EXM108-FHIR
type: Measure
node role: treeRoot
id:
  v: EXM108-FHIR
meta:
  profile:
    v: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareablemeasure
    l: crmi-shareablemeasure
  profile:
    v: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure
    l: cqm-computablemeasure
  profile:
    v: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-proportionmeasure
    l: cqm-proportionmeasure
  profile:
    v: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-cqlmeasure
    l: cqm-cqlmeasure
  profile:
    v: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure
    l: cqm-computablemeasure
language:
  v: en
text:
  status:
    v: extensions
  div:
    v: Metadata Title EXM108 - Venous Thromboembolism Prophylaxis Version 8.2.000 Identifier 108 Identifier urn:oid:2.16.840.1.113883.4.642.40.61.29.3 Effective Period 2018-01-01 through 2018-12-31 Approval Date 2019-03-08 Last Review Date 2019-03-08 Experimental true Use Context Clinical Venue = EH Jurisdiction Global (Whole world) Topic Health Quality Measure Document Steward (Publisher) HL7 International / Clinical Quality Information Description This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission Copyright Measure specifications are in the Public Domain. LOINC(R) is a registered trademark of the Regenstrief Institute. This material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2017 International Health Terminology Standards Development Organization. All rights reserved. Disclaimer These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty Measure Basis Encounter Measure Scoring Proportion Measure Type Process Rationale Hospitalized patients at high-risk for VTE may develop an asymptomatic deep vein thrombosis (DVT), and die from pulmonary embolism (PE) even before the diagnosis is suspected. The majority of fatal events occur as sudden or abrupt death, underscoring the importance of prevention as the most critical action step for reducing death from PE (Geerts, et al, 2008). The estimated annual incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE), known collectively as venous thromboembolism (VTE), is approximately 900,000 (Geerts, et al, 2008). Approximately two-thirds of cases of DVT or PE are associated with recent hospitalization. This is consistent with the …
contained: Library
  id:
    v: effective-data-requirements
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode
      l: cqf-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-clinical
        l: condition-clinical
      code:
        v: active
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode
      l: cqf-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-clinical
        l: condition-clinical
      code:
        v: recurrence
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode
      l: cqf-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-clinical
        l: condition-clinical
      code:
        v: relapse
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode
      l: cqf-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-clinical
        l: condition-clinical
      code:
        v: inactive
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode
      l: cqf-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-clinical
        l: condition-clinical
      code:
        v: remission
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode
      l: cqf-directReferenceCode
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/condition-clinical
        l: condition-clinical
      code:
        v: resolved
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode
      l: cqf-directReferenceCode
    value: Coding
      type: https://loinc.org/rdf/72136-5
      system:
        v: http://loinc.org
        l: loinc.org
      code:
        v: 72136-5
      display:
        v: Risk for venous thromboembolism
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: SupplementalDataElements
    extension:
      url:
        v: name
        l: name
      value: String
        v: SDE Sex
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "SDE Sex": case when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' } when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' } else null end
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 0
    url:
      v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
      l: cqf-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: EXM108
    extension:
      url:
        v: name
        l: name
      value: String
        v: SDE Sex
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "SDE Sex": SDE."SDE Sex"
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 1
    url:
      v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
      l: cqf-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: MATGlobalCommonFunctions
    extension:
      url:
        v: name
        l: name
      value: String
        v: Inpatient Encounter
    extension:
      url:
        v: statement
        l: statement
      value: String
        v: define "Inpatient Encounter": [Encounter: "Encounter Inpatient"] EncounterInpatient where EncounterInpatient.status = 'finished' and "LengthInDays"(EncounterInpatient.period) <= 120 and EncounterInpatient.period ends during "Measurement Period"
    extension:
      url:
        v: displaySequence
        l: displaySequence
      value: Integer
        v: 2
    url:
      v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
      l: cqf-logicDefinition
  extension:
    extension:
      url:
        v: libraryName
        l: libraryName
      value: String
        v: EXM108
    extension:
      url:
        v: name
        l: name
      value: String
        v: Admission Without VTE or Obstetrical Conditions
    extension:
      url:
        v: statement
        l: statement
      value: String

String
v: define "Admission Without VTE or Obstetrical Conditions": Global."Inpatient Encounter" InpatientEncounter where not exists ( (Global.EncounterDiagnosis(InpatientEncounter)) EncounterDiagnosis where EncounterDiagnosis.code in "Obstetrics" or EncounterDiagnosis.code in "Venous Thromboembolism" or EncounterDiagnosis.code in "Obstetrics VTE" )

url:
  v: displaySequence
  l: displaySequence
value: Integer
  v: 3

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions
extension:
  url:
    v: statement
    l: statement
  value: String
    v: // Note: added FHIRHelpers.ToDate() in R4 define "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions": ( Global."Inpatient Encounter" InpatientEncounter where Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of InpatientEncounter.period) >= 18 ) intersect "Admission Without VTE or Obstetrical Conditions"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 4
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: VTE Prophylaxis by Medication Administered or Device Applied
extension:
  url:
    v: statement
    l: statement
  value: String
    v: // 10/29: Replaced DeviceUseStatement with Procedure with a new value set and procedure.usdCode for specifying devices define "VTE Prophylaxis by Medication Administered or Device Applied": ( ["MedicationAdministration": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"] VTEMedication where VTEMedication.status ='completed' and VTEMedication.dosage.route in "Subcutaneous route" ) union (["MedicationAdministration": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"] LMWH where LMWH.status = 'completed') union (["MedicationAdministration": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"] FactorXa where FactorXa.status = 'completed') union (["MedicationAdministration": medication in "Warfarin"] Warfarin where Warfarin.status = 'completed') union ( ["Procedure": "Device Application"] DeviceApplied where DeviceApplied.status = 'complete' and (DeviceApplied.usedCode in "Intermittent pneumatic compression devices (IPC)" or DeviceApplied.usedCode in"Venous foot pumps (VFP)" or DeviceApplied.usedCode in "Graduated compression stockings (GCS)" ) )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 5
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure": ( from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, "VTE Prophylaxis by Medication Administered or Device Applied" VTEProphylaxis where Coalesce(Global."Normalize Interval"(VTEProphylaxis.effective), Global."Normalize Interval"(VTEProphylaxis.performed)) starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period) return QualifyingEncounter ) union ( from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure, "VTE Prophylaxis by Medication Administered or Device Applied" VTEProphylaxis where Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period and Coalesce(Global."Normalize Interval"(VTEProphylaxis.effective), Global."Normalize Interval"(VTEProphylaxis.performed)) starts during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed)) return QualifyingEncounter )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 6
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure": ( from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, ["MedicationAdministration": medication in "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication where FactorXaMedication.status = 'completed' and Global."Normalize Interval"(FactorXaMedication.effective) starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period) return QualifyingEncounter ) union ( from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure, ["MedicationAdministration": medication in "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication where FactorXaMedication.status = 'completed' and AnesthesiaProcedure.status = 'completed' and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period and Global."Normalize Interval"(FactorXaMedication.effective) starts during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed)) return QualifyingEncounter )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 7
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE": ( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter with ["Condition": code in "Atrial Fibrillation/Flutter"] AtrialFibrillation such that FHIRHelpers.ToConcept(AtrialFibrillation.clinicalStatus) in { Global."active", Global."recurrence", Global."relapse" } and Global."Normalize Interval"(AtrialFibrillation.onset) starts on or before end of QualifyingEncounter.period ) union ( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter where Global.EncounterDiagnosis(QualifyingEncounter).code in "Atrial Fibrillation/Flutter" ) union ( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter with ["Condition": code in "Venous Thromboembolism"] VTEDiagnosis such that FHIRHelpers.ToConcept(VTEDiagnosis.clinicalStatus) in { Global."inactive", Global."remission", Global."resolved" } //and VTEDiagnosis.verificationStatus = 'confirmed' and Global."Normalize Interval"(VTEDiagnosis.onset) before start of QualifyingEncounter.period )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 8
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery": "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter with ( ["Procedure": "Hip Replacement Surgery"] union ["Procedure": "Knee Replacement Surgery"] ) HipKneeProcedure such that HipKneeProcedure.status = 'completed' and Global."Normalize Interval"(HipKneeProcedure.performed) starts on or before end of QualifyingEncounter.period
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 9
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Is In Low Risk for VTE or On Anticoagulant
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Is In Low Risk for VTE or On Anticoagulant": ( ["Observation": "Risk for venous thromboembolism"] VTERiskAssessment where VTERiskAssessment.value in "Low Risk" and VTERiskAssessment.status in {'final','amended', 'corrected'} ) union ( ["Observation": "INR"] INRLabTest where INRLabTest.value as Quantity > 3.0 and INRLabTest.status in {'final','amended', 'corrected'} return "Observation" { id: INRLabTest.id, effective: INRLabTest.issued } ) union ((( ["MedicationAdministration": "Unfractionated Heparin"] UnfractionatedHeparin where UnfractionatedHeparin.dosage.route in "Intravenous route" ) union ["MedicationAdministration": "Direct Thrombin Inhibitor"] union ["MedicationAdministration": "Glycoprotein IIb/IIIa Inhibitors"] ) AnticoagulantMedication where AnticoagulantMedication.status = 'complete' return "Observation" { id: AnticoagulantMedication.id, effective: AnticoagulantMedication.effective } )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 10
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission": "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter with "Is In Low Risk for VTE or On Anticoagulant" VTERiskAssessment such that Global."Normalize Interval"(VTERiskAssessment.effective) starts during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 11
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure": from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure, "Is In Low Risk for VTE or On Anticoagulant" VTERiskAssessment where Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period and Global."Normalize Interval"(VTERiskAssessment.effective) starts during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed)) return QualifyingEncounter
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 12
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter With Low Risk for VTE or Anticoagulant Administered
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Encounter With Low Risk for VTE or Anticoagulant Administered": "Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission" union "Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 13
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: No VTE Prophylaxis Medication Administered or Ordered
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "No VTE Prophylaxis Medication Administered or Ordered": (( ["MedicationAdministration": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"] union ["MedicationAdministration": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"] union ["MedicationAdministration": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"] union ["MedicationAdministration": medication in "Warfarin"] ) MedicationAdm where MedicationAdm.status = 'not-done' ) union (( ["MedicationRequest": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"] union ["MedicationRequest": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"] union ["MedicationRequest": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"] union ["MedicationRequest": medication in "Warfarin"] ) MedicationOrder where MedicationOrder.doNotPerform is true and MedicationOrder.status in {'completed', 'cancelled'} //11/5 discussion: all expressions for QI-Core must include a status. //Therefore, we need ServiceRequest.status = completed; and MedicationRequest.status = cancelled (or completed, since cancelled indicates it was once ordered but intentionally never filled). //So the not done issue is handled by ServiceRequest.doNotPerform = True Or MedicationRequest.doNotPerform = True )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 14
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission": "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter with "No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication such that Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Medical Reason" and Coalesce(NoVTEMedication.authoredOn, start of Global."Normalize Interval"(NoVTEMedication.effective)) during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 15
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: No VTE Prophylaxis Device Applied or Ordered
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "No VTE Prophylaxis Device Applied or Ordered": (( ["ServiceRequest": "Venous foot pumps (VFP)"] union ["ServiceRequest": "Intermittent pneumatic compression devices (IPC)"] union ["ServiceRequest": "Graduated compression stockings (GCS)"] ) DeviceOrder where DeviceOrder.status = 'completed' and DeviceOrder.doNotPerform is true return {id: DeviceOrder.id, requestStatusReason: GetStatusReason(DeviceOrder), authoredOn: DeviceOrder.authoredOn} ) union ( ["Procedure": "Device Application"] DeviceApplied let DeviceNotDoneTiming: Global.GetExtension(DeviceApplied, 'qicore-recorded').value where (DeviceApplied.usedCode in "Intermittent pneumatic compression devices (IPC)" or DeviceApplied.usedCode in "Venous foot pumps (VFP)" or DeviceApplied.usedCode in "Graduated compression stockings (GCS)" ) and DeviceApplied.status = 'not-done' return {id: DeviceApplied.id, requestStatusReason: DeviceApplied.statusReason, authoredOn: DeviceNotDoneTiming} )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 16
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: No VTE Prophylaxis Device Due to Medical Reason From Day of Start of Hospitalization To Day After Admission
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "No VTE Prophylaxis Device Due to Medical Reason From Day of Start of Hospitalization To Day After Admission": "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter with "No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice such that NoVTEDevice.requestStatusReason in "Medical Reason" and NoVTEDevice.authoredOn during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 17
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure": from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure, "No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication where Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Medical Reason" and AnesthesiaProcedure.status = 'completed' and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period and Coalesce(NoVTEMedication.authoredOn, start of Global."Normalize Interval"(NoVTEMedication.effective)) during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed)) return QualifyingEncounter
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 18
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure": from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure, "No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice where NoVTEDevice.requestStatusReason in "Medical Reason" and AnesthesiaProcedure.status = 'completed' and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period and NoVTEDevice.authoredOn during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed)) return QualifyingEncounter
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 19
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter With No VTE Prophylaxis Due to Medical Reason
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Encounter With No VTE Prophylaxis Due to Medical Reason": ( "No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission" intersect "No VTE Prophylaxis Device Due to Medical Reason From Day of Start of Hospitalization To Day After Admission" ) union ( "No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure" intersect "No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure" )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 20
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: No VTE Prophylaxis Medication or Device Due to Patient Refusal
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "No VTE Prophylaxis Medication or Device Due to Patient Refusal": ( "No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication where Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Patient Refusal" ) union ("No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice where NoVTEDevice.requestStatusReason in "Patient Refusal" )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 21
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission": "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter with "No VTE Prophylaxis Medication or Device Due to Patient Refusal" PatientRefusal such that Coalesce(start of Global."Normalize Interval"(PatientRefusal.effective), PatientRefusal.authoredOn) during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 22
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure": from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure, "No VTE Prophylaxis Medication or Device Due to Patient Refusal" PatientRefusal where Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period and Coalesce(start of Global."Normalize Interval"(PatientRefusal.effective), PatientRefusal.authoredOn) during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed)) return QualifyingEncounter
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 23
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter With No VTE Prophylaxis Due to Patient Refusal
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Encounter With No VTE Prophylaxis Due to Patient Refusal": "No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission" union "No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 24
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Numerator
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Numerator": "Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure" union ( "Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure" intersect ( "Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE" union "Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery" ) ) union "Encounter With Low Risk for VTE or Anticoagulant Administered" union "Encounter With No VTE Prophylaxis Due to Medical Reason" union "Encounter With No VTE Prophylaxis Due to Patient Refusal"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 25
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Initial Population
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Initial Population": "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 26
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Denominator
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Denominator": "Initial Population"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 27
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SupplementalDataElements
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Payer
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Payer": [Coverage: type in "Payer"] Payer return { code: Payer.type, period: Payer.period }
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 28
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Payer
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Payer": SDE."SDE Payer"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 29
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SupplementalDataElements
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Ethnicity
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Ethnicity": (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:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 30
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Ethnicity
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Ethnicity": SDE."SDE Ethnicity"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 31
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter Less Than 2 Days
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Encounter Less Than 2 Days": "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter where Global."LengthInDays"(QualifyingEncounter.period)< 2
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 32
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter With ICU Location Stay 1 Day or More
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Encounter With ICU Location Stay 1 Day or More": "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter where exists ( QualifyingEncounter.location Location where Global.GetLocation(Location.location).type in "Intensive Care Unit" and Global."LengthInDays"(Location.period)>= 1 and Location.period starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period) )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 33
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter With Principal Diagnosis of Mental Disorder or Stroke
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Encounter With Principal Diagnosis of Mental Disorder or Stroke": "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter where Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Mental Health Diagnoses" or Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Hemorrhagic Stroke" or Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Ischemic Stroke"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 34
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: SCIP VTE Selected Surgery
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SCIP VTE Selected Surgery": ( ["Procedure": "General Surgery"] union ["Procedure": "Gynecological Surgery"] union ["Procedure": "Hip Fracture Surgery"] union ["Procedure": "Hip Replacement Surgery"] union ["Procedure": "Intracranial Neurosurgery"] union ["Procedure": "Knee Replacement Surgery"] union ["Procedure": "Urological Surgery"] ) Procedure where Procedure.status = 'completed'
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 35
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter With Principal Procedure of SCIP VTE Selected Surgery
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Encounter With Principal Procedure of SCIP VTE Selected Surgery": from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, "SCIP VTE Selected Surgery" SelectedProcedure let EncounterProcedure: Global.GetExtension(QualifyingEncounter, 'qicore-encounter-procedure') where FHIRHelpers.ToInteger(Global.GetExtension(EncounterProcedure, 'rank').value as FHIR.positiveInt) = 1 and Global.GetId(FHIRHelpers.ToString((Global.GetExtension(EncounterProcedure, 'procedure').value as FHIR.Reference).reference)) = SelectedProcedure.id and Global."Normalize Interval"(SelectedProcedure.performed) during QualifyingEncounter.period
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 36
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Intervention Comfort Measures
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Intervention Comfort Measures": (["ServiceRequest": "Comfort Measures"] P where P.intent = 'order' ) union (["Procedure": "Comfort Measures"] InterventionPerformed where InterventionPerformed.status in {'completed', 'in-progress'})
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 37
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission": "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter with "Intervention Comfort Measures" ComfortMeasure such that Coalesce(start of Global."Normalize Interval"(ComfortMeasure.performed), ComfortMeasure.authoredOn) during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 38
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Encounter With Intervention Comfort Measures on Day of or Day After Procedure
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Encounter With Intervention Comfort Measures on Day of or Day After Procedure": from "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter, ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure, "Intervention Comfort Measures" ComfortMeasure where AnesthesiaProcedure.status = 'completed' and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period and Coalesce(start of Global."Normalize Interval"(ComfortMeasure.performed), ComfortMeasure.authoredOn) during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed)) return QualifyingEncounter
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 39
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: Denominator Exclusion
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "Denominator Exclusion": "Encounter Less Than 2 Days" union "Encounter With ICU Location Stay 1 Day or More" union "Encounter With Principal Diagnosis of Mental Disorder or Stroke" union "Encounter With Principal Procedure of SCIP VTE Selected Surgery" union "Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission" union "Encounter With Intervention Comfort Measures on Day of or Day After Procedure"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 40
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: SupplementalDataElements
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Race
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Race": (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:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 41
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: SDE Race
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define "SDE Race": SDE."SDE Race"
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 42
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToString
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value AdministrativeGender): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 43
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToString
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value EncounterStatus): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 44
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: MATGlobalCommonFunctions
extension:
  url:
    v: name
    l: name
  value: String
    v: LengthInDays
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function "LengthInDays"(Value Interval<DateTime>): difference in days between start of Value and end of Value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 45
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToInterval
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @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."start" is null then Interval(period."start".value, period."end".value] else Interval[period."start".value, period."end".value]
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 46
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: MATGlobalCommonFunctions
extension:
  url:
    v: name
    l: name
  value: String
    v: CalendarAgeInYearsAt
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function "CalendarAgeInYearsAt"(BirthDateTime DateTime, AsOf DateTime): years between ToDate(BirthDateTime)and ToDate(AsOf)
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 47
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: MATGlobalCommonFunctions
extension:
  url:
    v: name
    l: name
  value: String
    v: ToDate
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function "ToDate"(Value DateTime): DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value)
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 48
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToDate
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToDate(value date): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 49
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: MATGlobalCommonFunctions
extension:
  url:
    v: name
    l: name
  value: String
    v: EncounterDiagnosis
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function "EncounterDiagnosis"(Encounter Encounter): Encounter.diagnosis D return singleton from ([Condition] C where C.id = "GetId"(D.condition.reference))
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 50
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToString
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value string): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 51
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: MATGlobalCommonFunctions
extension:
  url:
    v: name
    l: name
  value: String
    v: GetId
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function "GetId"(uri String): Last(Split(uri, '/'))
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 52
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToConcept
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @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:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 53
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToCode
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @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:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 54
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToString
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value MedicationAdministrationStatus): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 55
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToString
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value ProcedureStatus): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 56
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: TJCOverall
extension:
  url:
    v: name
    l: name
  value: String
    v: CalendarDayOfOrDayAfter
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function "CalendarDayOfOrDayAfter"(StartValue DateTime ): Interval(Global."ToDate"(StartValue), Global."ToDate"(StartValue + 2 days))
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 57
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToString
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value ObservationStatus): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 58
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToQuantity
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) value to a CQL Quantity @comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity has a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`) an error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used. @seealso: ToCalendarUnit */ define function ToQuantity(quantity FHIR.Quantity): case when quantity is null then null when quantity.value is null then null when quantity.comparator is not null then Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.') when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org' or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) } else Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')') end
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 59
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToCalendarUnit
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* @description: Converts a UCUM definite duration unit to a CQL calendar duration unit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities) topic of the CQL specification. @comment: Note that for durations above days (or weeks), the conversion is understood to be approximate */ define function ToCalendarUnit(unit System.String): case unit when 'ms' then 'millisecond' when 's' then 'second' when 'min' then 'minute' when 'h' then 'hour' when 'd' then 'day' when 'wk' then 'week' when 'mo' then 'month' when 'a' then 'year' else unit end
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 60
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: VTEICU
extension:
  url:
    v: name
    l: name
  value: String
    v: FromDayOfStartOfHospitalizationToDayAfterAdmission
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function "FromDayOfStartOfHospitalizationToDayAfterAdmission"(Encounter FHIR.Encounter ): Interval[Global."ToDate"(start of Global."HospitalizationWithObservation"(Encounter)), Global."ToDate"(start of Encounter.period + 2 days))
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 61
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: MATGlobalCommonFunctions
extension:
  url:
    v: name
    l: name
  value: String
    v: HospitalizationWithObservation
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function "HospitalizationWithObservation"(TheEncounter FHIR.Encounter): TheEncounter Visit let ObsVisit: Last([Encounter: "Observation Services"] LastObs where LastObs.period ends 1 hour or less on or before start of Visit.period sort by end of period ), VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period), EDVisit: Last([Encounter: "Emergency Department Visit"] LastED where LastED.period ends 1 hour or less on or before VisitStart sort by end of period ) return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 62
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToBoolean
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToBoolean(value boolean): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 63
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToString
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value MedicationRequestStatus): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 64
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToDateTime
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToDateTime(value dateTime): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 65
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToString
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value ServiceRequestStatus): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 66
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: EXM108
extension:
  url:
    v: name
    l: name
  value: String
    v: GetStatusReason
extension:
  url:
    v: statement
    l: statement
  value: String
    v: //11/5: ServiceRequest not done reason is an extension in QI-Core R4 as ServiceRequest.extension:statusReason define function GetStatusReason(requestReason ServiceRequest): Global.GetBaseExtension(requestReason, 'request-statusReason')
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 67
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: MATGlobalCommonFunctions
extension:
  url:
    v: name
    l: name
  value: String
    v: GetBaseExtension
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function "GetBaseExtension"(domainResource DomainResource, url String): singleton from "GetBaseExtensions"(domainResource, url)
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 68
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: MATGlobalCommonFunctions
extension:
  url:
    v: name
    l: name
  value: String
    v: GetBaseExtensions
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* NOTE: Extensions are not the preferred approach, but are used as a way to access content that is defined by extensions but not yet surfaced in the CQL model info. */ define function "GetBaseExtensions"(domainResource DomainResource, url String): domainResource.extension E where E.url = ('http://hl7.org/fhir/StructureDefinition/' + url) return E
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 69
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToString
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value uri): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 70
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: MATGlobalCommonFunctions
extension:
  url:
    v: name
    l: name
  value: String
    v: GetExtension
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function "GetExtension"(domainResource DomainResource, url String): singleton from "GetExtensions"(domainResource, url)
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 71
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: MATGlobalCommonFunctions
extension:
  url:
    v: name
    l: name
  value: String
    v: GetExtensions
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* NOTE: Extensions are not the preferred approach, but are used as a way to access content that is defined by extensions but not yet surfaced in the CQL model info. */ define function "GetExtensions"(domainResource DomainResource, url String): domainResource.extension E where E.url = ('http://hl7.org/fhir/us/qicore/StructureDefinition/' + url) return E
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 72
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToDateTime
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToDateTime(value instant): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 73
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: MATGlobalCommonFunctions
extension:
  url:
    v: name
    l: name
  value: String
    v: GetLocation
extension:
  url:
    v: statement
    l: statement
  value: String
    v: // Returns the location for the given location reference define function GetLocation(reference Reference): singleton from ( [Location] L where L.id = GetId(reference.reference) )
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 74
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: MATGlobalCommonFunctions
extension:
  url:
    v: name
    l: name
  value: String
    v: PrincipalDiagnosis
extension:
  url:
    v: statement
    l: statement
  value: String
    v: // Returns the condition that is specified as the principal diagnosis for the encounter // TODO: BTR 2019-07-30: Shouldn't need the FHIRHelpers reference here, investigate define function "PrincipalDiagnosis"(Encounter Encounter): (singleton from (Encounter.diagnosis D where FHIRHelpers.ToInteger(D.rank) = 1)) PD return singleton from ([Condition] C where C.id = "GetId"(PD.condition.reference))
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 75
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToInteger
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToInteger(value integer): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 76
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: MATGlobalCommonFunctions
extension:
  url:
    v: name
    l: name
  value: String
    v: GetExtension
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function "GetExtension"(element Element, url String): singleton from "GetExtensions"(element, url)
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 77
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: MATGlobalCommonFunctions
extension:
  url:
    v: name
    l: name
  value: String
    v: GetExtensions
extension:
  url:
    v: statement
    l: statement
  value: String
    v: /* NOTE: Extensions are not the preferred approach, but are used as a way to access content that is defined by extensions but not yet surfaced in the CQL model info. */ define function "GetExtensions"(element Element, url String): element.extension E where E.url = (url) return E
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 78
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

extension:
  url:
    v: libraryName
    l: libraryName
  value: String
    v: FHIRHelpers
extension:
  url:
    v: name
    l: name
  value: String
    v: ToString
extension:
  url:
    v: statement
    l: statement
  value: String
    v: define function ToString(value ServiceRequestIntent): value.value
extension:
  url:
    v: displaySequence
    l: displaySequence
  value: Integer
    v: 79
url:
  v: http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition
  l: cqf-logicDefinition

v: EffectiveDataRequirements

v: active

coding:
  system:
    v: http://terminology.hl7.org/CodeSystem/library-type
    l: library-type
  code:
    v: module-definition

type:
  v: depends-on
display:
  v: Library SDE
resource:
  v: http://hl7.org/fhir/uv/cqm/Library/SupplementalDataElements|2.0.000
  l: http://hl7.org/fhir/uv/cqm/Library/SupplementalDataElements

type:
  v: depends-on
display:
  v: Library FHIRHelpers
resource:
  v: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1
  l: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers

type:
  v: depends-on
display:
  v: Library Global
resource:
  v: http://hl7.org/fhir/uv/cqm/Library/MATGlobalCommonFunctions|5.0.000
  l: http://hl7.org/fhir/uv/cqm/Library/MATGlobalCommonFunctions

type:
  v: depends-on
display:
  v: Library TJC
resource:
  v: http://hl7.org/fhir/uv/cqm/Library/TJCOverall|4.0.000
  l: http://hl7.org/fhir/uv/cqm/Library/TJCOverall

type:
  v: depends-on
display:
  v: Library VTEICU
resource:
  v: http://hl7.org/fhir/uv/cqm/Library/VTEICU|5.0.000
  l: http://hl7.org/fhir/uv/cqm/Library/VTEICU

type:
  v: depends-on
display:
  v: Code system ConditionClinicalStatusCodes
resource:
  v: http://terminology.hl7.org/CodeSystem/condition-clinical
  l: condition-clinical

type:
  v: depends-on
display:
  v: Code system LOINC
resource:
  v: http://loinc.org
  l: loinc.org

type:
  v: depends-on
display:
  v: Value set Encounter Inpatient
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307

type:
  v: depends-on
display:
  v: Value set Obstetrics
resource:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.263
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.263

type:
  v: depends-on
display:
  v: Value set Venous Thromboembolism
resource:
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    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.48
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.48

type:
  v: Procedure
profile:
  v: http://hl7.org/fhir/StructureDefinition/Procedure
  l: Procedure
must support:
  v: code
must support:
  v: status
must support:
  v: performed
must support:
  v: id
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.255
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.255

type:
  v: Procedure
profile:
  v: http://hl7.org/fhir/StructureDefinition/Procedure
  l: Procedure
must support:
  v: code
must support:
  v: status
must support:
  v: performed
must support:
  v: id
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.257
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.257

type:
  v: Procedure
profile:
  v: http://hl7.org/fhir/StructureDefinition/Procedure
  l: Procedure
must support:
  v: code
must support:
  v: status
must support:
  v: performed
must support:
  v: id
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.258
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.258

type:
  v: Procedure
profile:
  v: http://hl7.org/fhir/StructureDefinition/Procedure
  l: Procedure
must support:
  v: code
must support:
  v: status
must support:
  v: performed
must support:
  v: id
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.259
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.259

type:
  v: Procedure
profile:
  v: http://hl7.org/fhir/StructureDefinition/Procedure
  l: Procedure
must support:
  v: code
must support:
  v: status
must support:
  v: performed
must support:
  v: id
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.260
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.260

type:
  v: Procedure
profile:
  v: http://hl7.org/fhir/StructureDefinition/Procedure
  l: Procedure
must support:
  v: code
must support:
  v: status
must support:
  v: performed
must support:
  v: id
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.261
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.261

type:
  v: Procedure
profile:
  v: http://hl7.org/fhir/StructureDefinition/Procedure
  l: Procedure
must support:
  v: code
must support:
  v: status
must support:
  v: performed
must support:
  v: id
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.272
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.272

type:
  v: Procedure
profile:
  v: http://hl7.org/fhir/StructureDefinition/Procedure
  l: Procedure
must support:
  v: code
must support:
  v: status
must support:
  v: performed
must support:
  v: id
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45
    l: http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45

type:
  v: Procedure
profile:
  v: http://hl7.org/fhir/StructureDefinition/Procedure
  l: Procedure
must support:
  v: code
must support:
  v: performed
must support:
  v: status
must support:
  v: id
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1743
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1743

type:
  v: Observation
profile:
  v: http://hl7.org/fhir/StructureDefinition/Observation
  l: Observation
must support:
  v: code
must support:
  v: value
must support:
  v: status
must support:
  v: effective
code filter:
  path:
    v: code
  code: https://loinc.org/rdf/72136-5
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 72136-5
    display:
      v: Risk for venous thromboembolism

type:
  v: Observation
profile:
  v: http://hl7.org/fhir/StructureDefinition/Observation
  l: Observation
must support:
  v: code
must support:
  v: value
must support:
  v: status
must support:
  v: id
must support:
  v: issued
must support:
  v: effective
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.213
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.213

type:
  v: Medication
profile:
  v: http://hl7.org/fhir/StructureDefinition/Medication
  l: Medication
must support:
  v: id
must support:
  v: code

type:
  v: MedicationRequest
profile:
  v: http://hl7.org/fhir/StructureDefinition/MedicationRequest
  l: MedicationRequest
must support:
  v: medication
must support:
  v: doNotPerform
must support:
  v: status
code filter:
  path:
    v: medication
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39

type:
  v: MedicationRequest
profile:
  v: http://hl7.org/fhir/StructureDefinition/MedicationRequest
  l: MedicationRequest
must support:
  v: medication
must support:
  v: doNotPerform
must support:
  v: status
code filter:
  path:
    v: medication
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219

type:
  v: MedicationRequest
profile:
  v: http://hl7.org/fhir/StructureDefinition/MedicationRequest
  l: MedicationRequest
must support:
  v: medication
must support:
  v: doNotPerform
must support:
  v: status
code filter:
  path:
    v: medication
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211

type:
  v: MedicationRequest
profile:
  v: http://hl7.org/fhir/StructureDefinition/MedicationRequest
  l: MedicationRequest
must support:
  v: medication
must support:
  v: doNotPerform
must support:
  v: status
code filter:
  path:
    v: medication
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232

type:
  v: ServiceRequest
profile:
  v: http://hl7.org/fhir/StructureDefinition/ServiceRequest
  l: ServiceRequest
must support:
  v: code
must support:
  v: status
must support:
  v: doNotPerform
must support:
  v: id
must support:
  v: authoredOn
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.230
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.230

type:
  v: ServiceRequest
profile:
  v: http://hl7.org/fhir/StructureDefinition/ServiceRequest
  l: ServiceRequest
must support:
  v: code
must support:
  v: status
must support:
  v: doNotPerform
must support:
  v: id
must support:
  v: authoredOn
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.214
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.214

type:
  v: ServiceRequest
profile:
  v: http://hl7.org/fhir/StructureDefinition/ServiceRequest
  l: ServiceRequest
must support:
  v: code
must support:
  v: status
must support:
  v: doNotPerform
must support:
  v: id
must support:
  v: authoredOn
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.256
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.256

type:
  v: ServiceRequest
profile:
  v: http://hl7.org/fhir/StructureDefinition/ServiceRequest
  l: ServiceRequest
must support:
  v: code
must support:
  v: intent
must support:
  v: status
must support:
  v: doNotPerform
must support:
  v: id
must support:
  v: authoredOn
code filter:
  path:
    v: code
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45
    l: http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45

type:
  v: Coverage
profile:
  v: http://hl7.org/fhir/StructureDefinition/Coverage
  l: Coverage
must support:
  v: type
must support:
  v: period
code filter:
  path:
    v: type
  value set:
    v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
    l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591

type:
  v: Location
profile:
  v: http://hl7.org/fhir/StructureDefinition/Location
  l: Location
must support:
  v: id

url:
  v: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis
  l: cqm-populationBasis
value: Code
  v: Encounter

id:
  v: effective-data-requirements
url:
  v: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements
  l: crmi-effectiveDataRequirements
value: Canonical
  v: #effective-data-requirements
  l: effective-data-requirements

use:
  v: official
system:
  v: http://example.org/fhir/cqi/ecqm/Measure/Identifier/cms
  l: cms
value:
  v: 108

system:
  v: urn:ietf:rfc:3986
  l: 3986
value:
  v: urn:oid:2.16.840.1.113883.4.642.40.61.29.3

v: 8.2.000

v: EXM108

v: EXM108 - Venous Thromboembolism Prophylaxis

v: active

v: true

v: 2025-08-13

v: HL7 International / Clinical Quality Information

telecom:
  system:
    v: url
  value:
    v: http://www.hl7.org/Special/committees/cqi

v: This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission

code:
  system:
    v: http://terminology.hl7.org/CodeSystem/usage-context-type
    l: usage-context-type
  code:
    v: venue
  display:
    v: Clinical Venue
value: CodeableConcept
  coding:
    system:
      v: http://hl7.org/fhir/uv/cqm/CodeSystem/intended-venue-codes
      l: intended-venue-codes
    code:
      v: eh
    display:
      v: EH

coding:
  system:
    v: http://unstats.un.org/unsd/methods/m49/m49.htm
    l: m49.htm
  code:
    v: 001

v: Measure specifications are in the Public Domain. LOINC(R) is a registered trademark of the Regenstrief Institute. This material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2017 International Health Terminology Standards Development Organization. All rights reserved.

v: 2019-03-08

v: 2019-03-08

start:
  v: 2018-01-01
end:
  v: 2018-12-31

coding: https://loinc.org/rdf/57024-2
  system:
    v: http://loinc.org
    l: loinc.org
  code:
    v: 57024-2
  display:
    v: Health Quality Measure Document

v: These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty

coding:
  system:
    v: http://terminology.hl7.org/CodeSystem/measure-scoring
    l: measure-scoring
  code:
    v: proportion
  display:
    v: Proportion

coding:
  system:
    v: http://terminology.hl7.org/CodeSystem/measure-type
    l: measure-type
  code:
    v: process

v: Hospitalized patients at high-risk for VTE may develop an asymptomatic deep vein thrombosis (DVT), and die from pulmonary embolism (PE) even before the diagnosis is suspected. The majority of fatal events occur as sudden or abrupt death, underscoring the importance of prevention as the most critical action step for reducing death from PE (Geerts, et al, 2008). The estimated annual incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE), known collectively as venous thromboembolism (VTE), is approximately 900,000 (Geerts, et al, 2008). Approximately two-thirds of cases of DVT or PE are associated with recent hospitalization. This is consistent with the 2001 report by The Agency for Healthcare Research and Quality (AHRQ). AHRQ indicates that "the appropriate application of effective preventive measures in hospitals has major potential for improving patient safety by reducing the incidence of venous thromboembolism" (Shojania, 2001). Despite its proven effectiveness, rates of appropriate thromboprophylaxis remain low in both medical and surgical patients. A recent analysis from the ENDORSE survey, which evaluated prophylaxis rates in 17,084 major surgery patients, found that more than one third of patients at risk for VTE (38%) did not receive prophylaxis and that rates varied by surgery type (Cohen, et al., 2008). In a review of evidence-based patient safety practices, the Agency for Healthcare Research and Quality defined thromboprophylaxis against VTE as the "number one patient safety practice" for hospitalized patients (Shojania, 2001). Updated "safe practices" published by the National Quality Forum (NQF) recommend routine evaluation of hospitalized patients for risk of VTE and use of appropriate prophylaxis (National Quality Forum. National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism, 2006). As noted by the ACCP, a vast number of randomized clinical trials provide irrefutable evidence that thromboprophylaxis reduces…

v: Failure to recognize and protect patients at risk for venous thromboembolism (VTE) increases the chances for acutely ill hospitalized patients at high risk for developing a deep vein thrombosis or dying from a pulmonary emboli. Screening all patients is the only evidence based practice in reducing incidence of disease. All hospitalized patients should be evaluated for primary VTE prophylaxis, and given appropriate prophylaxis when indicated.

coding:
  system:
    v: http://terminology.hl7.org/CodeSystem/measure-improvement-notation
    l: measure-improvement-notation
  code:
    v: increase
  display:
    v: Increased score indicates improvement

v: When low dose unfractionated heparin is administered for VTE Prophylaxis, the intended administration route for low dose unfractionated heparin is subcutaneous. Reasons for no pharmacological and no mechanical VTE prophylaxis must be explicitly documented by the MD/APN/PA or pharmacist and linked with VTE prophylaxis. Ambulation alone is not a sufficient reason for not administering VTE prophylaxis. In order for ambulation/patient ambulating to be considered as an acceptable reason, there needs to be explicit documentation, e.g., "patient out of bed and ambulating in halls - no VTE prophylaxis needed."

id:
  v: group-1
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.linkId
    l: extension-Measure.group.linkId
  value: String
    v: primary
population:
  extension:
    url:
      v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId
      l: extension-Measure.group.population.linkId
    value: String
      v: primary-exm108-initial-population
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: initial-population
      display:
        v: Initial Population
  description:
    v: Patients age 18 and older discharged from hospital inpatient acute care without a diagnosis of venous thromboembolism (VTE) or obstetrics with a length of stay less than or equal to 120 days that ends during the measurement period
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Initial Population
population:
  extension:
    url:
      v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId
      l: extension-Measure.group.population.linkId
    value: String
      v: primary-exm108-numerator
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: numerator
      display:
        v: Numerator
  description:
    v: Patients who received VTE prophylaxis: - the day of or the day after hospital admission - the day of or the day after surgery end date for surgeries that end the day of or the day after hospital admission Patients who have documentation of a reason why no VTE prophylaxis was given: - between arrival and hospital admission - the day of or the day after hospital admission - the day of or the day after surgery end date (for surgeries that end the day of or the day after hospital admission)
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Numerator
population:
  extension:
    url:
      v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId
      l: extension-Measure.group.population.linkId
    value: String
      v: primary-exm108-denominator
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: denominator
      display:
        v: Denominator
  description:
    v: All patients in the initial population
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Denominator
population:
  extension:
    url:
      v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId
      l: extension-Measure.group.population.linkId
    value: String
      v: primary-exm108-denominator-exclusion
  code:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/measure-population
        l: measure-population
      code:
        v: denominator-exclusion
      display:
        v: Denominator Exclusion
  description:
    v: * Patients who have a length of stay less than 2 days * Patients with comfort measures documented anytime between arrival and the day after hospital admission * Patients with comfort measures documented by the day after surgery end date for surgeries that start the day of or the day after hospital admission * Patients who are direct admits to intensive care unit (ICU), or transferred to ICU the day of or the day after hospital admission with ICU length of stay greater than or equal to one day * Patients with a principal diagnosis of mental disorders or stroke * Patients with a principal procedure of Surgical Care Improvement Project (SCIP) VTE selected surgeries
  criteria:
    language:
      v: text/cql-identifier
    expression:
      v: Denominator Exclusion

extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId
    l: extension-Measure.supplementalData.linkId
  value: String
    v: primary-sde-ethnicity
extension:
  url:
    v: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-includeInReportType
    l: cqm-includeInReportType
  value: Code
    v: summary
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Ethnicity

extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId
    l: extension-Measure.supplementalData.linkId
  value: String
    v: primary-sde-payer
extension:
  url:
    v: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-includeInReportType
    l: cqm-includeInReportType
  value: Code
    v: summary
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Payer

extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId
    l: extension-Measure.supplementalData.linkId
  value: String
    v: primary-sde-race
extension:
  url:
    v: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-includeInReportType
    l: cqm-includeInReportType
  value: Code
    v: summary
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Race

extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId
    l: extension-Measure.supplementalData.linkId
  value: String
    v: primary-sde-sex
extension:
  url:
    v: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-includeInReportType
    l: cqm-includeInReportType
  value: Code
    v: summary
usage:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/measure-data-usage
      l: measure-data-usage
    code:
      v: supplemental-data
criteria:
  language:
    v: text/cql-identifier
  expression:
    v: SDE Sex