizationWithObservation"(). "lengthInDays"()))
/* @description: Calculates the difference in calendar days between the start and end of the given interval. */ define fluent function lengthInDays(Value Interval<DateTime> ): difference in days between start of Value and end of Value
/* @description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter */ define fluent function hospitalizationWithObservation(TheEncounter Encounter ): TheEncounter Visit let ObsVisit: Last([Encounter: "Observation Services"] LastObs where LastObs.status = 'finished' and LastObs.period ends 1 hour or less on or before start of Visit.period sort by end of period ), VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period), EDVisit: Last([Encounter: "Emergency Department Visit"] LastED where LastED.status = 'finished' and LastED.period ends 1 hour or less on or before VisitStart sort by end of period ) return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]
/* @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<DateTime>, or Interval<Quantity> 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<DateTime> or Interval<Quantity>. 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<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>>): case when choice is DateTime then Interval[choice as DateTime, choice as DateTime] when choice is Interval<DateTime> then choice as Interval<DateTime> when choice is Quantity then Interval[Patient.birthDate + (choice as Quantity), Patient.birthDate + (choice as Quantity) + 1 year) when choice is Interval<Quantity> 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<DateTime> else null as Interval<DateTime> end
define function "FirstLabTestWithEncounterId"(LabList List<Observation>, CCDE String): "Inpatient Encounters" Encounter let firstlab: First(LabList Lab where Lab.issued is not null and Lab.issued during Interval[start of Encounter.period - 1440 minutes, start of Encounter.period + 1440 minutes] and Lab.status in { 'final', 'amended', 'preliminary' } and Lab.value is not null sort by issued ) return '\r\n' & CCDE & ',' & Encounter.id & ',' & ( ToString(firstlab.value as Quantity) ) & ',' & ToString(firstlab.issued)
define function ToString(value uri): value.value
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 }
Value set Oxygen Saturation by Pulse Oximetry
Value set White blood cells count lab test
Core Clinical Data Elements for the Hybrid Hospital-Wide (All-Condition, All-Procedure) Risk-Standardized Mortality Measure (HWM) FHIR Example
This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from encounters for adult Medicare Fee-For-Service patients admitted to acute care short stay hospitals.
This FHIR-based measure has been derived from the QDM-based measure: CMS844v3.1 (QDM 5.6). 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). These specifications are for use for data with discharges that occur between July 1, 2023 and June 30, 2024. This logic guides the user to extract the FIRST resulted HWM-specific core clinical data elements for all Medicare Fee-For-Service encounters for patients age 65 to 94 (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area, such as the emergency department or hospital outpatient location. The logic supports extraction of the FIRST set of HWM-specific core clinical data elements in two different ways, depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility: 1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission. 2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for core clinical data element values related to a patient who is subsequently admitted. Value sets for the laboratory tests represent the LOINC codes currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements. NOTE: Do not report ALL values on an encounter during their entire admission. Only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. For each core clinical data element, please report values using one of the appropriate units of measurement listed below, which represent valid UCUM codes: Core Clinical Data Element UCUM Unit Bicarbonate-----------------------------------meq/L mmol/L Creatinine-------------------------------------mg/dL umol/L Heart rate------------------------------------{Beats}/min Hematocrit -----------------------------------% Oxygen saturation (by pulse oximetry)-----%{Oxygen} Platelet----------------------------------------10*3/uL 10*9/L /mm3 Sodium----------------------------------------meq/L mmol/L Systolic blood pressure----------------------mm[Hg] Temperature----------------------------------Cel [degF] White blood cell count ----------------------{Cells}/uL 10*3/uL 10*9/L /mm3 For each encounter please also submit the following Linking Variables: CMS Certification Number; Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI); Date of Birth; Sex; Inpatient Admission Date; and, Discharge Date. The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.
Limited proprietary coding is contained in these specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2021 International Health Terminology Standards Development Organisation. All rights reserved. LOINC(R) copyright 2004-2021 Regenstrief Institute, Inc.
Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation
These performance specifications are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” 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].
The intent of this logic is to extract the FIRST set of clinical data elements from hospital electronic health records (EHRs) for all qualifying encounters. The data will be linked with administrative claims to risk adjust the Hybrid HWM outcome measure. This work addresses stakeholder concerns that clinical data garnered from patients, and used by clinicians to guide diagnostic decisions and treatment, are preferable to administrative claims data when profiling hospitals’ case mix. We are calling the list of data elements for extraction the "HWM-specific core clinical data elements". The core clinical data elements are the first set of vital signs and basic laboratory tests resulted from encounters for adult Medicare Fee-For-Service patients, age 65 to 94 (Initial Population), after they arrive at the hospital to which they are subsequently admitted. For example, this first set of data values are often captured in the emergency department or in the pre-operative area, sometimes hours before a patient is admitted to that same facility. Encounters over the age of 94 are not included to avoid holding hospitals responsible for the survival of the oldest elderly patients, who may be less likely to have survival as a primary goal. While we acknowledge that many elderly patients do have survival beyond 30 days as a primary goal for their hospitalization, with input from our Technical Expert Panel and work groups, we decided to only include encounters between 65 and 94 years of age. These core clinical data elements were selected because they: 1. reflect patients' clinical status when they first present to the hospital; 2. are clinically and statistically relevant to patient outcomes; 3. are consistently obtained on adult inpatient encounters based on current clinical practice; 4. are captured with a standard definition and recorded in a standard format across providers; and 5. are entered in structured fields that are feasibly retrieved from current EHR systems (YNHHSC/CORE, 2015). Additional data called Linking Variables are used to link EHR data files with administrative claims data for CMS to calculate results for the Hybrid HWM measure, which are: CMS Certification Number; Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI); date of birth; sex; admission date; and discharge date.
The logic is not meant to guide or alter the care patients receive. The purpose of this core clinical data elements logic is to extract clinical data that are already routinely captured in EHRs from encounters for hospitalized adult patients. It is not intended to require that clinical staff perform additional measurements or tests that are not needed for diagnostic assessment or treatment of patients.
All Medicare Fee-For-Service encounters age 65 to 94 years at the start of an inpatient admission, who are discharged during the measurement period (length of stay <365 days). NOTE: All Medicare Fee-For-Service encounters meeting the above criteria should be included, regardless if Medicare Fee-For-Service is the primary, secondary, or tertiary payer.