Quality Measure Implementation Guide
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Quality Measure Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 1.0.1-cibuild built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-cqm/ and changes regularly. See the Directory of published versions

: EXM Measure - XML Representation

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<Measure xmlns="http://hl7.org/fhir">
  <id value="EXMLogic-FHIR"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-cvmeasure"/>
    <profile
             value="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure"/>
    <profile
             value="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-executablemeasure"/>
    <profile
             value="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-cqlmeasure"/>
    <profile
             value="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-elmmeasure"/>
    <profile
             value="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure"/>
  </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">EXM Measure</td>
</tr>



<tr>


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


<td class="content-container">2.0.0</td>
</tr>







  
<tr>


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


<td class="content-container">EXM</td>
</tr>


  
<tr>


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


<td class="content-container">urn:oid:2.16.840.1.113883.4.642.40.61.29.9</td>
</tr>



  
    
    
    
    
<tr>


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


<td class="content-container">2018-01-01 + 1 year(s)</td>
</tr>

  


<tr>


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


<td class="content-container">2019-02-17</td>
</tr>


<tr>


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


<td class="content-container">2019-02-17</td>
</tr>




<tr>


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


<td class="content-container">true</td>
</tr>




<tr>


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


<td class="content-container"><span title="{http://terminology.hl7.org/CodeSystem/usage-context-type venue}">Clinical Venue</span> = <span title="Codes:{http://hl7.org/fhir/uv/cqm/CodeSystem/intended-venue-codes ec}">EC</span></td>
</tr>


<tr>


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


<td class="content-container"><span title="Codes:{http://unstats.un.org/unsd/methods/m49/m49.htm 001}">Global (Whole world)</span></td>
</tr>


<tr>


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


<td class="content-container"><span title="Codes:{http://loinc.org 57024-2}">Health Quality Measure Document</span></td>
</tr>







<tr>


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


<td class="content-container">HL7 International / Clinical Quality Information</td>
</tr>






<tr>


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


<td class="content-container">Example Measure Content Developer</td>
</tr>






<tr>


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


<td class="content-container"><div><p>An example FHIR-based measure</p>
</div></td>
</tr>



<tr>


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


<td class="content-container"><div><p>This measure has been developed to support improvement in clinical care.</p>
</div></td>
</tr>



<tr>


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


<td class="content-container"><div><p>Example Copyright Statement</p>
</div></td>
</tr>


<tr>


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


<td class="content-container"><div><p>Example disclaimer</p>
</div></td>
</tr>



  
<tr>


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


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



<tr>


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


<td class="content-container"><span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-scoring continuous-variable}">Continuous Variable</span></td>
</tr>



  
<tr>


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


<td class="content-container">2</td>
</tr>




<tr>


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


<td class="content-container"><span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-type process}">Process</span></td>
</tr>


<tr>


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


<td class="content-container">Risk adjustment for this measure is performed by...</td>
</tr>


<tr>


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


<td class="content-container">Rate aggregation for this measure is performed by...</td>
</tr>


<tr>


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


<td class="content-container"><div><p>The purpose of this measure is to show how all the elements of a FHIR-based quality measure are represented.</p>
</div></td>
</tr>


<tr>


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


<td class="content-container"><div><p>The clinical recommendation statement for this measure is...</p>
</div></td>
</tr>


<tr>


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


<td class="content-container"><span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-improvement-notation increase}">Increased score indicates improvement</span></td>
</tr>







<tr>


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


<td class="content-container">Users of this measure should be aware that this is intentionally simplified to show specific aspects of a measure.</td>
</tr>



  
  
  
    
    <tr>


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


</tr>
  
  
  









  
  
    
    
    <tr>
      
        

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


      
      <td class="content-container">
        
        <em>ID</em>: primary-exmlogic-initial-population
        <br/>
        
        
          
          <em>Description</em>: No description provided
          
        
        
          
            
              
              <em>Criteria</em>: <a href="#primary-primary-exmlogic-initial-population">Initial Population</a> 
            
          
          
        
        
        
      </td>
    </tr>
  

  
    
    
    <tr>
      
        

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


      
      <td class="content-container">
        
        <em>ID</em>: primary-exmlogic-measure-population
        <br/>
        
        
          
          <em>Description</em>: No description provided
          
        
        
          
            
              
              <em>Criteria</em>: <a href="#primary-primary-exmlogic-measure-population">Measure Population</a> 
            
          
          
        
        
        
      </td>
    </tr>
  

  
    
    
    <tr>
      
        

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


      
      <td class="content-container">
        
        <em>ID</em>: primary-exmlogic-measure-observation
        <br/>
        
        
          
          <em>Description</em>: No description provided
          
        
        
          
            
              
              <em>Criteria</em>: <a href="#primary-primary-exmlogic-measure-observation">Measure Observation</a> 
            
          
          
        
        
          <br/><em>Input Population</em>: measure-population
        
        
          <em>AggregateMethod</em>: median
        
      </td>
    </tr>
  

  
<tr>
  

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


  <td class="content-container">
    
      <em>ID</em>: stratifier-1
      
        <br/>
      
    
    
      
        <em>Code</em>: <span title="Codes:">Stratifier 1</span>
      
      
    
    
  </td>
</tr>

<tr>
  

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


  <td class="content-container">
    
      <em>ID</em>: stratifier-2
      
        <br/>
      
    
    
      
        <em>Code</em>: <span title="Codes:">Stratifier 2</span>
      
      
    
    
  </td>
</tr>

<tr>
  

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


  <td class="content-container">
    
      <em>ID</em>: stratifier-3
      
        <br/>
      
    
    
      
        <em>Code</em>: <span title="Codes:">Stratifier 3</span>
      
      
    
    
  </td>
</tr>

<tr>
  

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


  <td class="content-container">
    
      <em>ID</em>: stratifier-4
      
        <br/>
      
    
    
      
        <em>Code</em>: <span title="Codes:">Stratifier 4</span>
      
      
    
    
  </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>: 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>: No description provided
    
    
      
        <br/>
        
          
          <em>Logic Definition</em>: <a href="#exmlogic-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-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>: No description provided
    
    
      
        <br/>
        
          
          <em>Logic Definition</em>: <a href="#exmlogic-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-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>: No description provided
    
    
      
        <br/>
        
          
          <em>Logic Definition</em>: <a href="#exmlogic-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-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>: No description provided
    
    
      
        <br/>
        
          
          <em>Logic Definition</em>: <a href="#exmlogic-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-EXMLogic.html">Example Logic Library</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/>
  </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: primary)</th>


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

  <td>
    
    
    
    
      
      <a name="primary-primary-exmlogic-initial-population"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Initial Population&quot; :
  &quot;Inpatient Encounter&quot; Encounter</code></pre>
    
      
      <a href="#exmlogic-initial-population"><em>Definition</em></a>
    
  </td>

</tr>

          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
      
    
  

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

  <td>
    
    
    
    
      
      <a name="primary-primary-exmlogic-measure-population"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Measure Population&quot; :
  &quot;Initial Population&quot;</code></pre>
    
      
      <a href="#exmlogic-measure-population"><em>Definition</em></a>
    
  </td>

</tr>

          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
      
    
  

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

  <td>
    
    
    
    
      
      <a name="primary-primary-exmlogic-measure-observation"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function &quot;Measure Observation&quot; (Encounter &quot;Encounter&quot; ) :
  duration in minutes of &quot;Related ED Visit&quot;(Encounter).period</code></pre>
    
      
      <a href="#exmlogic-measure-observation"><em>Definition</em></a>
    
  </td>

</tr>

          
        
          
        
          
        
      
    
  

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

  <td>
    
    
    
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Stratifier 1&quot; :
  &quot;Inpatient Encounter&quot; Encounter
    where not (PrincipalDiagnosis(Encounter).code in &quot;Psychiatric/Mental Health Patient&quot;)</code></pre>
    
      
      <a href="#exmlogic-stratifier-1"><em>Definition</em></a>
    
  </td>

</tr>

          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
    
  

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

  <td>
    
    
    
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Stratifier 2&quot; :
  &quot;Inpatient Encounter&quot; Encounter
    where PrincipalDiagnosis(Encounter).code in &quot;Psychiatric/Mental Health Patient&quot;</code></pre>
    
      
      <a href="#exmlogic-stratifier-2"><em>Definition</em></a>
    
  </td>

</tr>

          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
    
  

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

  <td>
    
    
    
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Stratifier 3&quot; :
  &quot;Inpatient Encounter&quot; Encounter
    where PrincipalDiagnosis(Encounter) is null</code></pre>
    
      
      <a href="#exmlogic-stratifier-3"><em>Definition</em></a>
    
  </td>

</tr>

          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
          
        
    
  

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

  <td>
    
    
    
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Stratifier 4&quot; :
  &quot;Inpatient Encounter&quot; Encounter
    where PrincipalDiagnosis(Encounter) is null</code></pre>
    
      
      <a href="#exmlogic-stratifier-4"><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> EXMLogic</td>

</tr>
<tr>

  <td>
    
    
    
    
      <a name="exmlogic-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> EXMLogic</td>

</tr>
<tr>

  <td>
    
    
    
    
      <a name="exmlogic-inpatient-encounter"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Inpatient Encounter&quot; :
  [&quot;Encounter&quot;] Encounter
    where LengthInDays(Encounter.period) &lt;= 120
      and Encounter.period ends during &quot;Measurement Period&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> EXMLogic</td>

</tr>
<tr>

  <td>
    
    
    
    
      <a name="exmlogic-stratifier-3"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Stratifier 3&quot; :
  &quot;Inpatient Encounter&quot; Encounter
    where PrincipalDiagnosis(Encounter) is null</code></pre>
  </td>

</tr>



        


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

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

</tr>
<tr>

  <td>
    
    
    
    
      <a name="exmlogic-stratifier-4"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Stratifier 4&quot; :
  &quot;Inpatient Encounter&quot; Encounter
    where PrincipalDiagnosis(Encounter) is null</code></pre>
  </td>

</tr>



        


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

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

</tr>
<tr>

  <td>
    
    
    
    
      <a name="exmlogic-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&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> EXMLogic</td>

</tr>
<tr>

  <td>
    
    
    
    
      <a name="exmlogic-initial-population"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Initial Population&quot; :
  &quot;Inpatient Encounter&quot; Encounter</code></pre>
  </td>

</tr>



        


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

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

</tr>
<tr>

  <td>
    
    
    
    
      <a name="exmlogic-sde-ethnicity"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Ethnicity&quot;:
  (flatten (
    Patient.extension Extension
      where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity'
        return Extension.extension
  )) E
    where E.url = 'ombCategory'
      or E.url = 'detailed'
    return E.value as Coding</code></pre>
  </td>

</tr>



        


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

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

</tr>
<tr>

  <td>
    
    
    
    
      <a name="exmlogic-sde-race"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Race&quot;:
  (flatten (
    Patient.extension Extension
      where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race'
        return Extension.extension
  )) E
    where E.url = 'ombCategory'
      or E.url = 'detailed'
    return E.value as Coding</code></pre>
  </td>

</tr>



        


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

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

</tr>
<tr>

  <td>
    
    
    
    
      <a name="exmlogic-measure-population"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Measure Population&quot; :
  &quot;Initial Population&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> EXMLogic</td>

</tr>
<tr>

  <td>
    
    
    
    
      <a name="exmlogic-stratifier-1"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Stratifier 1&quot; :
  &quot;Inpatient Encounter&quot; Encounter
    where not (PrincipalDiagnosis(Encounter).code in &quot;Psychiatric/Mental Health Patient&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> EXMLogic</td>

</tr>
<tr>

  <td>
    
    
    
    
      <a name="exmlogic-stratifier-2"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Stratifier 2&quot; :
  &quot;Inpatient Encounter&quot; Encounter
    where PrincipalDiagnosis(Encounter).code in &quot;Psychiatric/Mental Health Patient&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> EXMLogic</td>

</tr>
<tr>

  <td>
    
    
    
    
      <a name="exmlogic-lengthindays"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function &quot;LengthInDays&quot;(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> EXMLogic</td>

</tr>
<tr>

  <td>
    
    
    
    
      <a name="exmlogic-principaldiagnosis"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function &quot;PrincipalDiagnosis&quot;(Encounter Encounter):
	(singleton from (Encounter.diagnosis D where D.use ~ ToConcept(&quot;Billing&quot;) and D.rank.value = 1)) PD
		return singleton from ([Condition: id in &quot;GetId&quot;(PD.condition.reference)])</code></pre>
  </td>

</tr>



        



        



        


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

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

</tr>
<tr>

  <td>
    
    
    
    
      <a name="exmlogic-getid"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function &quot;GetId&quot;(uri String):
	Last(Split(uri, '/'))</code></pre>
  </td>

</tr>



        



        



        


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

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

</tr>
<tr>

  <td>
    
    
    
    
      <a name="exmlogic-measure-observation"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function &quot;Measure Observation&quot; (Encounter &quot;Encounter&quot; ) :
  duration in minutes of &quot;Related ED Visit&quot;(Encounter).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> EXMLogic</td>

</tr>
<tr>

  <td>
    
    
    
    
      <a name="exmlogic-related-ed-visit"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">//Measure Observation
define function &quot;Related ED Visit&quot; (Encounter &quot;Encounter&quot; ) :
  Last([&quot;Encounter&quot; : &quot;Emergency Department Visit&quot;] ED
    where ED.status = 'finished'
      and ED.period ends 1 hour or less before start of Encounter.period
    sort by start of 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> 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 AdministrativeGender): 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-tointerval"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
value to a CQL DateTime Interval
@comment: If the start value of the given period is unspecified, the starting
boundary of the resulting interval will be open (meaning the start of the interval
is unknown, as opposed to interpreted as the beginning of time).
*/
define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period.&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-toconcept"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }</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">/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }</code></pre>
  </td>

</tr>



        



        


<tr>
  <th 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 string): 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-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-tostring"> </a>
    
    <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function ToString(value EncounterStatus): value.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 Diagnosis Role
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: <a href="http://terminology.hl7.org/6.5.0/CodeSystem-diagnosis-role.html">Diagnosis Role</a>
    <br/>
    <em>Canonical URL</em>: <tt>http://terminology.hl7.org/CodeSystem/diagnosis-role</tt>
    
  </td>
</tr>
 


<tr>
  
  

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


  
  
  <td class="content-container">
    
    <em>Description</em>: Value set Payer
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer Type</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">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 Psychiatric/Mental Health Patient
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.299/expansion">Psychiatric/Mental Health Diagnosis</a>
    <br/>
    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.299</tt>
    
  </td>
</tr>
 


  
  <tr>
    <th scope="row" class="row-header">Direct Reference Code</th>
    <td class="content-container">
      
        <em>Display</em>: Billing
        <br/>
      
      <em>Code</em>: billing
      <br/>
      <em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/diagnosis-role</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 FHIRHelpers
    
    <br/>
    
    
    
    
    
    
    <em>Resource</em>: <a href="http://hl7.org/fhir/uv/cql/STU2/Library-FHIRHelpers.html">http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1</a>
    <br/>
    <em>Canonical URL</em>: <tt>http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1</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/R4/patient.html">Patient</a>
    <br/>        
  
   
   
    <em>Must Support Elements</em>: url, extension, value
    <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/R4/encounter.html">Encounter</a>
    <br/>        
  
   
   
    <em>Must Support Elements</em>: type, status, period, use, rank, rank.value, condition, condition.reference
    <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/R4/encounter.html">Encounter</a>
    <br/>        
  
   
   
    <em>Must Support Elements</em>: period, use, rank, rank.value, condition, condition.reference
    <br/>
   
   
  </td>
</tr>

<tr>
  <th scope="row" class="row-header">Data Requirement</th>
  <td class="content-container">
    <em>Type</em>: Condition
    <br/>
  
    <em>Profile(s)</em>: 
  
    <a href="http://hl7.org/fhir/R4/condition.html">Condition</a>
    <br/>        
  
   
   
    <em>Must Support Elements</em>: id
    <br/>
   
  
    <em>Code Filter(s)</em>: 
    <br/>
  
  
    <span class="tab-one"><em>Path</em>: id</span>
    <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/R4/coverage.html">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 Type</a>
    <br/> 
  
  
  
   
  </td>
</tr>

  
  

<tr>
  <th colspan="2" scope="row" class="row-header">Generated using version 0.4.9 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/diagnosis-role"/>
          <code value="billing"/>
          <display value="Billing"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="EXMLogic"/>
        </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="EXMLogic"/>
        </extension>
        <extension url="name">
          <valueString value="Inpatient Encounter"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Inpatient Encounter&quot; :
  [&quot;Encounter&quot;] Encounter
    where LengthInDays(Encounter.period) &lt;= 120
      and Encounter.period ends during &quot;Measurement Period&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="1"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="EXMLogic"/>
        </extension>
        <extension url="name">
          <valueString value="Stratifier 3"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Stratifier 3&quot; :
  &quot;Inpatient Encounter&quot; Encounter
    where PrincipalDiagnosis(Encounter) is null"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="2"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="EXMLogic"/>
        </extension>
        <extension url="name">
          <valueString value="Stratifier 4"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Stratifier 4&quot; :
  &quot;Inpatient Encounter&quot; Encounter
    where PrincipalDiagnosis(Encounter) is null"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="3"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="EXMLogic"/>
        </extension>
        <extension url="name">
          <valueString value="SDE Payer"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;SDE Payer&quot;:
    [Coverage: type in &quot;Payer&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="EXMLogic"/>
        </extension>
        <extension url="name">
          <valueString value="Initial Population"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Initial Population&quot; :
  &quot;Inpatient Encounter&quot; Encounter"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="5"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="EXMLogic"/>
        </extension>
        <extension url="name">
          <valueString value="SDE Ethnicity"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;SDE Ethnicity&quot;:
  (flatten (
    Patient.extension Extension
      where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity'
        return Extension.extension
  )) E
    where E.url = 'ombCategory'
      or E.url = 'detailed'
    return E.value as Coding"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="6"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="EXMLogic"/>
        </extension>
        <extension url="name">
          <valueString value="SDE Race"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;SDE Race&quot;:
  (flatten (
    Patient.extension Extension
      where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race'
        return Extension.extension
  )) E
    where E.url = 'ombCategory'
      or E.url = 'detailed'
    return E.value as Coding"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="7"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="EXMLogic"/>
        </extension>
        <extension url="name">
          <valueString value="Measure Population"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Measure Population&quot; :
  &quot;Initial Population&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="8"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="EXMLogic"/>
        </extension>
        <extension url="name">
          <valueString value="Stratifier 1"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Stratifier 1&quot; :
  &quot;Inpatient Encounter&quot; Encounter
    where not (PrincipalDiagnosis(Encounter).code in &quot;Psychiatric/Mental Health Patient&quot;)"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="9"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="EXMLogic"/>
        </extension>
        <extension url="name">
          <valueString value="Stratifier 2"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Stratifier 2&quot; :
  &quot;Inpatient Encounter&quot; Encounter
    where PrincipalDiagnosis(Encounter).code in &quot;Psychiatric/Mental Health Patient&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="10"/>
        </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 AdministrativeGender): value.value"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="11"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="EXMLogic"/>
        </extension>
        <extension url="name">
          <valueString value="LengthInDays"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define function &quot;LengthInDays&quot;(Value Interval&lt;DateTime&gt;):
	difference in days between start of Value and end of Value"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="12"/>
        </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="/*
@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
value to a CQL DateTime Interval
@comment: If the start value of the given period is unspecified, the starting
boundary of the resulting interval will be open (meaning the start of the interval
is unknown, as opposed to interpreted as the beginning of time).
*/
define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period.&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="13"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="EXMLogic"/>
        </extension>
        <extension url="name">
          <valueString value="PrincipalDiagnosis"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define function &quot;PrincipalDiagnosis&quot;(Encounter Encounter):
	(singleton from (Encounter.diagnosis D where D.use ~ ToConcept(&quot;Billing&quot;) and D.rank.value = 1)) PD
		return singleton from ([Condition: id in &quot;GetId&quot;(PD.condition.reference)])"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="14"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="FHIRHelpers"/>
        </extension>
        <extension url="name">
          <valueString value="ToConcept"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="15"/>
        </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="/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="16"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="EXMLogic"/>
        </extension>
        <extension url="name">
          <valueString value="GetId"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define function &quot;GetId&quot;(uri String):
	Last(Split(uri, '/'))"/>
        </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 string): 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="ToString"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define function ToString(value uri): value.value"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="19"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="EXMLogic"/>
        </extension>
        <extension url="name">
          <valueString value="Measure Observation"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define function &quot;Measure Observation&quot; (Encounter &quot;Encounter&quot; ) :
  duration in minutes of &quot;Related ED Visit&quot;(Encounter).period"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="20"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
        <extension url="libraryName">
          <valueString value="EXMLogic"/>
        </extension>
        <extension url="name">
          <valueString value="Related ED Visit"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//Measure Observation
define function &quot;Related ED Visit&quot; (Encounter &quot;Encounter&quot; ) :
  Last([&quot;Encounter&quot; : &quot;Emergency Department Visit&quot;] ED
    where ED.status = 'finished'
      and ED.period ends 1 hour or less before start of Encounter.period
    sort by start of period )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="21"/>
        </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 EncounterStatus): value.value"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="22"/>
        </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 FHIRHelpers"/>
        <resource
                  value="http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Code system Diagnosis Role"/>
        <resource
                  value="http://terminology.hl7.org/CodeSystem/diagnosis-role"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Payer"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set 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 Psychiatric/Mental Health Patient"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.299"/>
      </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="Stratifier 3"/>
        <use value="out"/>
        <min value="0"/>
        <max value="*"/>
        <type value="Encounter"/>
      </parameter>
      <parameter>
        <name value="Stratifier 4"/>
        <use value="out"/>
        <min value="0"/>
        <max value="*"/>
        <type value="Encounter"/>
      </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="Encounter"/>
      </parameter>
      <parameter>
        <name value="SDE Ethnicity"/>
        <use value="out"/>
        <min value="0"/>
        <max value="*"/>
        <type value="Coding"/>
      </parameter>
      <parameter>
        <name value="SDE Race"/>
        <use value="out"/>
        <min value="0"/>
        <max value="*"/>
        <type value="Coding"/>
      </parameter>
      <parameter>
        <name value="Measure Population"/>
        <use value="out"/>
        <min value="0"/>
        <max value="*"/>
        <type value="Encounter"/>
      </parameter>
      <parameter>
        <name value="Stratifier 1"/>
        <use value="out"/>
        <min value="0"/>
        <max value="*"/>
        <type value="Encounter"/>
      </parameter>
      <parameter>
        <name value="Stratifier 2"/>
        <use value="out"/>
        <min value="0"/>
        <max value="*"/>
        <type value="Encounter"/>
      </parameter>
      <dataRequirement>
        <type value="Patient"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Patient"/>
        <mustSupport value="url"/>
        <mustSupport value="extension"/>
        <mustSupport value="value"/>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="status"/>
        <mustSupport value="period"/>
        <mustSupport value="use"/>
        <mustSupport value="rank"/>
        <mustSupport value="rank.value"/>
        <mustSupport value="condition"/>
        <mustSupport value="condition.reference"/>
        <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/StructureDefinition/Encounter"/>
        <mustSupport value="period"/>
        <mustSupport value="use"/>
        <mustSupport value="rank"/>
        <mustSupport value="rank.value"/>
        <mustSupport value="condition"/>
        <mustSupport value="condition.reference"/>
      </dataRequirement>
      <dataRequirement>
        <type value="Condition"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
        <mustSupport value="id"/>
        <codeFilter>
          <path value="id"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Coverage"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/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>
    </Library>
  </contained>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-artifactComment">
    <extension url="type">
      <valueCode value="documentation"/>
    </extension>
    <extension url="text">
      <valueMarkdown value="This illustrates an example comment"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis">
    <valueCode value="Encounter"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem">
    <valueReference>🔗 
      <reference value="Device/software-system-example"/>
    </valueReference>
  </extension>
  <extension
             url="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringPrecision">
    <valuePositiveInt value="2"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements" id="effective-data-requirements">
    <valueCanonical value="#effective-data-requirements"/>
  </extension>
  <url value="http://hl7.org/fhir/uv/cqm/Measure/EXMLogic-FHIR"/>
  <identifier>
    <system value="http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm"/>
    <value value="EXM"/>
  </identifier>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.40.61.29.9"/>
  </identifier>
  <version value="2.0.0"/>
  <name value="MeasureEXM"/>
  <title value="EXM Measure"/>
  <status value="active"/>
  <experimental value="true"/>
  <date value="2025-08-13"/>
  <publisher value="HL7 International / Clinical Quality Information"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/cqi"/>
    </telecom>
  </contact>
  <description value="An example FHIR-based measure"/>
  <useContext>
    <code>
      <system
              value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
      <code value="venue"/>
      <display value="Clinical Venue"/>
    </code>
    <valueCodeableConcept>
      <coding>
        <system
                value="http://hl7.org/fhir/uv/cqm/CodeSystem/intended-venue-codes"/>
        <code value="ec"/>
        <display value="EC"/>
      </coding>
    </valueCodeableConcept>
  </useContext>
  <jurisdiction>
    <coding>
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
    </coding>
  </jurisdiction>
  <purpose
           value="This measure has been developed to support improvement in clinical care."/>
  <usage
         value="Users of this measure should be aware that this is intentionally simplified to show specific aspects of a measure."/>
  <copyright value="Example Copyright Statement"/>
  <approvalDate value="2019-02-17"/>
  <lastReviewDate value="2019-02-17"/>
  <effectivePeriod>
    <extension
               url="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-effectivePeriodAnchor">
      <valueDateTime value="2018-01-01"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-effectivePeriodDuration">
      <valueDuration>
        <value value="1"/>
        <system value="http://unitsofmeasure.org"/>
        <code value="a"/>
      </valueDuration>
    </extension>
    <start value="2018-01-01"/>
    <end value="2018-12-31"/>
  </effectivePeriod>
  <topic>
    <coding>
      <system value="http://loinc.org"/>
      <code value="57024-2"/>
    </coding>
    <text value="Health Quality Measure Document"/>
  </topic>
  <author>
    <name value="Example Measure Content Developer"/>
  </author>
  <library value="http://hl7.org/fhir/uv/cqm/Library/EXMLogic"/>
  <disclaimer value="Example disclaimer"/>
  <scoring>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
      <code value="continuous-variable"/>
      <display value="Continuous Variable"/>
    </coding>
  </scoring>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
      <code value="process"/>
    </coding>
  </type>
  <riskAdjustment
                  value="Risk adjustment for this measure is performed by..."/>
  <rateAggregation
                   value="Rate aggregation for this measure is performed by..."/>
  <rationale
             value="The purpose of this measure is to show how all the elements of a FHIR-based quality measure are represented."/>
  <clinicalRecommendationStatement
                                   value="The clinical recommendation statement for this measure is..."/>
  <improvementNotation>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
      <code value="increase"/>
      <display value="Increased score indicates improvement"/>
    </coding>
  </improvementNotation>
  <guidance
            value="Additional guidance provided to help communicate the intent of the measure"/>
  <group id="group-1">
    <extension
               url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.linkId">
      <valueString value="primary"/>
    </extension>
    <code>
      <coding>
        <system value="http://example.org/group"/>
        <code value="group"/>
        <display value="group-1"/>
      </coding>
    </code>
    <population id="initial-population-1">
      <extension
                 url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId">
        <valueString value="primary-exmlogic-initial-population"/>
      </extension>
      <code>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="initial-population"/>
          <display value="Initial Population"/>
        </coding>
      </code>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Initial Population"/>
      </criteria>
    </population>
    <population id="measure-population">
      <extension
                 url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId">
        <valueString value="primary-exmlogic-measure-population"/>
      </extension>
      <code>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="measure-population"/>
          <display value="Measure Population"/>
        </coding>
      </code>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Measure Population"/>
      </criteria>
    </population>
    <population id="measure-observation">
      <extension
                 url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId">
        <valueString value="primary-exmlogic-measure-observation"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference">
        <valueString value="measure-population"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-aggregateMethod">
        <valueCode value="median"/>
      </extension>
      <code>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="measure-observation"/>
          <display value="Measure Observation"/>
        </coding>
      </code>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Measure Observation"/>
      </criteria>
    </population>
    <stratifier id="stratifier-1">
      <extension
                 url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.linkId">
        <valueString value="primary-exmlogic-stratification-1"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-appliesTo">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-population"/>
            <code value="initial-population"/>
            <display value="Initial Population"/>
          </coding>
          <text value="initial-population"/>
        </valueCodeableConcept>
      </extension>
      <code>
        <text value="Stratifier 1"/>
      </code>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Stratifier 1"/>
      </criteria>
    </stratifier>
    <stratifier id="stratifier-2">
      <extension
                 url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.linkId">
        <valueString value="primary-exmlogic-stratification-2"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-appliesTo">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-population"/>
            <code value="initial-population"/>
            <display value="Initial Population"/>
          </coding>
          <text value="initial-population"/>
        </valueCodeableConcept>
      </extension>
      <code>
        <text value="Stratifier 2"/>
      </code>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Stratifier 2"/>
      </criteria>
    </stratifier>
    <stratifier id="stratifier-3">
      <extension
                 url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.linkId">
        <valueString value="primary-exmlogic-stratification-3"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-appliesTo">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-population"/>
            <code value="initial-population"/>
            <display value="Initial Population"/>
          </coding>
          <text value="initial-population"/>
        </valueCodeableConcept>
      </extension>
      <code>
        <text value="Stratifier 3"/>
      </code>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Stratifier 3"/>
      </criteria>
    </stratifier>
    <stratifier id="stratifier-4">
      <extension
                 url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.linkId">
        <valueString value="primary-exmlogic-stratification-4"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-appliesTo">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-population"/>
            <code value="initial-population"/>
            <display value="Initial Population"/>
          </coding>
          <text value="initial-population"/>
        </valueCodeableConcept>
      </extension>
      <code>
        <text value="Stratifier 4"/>
      </code>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Stratifier 4"/>
      </criteria>
    </stratifier>
  </group>
  <supplementalData id="sde-ethnicity">
    <extension
               url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId">
      <valueString value="primary-sde-ethnicity"/>
    </extension>
    <usage>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Ethnicity"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-race">
    <extension
               url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId">
      <valueString value="primary-sde-race"/>
    </extension>
    <usage>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Race"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-payer">
    <extension
               url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId">
      <valueString value="primary-sde-payer"/>
    </extension>
    <usage>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Payer"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-sex">
    <extension
               url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId">
      <valueString value="primary-sde-sex"/>
    </extension>
    <usage>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Sex"/>
    </criteria>
  </supplementalData>
</Measure>