Quality Measure Implementation Guide
2.0.0 - STU 2 International flag

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 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: CCS Component Library

Official URL: http://hl7.org/fhir/uv/cqm/Library/CCSComponent Version: 2.0.0
Standards status: Informative Computable Name: CCSComponent
Other Identifiers: OID:2.16.840.1.113883.4.642.40.61.28.5

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

Metadata
Title CCS Component Library
Version 2.0.0
Identifier urn:oid:2.16.840.1.113883.4.642.40.61.28.5
Status Draft
Jurisdiction http://unstats.un.org/unsd/methods/m49/m49.htm#001
Steward (Publisher) HL7 International / Clinical Quality Information
Description

This library is the primary measure library for the Cervical Cancer Screening component of the composite measure examples in this implementation guide.
Type http://terminology.hl7.org/CodeSystem/library-type#logic-library
Data Requirement Type: Procedure
Profile(s): Procedure version: 4.0.1
Code Filter(s):
Path: code
ValueSet: Flexible Sigmoidoscopy version: 20171219
Data Requirement Type: Procedure
Profile(s): Procedure version: 4.0.1
Code Filter(s):
Path: code
ValueSet: CT Colonography version: 20190315
Data Requirement Type: Procedure
Profile(s): Procedure version: 4.0.1
Code Filter(s):
Path: code
ValueSet: Total Colectomy version: 20190315
Data Requirement Type: Observation
Profile(s): Observation version: 4.0.1
Code Filter(s):
Path: code
ValueSet: Fecal Occult Blood Test (FOBT) version: 20171219
Data Requirement Type: Observation
Profile(s): Observation version: 4.0.1
Code Filter(s):
Path: code
ValueSet: sDNA FIT Test version: 20171219
Data Requirement Type: Procedure
Profile(s): Procedure version: 4.0.1
Code Filter(s):
Path: code
ValueSet: Colonoscopy version: 20171219
Data Requirement Type: Condition
Profile(s): Condition version: 4.0.1
Code Filter(s):
Path: code
ValueSet: Malignant Neoplasm of Colon version: 20171222
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
Flexible Sigmoidoscopy Performed Out 0..* Procedure
CT Colonography Performed Out 0..* Procedure
Total Colectomy Performed Out 0..* Procedure
Fecal Occult Blood Test Performed Out 0..* Observation
Fecal Immunochemical Test DNA Out 0..* Observation
Colonoscopy Performed Out 0..* Procedure
Numerator Out 0..1 boolean
Malignant Neoplasm 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 CCSComponent

using FHIR version '4.0.1'

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

include SupplementalDataElements called SDE
include MATGlobalCommonFunctions called Global
include AdultOutpatientEncounters called AdultOutpatientEncounters
include Hospice called Hospice
include AdvancedIllnessandFrailtyExclusion called Frailty

codesystem "LOINC": 'http://loinc.org'

valueset "Acute Inpatient": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1083'
valueset "Advanced Illness": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1082'
valueset "Annual Wellness Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240'
valueset "Care Services in Long-Term Residential Facility": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014'
valueset "Colonoscopy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020'
valueset "CT Colonography": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038'
valueset "Dementia Medications": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1510'
valueset "Discharged to Health Care Facility for Hospice Care": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.207'
valueset "Discharged to Home for Hospice Care": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.209'
valueset "ED": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1085'
valueset "Encounter Inpatient": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307'
valueset "Fecal Occult Blood Test (FOBT)": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011'
valueset "FIT DNA": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039'
valueset "Flexible Sigmoidoscopy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010'
valueset "Frailty Device": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.118.12.1300'
valueset "Frailty Diagnosis": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1074'
valueset "Frailty Encounter": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1088'
valueset "Frailty Symptom": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1075'
valueset "Home Healthcare Services": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016'
valueset "Hospice care ambulatory": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15'
valueset "Malignant Neoplasm of Colon": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001'
valueset "Nonacute Inpatient": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1084'
valueset "Nursing Facility Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012'
valueset "Observation": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1086'
valueset "Office Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001'
valueset "Outpatient": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1087'
valueset "Preventive Care Services - Established Office Visit, 18 and Up": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025'
valueset "Preventive Care Services-Initial Office Visit, 18 and Up": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023'
valueset "Total Colectomy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019'

code "Birth date": '21112-8' from "LOINC" display 'Birth date'

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":
  Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) in Interval[50, 75]
      and exists AdultOutpatientEncounters."Qualifying Encounters"

define "Denominator":
  "Initial Population"

define "Flexible Sigmoidoscopy Performed":
  [Procedure: "Flexible Sigmoidoscopy"] FlexibleSigmoidoscopy
      where FlexibleSigmoidoscopy.status = 'completed'
        and Global."Normalize Interval" ( FlexibleSigmoidoscopy.performed ) ends 5 years or less on or before
        end of "Measurement Period"

define "CT Colonography Performed":
  [Procedure: "CT Colonography"] Colonography
      where Colonography.status = 'completed'
        and Global."Normalize Interval" ( Colonography.performed ) ends 5 years or less on or before
        end of "Measurement Period"

define "Total Colectomy Performed":
  [Procedure: "Total Colectomy"] Colectomy
      where Colectomy.status = 'completed'
        and Global."Normalize Interval" ( Colectomy.performed ) starts on or before
        end of "Measurement Period"

define "Fecal Occult Blood Test Performed":
  [Observation: "Fecal Occult Blood Test (FOBT)"] FecalOccultResult
      where FecalOccultResult.status in { 'final', 'amended', 'corrected', 'preliminary' }
        and FecalOccultResult.value is not null
        and Global."Normalize Interval" ( FecalOccultResult.effective ) during day of "Measurement Period"

define "Fecal Immunochemical Test DNA":
  [Observation: "FIT DNA"] FitDNA
      where FitDNA.status in { 'final', 'amended', 'corrected', 'preliminary' }
        and FitDNA.value is not null
        and Global."Normalize Interval" ( FitDNA.effective ) occurs 3 years or less on or before day of
        end of "Measurement Period"

define "Colonoscopy Performed":
  [Procedure: "Colonoscopy"] Colonoscopy
      where Colonoscopy.status = 'completed'
        and Global."Normalize Interval" ( Colonoscopy.performed ) ends 10 years or less on or before
        end of "Measurement Period"

define "Numerator":
  exists "Colonoscopy Performed"
      or exists "Fecal Occult Blood Test Performed"
      or exists "Flexible Sigmoidoscopy Performed"
      or exists "Fecal Immunochemical Test DNA"
      or exists "CT Colonography Performed"

define "Malignant Neoplasm":
  [Condition: "Malignant Neoplasm of Colon"] ColorectalCancer
      where Global."Prevalence Period" ( ColorectalCancer ) starts on or before
      end of "Measurement Period"

define "Denominator Exclusion":
  Hospice."Has Hospice"
      or exists "Malignant Neoplasm"
      or exists "Total Colectomy Performed"
      or Frailty."Advanced Illness and Frailty Exclusion Not Including Over Age 80"
        and Frailty."Long Term Care Periods Longer Than 90 Consecutive Days"
ELM XML Content 
Encoded data
ELM JSON Content 
Encoded data
Citations and References
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 Elements
Canonical URL: http://hl7.org/fhir/uv/cqm/Library/SupplementalDataElements
Dependency Description: Library Global
Resource: MAT Global Common Functions FHIR Library
Canonical URL: http://hl7.org/fhir/uv/cqm/Library/MATGlobalCommonFunctions
Dependency Description: Library AdultOutpatientEncounters
Resource: Adult Outpatient Encounters Common Library version: 2.0.0
Canonical URL: http://hl7.org/fhir/uv/cqm/Library/AdultOutpatientEncounters|2.0.0
Dependency Description: Library Hospice
Resource: Hospice FHIR Library
Canonical URL: http://hl7.org/fhir/uv/cqm/Library/Hospice
Dependency Description: Library Frailty
Resource: Advanced Illness and Frailty Exclusion Library version: 2.0.0
Canonical URL: http://hl7.org/fhir/uv/cqm/Library/AdvancedIllnessandFrailtyExclusion|2.0.0
Dependency Description: Code System LOINC
Resource: Logical Observation Identifiers, Names and Codes (LOINC)
Canonical URL: http://loinc.org
Dependency Description: Value Set Acute Inpatient
Resource: Acute Inpatient version: 20190315
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1083|20190315
Dependency Description: Value Set Advanced Illness
Resource: Advanced Illness version: 20190315
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1082|20190315
Dependency Description: Value Set Annual Wellness Visit
Resource: Annual Wellness Visit version: 20190315
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240|20190315
Dependency Description: Value Set Care Services in Long-Term Residential Facility
Resource: Care Services in Long Term Residential Facility version: 20180310
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014|20180310
Dependency Description: Value Set Colonoscopy
Resource: Colonoscopy version: 20171219
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020|20171219
Dependency Description: Value Set CT Colonography
Resource: CT Colonography version: 20190315
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038|20190315
Dependency Description: Value Set Dementia Medications
Resource: Dementia Medications version: 20190315
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1510|20190315
Dependency Description: Value Set Discharged to Health Care Facility for Hospice Care
Resource: Discharged to Health Care Facility for Hospice Care version: 20210611
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.207|20210611
Dependency Description: Value Set Discharged to Home for Hospice Care
Resource: Discharged to Home for Hospice Care version: 20210220
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.209|20210220
Dependency Description: Value Set ED
Resource: ED version: 20190315
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1085|20190315
Dependency Description: Value Set Encounter Inpatient
Resource: Encounter Inpatient version: 20200307
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307|20200307
Dependency Description: Value Set Fecal Occult Blood Test (FOBT)
Resource: Fecal Occult Blood Test (FOBT) version: 20171219
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011|20171219
Dependency Description: Value Set FIT DNA
Resource: sDNA FIT Test version: 20171219
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039|20171219
Dependency Description: Value Set Flexible Sigmoidoscopy
Resource: Flexible Sigmoidoscopy version: 20171219
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010|20171219
Dependency Description: Value Set Frailty Device
Resource: Frailty Device version: 20200310
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.118.12.1300|20200310
Dependency Description: Value Set Frailty Diagnosis
Resource: Frailty Diagnosis version: 20190315
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1074|20190315
Dependency Description: Value Set Frailty Encounter
Resource: Frailty Encounter version: 20210224
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1088|20210224
Dependency Description: Value Set Frailty Symptom
Resource: Frailty Symptom version: 20190315
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1075|20190315
Dependency Description: Value Set Home Healthcare Services
Resource: Home Healthcare Services version: 20180310
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016|20180310
Dependency Description: Value Set Hospice care ambulatory
Resource: Hospice Care Ambulatory version: 20230118
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15|20230118
Dependency Description: Value Set Malignant Neoplasm of Colon
Resource: Malignant Neoplasm of Colon version: 20171222
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001|20171222
Dependency Description: Value Set Nonacute Inpatient
Resource: Nonacute Inpatient version: 20190315
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1084|20190315
Dependency Description: Value Set Nursing Facility Visit
Resource: Nursing Facility Visit version: 20180310
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012|20180310
Dependency Description: Value Set Observation
Resource: Observation version: 20190315
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1086|20190315
Dependency Description: Value Set Office Visit
Resource: Office Visit version: 20180310
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001|20180310
Dependency Description: Value Set Outpatient
Resource: Outpatient version: 20210220
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1087|20210220
Dependency Description: Value Set Preventive Care Services - Established Office Visit, 18 and Up
Resource: Preventive Care Services Established Office Visit, 18 and Up version: 20170504
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025|20170504
Dependency Description: Value Set Preventive Care Services-Initial Office Visit, 18 and Up
Resource: Preventive Care Services Initial Office Visit, 18 and Up version: 20170504
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023|20170504
Dependency Description: Value Set Total Colectomy
Resource: Total Colectomy version: 20190315
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019|20190315
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