WHO Antenatal Care Guideline Implementation Guide, published by World Health Organization (WHO). This guide is not an authorized publication; it is the continuous build for version 0.3.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/WorldHealthOrganization/smart-anc/ and changes regularly. See the Directory of published versions

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: ANC.IND.09 Percentage of pregnant women whose baby’s heartbeat was listened to at least once during ANC - XML Representation

Draft as of 2023-03-13

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<Measure xmlns="http://hl7.org/fhir">
  <id value="ANCIND09"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
    <table class="grid dict">
        
        <tr>
            <th scope="row"><b>Id: </b></th>
            <td style="padding-left: 4px;">ANCIND09</td>
        </tr>
        
        
        <tr>
            <th scope="row"><b>Url: </b></th>
            <td style="padding-left: 4px;"><a href="Measure-ANCIND09.html">ANC.IND.09 Percentage of pregnant women whose baby’s heartbeat was listened to at least once during ANC</a></td>
        </tr>
        
        
        <tr>
            <th scope="row"><b>Version: </b></th>
            <td style="padding-left: 4px;">0.3.0</td>
        </tr>
        
        
        
        <tr>
            <th scope="row"><b>Name: </b></th>
            <td style="padding-left: 4px;">ANCIND09</td>
        </tr>
        
        
        <tr>
            <th scope="row"><b>Title: </b></th>
            <td style="padding-left: 4px;">ANC.IND.09 Percentage of pregnant women whose baby’s heartbeat was listened to at least once during ANC</td>
        </tr>
        
        
        
        <tr>
            <th scope="row"><b>Status: </b></th>
            <td style="padding-left: 4px;">draft</td>
        </tr>
        
        
        <tr>
            <th scope="row"><b>Experimental: </b></th>
            <td style="padding-left: 4px;">false</td>
        </tr>
        
        
        <tr>
            <th scope="row"><b>Scoring: </b></th>
            <td style="padding-left: 4px;">
                
                    
                        
                        <p style="margin-bottom: 5px;">
                            <b>system: </b> <span><a href="http://hl7.org/fhir/R4/codesystem-measure-scoring.html">http://terminology.hl7.org/CodeSystem/measure-scoring</a></span>
                        </p>
                        
                        
                        <p style="margin-bottom: 5px;">
                            <b>code: </b> <span>proportion</span>
                        </p>
                        
                        
                    
                
                
            </td>
        </tr>
        
        
        <tr>
            <th scope="row"><b>Improvement Notation: </b></th>
            <td style="padding-left: 4px;">
                
                    
                        
                        <p style="margin-bottom: 5px;">
                            <b>system: </b> <span><a href="http://hl7.org/fhir/R4/codesystem-measure-improvement-notation.html">http://terminology.hl7.org/CodeSystem/measure-improvement-notation</a></span>
                        </p>
                        
                        
                        <p style="margin-bottom: 5px;">
                            <b>code: </b> <span>increase</span>
                        </p>
                        
                        
                    
                
                
            </td>
        </tr>
        
        
        <tr>
            <th scope="row"><b>Type: </b></th>
            <td style="padding-left: 4px;">
                
                    
                        
                        <p style="margin-bottom: 5px;">
                            <b>system: </b> <span><a href="http://hl7.org/fhir/R4/codesystem-measure-type.html">http://terminology.hl7.org/CodeSystem/measure-type</a></span>
                        </p>
                        
                        
                        <p style="margin-bottom: 5px;">
                            <b>code: </b> <span>process</span>
                        </p>
                        
                        
                    
                
                
            </td>
        </tr>
        
        
        
        <tr>
            <th scope="row"><b>Date: </b></th>
            <td style="padding-left: 4px;">2023-03-13 22:32:10-0600</td>
        </tr>
        
        
        <tr>
            <th scope="row"><b>Publisher: </b></th>
            <td style="padding-left: 4px;">World Health Organization (WHO)</td>
        </tr>
        
        
        <tr>
            <th scope="row"><b>Description: </b></th>
            <td style="padding-left: 4px;">Percentage of pregnant women whose baby’s heartbeat was listened to at least once during ANC</td>
        </tr>
        
        
        
        
        
        
        
        
        
        <tr>
            <th scope="row"><b>Jurisdiction: </b></th>
            <td style="padding-left: 25px;">001</td>
        </tr>
        
        
        
        
        
        
        
        
        
        
        
        
        

        
        <tr>
          <th scope="row"><b>Libraries: </b></th>
          <td style="padding-left: 4px;">
            <table class="grid-dict">
              
                <tr><td><a href="Library-ANCIND09.html">ANC.IND.09 Percentage of pregnant women whose baby’s heartbeat was listened to at least once during ANC</a></td></tr>
              
            </table>
          </td>
        </tr>
        

        
    </table>
</div>
  </text>
  <contained>
    <Library>
      <id value="effective-data-requirements"/>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system
                  value="http://ohie.org/CodeSystem/iso-8601-derived-periods"/>
          <code value="P10Y--P14Y"/>
          <display value="10-14 years"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system
                  value="http://ohie.org/CodeSystem/iso-8601-derived-periods"/>
          <code value="P15Y--P19Y"/>
          <display value="15-19 years"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system
                  value="http://ohie.org/CodeSystem/iso-8601-derived-periods"/>
          <code value="P20Y--P9999Y"/>
          <display value="20+ years"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ANCDataElements"/>
        </extension>
        <extension url="name">
          <valueString value="Fetal heartbeat present"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
  @dataElement: ANC.B8.DE106 Fetal heartbeat present
  @activity: ANC.B8. Conduct physical exam
  @description: Whether or not the health worker observes a fetal heartbeat
*/
define &quot;Fetal heartbeat present&quot;:
  [Observation: Cx.&quot;Fetal heartbeat present&quot;] O
    where O.status in { 'final', 'amended', 'corrected' }
      and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="0"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ANCBaseDataElements"/>
        </extension>
        <extension url="name">
          <valueString value="Antenatal care case"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
define &quot;Pregnant&quot;:
  &quot;Pregnancy&quot; is not null
    or &quot;Pregnancy status&quot; in BCx.&quot;Pregnancy status - pregnant&quot;

define &quot;Pregnancy status&quot;:
  FHIRHelpers.ToConcept(
    Last(
      [Observation: BCx.&quot;Pregnancy status&quot;] O
        where O.status = 'final'
        sort by FHIRHelpers.ToDateTime(effective as FHIR.dateTime)
    ).value
  )
*/
define &quot;Antenatal care case&quot;:
  [&quot;EpisodeOfCare&quot;: type in BCx.&quot;Antenatal care case&quot;]"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="1"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ANCBaseDataElements"/>
        </extension>
        <extension url="name">
          <valueString value="Pregnancy"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
@description: Most recent antenatal care case
*/
define &quot;Pregnancy&quot;:
  First(
    &quot;Antenatal care case&quot; E
		  sort by start of period descending
	)"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="2"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ANCIND09"/>
        </extension>
        <extension url="name">
          <valueString value="Numerator"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
Numerator: Number of pregnant women whose baby’s heartbeat was listened to  
Numerator Computation: COUNT of all women who had their baby’s heartbeat listened to at least once during pregnancy 
*/
define Numerator:
  exists (
    PatientData.&quot;Fetal heartbeat present&quot; O
      where O.issued during BaseData.&quot;Pregnancy&quot;.period
  )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="3"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ANCStratifiers"/>
        </extension>
        <extension url="name">
          <valueString value="By Age"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
By Patient Age as of the start of the Measurement Period
Age (10-14, 15-19, 20+)
*/
define &quot;By Age&quot;:
  case
    when AgeInYearsAt(start of &quot;Measurement Period&quot;) in Interval[10, 14] then &quot;P10Y--P14Y&quot;
    when AgeInYearsAt(start of &quot;Measurement Period&quot;) in Interval[15, 19] then &quot;P15Y--P19Y&quot;
    when AgeInYearsAt(start of &quot;Measurement Period&quot;) &gt;= 20 then &quot;P20Y--P9999Y&quot;
    else null
  end"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="4"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ANCIND09"/>
        </extension>
        <extension url="name">
          <valueString value="Age Stratifier"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
Disaggregation: Age (10-14, 15-19, 20+)
*/
define &quot;Age Stratifier&quot;:
  Stratifiers.&quot;By Age&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="5"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ANCDataElements"/>
        </extension>
        <extension url="name">
          <valueString value="Reason for closing ANC record"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
  @dataElement: ANC.End.1 Reason for closing ANC record
  @activity: ANC.End End
  @description: Select the reason why you are closing the woman's ANC record
*/
define &quot;Reason for closing ANC record&quot;:
  [Observation: Cx.&quot;Reason for closing ANC record&quot;] O
    where O.status in { 'final', 'amended', 'corrected' }
      and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="6"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ANCIND09"/>
        </extension>
        <extension url="name">
          <valueString value="Denominator"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
Denominator: Total number of antenatal clients with a first contact
Denominator Computation: COUNT of all women whose records were closed (ANC close form) in the last reporting period due to any of the reasons below:
*live birth
*stillbirth
*miscarriage
*abortion
*woman died
*lost to follow-up
*moved away
*/
define Denominator:
  exists (
    PatientData.&quot;Reason for closing ANC record&quot; R
      where FC.ToInterval(R.effective) during &quot;Measurement Period&quot;
        and R.value as FHIR.CodeableConcept in Stratifiers.&quot;Qualifying Reason for closing ANC record Choices&quot;
  )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="7"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ANCStratifiers"/>
        </extension>
        <extension url="name">
          <valueString value="By Education Level"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
By Patient Education Level (none, don't know, primary, secondary, higher)
*/
define &quot;By Education Level&quot;:
  Patient.extension E
    where E.url = 'http://fhir.org/guides/who/anc-cds/StructureDefinition/educationlevel'
    return E.value as CodeableConcept"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="8"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ANCIND09"/>
        </extension>
        <extension url="name">
          <valueString value="Education Level Stratifier"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
Disaggregation: Education Level (none, don't know, primary, secondary, higher)
*/
define &quot;Education Level Stratifier&quot;:
  Stratifiers.&quot;By Education Level&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="9"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="ANCIND09"/>
        </extension>
        <extension url="name">
          <valueString value="Initial Population"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
Initial population: Antenatal clients
*/
define &quot;Initial Population&quot;:
  exists (BaseData.&quot;Antenatal care case&quot;)"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="10"/>
        </extension>
      </extension>
      <status value="active"/>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/library-type"/>
          <code value="module-definition"/>
        </coding>
      </type>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library PatientData"/>
        <resource
                  value="http://fhir.org/guides/who/anc-cds/Library/ANCDataElements"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library Cx"/>
        <resource
                  value="http://fhir.org/guides/who/anc-cds/Library/ANCConcepts"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library FHIRHelpers"/>
        <resource
                  value="http://fhir.org/guides/who/anc-cds/Library/FHIRHelpers|4.0.1"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library WC"/>
        <resource
                  value="http://fhir.org/guides/who/anc-cds/Library/WHOCommon"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library BaseData"/>
        <resource
                  value="http://fhir.org/guides/who/anc-cds/Library/ANCBaseDataElements"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library BCx"/>
        <resource
                  value="http://fhir.org/guides/who/anc-cds/Library/ANCBaseConcepts"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library Stratifiers"/>
        <resource
                  value="http://fhir.org/guides/who/anc-cds/Library/ANCStratifiers"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library FC"/>
        <resource
                  value="http://fhir.org/guides/who/anc-cds/Library/FHIRCommon"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Code system ISO-8601-Derived Periods"/>
        <resource
                  value="http://ohie.org/CodeSystem/iso-8601-derived-periods"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Fetal heartbeat present"/>
        <resource
                  value="http://fhir.org/guides/who/anc-cds/ValueSet/anc-b8-de106"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Antenatal care case"/>
        <resource
                  value="http://fhir.org/guides/who/anc-cds/ValueSet/antenatal-care-case"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Reason for closing ANC record"/>
        <resource
                  value="http://fhir.org/guides/who/anc-cds/ValueSet/anc-end-1"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Qualifying Reason for closing ANC record Choices"/>
        <resource
                  value="http://fhir.org/guides/who/anc-cds/ValueSet/qualifying-reason-for-closing-anc-record-choices"/>
      </relatedArtifact>
      <parameter>
        <name value="Measurement Period"/>
        <use value="in"/>
        <min value="0"/>
        <max value="1"/>
        <type value="Period"/>
      </parameter>
      <parameter>
        <name value="Numerator"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <parameter>
        <name value="Age Stratifier"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="Coding"/>
      </parameter>
      <parameter>
        <name value="Denominator"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <parameter>
        <name value="Education Level Stratifier"/>
        <use value="out"/>
        <min value="0"/>
        <max value="*"/>
        <type value="CodeableConcept"/>
      </parameter>
      <parameter>
        <name value="Initial Population"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <dataRequirement>
        <type value="Observation"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
        <mustSupport value="code"/>
        <mustSupport value="status"/>
        <mustSupport value="issued"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://fhir.org/guides/who/anc-cds/ValueSet/anc-b8-de106"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Observation"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
        <mustSupport value="code"/>
        <mustSupport value="status"/>
        <mustSupport value="effective"/>
        <mustSupport value="value"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://fhir.org/guides/who/anc-cds/ValueSet/anc-end-1"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="EpisodeOfCare"/>
        <profile
                 value="http://hl7.org/fhir/StructureDefinition/EpisodeOfCare"/>
        <mustSupport value="type"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://fhir.org/guides/who/anc-cds/ValueSet/antenatal-care-case"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Patient"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/Patient"/>
        <mustSupport value="url"/>
        <mustSupport value="value"/>
      </dataRequirement>
    </Library>
  </contained>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem">
    <valueReference>🔗 
      <reference value="Device/cqf-tooling"/>
    </valueReference>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem">
    <valueReference>🔗 
      <reference value="Device/cqf-tooling"/>
    </valueReference>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements" id="effective-data-requirements">
    <valueReference>
      <reference value="#effective-data-requirements"/>
    </valueReference>
  </extension>
  <url value="http://fhir.org/guides/who/anc-cds/Measure/ANCIND09"/>
  <version value="0.3.0"/>
  <name value="ANCIND09"/>
  <title
         value="ANC.IND.09 Percentage of pregnant women whose baby’s heartbeat was listened to at least once during ANC"/>
  <status value="draft"/>
  <experimental value="false"/>
  <date value="2023-03-13T22:32:10-06:00"/>
  <publisher value="World Health Organization (WHO)"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="https://www.who.int"/>
    </telecom>
  </contact>
  <description
               value="Percentage of pregnant women whose baby’s heartbeat was listened to at least once during ANC"/>
  <jurisdiction>
    <coding>
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
    </coding>
  </jurisdiction>
  <library value="http://fhir.org/guides/who/anc-cds/Library/ANCIND09"/>
  <scoring>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
      <code value="proportion"/>
    </coding>
  </scoring>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
      <code value="process"/>
    </coding>
  </type>
  <improvementNotation>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
      <code value="increase"/>
    </coding>
  </improvementNotation>
  <group id="group-1">
    <population id="initial-population">
      <code>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="initial-population"/>
        </coding>
      </code>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Initial Population"/>
      </criteria>
    </population>
    <population id="denominator">
      <code>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="denominator"/>
        </coding>
      </code>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Denominator"/>
      </criteria>
    </population>
    <population id="numerator">
      <code>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="numerator"/>
        </coding>
      </code>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Numerator"/>
      </criteria>
    </population>
    <stratifier id="by-age">
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Age Stratifier"/>
      </criteria>
    </stratifier>
    <stratifier id="by-education-level">
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Education Level Stratifier"/>
      </criteria>
    </stratifier>
  </group>
</Measure>