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 2.0.0-ballot 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

Library: BCS Component Library

Official URL: http://hl7.org/fhir/uv/cqm/Library/BCSComponent Version: 0.0.001
Standards status: Trial-use Draft as of 2026-04-03 Maturity Level: 4 Computable Name: BCSComponent
Other Identifiers: OID:2.16.840.1.113883.4.642.40.61.28.4

This library is the primary measure library for the Breast Cancer Screening component of the composite measure examples in this implementation guide.

Metadata
Title BCS Component Library
Version 0.0.001
Identifier urn:oid:2.16.840.1.113883.4.642.40.61.28.4
Status Draft
Jurisdiction 001 from http://unstats.un.org/unsd/methods/m49/m49.htm
Steward (Publisher) HL7 International / Clinical Quality Information
Description

This library is the primary measure library for the Breast Cancer Screening component of the composite measure examples in this implementation guide.
Type logic-library from http://terminology.hl7.org/CodeSystem/library-type
Dependency Description: Library FHIRHelpers
Resource: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1
Canonical URL: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1
Dependency Description: Library SDE
Resource: Supplemental Data Elementsversion: null2.0.000)
Canonical URL: http://hl7.org/fhir/uv/cqm/Library/SupplementalDataElements|2.0.000
Dependency Description: Library Global
Resource: MAT Global Common Functions FHIR Libraryversion: null5.0.000)
Canonical URL: http://hl7.org/fhir/uv/cqm/Library/MATGlobalCommonFunctions|5.0.000
Dependency Description: Library AdultOutpatientEncounters
Resource: Adult Outpatient Encounters Common Libraryversion: null2.0.000)
Canonical URL: http://hl7.org/fhir/uv/cqm/Library/AdultOutpatientEncounters|2.0.000
Dependency Description: Library Hospice
Resource: Hospice FHIR Libraryversion: null2.0.000)
Canonical URL: http://hl7.org/fhir/uv/cqm/Library/Hospice|2.0.000
Dependency Description: Library Frailty
Resource: Advanced Illness and Frailty Exclusion Libraryversion: null5.12.000)
Canonical URL: http://hl7.org/fhir/uv/cqm/Library/AdvancedIllnessandFrailtyExclusion|5.12.000
Dependency Description: Code System LOINC
Resource: Logical Observation Identifiers, Names and Codes (LOINC)
Canonical URL: http://loinc.org
Dependency Description: Code System SNOMEDCT
Resource: SNOMED CT (all versions)
Canonical URL: http://snomed.info/sct
Dependency Description: Value Set Bilateral Mastectomy
Resource: Bilateral Mastectomy
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1005
Dependency Description: Value Set Ethnicity
Resource: Ethnicity
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.837
Dependency Description: Value Set Female
Resource: Female
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.560.100.2
Dependency Description: Value Set History of bilateral mastectomy
Resource: History of bilateral mastectomy
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1068
Dependency Description: Value Set Left
Resource: Left
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.122.12.1036
Dependency Description: Value Set Mammography
Resource: Mammography
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1018
Dependency Description: Value Set ONC Administrative Sex
Resource: ONC Administrative Sex
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1
Dependency Description: Value Set Payer
Resource: Payer Type
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Dependency Description: Value Set Race
Resource: Race
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.836
Dependency Description: Value Set Right
Resource: Right
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.122.12.1035
Dependency Description: Value Set Status Post Left Mastectomy
Resource: Status Post Left Mastectomy
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1069
Dependency Description: Value Set Status Post Right Mastectomy
Resource: Status Post Right Mastectomy
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1070
Dependency Description: Value Set Unilateral Mastectomy Left
Resource: Unilateral Mastectomy Left
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1133
Dependency Description: Value Set Unilateral Mastectomy Right
Resource: Unilateral Mastectomy Right
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1134
Dependency Description: Value Set Unilateral Mastectomy, Unspecified Laterality
Resource: Unilateral Mastectomy, Unspecified Laterality
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1071
Data Requirement Type: Condition
Profile(s): Condition
Code Filter(s):
Path: code
ValueSet: Status Post Right Mastectomy
Data Requirement Type: Procedure
Profile(s): Procedure
Code Filter(s):
Path: code
ValueSet: Unilateral Mastectomy Right
Data Requirement Type: Procedure
Profile(s): Procedure
Code Filter(s):
Path: code
ValueSet: Unilateral Mastectomy Left
Data Requirement Type: Condition
Profile(s): Condition
Code Filter(s):
Path: code
ValueSet: History of bilateral mastectomy
Data Requirement Type: Procedure
Profile(s): Procedure
Code Filter(s):
Path: code
ValueSet: Bilateral Mastectomy
Data Requirement Type: DiagnosticReport
Profile(s): DiagnosticReport
Code Filter(s):
Path: code
ValueSet: Mammography
Data Requirement Type: Condition
Profile(s): Condition
Code Filter(s):
Path: code
ValueSet: Status Post Left Mastectomy
Data Requirement Type: Condition
Profile(s): Condition
Code Filter(s):
Path: code
ValueSet: Unilateral Mastectomy, Unspecified Laterality
Parameters
Name Use Card. Type Documentation
Measurement Period In 0..1 Period
Patient Out 0..1 Patient
SDE Ethnicity Out 0..* Coding
SDE Payer Out 0..* Resource
SDE Race Out 0..* Coding
SDE Sex Out 0..1 Coding
Initial Population Out 0..1 boolean
Denominator Out 0..1 boolean
Right Mastectomy Diagnosis Out 0..* Condition
Right Mastectomy Procedure Out 0..* Procedure
Left Mastectomy Procedure Out 0..* Procedure
Bilateral Mastectomy Diagnosis Out 0..* Condition
Bilateral Mastectomy Procedure Out 0..* Procedure
Numerator Out 0..1 boolean
Left Mastectomy Out 0..* Condition
Denominator Exclusion Out 0..1 boolean
Library Content
CQL Content 
/*
This example is a work in progress and should not be considered a final specification
or recommendation for guidance. This example will help guide and direct the process
of finding conventions and usage patterns that meet the needs of the various stakeholders
in the measure development community.
*/
library BCSComponent version '0.0.001'

using FHIR version '4.0.1'

include hl7.fhir.uv.cql.FHIRHelpers version '4.0.1' called FHIRHelpers

include SupplementalDataElements version '2.0.000' called SDE
include MATGlobalCommonFunctions version '5.0.000' called Global
include AdultOutpatientEncounters version '2.0.000' called AdultOutpatientEncounters
include Hospice version '2.0.000' called Hospice
include AdvancedIllnessandFrailtyExclusion version '5.12.000' called Frailty

codesystem "LOINC": 'http://loinc.org'
codesystem "SNOMEDCT": 'http://snomed.info/sct'

valueset "Bilateral Mastectomy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1005'
valueset "Ethnicity": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.837'
valueset "Female": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.560.100.2'
valueset "History of bilateral mastectomy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1068'
valueset "Left": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.122.12.1036'
valueset "Mammography": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1018'
valueset "ONC Administrative Sex": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1'
valueset "Payer": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591'
valueset "Race": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.836'
valueset "Right": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.122.12.1035'
valueset "Status Post Left Mastectomy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1069'
valueset "Status Post Right Mastectomy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1070'
valueset "Unilateral Mastectomy Left": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1133'
valueset "Unilateral Mastectomy Right": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1134'
valueset "Unilateral Mastectomy, Unspecified Laterality": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1071'

code "Birth date": '21112-8' from "LOINC" display 'Birth date'
code "Left (qualifier value)": '7771000' from "SNOMEDCT" display 'Left (qualifier value)'
code "Right (qualifier value)": '24028007' from "SNOMEDCT" display 'Right (qualifier value)'

parameter "Measurement Period" Interval<DateTime>

context Patient

define "SDE Ethnicity":
  SDE."SDE Ethnicity"

define "SDE Payer":
  SDE."SDE Payer"

define "SDE Race":
  SDE."SDE Race"

define "SDE Sex":
  SDE."SDE Sex"

define "Initial Population":
  Patient.gender = 'female'
      and Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) in Interval[51, 74 )
      and exists AdultOutpatientEncounters."Qualifying Encounters"

define "Denominator":
  "Initial Population"

define "Right Mastectomy Diagnosis":
  ( ( [Condition: "Status Post Right Mastectomy"] )
      union ( [Condition: "Unilateral Mastectomy, Unspecified Laterality"] UnilateralMastectomyDiagnosis
          where UnilateralMastectomyDiagnosis.bodySite in "Right"
      ) ) RightMastectomy
      where Global."Normalize Interval" ( RightMastectomy.onset ) starts on or before
      end of "Measurement Period"

define "Right Mastectomy Procedure":
  [Procedure: "Unilateral Mastectomy Right"] UnilateralMastectomyRightPerformed
      where Global."Normalize Interval" ( UnilateralMastectomyRightPerformed.performed ) ends on or before
      end of "Measurement Period"
        and UnilateralMastectomyRightPerformed.status = 'completed'

define "Left Mastectomy Procedure":
  [Procedure: "Unilateral Mastectomy Left"] UnilateralMastectomyLeftPerformed
      where Global."Normalize Interval" ( UnilateralMastectomyLeftPerformed.performed ) ends on or before
      end of "Measurement Period"
        and UnilateralMastectomyLeftPerformed.status = 'completed'

define "Bilateral Mastectomy Diagnosis":
  [Condition: "History of bilateral mastectomy"] BilateralMastectomyHistory
      where Global."Normalize Interval" ( BilateralMastectomyHistory.onset ) starts on or before
      end of "Measurement Period"

define "Bilateral Mastectomy Procedure":
  [Procedure: "Bilateral Mastectomy"] BilateralMastectomyPerformed
      where Global."Normalize Interval" ( BilateralMastectomyPerformed.performed ) ends on or before
      end of "Measurement Period"
        and BilateralMastectomyPerformed.status = 'completed'

define "Numerator":
  exists ( [DiagnosticReport: "Mammography"] Mammogram
        where ( Global."Normalize Interval" ( Mammogram.effective ) ends 27 months or less on or before
          end of "Measurement Period"
        )
          and Mammogram.status in { 'final', 'amended', 'corrected', 'appended' }
    )

define "Denominator Exclusion":
  Hospice."Has Hospice"
      or ( ( exists "Right Mastectomy Diagnosis"
            or exists "Right Mastectomy Procedure"
        )
          and ( exists "Left Mastectomy"
              or exists "Left Mastectomy Procedure"
          )
      )
      or exists "Bilateral Mastectomy Diagnosis"
      or exists "Bilateral Mastectomy Procedure"
      or Frailty."Advanced Illness and Frailty Exclusion Not Including Over Age 80"
      or ( Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) >= 65
          and Frailty."Long Term Care Periods Longer Than 90 Consecutive Days"
      )

define "Left Mastectomy":
  ( ( [Condition: "Status Post Left Mastectomy"] )
      union ( [Condition: "Unilateral Mastectomy, Unspecified Laterality"] UnilateralMastectomyDiagnosis
          where UnilateralMastectomyDiagnosis.bodySite in "Left"
      ) ) LeftMastectomy
      where Global."Normalize Interval" ( LeftMastectomy.onset ) starts on or before
      end of "Measurement Period"
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ELM JSON Content 
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Generated using version 0.5.4 of the sample-content-ig Liquid templates