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0.5.3 - CI Build

Your User Friendly Name for MyContentIG Here, published by HL7 International - [Some] Work Group. This guide is not an authorized publication; it is the continuous build for version 0.5.3 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/sample-content-ig/ and changes regularly. See the Directory of published versions

## : Core Clinical Data Elements for the Hybrid Hospital-Wide (All-Condition, All-Procedure) Risk-Standardized Mortality Measure (HWM) FHIR Example - XML Representation

Draft as of 2025-09-30

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    <Measure xmlns="http://hl7.org/fhir">
      <id value="HybridHospitalWideMortalityFHIRExample"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"/>
      </meta>
      <text>
        <status value="extensions"/>
        <div xmlns="http://www.w3.org/1999/xhtml">
      <table class="narrative-table">
        <tbody>
    <tr>

    <th colspan="2" scope="row" class="row-header">Metadata</th>

    </tr>

    <tr>

    <th scope="row" class="row-header">Title</th>

    <td class="content-container">Core Clinical Data Elements for the Hybrid Hospital-Wide (All-Condition, All-Procedure) Risk-Standardized Mortality Measure (HWM) FHIR Example</td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Version</th>

    <td class="content-container">0.5.3</td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Short Name</th>

    <td class="content-container">CMS844FHIR</td>

    </tr>

    <tr>

    <th scope="row" class="row-header">GUID (Version Independent)</th>

    <td class="content-container">urn:uuid:965255e9-dfeb-42d0-8416-2c4b7ecc5109</td>

    </tr>

    <tr>

    <th scope="row" class="row-header">GUID (Version Specific)</th>

    <td class="content-container">urn:uuid:2c92808482113ece0182c5d4fc662f1a</td>

    </tr>

    <tr>

    <th scope="row" class="row-header">CMS Identifier</th>

    <td class="content-container">844FHIR</td>

    </tr>

    <tr>

    <th scope="row" class="row-header">NQF Identifier</th>

    <td class="content-container">3502</td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Effective Period</th>

    <td class="content-container">2024-07-01 through 2025-06-30</td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Approval Date</th>

    <td class="content-container">2023-08-14</td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Last Review Date</th>

    <td class="content-container">2023-08-14</td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Status</th>

    <td class="content-container">Draft</td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Jurisdiction</th>

    <td class="content-container">
        001 from <a href="http://unstats.un.org/unsd/methods/m49/m49.htm">http://unstats.un.org/unsd/methods/m49/m49.htm</a>

    </td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Steward (Publisher)</th>

    <td class="content-container">HL7 International - [Some] Work Group</td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Developer</th>

    <td class="content-container">Mathematica</td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Developer</th>

    <td class="content-container">Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation</td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Description</th>

    <td class="content-container"><div><p>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.</p>
    </div></td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Copyright</th>

    <td class="content-container"><div><p>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.</p>
    <p>This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2021 International Health Terminology Standards Development Organisation. All rights reserved.</p>
    <p>LOINC(R) copyright 2004-2021 Regenstrief Institute, Inc.</p>
    </div></td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Disclaimer</th>

    <td class="content-container"><div><p>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.</p>
    <p>THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.</p>
    <p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>
    </div></td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Rationale</th>

    <td class="content-container"><div><p>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 &quot;HWM-specific core clinical data elements&quot;. 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.</p>
    <p>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).</p>
    <p>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.</p>
    </div></td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Clinical Recommendation Statement</th>

    <td class="content-container"><div><p>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.</p>
    </div></td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Guidance (Usage)</th>

    <td class="content-container">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.</td>

    </tr>

        <tr>

    <th colspan="2" scope="row" class="row-header">Measure Group (Rate) (ID: 6385011c4ba3d47c885c02aa)</th>

    </tr>

    <tr>

    <th scope="row" class="row-header">Basis</th>

    <td class="content-container">Encounter</td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Scoring</th>

    <td class="content-container">
        Cohort

    </td>

    </tr>

    <tr>

    <th scope="row" class="row-header">Type</th>

    <td class="content-container">
        Outcome

    </td>

    </tr>

        <tr>

    <th scope="row" class="row-header">Initial Population</th>

          <td class="content-container">

            <em>ID</em>: 24BB5BA9-820F-4958-B8AA-AA8962E9E398
            <br/>

              <em>Description</em>:
              <p style="white-space: pre-line" class="tab-one">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 &lt;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.</p>

                  <em>Criteria</em>: <a href="#6385011c4ba3d47c885c02aa-24BB5BA9-820F-4958-B8AA-AA8962E9E398">Initial Population</a>

          </td>
        </tr>

      <tr>

    <th colspan="2" scope="row" class="row-header">Supplemental Data Elements</th>

    </tr>

    <tr>

    <th scope="row" class="row-header">Supplemental Data Element</th>

      <td class="content-container">

          <em>ID</em>: results

          <br/>

              <em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>

            <br/>

          <em>Description</em>: Results

            <br/>

              <em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhirexample-results">Results</a>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Supplemental Data Element</th>

      <td class="content-container">

          <em>ID</em>: sde-ethnicity

          <br/>

              <em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>

            <br/>

          <em>Description</em>: SDE Ethnicity

            <br/>

              <em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhirexample-sde-ethnicity">SDE Ethnicity</a>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Supplemental Data Element</th>

      <td class="content-container">

          <em>ID</em>: sde-payer

          <br/>

              <em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>

            <br/>

          <em>Description</em>: SDE Payer

            <br/>

              <em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhirexample-sde-payer">SDE Payer</a>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Supplemental Data Element</th>

      <td class="content-container">

          <em>ID</em>: sde-race

          <br/>

              <em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>

            <br/>

          <em>Description</em>: SDE Race

            <br/>

              <em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhirexample-sde-race">SDE Race</a>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Supplemental Data Element</th>

      <td class="content-container">

          <em>ID</em>: sde-sex

          <br/>

              <em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>

            <br/>

          <em>Description</em>: SDE Sex

            <br/>

              <em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhirexample-sde-sex">SDE Sex</a>

      </td>
    </tr>

    <tr>

    <th colspan="2" scope="row" class="row-header">Measure Logic</th>

    </tr>

    <tr>

    <th scope="row" class="row-header">Primary Library</th>

    <td class="content-container"><a href="Library-HybridHospitalWideMortalityFHIRExample.html">HybridHospitalWideMortalityFHIRExample</a></td>

    </tr>

    <tr>
      <th scope="row" class="row-header">Contents</th>
      <td class="content-container">
        <em><a href="#population-criteria">Population Criteria</a></em>
        <br/>
        <em><a href="#definitions">Logic Definitions</a></em>
        <br/>
        <em><a href="#terminology">Terminology</a></em>
        <br/>
        <em><a href="#dependencies">Dependencies</a></em>
        <br/>
        <em><a href="#data-requirements">Data Requirements</a></em>
        <br/>
        <em><a href="#parameters">Parameters</a></em>
        <br/>
      </td>
    </tr>

      <tr>

    <th colspan="2" scope="row" class="row-header"><a name="population-criteria"> </a>Population Criteria</th>

    </tr>

        <tr>

    <th colspan="2" scope="row" class="row-header">Measure Group (Rate) (ID: 6385011c4ba3d47c885c02aa)</th>

    </tr>

                <tr>
      <th scope="row" rowspan="2" class="row-header">

        Initial Population

      </th>
    </tr>
    <tr>

      <td>

          <a name="6385011c4ba3d47c885c02aa-24BB5BA9-820F-4958-B8AA-AA8962E9E398"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Initial Population&quot;:
      &quot;Inpatient Encounters&quot;</code></pre>

          <a href="#hybridhospitalwidemortalityfhirexample-initial-population"><em>Definition</em></a>

      </td>

    </tr>

      <tr>

    <th colspan="2" scope="row" class="row-header"><a name="definitions"> </a>Logic Definitions</th>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> SupplementalDataElementsExample</td>

    </tr>
    <tr>

      <td>

          <a name="supplementaldataelementsexample-sde-sex"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Sex&quot;:
      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</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> SupplementalDataElementsExample</td>

    </tr>
    <tr>

      <td>

          <a name="supplementaldataelementsexample-sde-payer"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Payer&quot;:
      [Coverage: type in &quot;Payer Type&quot;] Payer
        return {
          code: Payer.type,
          period: Payer.period
        }</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> SupplementalDataElementsExample</td>

    </tr>
    <tr>

      <td>

          <a name="supplementaldataelementsexample-sde-ethnicity"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Ethnicity&quot;:
      Patient.ethnicity E
        return Tuple {
          codes: { E.ombCategory } union E.detailed,
          display: E.text
        }</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> SupplementalDataElementsExample</td>

    </tr>
    <tr>

      <td>

          <a name="supplementaldataelementsexample-sde-race"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Race&quot;:
      Patient.race R
        return Tuple {
          codes: R.ombCategory union R.detailed,
          display: R.text
        }</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> CQMCommonExample</td>

    </tr>
    <tr>

      <td>

          <a name="cqmcommonexample-hospitalizationwithobservationlengthofstay"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
    @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 &quot;Encounter&quot; ):
      ((TheEncounter.&quot;hospitalizationWithObservation&quot;(). &quot;lengthInDays&quot;()))</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> CQMCommonExample</td>

    </tr>
    <tr>

      <td>

          <a name="cqmcommonexample-lengthindays"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
    @description: Calculates the difference in calendar days between the start and end of the given interval.
    */
    define fluent function lengthInDays(Value Interval&lt;DateTime&gt; ):
      difference in days between start of Value and end of Value</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> CQMCommonExample</td>

    </tr>
    <tr>

      <td>

          <a name="cqmcommonexample-hospitalizationwithobservation"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
    @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: &quot;Observation Services&quot;] 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: &quot;Emergency Department Visit&quot;] 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]</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> QICoreCommonExample</td>

    </tr>
    <tr>

      <td>

          <a name="qicorecommonexample-tointerval"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
    @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
    @comment: Normalizes a choice type of DateTime, Quanitty, Interval&lt;DateTime&gt;, or Interval&lt;Quantity&gt; types
    to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
    representations for timing-valued elements in QICore, allowing this function to be used across any resource.
    The input can be provided as a DateTime, Quantity, Interval&lt;DateTime&gt; or Interval&lt;Quantity&gt;.
    The intent of this function is to provide a clear and concise mechanism to treat single
    elements that have multiple possible representations as intervals so that logic doesn't have to account
    for the variability. More complex calculations (such as medication request period or dispense period
    calculation) need specific guidance and consideration. That guidance may make use of this function, but
    the focus of this function is on single element calculations where the semantics are unambiguous.
    If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
    If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
    and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
    If the input is a DateTime Interval, the result is the input.
    If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
    is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
    immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
    Any other input will reslt in a null DateTime Interval
    @deprecated: This function is deprecated. Use the fluent function `toInterval()` instead
    */
    define function ToInterval(choice Choice&lt;DateTime, Quantity, Interval&lt;DateTime&gt;, Interval&lt;Quantity&gt;&gt;):
      case
    	  when choice is DateTime then
        	Interval[choice as DateTime, choice as DateTime]
    		when choice is Interval&lt;DateTime&gt; then
      		choice as Interval&lt;DateTime&gt;
    		when choice is Quantity then
    		  Interval[Patient.birthDate + (choice as Quantity),
    			  Patient.birthDate + (choice as Quantity) + 1 year)
    		when choice is Interval&lt;Quantity&gt; then
    		  Interval[Patient.birthDate + (choice.low as Quantity),
    			  Patient.birthDate + (choice.high as Quantity) + 1 year)
    		when choice is QICore.Timing then
                null as Interval&lt;DateTime&gt;
    		else
    			null as Interval&lt;DateTime&gt;
    	end</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIRExample</td>

    </tr>
    <tr>

      <td>

          <a name="hybridhospitalwidemortalityfhirexample-sde-sex"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Sex&quot;:
      SDE.&quot;SDE Sex&quot;</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIRExample</td>

    </tr>
    <tr>

      <td>

          <a name="hybridhospitalwidemortalityfhirexample-inpatient-encounters"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Inpatient Encounters&quot;:
      from
        [&quot;Encounter&quot;: &quot;Encounter Inpatient&quot;] InpatientEncounter,
        [&quot;Coverage&quot;: &quot;Medicare payer&quot;] Payer
        where InpatientEncounter.status = 'finished'
          and ( InpatientEncounter.class ~ &quot;IMP&quot;
              or InpatientEncounter.class ~ &quot;ACUTE&quot;
              or InpatientEncounter.class ~ &quot;NONAC&quot;
              or InpatientEncounter.class ~ &quot;OBSENC&quot;
          )
          and AgeInYearsAt(date from start of InpatientEncounter.period) in Interval[65, 94]
          and InpatientEncounter.hospitalizationWithObservationLengthofStay ( ) &lt; 365
          and InpatientEncounter.period ends during day of &quot;Measurement Period&quot;
        return InpatientEncounter</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIRExample</td>

    </tr>
    <tr>

      <td>

          <a name="hybridhospitalwidemortalityfhirexample-results"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*Inpatient encounter initially listed as AMB class; changed this to inpatient classes as discussed with CORE team- AM*/

    define &quot;Results&quot;:
      flatten {
        //First physical exams (vital signs)
      &quot;FirstPhysicalExamWithEncounterId&quot;([Observation: &quot;Heart Rate&quot;], 'FirstHeartRate'), &quot;FirstPhysicalExamWithEncounterId&quot;([Observation: &quot;Systolic Blood Pressure&quot;], 'FirstSystolicBP'), &quot;FirstPhysicalExamWithEncounterId&quot;([Observation: &quot;Body temperature&quot;], 'FirstTemperature'), &quot;FirstPhysicalExamWithEncounterId&quot;([Observation: &quot;Oxygen Saturation by Pulse Oximetry&quot;], 'FirstO2Saturation'),
        //First lab tests
      &quot;FirstLabTestWithEncounterId&quot;([Observation: &quot;Hematocrit lab test&quot;], 'FirstHematocrit'), &quot;FirstLabTestWithEncounterId&quot;([Observation: &quot;Platelet count lab test&quot;], 'FirstPlateletCount'), &quot;FirstLabTestWithEncounterId&quot;([Observation: &quot;White blood cells count lab test&quot;], 'FirstWhiteBloodCell'), &quot;FirstLabTestWithEncounterId&quot;([Observation: &quot;Sodium lab test&quot;], 'FirstSodium'), &quot;FirstLabTestWithEncounterId&quot;([Observation: &quot;Bicarbonate lab test&quot;], 'FirstBicarbonate'), &quot;FirstLabTestWithEncounterId&quot;([Observation: &quot;Creatinine lab test&quot;], 'FirstCreatinine') }</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIRExample</td>

    </tr>
    <tr>

      <td>

          <a name="hybridhospitalwidemortalityfhirexample-sde-payer"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Payer&quot;:
      SDE.&quot;SDE Payer&quot;</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIRExample</td>

    </tr>
    <tr>

      <td>

          <a name="hybridhospitalwidemortalityfhirexample-initial-population"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Initial Population&quot;:
      &quot;Inpatient Encounters&quot;</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIRExample</td>

    </tr>
    <tr>

      <td>

          <a name="hybridhospitalwidemortalityfhirexample-sde-ethnicity"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Ethnicity&quot;:
      SDE.&quot;SDE Ethnicity&quot;</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIRExample</td>

    </tr>
    <tr>

      <td>

          <a name="hybridhospitalwidemortalityfhirexample-sde-race"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Race&quot;:
      SDE.&quot;SDE Race&quot;</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIRExample</td>

    </tr>
    <tr>

      <td>

          <a name="hybridhospitalwidemortalityfhirexample-firstphysicalexamwithencounterid"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function &quot;FirstPhysicalExamWithEncounterId&quot;(ExamList List&lt;Observation&gt;, CCDE String):
      &quot;Inpatient Encounters&quot; Encounter
        let firstexam: First(ExamList Exam
            where start of QICoreCommon.&quot;ToInterval&quot;(Exam.effective) is not null
              and start of QICoreCommon.&quot;ToInterval&quot;(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.&quot;ToInterval&quot;(effective)
        )
        return '\r\n' &amp; CCDE &amp; ',' &amp; Encounter.id &amp; ' , ' &amp; ( ToString(firstexam.value as Quantity) ) &amp; ',' &amp; ToString(start of QICoreCommon.&quot;ToInterval&quot;(firstexam.effective))</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIRExample</td>

    </tr>
    <tr>

      <td>

          <a name="hybridhospitalwidemortalityfhirexample-firstlabtestwithencounterid"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function &quot;FirstLabTestWithEncounterId&quot;(LabList List&lt;Observation&gt;, CCDE String):
      &quot;Inpatient Encounters&quot; 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' &amp; CCDE &amp; ',' &amp; Encounter.id &amp; ',' &amp; ( ToString(firstlab.value as Quantity) ) &amp; ',' &amp; ToString(firstlab.issued)</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> FHIRHelpers</td>

    </tr>
    <tr>

      <td>

          <a name="fhirhelpers-tointerval"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function ToInterval(period FHIR.Period):
        if period is null then
            null
        else
            if period.&quot;start&quot; is null then
                Interval(period.&quot;start&quot;.value, period.&quot;end&quot;.value]
            else
                Interval[period.&quot;start&quot;.value, period.&quot;end&quot;.value]</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> FHIRHelpers</td>

    </tr>
    <tr>

      <td>

          <a name="fhirhelpers-tostring"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function ToString(value uri): value.value</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> FHIRHelpers</td>

    </tr>
    <tr>

      <td>

          <a name="fhirhelpers-tocode"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function ToCode(coding FHIR.Coding):
        if coding is null then
            null
        else
            System.Code {
              code: coding.code.value,
              system: coding.system.value,
              version: coding.version.value,
              display: coding.display.value
            }</code></pre>
      </td>

    </tr>

      <tr>

    <th colspan="2" scope="row" class="row-header"><a name="terminology"> </a>Terminology</th>

    </tr>

    <tr>

    <th scope="row" class="row-header">Code System</th>

      <td class="content-container">

        <em>Description</em>: Code system ActCode

        <br/>

        <em>Resource</em>: <a href="http://terminology.hl7.org/7.0.0/CodeSystem-v3-ActCode.html">ActCode</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://terminology.hl7.org/CodeSystem/v3-ActCode</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set Encounter Inpatient

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set Medicare payer

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1104.10/expansion">Medicare payer</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.10</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set Observation Services

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion">Observation Services</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set Emergency Department Visit

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion">Emergency Department Visit</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set Heart Rate

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.149/expansion">Heart Rate</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.149</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set Systolic Blood Pressure

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.163/expansion">Systolic Blood Pressure</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.163</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set Body temperature

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.152/expansion">Body temperature</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.152</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set Oxygen Saturation by Pulse Oximetry

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.151/expansion">Oxygen Saturation by Pulse Oximetry</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.151</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set Hematocrit lab test

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.114/expansion">Hematocrit lab test</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.114</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set Platelet count lab test

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.127/expansion">Platelet count lab test</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.127</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set White blood cells count lab test

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.129/expansion">White blood cells count lab test</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.129</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set Sodium lab test

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.119/expansion">Sodium lab test</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.119</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set Bicarbonate lab test

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.139/expansion">Bicarbonate lab test</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.139</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set Creatinine lab test

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.2363/expansion">Creatinine lab test</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.2363</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set Payer Type

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591</tt>

      </td>
    </tr>

      <tr>
        <th scope="row" class="row-header">Direct Reference Code</th>
        <td class="content-container">

            <em>Display</em>: Inpatient
            <br/>

          <em>Code</em>: IMP
          <br/>
          <em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/v3-ActCode</tt>
        </td>
      </tr>

      <tr>
        <th scope="row" class="row-header">Direct Reference Code</th>
        <td class="content-container">

            <em>Display</em>: Acute
            <br/>

          <em>Code</em>: ACUTE
          <br/>
          <em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/v3-ActCode</tt>
        </td>
      </tr>

      <tr>
        <th scope="row" class="row-header">Direct Reference Code</th>
        <td class="content-container">

            <em>Display</em>: Nonacute
            <br/>

          <em>Code</em>: NONAC
          <br/>
          <em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/v3-ActCode</tt>
        </td>
      </tr>

      <tr>
        <th scope="row" class="row-header">Direct Reference Code</th>
        <td class="content-container">

            <em>Display</em>: Observation Encounter
            <br/>

          <em>Code</em>: OBSENC
          <br/>
          <em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/v3-ActCode</tt>
        </td>
      </tr>

      <tr>

    <th colspan="2" scope="row" class="row-header"><a name="dependencies"> </a>Dependencies</th>

    </tr>

    <tr>

    <th scope="row" class="row-header">Dependency</th>

      <td class="content-container">

        <em>Description</em>: Library SDE

        <br/>

        <em>Resource</em>: <a href="Library-SupplementalDataElementsExample.html">SupplementalDataElementsExample</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://somewhere.org/fhir/uv/mycontentig/Library/SupplementalDataElementsExample</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Dependency</th>

      <td class="content-container">

        <em>Description</em>: Library FHIRHelpers

        <br/>

        <em>Resource</em>: <code>http://somewhere.org/fhir/uv/mycontentig/Library/FHIRHelpers|4.0.1</code>
        <br/>
        <em>Canonical URL</em>: <tt>http://somewhere.org/fhir/uv/mycontentig/Library/FHIRHelpers|4.0.1</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Dependency</th>

      <td class="content-container">

        <em>Description</em>: Library CQMCommon

        <br/>

        <em>Resource</em>: <a href="Library-CQMCommonExample.html">CQMCommonExample</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://somewhere.org/fhir/uv/mycontentig/Library/CQMCommonExample</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Dependency</th>

      <td class="content-container">

        <em>Description</em>: Library QICoreCommon

        <br/>

        <em>Resource</em>: <a href="Library-QICoreCommonExample.html">QICoreCommonExample</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://somewhere.org/fhir/uv/mycontentig/Library/QICoreCommonExample</tt>

      </td>
    </tr>

      <tr>

    <th colspan="2" scope="row" class="row-header"><a name="data-requirements"> </a>Data Requirements</th>

    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Patient
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-patient.html">QICore Patient</a>
        <br/>

        <em>Must Support Elements</em>: url, extension
        <br/>

      </td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Encounter
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-encounter.html">QICore Encounter</a>
        <br/>

        <em>Must Support Elements</em>: type, status, status.value, period, id, id.value
        <br/>

        <em>Code Filter(s)</em>:
        <br/>

        <span class="tab-one"><em>Path</em>: type</span>
        <br/>

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion">Observation Services</a>
        <br/>

      </td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Encounter
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-encounter.html">QICore Encounter</a>
        <br/>

        <em>Must Support Elements</em>: type, status, status.value, period, id, id.value
        <br/>

        <em>Code Filter(s)</em>:
        <br/>

        <span class="tab-one"><em>Path</em>: type</span>
        <br/>

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion">Emergency Department Visit</a>
        <br/>

      </td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Encounter
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-encounter.html">QICore Encounter</a>
        <br/>

        <em>Must Support Elements</em>: type, status, status.value, class, period, id, id.value
        <br/>

        <em>Code Filter(s)</em>:
        <br/>

        <span class="tab-one"><em>Path</em>: type</span>
        <br/>

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a>
        <br/>

      </td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Coverage
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-coverage.html">QICore Coverage</a>
        <br/>

        <em>Must Support Elements</em>: type
        <br/>

        <em>Code Filter(s)</em>:
        <br/>

        <span class="tab-one"><em>Path</em>: type</span>
        <br/>

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1104.10/expansion">Medicare payer</a>
        <br/>

      </td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Coverage
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-coverage.html">QICore Coverage</a>
        <br/>

        <em>Must Support Elements</em>: type, period
        <br/>

        <em>Code Filter(s)</em>:
        <br/>

        <span class="tab-one"><em>Path</em>: type</span>
        <br/>

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a>
        <br/>

      </td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Observation
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-observation.html">QICore Observation</a>
        <br/>

        <em>Must Support Elements</em>: code, effective, status, status.value, value, issued, issued.value
        <br/>

        <em>Code Filter(s)</em>:
        <br/>

        <span class="tab-one"><em>Path</em>: code</span>
        <br/>

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.149/expansion">Heart Rate</a>
        <br/>

      </td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Observation
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-observation.html">QICore Observation</a>
        <br/>

        <em>Must Support Elements</em>: code, effective, status, status.value, value, issued, issued.value
        <br/>

        <em>Code Filter(s)</em>:
        <br/>

        <span class="tab-one"><em>Path</em>: code</span>
        <br/>

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.163/expansion">Systolic Blood Pressure</a>
        <br/>

      </td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Observation
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-observation.html">QICore Observation</a>
        <br/>

        <em>Must Support Elements</em>: code, effective, status, status.value, value, issued, issued.value
        <br/>

        <em>Code Filter(s)</em>:
        <br/>

        <span class="tab-one"><em>Path</em>: code</span>
        <br/>

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.152/expansion">Body temperature</a>
        <br/>

      </td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Observation
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-observation.html">QICore Observation</a>
        <br/>

        <em>Must Support Elements</em>: code, effective, status, status.value, value, issued, issued.value
        <br/>

        <em>Code Filter(s)</em>:
        <br/>

        <span class="tab-one"><em>Path</em>: code</span>
        <br/>

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.151/expansion">Oxygen Saturation by Pulse Oximetry</a>
        <br/>

      </td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Observation
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-observation.html">QICore Observation</a>
        <br/>

        <em>Must Support Elements</em>: code, effective, status, status.value, value, issued, issued.value
        <br/>

        <em>Code Filter(s)</em>:
        <br/>

        <span class="tab-one"><em>Path</em>: code</span>
        <br/>

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.114/expansion">Hematocrit lab test</a>
        <br/>

      </td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Observation
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-observation.html">QICore Observation</a>
        <br/>

        <em>Must Support Elements</em>: code, effective, status, status.value, value, issued, issued.value
        <br/>

        <em>Code Filter(s)</em>:
        <br/>

        <span class="tab-one"><em>Path</em>: code</span>
        <br/>

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.127/expansion">Platelet count lab test</a>
        <br/>

      </td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Observation
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-observation.html">QICore Observation</a>
        <br/>

        <em>Must Support Elements</em>: code, effective, status, status.value, value, issued, issued.value
        <br/>

        <em>Code Filter(s)</em>:
        <br/>

        <span class="tab-one"><em>Path</em>: code</span>
        <br/>

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.129/expansion">White blood cells count lab test</a>
        <br/>

      </td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Observation
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-observation.html">QICore Observation</a>
        <br/>

        <em>Must Support Elements</em>: code, effective, status, status.value, value, issued, issued.value
        <br/>

        <em>Code Filter(s)</em>:
        <br/>

        <span class="tab-one"><em>Path</em>: code</span>
        <br/>

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.119/expansion">Sodium lab test</a>
        <br/>

      </td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Observation
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-observation.html">QICore Observation</a>
        <br/>

        <em>Must Support Elements</em>: code, effective, status, status.value, value, issued, issued.value
        <br/>

        <em>Code Filter(s)</em>:
        <br/>

        <span class="tab-one"><em>Path</em>: code</span>
        <br/>

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.139/expansion">Bicarbonate lab test</a>
        <br/>

      </td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Observation
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-observation.html">QICore Observation</a>
        <br/>

        <em>Must Support Elements</em>: code, effective, status, status.value, value, issued, issued.value
        <br/>

        <em>Code Filter(s)</em>:
        <br/>

        <span class="tab-one"><em>Path</em>: code</span>
        <br/>

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.2363/expansion">Creatinine lab test</a>
        <br/>

      </td>
    </tr>

      <tr>

    <th colspan="2" scope="row" class="row-header"><a name="parameters"> </a>Parameters</th>

    </tr>

      <tr>

    <th scope="row" class="row-header"/>

      <td class="content-container">
        <table>
          <thead>
            <tr>
              <td><em>Name</em></td>
              <td><em>Use</em></td>
              <td><em>Card.</em></td>
              <td><em>Type</em></td>
              <td><em>Documentation</em></td>
            </tr>
          </thead>
          <tbody>

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

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

            <tr>
              <td>Results</td>
              <td>Out</td>
              <td>0..*</td>
              <td>string</td>
              <td/>
            </tr>

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

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

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

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

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

    <tr>
      <th colspan="2" scope="row" class="row-header">Generated using version 0.5.3 of the sample-content-ig Liquid templates</th>
    </tr>

        </tbody>
      </table>
    </div>
      </text>
      <contained>
        <Library>
          <id value="effective-data-requirements"/>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
              <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
              <code value="IMP"/>
              <display value="Inpatient"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
              <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
              <code value="ACUTE"/>
              <display value="Acute"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
              <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
              <code value="NONAC"/>
              <display value="Nonacute"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
              <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
              <code value="OBSENC"/>
              <display value="Observation Encounter"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="SupplementalDataElementsExample"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Sex"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Sex&quot;:
      case
          when Patient.gender = 'male' then 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"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="0"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="HybridHospitalWideMortalityFHIRExample"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Sex"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Sex&quot;:
      SDE.&quot;SDE Sex&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="1"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="HybridHospitalWideMortalityFHIRExample"/>
            </extension>
            <extension url="name">
              <valueString value="Inpatient Encounters"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Inpatient Encounters&quot;:
      from
        [&quot;Encounter&quot;: &quot;Encounter Inpatient&quot;] InpatientEncounter,
        [&quot;Coverage&quot;: &quot;Medicare payer&quot;] Payer
        where InpatientEncounter.status = 'finished'
          and ( InpatientEncounter.class ~ &quot;IMP&quot;
              or InpatientEncounter.class ~ &quot;ACUTE&quot;
              or InpatientEncounter.class ~ &quot;NONAC&quot;
              or InpatientEncounter.class ~ &quot;OBSENC&quot;
          )
          and AgeInYearsAt(date from start of InpatientEncounter.period) in Interval[65, 94]
          and InpatientEncounter.hospitalizationWithObservationLengthofStay ( ) &lt; 365
          and InpatientEncounter.period ends during day of &quot;Measurement Period&quot;
        return InpatientEncounter"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="2"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="HybridHospitalWideMortalityFHIRExample"/>
            </extension>
            <extension url="name">
              <valueString value="Results"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="/*Inpatient encounter initially listed as AMB class; changed this to inpatient classes as discussed with CORE team- AM*/

    define &quot;Results&quot;:
      flatten {
        //First physical exams (vital signs)
      &quot;FirstPhysicalExamWithEncounterId&quot;([Observation: &quot;Heart Rate&quot;], 'FirstHeartRate'), &quot;FirstPhysicalExamWithEncounterId&quot;([Observation: &quot;Systolic Blood Pressure&quot;], 'FirstSystolicBP'), &quot;FirstPhysicalExamWithEncounterId&quot;([Observation: &quot;Body temperature&quot;], 'FirstTemperature'), &quot;FirstPhysicalExamWithEncounterId&quot;([Observation: &quot;Oxygen Saturation by Pulse Oximetry&quot;], 'FirstO2Saturation'),
        //First lab tests
      &quot;FirstLabTestWithEncounterId&quot;([Observation: &quot;Hematocrit lab test&quot;], 'FirstHematocrit'), &quot;FirstLabTestWithEncounterId&quot;([Observation: &quot;Platelet count lab test&quot;], 'FirstPlateletCount'), &quot;FirstLabTestWithEncounterId&quot;([Observation: &quot;White blood cells count lab test&quot;], 'FirstWhiteBloodCell'), &quot;FirstLabTestWithEncounterId&quot;([Observation: &quot;Sodium lab test&quot;], 'FirstSodium'), &quot;FirstLabTestWithEncounterId&quot;([Observation: &quot;Bicarbonate lab test&quot;], 'FirstBicarbonate'), &quot;FirstLabTestWithEncounterId&quot;([Observation: &quot;Creatinine lab test&quot;], 'FirstCreatinine') }"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="3"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="SupplementalDataElementsExample"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Payer"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Payer&quot;:
      [Coverage: type in &quot;Payer Type&quot;] Payer
        return {
          code: Payer.type,
          period: Payer.period
        }"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="4"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="HybridHospitalWideMortalityFHIRExample"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Payer"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Payer&quot;:
      SDE.&quot;SDE Payer&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="5"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="HybridHospitalWideMortalityFHIRExample"/>
            </extension>
            <extension url="name">
              <valueString value="Initial Population"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Initial Population&quot;:
      &quot;Inpatient Encounters&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="6"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="SupplementalDataElementsExample"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Ethnicity"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Ethnicity&quot;:
      Patient.ethnicity E
        return Tuple {
          codes: { E.ombCategory } union E.detailed,
          display: E.text
        }"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="7"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="HybridHospitalWideMortalityFHIRExample"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Ethnicity"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Ethnicity&quot;:
      SDE.&quot;SDE Ethnicity&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="8"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="SupplementalDataElementsExample"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Race"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Race&quot;:
      Patient.race R
        return Tuple {
          codes: R.ombCategory union R.detailed,
          display: R.text
        }"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="9"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="HybridHospitalWideMortalityFHIRExample"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Race"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Race&quot;:
      SDE.&quot;SDE Race&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="10"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="HybridHospitalWideMortalityFHIRExample"/>
            </extension>
            <extension url="name">
              <valueString value="FirstPhysicalExamWithEncounterId"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define function &quot;FirstPhysicalExamWithEncounterId&quot;(ExamList List&lt;Observation&gt;, CCDE String):
      &quot;Inpatient Encounters&quot; Encounter
        let firstexam: First(ExamList Exam
            where start of QICoreCommon.&quot;ToInterval&quot;(Exam.effective) is not null
              and start of QICoreCommon.&quot;ToInterval&quot;(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.&quot;ToInterval&quot;(effective)
        )
        return '\r\n' &amp; CCDE &amp; ',' &amp; Encounter.id &amp; ' , ' &amp; ( ToString(firstexam.value as Quantity) ) &amp; ',' &amp; ToString(start of QICoreCommon.&quot;ToInterval&quot;(firstexam.effective))"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="11"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="FHIRHelpers"/>
            </extension>
            <extension url="name">
              <valueString value="ToInterval"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define function ToInterval(period FHIR.Period):
        if period is null then
            null
        else
            if period.&quot;start&quot; is null then
                Interval(period.&quot;start&quot;.value, period.&quot;end&quot;.value]
            else
                Interval[period.&quot;start&quot;.value, period.&quot;end&quot;.value]"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="12"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="CQMCommonExample"/>
            </extension>
            <extension url="name">
              <valueString value="hospitalizationWithObservationLengthofStay"/>
            </extension>
            <extension url="statement">
              <valueString
                           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 &quot;Encounter&quot; ):
      ((TheEncounter.&quot;hospitalizationWithObservation&quot;(). &quot;lengthInDays&quot;()))"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="13"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="CQMCommonExample"/>
            </extension>
            <extension url="name">
              <valueString value="lengthInDays"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="/*
    @description: Calculates the difference in calendar days between the start and end of the given interval.
    */
    define fluent function lengthInDays(Value Interval&lt;DateTime&gt; ):
      difference in days between start of Value and end of Value"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="14"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="CQMCommonExample"/>
            </extension>
            <extension url="name">
              <valueString value="hospitalizationWithObservation"/>
            </extension>
            <extension url="statement">
              <valueString
                           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: &quot;Observation Services&quot;] 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: &quot;Emergency Department Visit&quot;] 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]"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="15"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="QICoreCommonExample"/>
            </extension>
            <extension url="name">
              <valueString value="ToInterval"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="/*
    @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
    @comment: Normalizes a choice type of DateTime, Quanitty, Interval&lt;DateTime&gt;, or Interval&lt;Quantity&gt; types
    to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
    representations for timing-valued elements in QICore, allowing this function to be used across any resource.
    The input can be provided as a DateTime, Quantity, Interval&lt;DateTime&gt; or Interval&lt;Quantity&gt;.
    The intent of this function is to provide a clear and concise mechanism to treat single
    elements that have multiple possible representations as intervals so that logic doesn't have to account
    for the variability. More complex calculations (such as medication request period or dispense period
    calculation) need specific guidance and consideration. That guidance may make use of this function, but
    the focus of this function is on single element calculations where the semantics are unambiguous.
    If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
    If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
    and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
    If the input is a DateTime Interval, the result is the input.
    If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
    is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
    immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
    Any other input will reslt in a null DateTime Interval
    @deprecated: This function is deprecated. Use the fluent function `toInterval()` instead
    */
    define function ToInterval(choice Choice&lt;DateTime, Quantity, Interval&lt;DateTime&gt;, Interval&lt;Quantity&gt;&gt;):
      case
    	  when choice is DateTime then
        	Interval[choice as DateTime, choice as DateTime]
    		when choice is Interval&lt;DateTime&gt; then
      		choice as Interval&lt;DateTime&gt;
    		when choice is Quantity then
    		  Interval[Patient.birthDate + (choice as Quantity),
    			  Patient.birthDate + (choice as Quantity) + 1 year)
    		when choice is Interval&lt;Quantity&gt; then
    		  Interval[Patient.birthDate + (choice.low as Quantity),
    			  Patient.birthDate + (choice.high as Quantity) + 1 year)
    		when choice is QICore.Timing then
                null as Interval&lt;DateTime&gt;
    		else
    			null as Interval&lt;DateTime&gt;
    	end"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="16"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="HybridHospitalWideMortalityFHIRExample"/>
            </extension>
            <extension url="name">
              <valueString value="FirstLabTestWithEncounterId"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define function &quot;FirstLabTestWithEncounterId&quot;(LabList List&lt;Observation&gt;, CCDE String):
      &quot;Inpatient Encounters&quot; 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' &amp; CCDE &amp; ',' &amp; Encounter.id &amp; ',' &amp; ( ToString(firstlab.value as Quantity) ) &amp; ',' &amp; ToString(firstlab.issued)"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="17"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="FHIRHelpers"/>
            </extension>
            <extension url="name">
              <valueString value="ToString"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define function ToString(value uri): value.value"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="18"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="FHIRHelpers"/>
            </extension>
            <extension url="name">
              <valueString value="ToCode"/>
            </extension>
            <extension url="statement">
              <valueString
                           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
            }"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="19"/>
            </extension>
          </extension>
          <name value="EffectiveDataRequirements"/>
          <status value="active"/>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/library-type"/>
              <code value="module-definition"/>
            </coding>
          </type>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Library SDE"/>
            <resource
                      value="http://somewhere.org/fhir/uv/mycontentig/Library/SupplementalDataElementsExample"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Library FHIRHelpers"/>
            <resource
                      value="http://somewhere.org/fhir/uv/mycontentig/Library/FHIRHelpers|4.0.1"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Library CQMCommon"/>
            <resource
                      value="http://somewhere.org/fhir/uv/mycontentig/Library/CQMCommonExample"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Library QICoreCommon"/>
            <resource
                      value="http://somewhere.org/fhir/uv/mycontentig/Library/QICoreCommonExample"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Code system ActCode"/>
            <resource value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Encounter Inpatient"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Medicare payer"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.10"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Observation Services"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Emergency Department Visit"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Heart Rate"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.149"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Systolic Blood Pressure"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.163"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Body temperature"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.152"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Oxygen Saturation by Pulse Oximetry"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.151"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Hematocrit lab test"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.114"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Platelet count lab test"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.127"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set White blood cells count lab test"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.129"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Sodium lab test"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.119"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Bicarbonate lab test"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.139"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Creatinine lab test"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.2363"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Payer Type"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
          </relatedArtifact>
          <parameter>
            <name value="Measurement Period"/>
            <use value="in"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Period"/>
          </parameter>
          <parameter>
            <name value="SDE Sex"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Coding"/>
          </parameter>
          <parameter>
            <name value="Results"/>
            <use value="out"/>
            <min value="0"/>
            <max value="*"/>
            <type value="string"/>
          </parameter>
          <parameter>
            <name value="SDE Payer"/>
            <use value="out"/>
            <min value="0"/>
            <max value="*"/>
            <type value="Resource"/>
          </parameter>
          <parameter>
            <name value="Initial Population"/>
            <use value="out"/>
            <min value="0"/>
            <max value="*"/>
            <type value="Resource"/>
          </parameter>
          <parameter>
            <name value="SDE Ethnicity"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Resource"/>
          </parameter>
          <parameter>
            <name value="SDE Race"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Resource"/>
          </parameter>
          <dataRequirement>
            <type value="Patient"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
            <mustSupport value="url"/>
            <mustSupport value="extension"/>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <mustSupport value="period"/>
            <mustSupport value="id"/>
            <mustSupport value="id.value"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <mustSupport value="period"/>
            <mustSupport value="id"/>
            <mustSupport value="id.value"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <mustSupport value="class"/>
            <mustSupport value="period"/>
            <mustSupport value="id"/>
            <mustSupport value="id.value"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Coverage"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
            <mustSupport value="type"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.10"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Coverage"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="effective"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <mustSupport value="value"/>
            <mustSupport value="issued"/>
            <mustSupport value="issued.value"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.149"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="effective"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <mustSupport value="value"/>
            <mustSupport value="issued"/>
            <mustSupport value="issued.value"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.163"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="effective"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <mustSupport value="value"/>
            <mustSupport value="issued"/>
            <mustSupport value="issued.value"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.152"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="effective"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <mustSupport value="value"/>
            <mustSupport value="issued"/>
            <mustSupport value="issued.value"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.151"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="effective"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <mustSupport value="value"/>
            <mustSupport value="issued"/>
            <mustSupport value="issued.value"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.114"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="effective"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <mustSupport value="value"/>
            <mustSupport value="issued"/>
            <mustSupport value="issued.value"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.127"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="effective"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <mustSupport value="value"/>
            <mustSupport value="issued"/>
            <mustSupport value="issued.value"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.129"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="effective"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <mustSupport value="value"/>
            <mustSupport value="issued"/>
            <mustSupport value="issued.value"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.119"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="effective"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <mustSupport value="value"/>
            <mustSupport value="issued"/>
            <mustSupport value="issued.value"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.139"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile
                     value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
            <mustSupport value="code"/>
            <mustSupport value="effective"/>
            <mustSupport value="status"/>
            <mustSupport value="status.value"/>
            <mustSupport value="value"/>
            <mustSupport value="issued"/>
            <mustSupport value="issued.value"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.2363"/>
            </codeFilter>
          </dataRequirement>
        </Library>
      </contained>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" id="supplementalDataGuidance">
        <extension url="guidance"/>
        <extension url="usage">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
              <code value="supplemental-data"/>
              <display value="Supplemental Data"/>
            </coding>
            <text value="Supplemental Data Guidance"/>
          </valueCodeableConcept>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem">
        <valueReference>🔗
          <reference value="Device/cqf-tooling"/>
        </valueReference>
      </extension>
      <extension
                 url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements">
        <valueCanonical value="#effective-data-requirements"/>
      </extension>
      <url
           value="http://somewhere.org/fhir/uv/mycontentig/Measure/HybridHospitalWideMortalityFHIRExample"/>
      <identifier>
        <use value="usual"/>
        <type>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
            <code value="short-name"/>
          </coding>
        </type>
        <system value="https://madie.cms.gov/measure/shortName"/>
        <value value="CMS844FHIR"/>
      </identifier>
      <identifier>
        <use value="official"/>
        <type>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
            <code value="version-independent"/>
          </coding>
        </type>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:uuid:965255e9-dfeb-42d0-8416-2c4b7ecc5109"/>
      </identifier>
      <identifier>
        <use value="official"/>
        <type>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
            <code value="version-specific"/>
          </coding>
        </type>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:uuid:2c92808482113ece0182c5d4fc662f1a"/>
      </identifier>
      <identifier>
        <use value="official"/>
        <type>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
            <code value="endorser"/>
          </coding>
        </type>
        <system value="https://madie.cms.gov/measure/nqfId"/>
        <value value="3502"/>
        <assigner>
          <display value="NQF"/>
        </assigner>
      </identifier>
      <identifier>
        <use value="official"/>
        <type>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
            <code value="publisher"/>
          </coding>
        </type>
        <system value="https://madie.cms.gov/measure/cmsId"/>
        <value value="844FHIR"/>
        <assigner>
          <display value="CMS"/>
        </assigner>
      </identifier>
      <version value="0.5.3"/>
      <name value="HybridHospitalWideMortalityFHIRExample"/>
      <title
             value="Core Clinical Data Elements for the Hybrid Hospital-Wide (All-Condition, All-Procedure) Risk-Standardized Mortality Measure (HWM) FHIR Example"/>
      <status value="draft"/>
      <experimental value="false"/>
      <date value="2025-09-30T04:16:55+00:00"/>
      <publisher value="HL7 International - [Some] Work Group"/>
      <contact>
        <telecom>
          <system value="url"/>
          <value value="http://hl7.org/Special/committees/[something]"/>
        </telecom>
      </contact>
      <description
                   value="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."/>
      <jurisdiction>
        <coding>
          <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
          <code value="001"/>
        </coding>
      </jurisdiction>
      <purpose value="UNKNOWN"/>
      <usage
             value="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."/>
      <copyright
                 value="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."/>
      <approvalDate value="2023-08-14"/>
      <lastReviewDate value="2023-08-14"/>
      <effectivePeriod>
        <start value="2024-07-01"/>
        <end value="2025-06-30"/>
      </effectivePeriod>
      <author>
        <name value="Mathematica"/>
        <telecom>
          <system value="url"/>
          <value value="https://www.mathematica.org/"/>
        </telecom>
      </author>
      <author>
        <name
              value="Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation"/>
        <telecom>
          <system value="url"/>
          <value value="https://medicine.yale.edu/core/"/>
        </telecom>
      </author>
      <library
               value="http://somewhere.org/fhir/uv/mycontentig/Library/HybridHospitalWideMortalityFHIRExample"/>
      <disclaimer
                  value="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
                 value="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 &quot;HWM-specific core clinical data elements&quot;. 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."/>
      <clinicalRecommendationStatement
                                       value="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."/>
      <group id="6385011c4ba3d47c885c02aa">
        <extension
                   url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
              <code value="cohort"/>
              <display value="Cohort"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
          <valueCode value="Encounter"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
          <valueCodeableConcept>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
              <code value="outcome"/>
              <display value="Outcome"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <population id="24BB5BA9-820F-4958-B8AA-AA8962E9E398">
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="initial-population"/>
              <display value="Initial Population"/>
            </coding>
          </code>
          <description
                       value="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 &lt;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>
            <language value="text/cql-identifier"/>
            <expression value="Initial Population"/>
          </criteria>
        </population>
      </group>
      <supplementalData id="results">
        <usage>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
            <code value="supplemental-data"/>
          </coding>
        </usage>
        <description value="Results"/>
        <criteria>
          <language value="text/cql-identifier"/>
          <expression value="Results"/>
        </criteria>
      </supplementalData>
      <supplementalData id="sde-ethnicity">
        <usage>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
            <code value="supplemental-data"/>
          </coding>
        </usage>
        <description value="SDE Ethnicity"/>
        <criteria>
          <language value="text/cql-identifier"/>
          <expression value="SDE Ethnicity"/>
        </criteria>
      </supplementalData>
      <supplementalData id="sde-payer">
        <usage>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
            <code value="supplemental-data"/>
          </coding>
        </usage>
        <description value="SDE Payer"/>
        <criteria>
          <language value="text/cql-identifier"/>
          <expression value="SDE Payer"/>
        </criteria>
      </supplementalData>
      <supplementalData id="sde-race">
        <usage>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
            <code value="supplemental-data"/>
          </coding>
        </usage>
        <description value="SDE Race"/>
        <criteria>
          <language value="text/cql-identifier"/>
          <expression value="SDE Race"/>
        </criteria>
      </supplementalData>
      <supplementalData id="sde-sex">
        <usage>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
            <code value="supplemental-data"/>
          </coding>
        </usage>
        <description value="SDE Sex"/>
        <criteria>
          <language value="text/cql-identifier"/>
          <expression value="SDE Sex"/>
        </criteria>
      </supplementalData>
    </Measure>