# Colorectal Cancer ScreeningFHIR - CMS Draft FHIR Measures v2024.1.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **Colorectal Cancer ScreeningFHIR**

## Measure: Colorectal Cancer ScreeningFHIR 

| | | |
| :--- | :--- | :--- |
| *Official URL*:https://madie.cms.gov/Measure/ColonCancerScreeningFHIR | *Version*:0.1.000 | |
| Draft as of 2026-03-13 | *Responsible:*[National Committee for Quality Assurance](https://www.ncqa.org/) | *Computable Name*:ColonCancerScreeningFHIR |
| *Other Identifiers:*Short Name (use: usual, ), UUID:627c6e27-5c46-4412-941a-ca387492bbaa (use: official, ), UUID:3ff5ff28-e118-4433-8467-15d0a585b45d (use: official, ), Publisher (use: official, ) | | |
| **Copyright/Legal**: This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2024 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications. CPT(R) codes, descriptions and other data are copyright 2024. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use. Some measure specifications contain coding from LOINC(R) (http://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved. Some measures use RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the measures and does not endorse or recommend this or any other product. “HL7” is the registered trademark of Health Level Seven International. | | |

 
Percentage of adults 45-75 years of age who had appropriate screening for colorectal cancer 

 
UNKNOWN 

* Metadata: Title
  * ?: Colorectal Cancer ScreeningFHIR
* Metadata: Version
  * ?: 0.1.000
* Metadata: Short Name
  * ?: CMS130FHIR
* Metadata: GUID (Version Independent)
  * ?: urn:uuid:627c6e27-5c46-4412-941a-ca387492bbaa
* Metadata: GUID (Version Specific)
  * ?: urn:uuid:3ff5ff28-e118-4433-8467-15d0a585b45d
* Metadata: CMS Identifier
  * ?: 130FHIR
* Metadata: Effective Period
  * ?: 2025-01-01 through 2025-12-31
* Metadata: Status
  * ?: Draft
* Metadata: Steward (Publisher)
  * ?: National Committee for Quality Assurance
* Metadata: Developer
  * ?: National Committee for Quality Assurance
* Metadata: Description
  * ?: Percentage of adults 45-75 years of age who had appropriate screening for colorectal cancer
* Metadata: Copyright
  * ?: This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2024 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications. CPT(R) codes, descriptions and other data are copyright 2024. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use. Some measure specifications contain coding from LOINC(R) (http://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved. Some measures use RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the measures and does not endorse or recommend this or any other product. “HL7” is the registered trademark of Health Level Seven International.
* Metadata: Disclaimer
  * ?: The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
* Metadata: Measure Scoring
  * ?: Proportion
* Metadata: Rationale
  * ?: Colorectal cancer represents eight percent of all new cancer cases in the United States. In 2020, there were an estimated 147,950 new cases of colorectal cancer and an estimated 53,200 deaths attributed to it. According to the National Cancer Institute, about 4.2 percent of men and women will be diagnosed with colorectal cancer at some point during their lifetimes. For most adults, older age is the most important risk factor for colorectal cancer, although being male and black are also associated with higher incidence and mortality. Colorectal cancer is most frequently diagnosed among people 65 to 74 years old (Howlader et al., 2020). Screening can be effective for finding precancerous lesions (polyps) that could later become malignant, and for detecting early cancers that can be more easily and effectively treated. Precancerous polyps usually take about 10 to 15 years to develop into colorectal cancer, and most can be found and removed before turning into cancer. The five-year relative survival rate for people whose colorectal cancer is found in the early stage before it has spread is about 90 percent (SEER, 2022).
* Metadata: Clinical Recommendation Statement
  * ?: The U.S. Preventive Services Task Force (2021) recommends screening for colorectal cancer in adults aged 45 to 49 years. This is a Grade B recommendation (U.S. Preventive Services Task Force, 2021). The U.S. Preventive Services Task Force (2021) recommends screening for colorectal cancer in adults aged 50 to 75 years. This is a Grade A recommendation (U.S. Preventive Services Task Force, 2021). Appropriate screenings are defined by any one of the following: - Fecal occult blood test (annually) - Stool DNA (sDNA) with FIT test (every 3 years) - Flexible sigmoidoscopy (every 5 years) - Computed tomographic (CT) colonography (every 5 years) - Colonoscopy (every 10 years)
* Metadata: Guidance (Usage)
  * ?: Do not count digital rectal exams (DRE), fecal occult blood tests (FOBTs) performed in an office setting or performed on a sample collected via DRE. Please note the measure may include screenings performed outside the age range of patients referenced in the initial population. Screenings that occur prior to the measurement period are valid to meet measure criteria. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS130v13. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).
* Metadata: Measure Group (Rate) (ID: 654a405f78418140875e351c)
* Metadata: Basis
  * ?: boolean
* Metadata: Scoring
  * ?: Proportion
* Metadata: Improvement Notation
  * ?: increase
* Metadata: Type
  * ?: Process
* Metadata: Rate Aggregation
  * ?: None
* Metadata: Initial Population
  * ?: **ID**: 7423DF07-8C1A-4B0C-89EA-64932F943566**Description**:Patients 46-75 years of age by the end of the measurement period with a visit during the measurement period**Criteria**:[Initial Population](#654a405f78418140875e351c-7423DF07-8C1A-4B0C-89EA-64932F943566)
* Metadata: Denominator
  * ?: **ID**: EB843F58-5BA6-4B74-BA7D-2D313E9C1F94**Description**:Equals Initial Population**Criteria**:[Denominator](#654a405f78418140875e351c-EB843F58-5BA6-4B74-BA7D-2D313E9C1F94)
* Metadata: Denominator Exclusion
  * ?: **ID**: 4a91dd44-46af-44ee-bcee-2bdc0e811188**Description**:Exclude patients who are in hospice care for any part of the measurement period. Exclude patients with a diagnosis or past history of total colectomy or colorectal cancer. Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness diagnosis during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients receiving palliative care for any part of the measurement period.**Criteria**:[Denominator Exclusion](#654a405f78418140875e351c-4a91dd44-46af-44ee-bcee-2bdc0e811188)
* Metadata: Numerator
  * ?: **ID**: AA394954-274E-4BAD-99FA-5B188C962903**Description**:Patients with one or more screenings for colorectal cancer. Appropriate screenings are defined by any one of the following criteria: - Fecal occult blood test (FOBT) during the measurement period - Stool DNA (sDNA) with FIT test during the measurement period or the two years prior to the measurement period - Flexible sigmoidoscopy during the measurement period or the four years prior to the measurement period - CT Colonography during the measurement period or the four years prior to the measurement period - Colonoscopy during the measurement period or the nine years prior to the measurement period**Criteria**:[Numerator](#654a405f78418140875e351c-AA394954-274E-4BAD-99FA-5B188C962903)
* Metadata: Stratifier
  * ?: **ID**: 736a0ff4-9544-4c88-88dd-76274cc3d540**Description**: Patients age 46-49 by the end of the measurement period
* Metadata: Stratifier
  * ?: **ID**: 426f0691-b064-459c-9661-88dadc8d3f7b**Description**: Patients age 50-75 by the end of the measurement period
* Metadata: Measure Logic
* Metadata: Primary Library
  * ?: [Colon Cancer Screening FHIR](Library-ColonCancerScreeningFHIR.md)
* Metadata: Contents
  * ?: **[Population Criteria](#population-criteria)****[Logic Definitions](#definitions)****[Terminology](#terminology)****[Dependencies](#dependencies)****[Data Requirements](#data-requirements)****[Parameters](#parameters)**
* Metadata:  Population Criteria
* Metadata: Measure Group (Rate) (ID: 654a405f78418140875e351c)
* Metadata: Initial Population
* Metadata:  ````define "Initial Population": AgeInYearsAt(date from end of "Measurement Period" ) in Interval[46, 75] and exists AdultOutpatientEncounters."Qualifying Encounters"````[**Definition**](#coloncancerscreeningfhir-initial-population)
* Metadata: Denominator
* Metadata:  ````define "Denominator": "Initial Population"````[**Definition**](#coloncancerscreeningfhir-denominator)
* Metadata: Denominator Exclusion
* Metadata:  ````define "Denominator Exclusion": Hospice."Has Hospice Services" or exists "Malignant Neoplasm" or exists "Total Colectomy Performed" or AIFrailLTCF."Is Age 66 or Older with Advanced Illness and Frailty" or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home" or PalliativeCare."Has Palliative Care in the Measurement Period"````[**Definition**](#coloncancerscreeningfhir-denominator-exclusion)
* Metadata: Numerator
* Metadata:  ````define "Numerator": exists "Fecal Occult Blood Test Performed" or exists "Stool DNA with FIT Test Performed" or exists "Flexible Sigmoidoscopy Performed" or exists "CT Colonography Performed" or exists "Colonoscopy Performed"````[**Definition**](#coloncancerscreeningfhir-numerator)
* Metadata: Stratifier
* Metadata: ````define "Stratification 1": AgeInYearsAt(date from end of "Measurement Period" ) in Interval[46, 49]````[**Definition**](#coloncancerscreeningfhir-stratification-1)
* Metadata: Stratifier
* Metadata: ````define "Stratification 2": AgeInYearsAt(date from end of "Measurement Period" ) in Interval[50, 75]````[**Definition**](#coloncancerscreeningfhir-stratification-2)
* Metadata:  Logic Definitions
* Metadata: Logic Definition
  * ?: **Library Name:**AdultOutpatientEncounters
* Metadata:  ````define "Qualifying Encounters": ( ( [Encounter: "Office Visit"] union [Encounter: "Annual Wellness Visit"] union [Encounter: "Preventive Care Services Established Office Visit, 18 and Up"] union [Encounter: "Preventive Care Services Initial Office Visit, 18 and Up"] union [Encounter: "Home Healthcare Services"] union [Encounter: "Virtual Encounter"] union [Encounter: "Telephone Visits"] ).isEncounterPerformed() ) ValidEncounter where ValidEncounter.period.toInterval() during day of "Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**Hospice
* Metadata:  ````define "Has Hospice Services": exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)" or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)" ) and InpatientEncounter.period.toInterval() ends during day of "Measurement Period" ) or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period" ) or exists ((([Observation: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment where HospiceAssessment.value ~ "Yes (qualifier value)" and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period" ) or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period" // and HospiceOrder.doNotPerform is not true // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447 ) or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period" ) or exists (([Condition: "Hospice Diagnosis"]) HospiceCareDiagnosis where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" )````
* Metadata: Logic Definition
  * ?: **Library Name:**AdvancedIllnessandFrailty
* Metadata:  ````define "Has Criteria Indicating Frailty": exists ( (([DeviceRequest: "Frailty Device"]).isDeviceOrder()) FrailtyDeviceOrder where FrailtyDeviceOrder.doNotPerform() is not true and FrailtyDeviceOrder.authoredOn.toInterval() during day of "Measurement Period" ) or exists ( (([Observation: "Medical equipment used"]).isAssessmentPerformed()) EquipmentUsed where EquipmentUsed.value as Concept in "Frailty Device" and EquipmentUsed.effective.toInterval() ends during day of "Measurement Period" ) or exists ( ([Condition: "Frailty Diagnosis"]) FrailtyDiagnosis where FrailtyDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" ) or exists ( (([Encounter: "Frailty Encounter"]).isEncounterPerformed()) FrailtyEncounter where FrailtyEncounter.period.toInterval() overlaps day of "Measurement Period" ) or exists ( (([Observation: "Frailty Symptom"]).isSymptom()) FrailtySymptom where FrailtySymptom.effective.toInterval() overlaps day of "Measurement Period" )````
* Metadata: Logic Definition
  * ?: **Library Name:**AdvancedIllnessandFrailty
* Metadata:  ````define "Has Advanced Illness in Year Before or During Measurement Period": exists ([Condition: "Advanced Illness"] AdvancedIllnessDiagnosis where AdvancedIllnessDiagnosis.prevalenceInterval() starts during day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"])````
* Metadata: Logic Definition
  * ?: **Library Name:**AdvancedIllnessandFrailty
* Metadata:  ````define "Has Dementia Medications in Year Before or During Measurement Period": exists (( ([MedicationRequest: medication in "Dementia Medications"]).isMedicationActive()) DementiaMedication // https://oncprojectracking.healthit.gov/support/browse/CQLIT-449 where DementiaMedication.medicationRequestPeriod() overlaps day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"] // and DementiaMedication.doNotPerform is not true // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447 )````
* Metadata: Logic Definition
  * ?: **Library Name:**AdvancedIllnessandFrailty
* Metadata:  ````define "Is Age 66 or Older with Advanced Illness and Frailty": AgeInYearsAt(date from end of "Measurement Period")>= 66 and "Has Criteria Indicating Frailty" and ( "Has Advanced Illness in Year Before or During Measurement Period" or "Has Dementia Medications in Year Before or During Measurement Period" )````
* Metadata: Logic Definition
  * ?: **Library Name:**AdvancedIllnessandFrailty
* Metadata:  ````define "Is Age 66 or Older Living Long Term in a Nursing Home": AgeInYearsAt(date from end of "Measurement Period" )>= 66 and ( ( Last( (([Observation: "Housing status"]).isAssessmentPerformed()) HousingStatus where HousingStatus.effective.toInterval() ends on or before day of end of "Measurement Period" sort by end of effective.toInterval() asc )) LastHousingStatus where LastHousingStatus.value ~ "Lives in a nursing home (finding)" ) is not null````
* Metadata: Logic Definition
  * ?: **Library Name:**PalliativeCare
* Metadata:  ````define "Has Palliative Care in the Measurement Period": exists ((([Observation: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period" ) or exists ([Condition: "Palliative Care Diagnosis"] PalliativeDiagnosis where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" ) or exists ((([Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter where PalliativeEncounter.period.toInterval() overlaps day of "Measurement Period" ) or exists ((([Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement Period" )````
* Metadata: Logic Definition
  * ?: **Library Name:**ColonCancerScreeningFHIR
* Metadata:  ````define "Fecal Occult Blood Test Performed": ( ( [Observation: "Fecal Occult Blood Test (FOBT)"] ).isLaboratoryTestPerformed ( ) ) FecalOccultResult where FecalOccultResult.value is not null and FecalOccultResult.effective.latest ( ) during day of "Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**ColonCancerScreeningFHIR
* Metadata:  ````define "Stool DNA with FIT Test Performed": ( ( [Observation: "sDNA FIT Test"] ).isLaboratoryTestPerformed ( ) ) sDNATest where sDNATest.value is not null and sDNATest.effective.latest ( ) during day of Interval[start of "Measurement Period" - 2 years, end of "Measurement Period"]````
* Metadata: Logic Definition
  * ?: **Library Name:**ColonCancerScreeningFHIR
* Metadata:  ````define "Flexible Sigmoidoscopy Performed": ( ( [Procedure: "Flexible Sigmoidoscopy"] ).isProcedurePerformed ( ) ) FlexibleSigmoidoscopy where FlexibleSigmoidoscopy.performed.toInterval ( ) ends during day of Interval[start of "Measurement Period" - 4 years, end of "Measurement Period"]````
* Metadata: Logic Definition
  * ?: **Library Name:**ColonCancerScreeningFHIR
* Metadata:  ````define "CT Colonography Performed": ( ( [Observation: "CT Colonography"] ).isDiagnosticStudyPerformed ( ) ) Colonography where Colonography.effective.toInterval ( ) ends during day of Interval[start of "Measurement Period" - 4 years, end of "Measurement Period"]````
* Metadata: Logic Definition
  * ?: **Library Name:**ColonCancerScreeningFHIR
* Metadata:  ````define "Colonoscopy Performed": ( ( [Procedure: "Colonoscopy"] ).isProcedurePerformed ( ) ) Colonoscopy where Colonoscopy.performed.toInterval ( ) ends during day of Interval[start of "Measurement Period" - 9 years, end of "Measurement Period"]````
* Metadata: Logic Definition
  * ?: **Library Name:**ColonCancerScreeningFHIR
* Metadata:  ````define "Numerator": exists "Fecal Occult Blood Test Performed" or exists "Stool DNA with FIT Test Performed" or exists "Flexible Sigmoidoscopy Performed" or exists "CT Colonography Performed" or exists "Colonoscopy Performed"````
* Metadata: Logic Definition
  * ?: **Library Name:**ColonCancerScreeningFHIR
* Metadata:  ````define "Stratification 2": AgeInYearsAt(date from end of "Measurement Period" ) in Interval[50, 75]````
* Metadata: Logic Definition
  * ?: **Library Name:**ColonCancerScreeningFHIR
* Metadata:  ````define "Stratification 1": AgeInYearsAt(date from end of "Measurement Period" ) in Interval[46, 49]````
* Metadata: Logic Definition
  * ?: **Library Name:**ColonCancerScreeningFHIR
* Metadata:  ````define "Initial Population": AgeInYearsAt(date from end of "Measurement Period" ) in Interval[46, 75] and exists AdultOutpatientEncounters."Qualifying Encounters"````
* Metadata: Logic Definition
  * ?: **Library Name:**ColonCancerScreeningFHIR
* Metadata:  ````define "Denominator": "Initial Population"````
* Metadata: Logic Definition
  * ?: **Library Name:**ColonCancerScreeningFHIR
* Metadata:  ````define "Malignant Neoplasm": ( [Condition: "Malignant Neoplasm of Colon"] ) ColorectalCancer where ColorectalCancer.prevalenceInterval ( ) starts on or before day of end of "Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**ColonCancerScreeningFHIR
* Metadata:  ````define "Total Colectomy Performed": ( ( [Procedure: "Total Colectomy"] ).isProcedurePerformed ( ) ) Colectomy where Colectomy.performed.toInterval ( ) ends on or before day of end of "Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**ColonCancerScreeningFHIR
* Metadata:  ````define "Denominator Exclusion": Hospice."Has Hospice Services" or exists "Malignant Neoplasm" or exists "Total Colectomy Performed" or AIFrailLTCF."Is Age 66 or Older with Advanced Illness and Frailty" or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home" or PalliativeCare."Has Palliative Care in the Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @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 }````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @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 }````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @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]````
* Metadata: Logic Definition
  * ?: **Library Name:**QICoreCommon
* Metadata:  ````/* @description: Given an interval, returns the ending point if the interval has an ending boundary specified, otherwise, returns the starting point */ define fluent function latest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ): (choice.toInterval()) period return if (period."hasEnd"()) then end of period else start of period````
* Metadata: Logic Definition
  * ?: **Library Name:**QICoreCommon
* Metadata:  ````/* @description: Given an interval, returns true if the interval has an ending boundary specified (i.e. the end of the interval is not null and not the maximum DateTime value) */ define fluent function hasEnd(period Interval<DateTime> ): not ( end of period is null or end of period = maximum DateTime )````
* Metadata: Logic Definition
  * ?: **Library Name:**QICoreCommon
* Metadata:  ````/* @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval @comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible representations for timing-valued elements in QICore, allowing this function to be used across any resource. The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>. The intent of this function is to provide a clear and concise mechanism to treat single elements that have multiple possible representations as intervals so that logic doesn't have to account for the variability. More complex calculations (such as medication request period or dispense period calculation) need specific guidance and consideration. That guidance may make use of this function, but the focus of this function is on single element calculations where the semantics are unambiguous. If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime. If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age, and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later. If the input is a DateTime Interval, the result is the input. If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending immediately before one year later than the date the patient turned the age given as the end of the quantity interval. If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval */ define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>): case when choice is DateTime then Interval[choice as DateTime, choice as DateTime] when choice is Interval<DateTime> then choice as Interval<DateTime> when choice is Quantity then Interval[Patient.birthDate + (choice as Quantity), Patient.birthDate + (choice as Quantity) + 1 year) when choice is Interval<Quantity> then Interval[Patient.birthDate + (choice.low as Quantity), Patient.birthDate + (choice.high as Quantity) + 1 year) when choice is Timing then Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime> else null as Interval<DateTime> end````
* Metadata: Logic Definition
  * ?: **Library Name:**QICoreCommon
* Metadata:  ````/* @description: Returns an interval representing the normalized prevalence period of a given Condition. @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary. */ define fluent function prevalenceInterval(condition Condition): if condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" then Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()] else (end of condition.abatementInterval()) abatementDate return if abatementDate is null then Interval[start of condition.onset.toInterval(), abatementDate) else Interval[start of condition.onset.toInterval(), abatementDate]````
* Metadata: Logic Definition
  * ?: **Library Name:**QICoreCommon
* Metadata:  ````/* @description: Returns an interval representing the normalized abatement of a given Condition. @comment: If the abatement element of the Condition is represented as a DateTime, the result is an interval beginning and ending on that DateTime. If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The result is an interval from the date the patient turned that age to immediately before one year later. If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately before one year later than the date the patient turned the ending age of the quantity interval. */ define fluent function abatementInterval(condition Condition): if condition.abatement is DateTime then Interval[condition.abatement as DateTime, condition.abatement as DateTime] else if condition.abatement is Quantity then Interval[Patient.birthDate + (condition.abatement as Quantity), Patient.birthDate + (condition.abatement as Quantity) + 1 year) else if condition.abatement is Interval<Quantity> then Interval[Patient.birthDate + (condition.abatement.low as Quantity), Patient.birthDate + (condition.abatement.high as Quantity) + 1 year) else if condition.abatement is Interval<DateTime> then Interval[condition.abatement.low, condition.abatement.high) else null as Interval<DateTime>````
* Metadata: Logic Definition
  * ?: **Library Name:**QICoreCommon
* Metadata:  ````/* @description: Returns true if the given DeviceRequest is a negation (i.e. do not perform this order) */ define fluent function doNotPerform(deviceRequest DeviceRequest): singleton from ( deviceRequest.modifierExtension E where E.url = 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-doNotPerform' return E.value as Boolean )````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Laboratory Test, Performed define fluent function isLaboratoryTestPerformed(Obs List<Observation>): Obs O where O.status in { 'final', 'amended', 'corrected' } and exists ( O.category ObservationCategory where ( ObservationCategory ) ~ "laboratory" )````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Procedure, Performed define fluent function isProcedurePerformed(Proc List<Procedure>): Proc P where P.status ~ 'completed'````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Diagnostic Study, Performed define fluent function isDiagnosticStudyPerformed(Obs List<Observation>): Obs O where O.status in {'final', 'amended', 'corrected' }````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Encounter, Performed //General usage unless required otherwise by measure intent (e.g., follow-up encounters) define fluent function isEncounterPerformed(Enc List<Encounter>): Enc E where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA. //Assessment, Performed define fluent function isAssessmentPerformed(Obs List<Observation>): Obs O where O.status in { 'final', 'amended', 'corrected' } and exists ( O.category ObservationCategory where ( ObservationCategory ) ~ "survey" )````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Intervention, Order: active and completed only define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>): ServiceRequest S where S.status in { 'active', 'completed' } and S.intent = 'order'````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Intervention, Performed define fluent function isInterventionPerformed(Proc List<Procedure>): Proc P where P.status ~ 'completed'````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Device, Order - Personal Use Devices: active and completed only define fluent function isDeviceOrder(DeviceRequest List<DeviceRequest>): DeviceRequest D where D.status in { 'active', 'completed' } and D.intent = 'order'````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Symptom define fluent function isSymptom(Obs List<Observation>): Obs O where O.status in { 'preliminary', 'final', 'amended', 'corrected' }````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Medication, Active define fluent function isMedicationActive(MedicationRequest List<MedicationRequest>): MedicationRequest M where M.status = 'active' and M.intent = 'order'````
* Metadata: Logic Definition
  * ?: **Library Name:**CumulativeMedicationDuration
* Metadata:  ````define fluent function medicationRequestPeriod(Request "MedicationRequest"): Request R let dosage: singleton from R.dosageInstruction, doseAndRate: singleton from dosage.doseAndRate, timing: dosage.timing, frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency), period: Quantity(timing.repeat.period, timing.repeat.periodUnit), doseRange: doseAndRate.dose, doseQuantity: doseAndRate.dose, dose: Coalesce(end of doseRange, doseQuantity), dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0), boundsPeriod: timing.repeat.bounds as Interval<DateTime>, daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value, quantity: R.dispenseRequest.quantity, refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0), startDate: Coalesce( date from start of boundsPeriod, date from R.authoredOn, date from start of R.dispenseRequest.validityPeriod ), totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills) return if startDate is not null and totalDaysSupplied is not null then Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ] else if startDate is not null and boundsPeriod."high" is not null then Interval[startDate, date from end of boundsPeriod] else null````
* Metadata: Logic Definition
  * ?: **Library Name:**CumulativeMedicationDuration
* Metadata:  ````/**********************************************************************/ /* Functions in this region are copied from opioid-mme-r4 */ /**********************************************************************/ define function Quantity(value Decimal, unit String): if value is not null then System.Quantity { value: value, unit: unit } else null````
* Metadata: Logic Definition
  * ?: **Library Name:**CumulativeMedicationDuration
* Metadata:  ````/* Goal is to get to number of days Two broad approaches to the calculation: 1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered 2) Based on relevant period, determine a covered interval and calculate the length of that interval in days This topic covers several use cases and illustrates how to calculate Cumulative Medication Duration for each type of medication resource using the supply and frequency approach. */ /* For the first approach, we need to get from frequency to a frequency/day So we define ToDaily */ /* Calculates daily frequency given frequency within a period */ define function ToDaily(frequency System.Integer, period System.Quantity): case period.unit when 'h' then frequency * (24.0 / period.value) when 'min' then frequency * (24.0 / period.value) * 60 when 's' then frequency * (24.0 / period.value) * 60 * 60 when 'd' then frequency * (24.0 / period.value) / 24 when 'wk' then frequency * (24.0 / period.value) / (24 * 7) when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ when 'hour' then frequency * (24.0 / period.value) when 'minute' then frequency * (24.0 / period.value) * 60 when 'second' then frequency * (24.0 / period.value) * 60 * 60 when 'day' then frequency * (24.0 / period.value) / 24 when 'week' then frequency * (24.0 / period.value) / (24 * 7) when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ when 'hours' then frequency * (24.0 / period.value) when 'minutes' then frequency * (24.0 / period.value) * 60 when 'seconds' then frequency * (24.0 / period.value) * 60 * 60 when 'days' then frequency * (24.0 / period.value) / 24 when 'weeks' then frequency * (24.0 / period.value) / (24 * 7) when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit) end````
* Metadata:  Terminology
* Metadata: Code System
  * ?: **Description**: Code system ObservationCategoryCodes**Resource**:[Observation Category Codes](http://terminology.hl7.org/5.5.0/CodeSystem-observation-category.html)**Canonical URL**:http://terminology.hl7.org/CodeSystem/observation-category
* Metadata: Code System
  * ?: **Description**: Code system SNOMEDCT**Resource**:[SNOMED CT (all versions)](http://hl7.org/fhir/R4/codesystem-snomedct.html)**Canonical URL**:http://snomed.info/sct
* Metadata: Code System
  * ?: **Description**: Code system LOINC**Resource**:[Logical Observation Identifiers, Names and Codes (LOINC)](http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html)**Canonical URL**:http://loinc.org
* Metadata: Code System
  * ?: **Description**: Code system ConditionClinicalStatusCodes**Resource**:[Condition Clinical Status Codes](http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html)**Canonical URL**:http://terminology.hl7.org/CodeSystem/condition-clinical
* Metadata: Value Set
  * ?: **Description**: Value set Fecal Occult Blood Test (FOBT)**Resource**:[Fecal Occult Blood Test (FOBT)](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1011/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011
* Metadata: Value Set
  * ?: **Description**: Value set sDNA FIT Test**Resource**:[FIT DNA](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1039/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039
* Metadata: Value Set
  * ?: **Description**: Value set Flexible Sigmoidoscopy**Resource**:[Flexible Sigmoidoscopy](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1010/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010
* Metadata: Value Set
  * ?: **Description**: Value set CT Colonography**Resource**:[CT Colonography](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1038/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038
* Metadata: Value Set
  * ?: **Description**: Value set Colonoscopy**Resource**:[Colonoscopy](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1020/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020
* Metadata: Value Set
  * ?: **Description**: Value set Office Visit**Resource**:[Office Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
* Metadata: Value Set
  * ?: **Description**: Value set Annual Wellness Visit**Resource**:[Annual Wellness Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240
* Metadata: Value Set
  * ?: **Description**: Value set Preventive Care Services Established Office Visit, 18 and Up**Resource**:[Preventive Care Services - Established Office Visit, 18 and Up](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025
* Metadata: Value Set
  * ?: **Description**: Value set Preventive Care Services Initial Office Visit, 18 and Up**Resource**:[Preventive Care Services-Initial Office Visit, 18 and Up](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
* Metadata: Value Set
  * ?: **Description**: Value set Home Healthcare Services**Resource**:[Home Healthcare Services](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016
* Metadata: Value Set
  * ?: **Description**: Value set Virtual Encounter**Resource**:[http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1089/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089
* Metadata: Value Set
  * ?: **Description**: Value set Telephone Visits**Resource**:[Telephone Visits](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080
* Metadata: Value Set
  * ?: **Description**: Value set Encounter Inpatient**Resource**:[Encounter Inpatient](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
* Metadata: Value Set
  * ?: **Description**: Value set Hospice Encounter**Resource**:[http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003
* Metadata: Value Set
  * ?: **Description**: Value set Hospice Care Ambulatory**Resource**:[Hospice Care Ambulatory](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584
* Metadata: Value Set
  * ?: **Description**: Value set Hospice Diagnosis**Resource**:[http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165
* Metadata: Value Set
  * ?: **Description**: Value set Malignant Neoplasm of Colon**Resource**:[Malignant Neoplasm of Colon](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1001/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001
* Metadata: Value Set
  * ?: **Description**: Value set Total Colectomy**Resource**:[Total Colectomy](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1019/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019
* Metadata: Value Set
  * ?: **Description**: Value set Frailty Device**Resource**:[Frailty Device](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.118.12.1300/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.118.12.1300
* Metadata: Value Set
  * ?: **Description**: Value set Frailty Diagnosis**Resource**:[Frailty Diagnosis](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.113.12.1074/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1074
* Metadata: Value Set
  * ?: **Description**: Value set Frailty Encounter**Resource**:[Frailty Encounter](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1088/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1088
* Metadata: Value Set
  * ?: **Description**: Value set Frailty Symptom**Resource**:[Frailty Symptom](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.113.12.1075/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1075
* Metadata: Value Set
  * ?: **Description**: Value set Advanced Illness**Resource**:[Advanced Illness](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1082/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1082
* Metadata: Value Set
  * ?: **Description**: Value set Dementia Medications**Resource**:[Dementia Medications](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1510/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1510
* Metadata: Value Set
  * ?: **Description**: Value set Palliative Care Diagnosis**Resource**:[http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1167/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167
* Metadata: Value Set
  * ?: **Description**: Value set Palliative Care Encounter**Resource**:[http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1090/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090
* Metadata: Value Set
  * ?: **Description**: Value set Palliative Care Intervention**Resource**:[http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1135/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135
* Metadata: Direct Reference Code
  * ?: **Display**: laboratory**Code**: laboratory**System**:http://terminology.hl7.org/CodeSystem/observation-category
* Metadata: Direct Reference Code
  * ?: **Display**: Discharge to home for hospice care (procedure)**Code**: 428361000124107**System**:http://snomed.info/sct
* Metadata: Direct Reference Code
  * ?: **Display**: Discharge to healthcare facility for hospice care (procedure)**Code**: 428371000124100**System**:http://snomed.info/sct
* Metadata: Direct Reference Code
  * ?: **Display**: survey**Code**: survey**System**:http://terminology.hl7.org/CodeSystem/observation-category
* Metadata: Direct Reference Code
  * ?: **Display**: Yes (qualifier value)**Code**: 373066001**System**:http://snomed.info/sct
* Metadata: Direct Reference Code
  * ?: **Display**: Hospice care [Minimum Data Set]**Code**: 45755-6**System**:http://loinc.org
* Metadata: Direct Reference Code
  * ?: **Display**: Active**Code**: active**System**:http://terminology.hl7.org/CodeSystem/condition-clinical
* Metadata: Direct Reference Code
  * ?: **Display**: Recurrence**Code**: recurrence**System**:http://terminology.hl7.org/CodeSystem/condition-clinical
* Metadata: Direct Reference Code
  * ?: **Display**: Relapse**Code**: relapse**System**:http://terminology.hl7.org/CodeSystem/condition-clinical
* Metadata: Direct Reference Code
  * ?: **Display**: Medical equipment used**Code**: 98181-1**System**:http://loinc.org
* Metadata: Direct Reference Code
  * ?: **Display**: Housing status**Code**: 71802-3**System**:http://loinc.org
* Metadata: Direct Reference Code
  * ?: **Display**: Lives in a nursing home (finding)**Code**: 160734000**System**:http://snomed.info/sct
* Metadata: Direct Reference Code
  * ?: **Display**: Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)**Code**: 71007-9**System**:http://loinc.org
* Metadata:  Dependencies
* Metadata: Dependency
  * ?: **Description**: QICore model information**Resource**:[http://hl7.org/fhir/us/qicore/Library/QICore-ModelInfo|4.1.1](http://hl7.org/fhir/us/qicore/STU4.1.1/4.1.1/Library-QICore-ModelInfo.html)**Canonical URL**:http://hl7.org/fhir/us/qicore/Library/QICore-ModelInfo|4.1.1
* Metadata: Dependency
  * ?: **Description**: Library Status**Resource**:[Statusversion: null1.8.000)](Library-Status.md)**Canonical URL**:https://madie.cms.gov/Library/Status|1.8.000
* Metadata: Dependency
  * ?: **Description**: Library FHIRHelpers**Resource**:[FHIRHelpersversion: null4.4.000)](Library-FHIRHelpers.md)**Canonical URL**:https://madie.cms.gov/Library/FHIRHelpers|4.4.000
* Metadata: Dependency
  * ?: **Description**: Library QICoreCommon**Resource**:[QICoreCommonversion: null2.1.000)](Library-QICoreCommon.md)**Canonical URL**:https://madie.cms.gov/Library/QICoreCommon|2.1.000
* Metadata: Dependency
  * ?: **Description**: Library AdultOutpatientEncounters**Resource**:[AdultOutpatientEncountersversion: null4.11.000)](Library-AdultOutpatientEncounters.md)**Canonical URL**:https://madie.cms.gov/Library/AdultOutpatientEncounters|4.11.000
* Metadata: Dependency
  * ?: **Description**: Library Hospice**Resource**:[Hospiceversion: null6.12.000)](Library-Hospice.md)**Canonical URL**:https://madie.cms.gov/Library/Hospice|6.12.000
* Metadata: Dependency
  * ?: **Description**: Library AIFrailLTCF**Resource**:[AdvancedIllnessandFrailtyversion: null1.16.000)](Library-AdvancedIllnessandFrailty.md)**Canonical URL**:https://madie.cms.gov/Library/AdvancedIllnessandFrailty|1.16.000
* Metadata: Dependency
  * ?: **Description**: Library CMD**Resource**:[CumulativeMedicationDurationversion: null4.1.000)](Library-CumulativeMedicationDuration.md)**Canonical URL**:https://madie.cms.gov/Library/CumulativeMedicationDuration|4.1.000
* Metadata: Dependency
  * ?: **Description**: Library PalliativeCare**Resource**:[PalliativeCareversion: null1.11.000)](Library-PalliativeCare.md)**Canonical URL**:https://madie.cms.gov/Library/PalliativeCare|1.11.000
* Metadata:  Data Requirements
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:[QICoreObservation](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html)**Must Support Elements**: code, value, effective, status, status.value, category**Code Filter(s)**:**Path**: code**ValueSet**:[Fecal Occult Blood Test (FOBT)](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1011/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:[QICoreObservation](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html)**Must Support Elements**: code, value, effective, status, status.value, category**Code Filter(s)**:**Path**: code**ValueSet**:[FIT DNA](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1039/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:[QICoreObservation](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html)**Must Support Elements**: code, effective, status, status.value, category**Code Filter(s)**:**Path**: code**ValueSet**:[CT Colonography](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1038/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:[QICoreObservation](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html)**Must Support Elements**: code, value, effective, status, status.value, category**Code Filter(s)**:**Path**: code**Code(s)**: [LOINC: 45755-6](https://loinc.org/45755-6) (Hospice care [Minimum Data Set]) **Path**: value
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:[QICoreObservation](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html)**Must Support Elements**: code, value, effective, status, status.value, category**Code Filter(s)**:**Path**: code**Code(s)**: [LOINC: 98181-1](https://loinc.org/98181-1) (Medical equipment used) **Path**: value**ValueSet**:[Frailty Device](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.118.12.1300/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:[QICoreObservation](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html)**Must Support Elements**: code, effective, status, status.value, category**Code Filter(s)**:**Path**: code**ValueSet**:[Frailty Symptom](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.113.12.1075/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:[QICoreObservation](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html)**Must Support Elements**: code, effective, status, status.value, category**Code Filter(s)**:**Path**: code**Code(s)**: [LOINC: 71802-3](https://loinc.org/71802-3) (Housing status) 
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:[QICoreObservation](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html)**Must Support Elements**: code, effective, value, status, status.value, category**Code Filter(s)**:**Path**: code**Code(s)**: [LOINC: 71802-3](https://loinc.org/71802-3) (Housing status) **Path**: value
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:[QICoreObservation](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html)**Must Support Elements**: code, effective, status, status.value, category**Code Filter(s)**:**Path**: code**Code(s)**: [LOINC: 71007-9](https://loinc.org/71007-9) (Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)) 
* Metadata: Data Requirement
  * ?: **Type**: Procedure**Profile(s)**:[QICoreProcedure](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html)**Must Support Elements**: code, performed, status, status.value**Code Filter(s)**:**Path**: code**ValueSet**:[Flexible Sigmoidoscopy](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1010/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Procedure**Profile(s)**:[QICoreProcedure](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html)**Must Support Elements**: code, performed, status, status.value**Code Filter(s)**:**Path**: code**ValueSet**:[Colonoscopy](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1020/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Procedure**Profile(s)**:[QICoreProcedure](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html)**Must Support Elements**: code, performed, status, status.value**Code Filter(s)**:**Path**: code**ValueSet**:[Hospice Care Ambulatory](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Procedure**Profile(s)**:[QICoreProcedure](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html)**Must Support Elements**: code, performed, status, status.value**Code Filter(s)**:**Path**: code**ValueSet**:[Total Colectomy](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1019/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Procedure**Profile(s)**:[QICoreProcedure](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html)**Must Support Elements**: code, performed, status, status.value**Code Filter(s)**:**Path**: code**ValueSet**:[http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1135/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Patient**Profile(s)**:[QICorePatient](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[QICoreEncounter](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html)**Must Support Elements**: type, status, status.value, period**Code Filter(s)**:**Path**: type**ValueSet**:[Office Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[QICoreEncounter](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html)**Must Support Elements**: type, status, status.value, period**Code Filter(s)**:**Path**: type**ValueSet**:[Annual Wellness Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[QICoreEncounter](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html)**Must Support Elements**: type, status, status.value, period**Code Filter(s)**:**Path**: type**ValueSet**:[Preventive Care Services - Established Office Visit, 18 and Up](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[QICoreEncounter](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html)**Must Support Elements**: type, status, status.value, period**Code Filter(s)**:**Path**: type**ValueSet**:[Preventive Care Services-Initial Office Visit, 18 and Up](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[QICoreEncounter](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html)**Must Support Elements**: type, status, status.value, period**Code Filter(s)**:**Path**: type**ValueSet**:[Home Healthcare Services](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[QICoreEncounter](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html)**Must Support Elements**: type, status, status.value, period**Code Filter(s)**:**Path**: type**ValueSet**:[http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1089/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[QICoreEncounter](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html)**Must Support Elements**: type, status, status.value, period**Code Filter(s)**:**Path**: type**ValueSet**:[Telephone Visits](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[QICoreEncounter](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html)**Must Support Elements**: type, hospitalization, hospitalization.dischargeDisposition, period, status, status.value**Code Filter(s)**:**Path**: type**ValueSet**:[Encounter Inpatient](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[QICoreEncounter](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html)**Must Support Elements**: type, period, status, status.value**Code Filter(s)**:**Path**: type**ValueSet**:[http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[QICoreEncounter](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html)**Must Support Elements**: type, period, status, status.value**Code Filter(s)**:**Path**: type**ValueSet**:[Frailty Encounter](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1088/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[QICoreEncounter](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html)**Must Support Elements**: type, period, status, status.value**Code Filter(s)**:**Path**: type**ValueSet**:[http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1090/expansion)
* Metadata: Data Requirement
  * ?: **Type**: ServiceRequest**Profile(s)**:[QICoreServiceRequest](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html)**Must Support Elements**: code, authoredOn, authoredOn.value, status, status.value, intent, intent.value**Code Filter(s)**:**Path**: code**ValueSet**:[Hospice Care Ambulatory](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[QICoreCondition](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html)**Must Support Elements**: code**Code Filter(s)**:**Path**: code**ValueSet**:[http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[QICoreCondition](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html)**Must Support Elements**: code**Code Filter(s)**:**Path**: code**ValueSet**:[Malignant Neoplasm of Colon](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1001/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[QICoreCondition](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html)**Must Support Elements**: code**Code Filter(s)**:**Path**: code**ValueSet**:[Frailty Diagnosis](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.113.12.1074/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[QICoreCondition](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html)**Must Support Elements**: code**Code Filter(s)**:**Path**: code**ValueSet**:[Advanced Illness](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1082/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[QICoreCondition](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html)**Must Support Elements**: code**Code Filter(s)**:**Path**: code**ValueSet**:[http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1167/expansion)
* Metadata: Data Requirement
  * ?: **Type**: DeviceRequest**Profile(s)**:[QICoreDeviceRequest](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-devicerequest.html)**Must Support Elements**: code, status, status.value, intent, intent.value, url, url.value, value, authoredOn, authoredOn.value**Code Filter(s)**:**Path**: code**ValueSet**:[Frailty Device](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.118.12.1300/expansion)
* Metadata: Data Requirement
  * ?: **Type**: MedicationRequest**Profile(s)**:[QICoreMedicationRequest](http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html)**Must Support Elements**: medication, status, status.value, intent, intent.value, dosageInstruction, dispenseRequest, dispenseRequest.expectedSupplyDuration, dispenseRequest.quantity, dispenseRequest.numberOfRepeatsAllowed, dispenseRequest.numberOfRepeatsAllowed.value, authoredOn, authoredOn.value, dispenseRequest.validityPeriod**Code Filter(s)**:**Path**: medication**ValueSet**:[Dementia Medications](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1510/expansion)
* Metadata:  Parameters
* Metadata: 
  * ?: 
| | | | | |
| :--- | :--- | :--- | :--- | :--- |
| **Name** | **Use** | **Card.** | **Type** | **Documentation** |
| Measurement Period | In | 0..1 | Period |  |
| ErrorLevel | In | 0..1 | string |  |
| Numerator | Out | 0..1 | boolean |  |
| Stratification 2 | Out | 0..1 | boolean |  |
| Stratification 1 | Out | 0..1 | boolean |  |
| Denominator | Out | 0..1 | boolean |  |
| Initial Population | Out | 0..1 | boolean |  |
| Denominator Exclusion | Out | 0..1 | boolean |  |

* Metadata: Generated using version 0.5.4-cibuild of the sample-content-ig Liquid templates



## Resource Content

```json
{
  "resourceType" : "Measure",
  "id" : "ColonCancerScreeningFHIR",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"]
  },
  "contained" : [{
    "resourceType" : "Library",
    "id" : "effective-data-requirements",
    "extension" : [{
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
        "code" : "laboratory",
        "display" : "laboratory"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "428361000124107",
        "display" : "Discharge to home for hospice care (procedure)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "428371000124100",
        "display" : "Discharge to healthcare facility for hospice care (procedure)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/observation-category",
        "code" : "survey",
        "display" : "survey"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "373066001",
        "display" : "Yes (qualifier value)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://loinc.org",
        "code" : "45755-6",
        "display" : "Hospice care [Minimum Data Set]"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
        "code" : "active",
        "display" : "Active"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
        "code" : "recurrence",
        "display" : "Recurrence"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
        "code" : "relapse",
        "display" : "Relapse"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://loinc.org",
        "code" : "98181-1",
        "display" : "Medical equipment used"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://loinc.org",
        "code" : "71802-3",
        "display" : "Housing status"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "160734000",
        "display" : "Lives in a nursing home (finding)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://loinc.org",
        "code" : "71007-9",
        "display" : "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"
      }
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "ColonCancerScreeningFHIR"
      },
      {
        "url" : "name",
        "valueString" : "Fecal Occult Blood Test Performed"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Fecal Occult Blood Test Performed\":\n  ( ( [Observation: \"Fecal Occult Blood Test (FOBT)\"] ).isLaboratoryTestPerformed ( ) ) FecalOccultResult\n    where FecalOccultResult.value is not null\n      and FecalOccultResult.effective.latest ( ) during day of \"Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 0
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "ColonCancerScreeningFHIR"
      },
      {
        "url" : "name",
        "valueString" : "Stool DNA with FIT Test Performed"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Stool DNA with FIT Test Performed\":\n  ( ( [Observation: \"sDNA FIT Test\"] ).isLaboratoryTestPerformed ( ) ) sDNATest\n    where sDNATest.value is not null\n      and sDNATest.effective.latest ( ) during day of Interval[start of \"Measurement Period\" - 2 years, end of \"Measurement Period\"]"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 1
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "ColonCancerScreeningFHIR"
      },
      {
        "url" : "name",
        "valueString" : "Flexible Sigmoidoscopy Performed"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Flexible Sigmoidoscopy Performed\":\n  ( ( [Procedure: \"Flexible Sigmoidoscopy\"] ).isProcedurePerformed ( ) ) FlexibleSigmoidoscopy\n    where FlexibleSigmoidoscopy.performed.toInterval ( ) ends during day of Interval[start of \"Measurement Period\" - 4 years, end of \"Measurement Period\"]"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 2
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "ColonCancerScreeningFHIR"
      },
      {
        "url" : "name",
        "valueString" : "CT Colonography Performed"
      },
      {
        "url" : "statement",
        "valueString" : "define \"CT Colonography Performed\":\n  ( ( [Observation: \"CT Colonography\"] ).isDiagnosticStudyPerformed ( ) ) Colonography\n    where Colonography.effective.toInterval ( ) ends during day of Interval[start of \"Measurement Period\" - 4 years, end of \"Measurement Period\"]"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 3
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "ColonCancerScreeningFHIR"
      },
      {
        "url" : "name",
        "valueString" : "Colonoscopy Performed"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Colonoscopy Performed\":\n  ( ( [Procedure: \"Colonoscopy\"] ).isProcedurePerformed ( ) ) Colonoscopy\n    where Colonoscopy.performed.toInterval ( ) ends during day of Interval[start of \"Measurement Period\" - 9 years, end of \"Measurement Period\"]"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 4
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "ColonCancerScreeningFHIR"
      },
      {
        "url" : "name",
        "valueString" : "Numerator"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Numerator\":\n  exists \"Fecal Occult Blood Test Performed\"\n    or exists \"Stool DNA with FIT Test Performed\"\n    or exists \"Flexible Sigmoidoscopy Performed\"\n    or exists \"CT Colonography Performed\"\n    or exists \"Colonoscopy Performed\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 5
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "ColonCancerScreeningFHIR"
      },
      {
        "url" : "name",
        "valueString" : "Stratification 2"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Stratification 2\":\n  AgeInYearsAt(date from \n    end of \"Measurement Period\"\n  ) in Interval[50, 75]"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 6
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "ColonCancerScreeningFHIR"
      },
      {
        "url" : "name",
        "valueString" : "Stratification 1"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Stratification 1\":\n  AgeInYearsAt(date from \n    end of \"Measurement Period\"\n  ) in Interval[46, 49]"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 7
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdultOutpatientEncounters"
      },
      {
        "url" : "name",
        "valueString" : "Qualifying Encounters"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Qualifying Encounters\":\n  ( ( [Encounter: \"Office Visit\"]\n    union [Encounter: \"Annual Wellness Visit\"]\n    union [Encounter: \"Preventive Care Services Established Office Visit, 18 and Up\"]\n    union [Encounter: \"Preventive Care Services Initial Office Visit, 18 and Up\"]\n    union [Encounter: \"Home Healthcare Services\"]\n    union [Encounter: \"Virtual Encounter\"]\n    union [Encounter: \"Telephone Visits\"] ).isEncounterPerformed() ) ValidEncounter\n    where ValidEncounter.period.toInterval() during day of \"Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 8
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "ColonCancerScreeningFHIR"
      },
      {
        "url" : "name",
        "valueString" : "Initial Population"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Initial Population\":\n  AgeInYearsAt(date from \n    end of \"Measurement Period\"\n  ) in Interval[46, 75]\n    and exists AdultOutpatientEncounters.\"Qualifying Encounters\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 9
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "ColonCancerScreeningFHIR"
      },
      {
        "url" : "name",
        "valueString" : "Denominator"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Denominator\":\n  \"Initial Population\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 10
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Hospice"
      },
      {
        "url" : "name",
        "valueString" : "Has Hospice Services"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Hospice Services\":\n  exists ((([Encounter: \"Encounter Inpatient\"]).isEncounterPerformed()) InpatientEncounter\n      where (InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n          or InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\"\n      )\n        and InpatientEncounter.period.toInterval() ends during day of \"Measurement Period\"\n  )\n    or exists ((([Encounter: \"Hospice Encounter\"]).isEncounterPerformed()) HospiceEncounter\n        where HospiceEncounter.period.toInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists ((([Observation: \"Hospice care [Minimum Data Set]\"]).isAssessmentPerformed()) HospiceAssessment\n        where HospiceAssessment.value ~ \"Yes (qualifier value)\"\n          and HospiceAssessment.effective.toInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists ((([ServiceRequest: \"Hospice Care Ambulatory\"]).isInterventionOrder()) HospiceOrder\n        where HospiceOrder.authoredOn.toInterval() during day of \"Measurement Period\"\n        // and HospiceOrder.doNotPerform is not true\n        // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447\n    )\n    or exists ((([Procedure: \"Hospice Care Ambulatory\"]).isInterventionPerformed()) HospicePerformed\n        where HospicePerformed.performed.toInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists (([Condition: \"Hospice Diagnosis\"]) HospiceCareDiagnosis\n        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"\n    )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 11
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "ColonCancerScreeningFHIR"
      },
      {
        "url" : "name",
        "valueString" : "Malignant Neoplasm"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Malignant Neoplasm\":\n  ( [Condition: \"Malignant Neoplasm of Colon\"] ) ColorectalCancer\n    where ColorectalCancer.prevalenceInterval ( ) starts on or before day of end of \"Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 12
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "ColonCancerScreeningFHIR"
      },
      {
        "url" : "name",
        "valueString" : "Total Colectomy Performed"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Total Colectomy Performed\":\n  ( ( [Procedure: \"Total Colectomy\"] ).isProcedurePerformed ( ) ) Colectomy\n    where Colectomy.performed.toInterval ( ) ends on or before day of end of \"Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 13
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdvancedIllnessandFrailty"
      },
      {
        "url" : "name",
        "valueString" : "Has Criteria Indicating Frailty"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Criteria Indicating Frailty\":\n  exists ( (([DeviceRequest: \"Frailty Device\"]).isDeviceOrder()) FrailtyDeviceOrder\n      where FrailtyDeviceOrder.doNotPerform() is not true\n      and FrailtyDeviceOrder.authoredOn.toInterval() during day of \"Measurement Period\"\n  )\n    or exists ( (([Observation: \"Medical equipment used\"]).isAssessmentPerformed()) EquipmentUsed\n        where EquipmentUsed.value as Concept in \"Frailty Device\" \n        and EquipmentUsed.effective.toInterval() ends during day of \"Measurement Period\"\n    )\n    or exists ( ([Condition: \"Frailty Diagnosis\"]) FrailtyDiagnosis\n        where FrailtyDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists ( (([Encounter: \"Frailty Encounter\"]).isEncounterPerformed()) FrailtyEncounter\n        where FrailtyEncounter.period.toInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists ( (([Observation: \"Frailty Symptom\"]).isSymptom()) FrailtySymptom\n        where FrailtySymptom.effective.toInterval() overlaps day of \"Measurement Period\"\n    )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 14
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdvancedIllnessandFrailty"
      },
      {
        "url" : "name",
        "valueString" : "Has Advanced Illness in Year Before or During Measurement Period"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Advanced Illness in Year Before or During Measurement Period\":\nexists ([Condition: \"Advanced Illness\"] AdvancedIllnessDiagnosis\nwhere AdvancedIllnessDiagnosis.prevalenceInterval() starts during day of Interval[start of \"Measurement Period\" - 1 year, end of \"Measurement Period\"])"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 15
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdvancedIllnessandFrailty"
      },
      {
        "url" : "name",
        "valueString" : "Has Dementia Medications in Year Before or During Measurement Period"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Dementia Medications in Year Before or During Measurement Period\":\n  exists (( ([MedicationRequest: medication in \"Dementia Medications\"]).isMedicationActive()) DementiaMedication\n        // https://oncprojectracking.healthit.gov/support/browse/CQLIT-449\n      where DementiaMedication.medicationRequestPeriod() overlaps day of Interval[start of \"Measurement Period\" - 1 year, \n        end of \"Measurement Period\"]\n        // and DementiaMedication.doNotPerform is not true\n        // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447\n  )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 16
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdvancedIllnessandFrailty"
      },
      {
        "url" : "name",
        "valueString" : "Is Age 66 or Older with Advanced Illness and Frailty"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Is Age 66 or Older with Advanced Illness and Frailty\":\n   AgeInYearsAt(date from end of \"Measurement Period\")>= 66\n    and \"Has Criteria Indicating Frailty\"\n    and ( \"Has Advanced Illness in Year Before or During Measurement Period\"\n        or \"Has Dementia Medications in Year Before or During Measurement Period\"\n    )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 17
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdvancedIllnessandFrailty"
      },
      {
        "url" : "name",
        "valueString" : "Is Age 66 or Older Living Long Term in a Nursing Home"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Is Age 66 or Older Living Long Term in a Nursing Home\":\n  AgeInYearsAt(date from \n     end of \"Measurement Period\"\n  )>= 66\n    and ( ( Last( (([Observation: \"Housing status\"]).isAssessmentPerformed()) HousingStatus    \n          where HousingStatus.effective.toInterval() ends on or before \n          day of end of \"Measurement Period\"\n          sort by \n          end of effective.toInterval() asc\n      )) LastHousingStatus\n        where LastHousingStatus.value ~ \"Lives in a nursing home (finding)\"\n    ) is not null"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 18
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "PalliativeCare"
      },
      {
        "url" : "name",
        "valueString" : "Has Palliative Care in the Measurement Period"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Palliative Care in the Measurement Period\":\n  exists ((([Observation: \"Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)\"]).isAssessmentPerformed()) PalliativeAssessment\n      where PalliativeAssessment.effective.toInterval() overlaps day of \"Measurement Period\"\n  )\n    or exists ([Condition: \"Palliative Care Diagnosis\"] PalliativeDiagnosis\n        where PalliativeDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists ((([Encounter: \"Palliative Care Encounter\"]).isEncounterPerformed()) PalliativeEncounter\n        where PalliativeEncounter.period.toInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists ((([Procedure: \"Palliative Care Intervention\"]).isInterventionPerformed()) PalliativeIntervention\n        where PalliativeIntervention.performed.toInterval() overlaps day of \"Measurement Period\"\n    )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 19
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "ColonCancerScreeningFHIR"
      },
      {
        "url" : "name",
        "valueString" : "Denominator Exclusion"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Denominator Exclusion\":\n  Hospice.\"Has Hospice Services\"\n    or exists \"Malignant Neoplasm\"\n    or exists \"Total Colectomy Performed\"\n    or AIFrailLTCF.\"Is Age 66 or Older with Advanced Illness and Frailty\"\n    or AIFrailLTCF.\"Is Age 66 or Older Living Long Term in a Nursing Home\"\n    or PalliativeCare.\"Has Palliative Care in the Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 20
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isLaboratoryTestPerformed"
      },
      {
        "url" : "statement",
        "valueString" : "//Laboratory Test, Performed\ndefine fluent function isLaboratoryTestPerformed(Obs List<Observation>):\n  Obs O\n    where O.status in { 'final', 'amended', 'corrected' }\n      and exists ( O.category ObservationCategory\n          where ( ObservationCategory ) ~ \"laboratory\"\n      )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 21
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToConcept"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 22
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToCode"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 23
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "QICoreCommon"
      },
      {
        "url" : "name",
        "valueString" : "latest"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Given an interval, returns the ending point if the interval has an ending boundary specified,\notherwise, returns the starting point\n*/\ndefine fluent function latest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):\n  (choice.toInterval()) period\n    return\n      if (period.\"hasEnd\"()) then end of period\n      else start of period"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 24
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "QICoreCommon"
      },
      {
        "url" : "name",
        "valueString" : "hasEnd"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Given an interval, returns true if the interval has an ending boundary specified\n(i.e. the end of the interval is not null and not the maximum DateTime value)\n*/\ndefine fluent function hasEnd(period Interval<DateTime> ):\n  not (\n    end of period is null\n      or end of period = maximum DateTime\n  )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 25
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isProcedurePerformed"
      },
      {
        "url" : "statement",
        "valueString" : "//Procedure, Performed\ndefine fluent function isProcedurePerformed(Proc List<Procedure>):\n  Proc P\n    where P.status ~ 'completed'"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 26
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isDiagnosticStudyPerformed"
      },
      {
        "url" : "statement",
        "valueString" : "//Diagnostic Study, Performed\ndefine fluent function isDiagnosticStudyPerformed(Obs List<Observation>):\n  Obs O\n    where O.status in {'final', 'amended', 'corrected' }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 27
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isEncounterPerformed"
      },
      {
        "url" : "statement",
        "valueString" : "//Encounter, Performed\n//General usage unless required otherwise by measure intent (e.g., follow-up encounters)\ndefine fluent function isEncounterPerformed(Enc List<Encounter>):\n  Enc E\n    where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 28
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "QICoreCommon"
      },
      {
        "url" : "name",
        "valueString" : "toInterval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in QICore, allowing this function to be used across any resource.\nThe input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.\nIf the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,\nand the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.\nIf the input is a DateTime Interval, the result is the input.\nIf the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result\nis a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending\nimmediately before one year later than the date the patient turned the age given as the end of the quantity interval.\nIf the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval\n*/\ndefine fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):\n  case\n\t  when choice is DateTime then\n    \tInterval[choice as DateTime, choice as DateTime]\n\t\twhen choice is Interval<DateTime> then\n  \t\tchoice as Interval<DateTime>\n\t\twhen choice is Quantity then\n\t\t  Interval[Patient.birthDate + (choice as Quantity),\n\t\t\t  Patient.birthDate + (choice as Quantity) + 1 year)\n\t\twhen choice is Interval<Quantity> then\n\t\t  Interval[Patient.birthDate + (choice.low as Quantity),\n\t\t\t  Patient.birthDate + (choice.high as Quantity) + 1 year)\n\t\twhen choice is Timing then\n      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>\n\t\telse\n\t\t\tnull as Interval<DateTime>\n\tend"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 29
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToInterval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)\nvalue to a CQL DateTime Interval\n@comment: If the start value of the given period is unspecified, the starting\nboundary of the resulting interval will be open (meaning the start of the interval\nis unknown, as opposed to interpreted as the beginning of time).\n*/\ndefine function ToInterval(period FHIR.Period):\n    if period is null then\n        null\n    else\n        if period.\"start\" is null then\n            Interval(period.\"start\".value, period.\"end\".value]\n        else\n            Interval[period.\"start\".value, period.\"end\".value]"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 30
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isAssessmentPerformed"
      },
      {
        "url" : "statement",
        "valueString" : "//This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA.\n\n//Assessment, Performed\ndefine fluent function isAssessmentPerformed(Obs List<Observation>):\n  Obs O\n    where O.status in { 'final', 'amended', 'corrected' }\n          and exists ( O.category ObservationCategory\n          where ( ObservationCategory ) ~ \"survey\"\n      )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 31
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isInterventionOrder"
      },
      {
        "url" : "statement",
        "valueString" : "//Intervention, Order: active and completed only    \ndefine fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):\n  ServiceRequest S\n    where S.status in { 'active', 'completed' }\n      and S.intent = 'order'"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 32
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isInterventionPerformed"
      },
      {
        "url" : "statement",
        "valueString" : "//Intervention, Performed\ndefine fluent function isInterventionPerformed(Proc List<Procedure>):\n  Proc P\n    where P.status ~ 'completed'"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 33
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "QICoreCommon"
      },
      {
        "url" : "name",
        "valueString" : "prevalenceInterval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting \ninterval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ \"active\"\n  or condition.clinicalStatus ~ \"recurrence\"\n  or condition.clinicalStatus ~ \"relapse\" then\n  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n    (end of condition.abatementInterval()) abatementDate\n    return if abatementDate is null then\n      Interval[start of condition.onset.toInterval(), abatementDate)\n    else\n      Interval[start of condition.onset.toInterval(), abatementDate]"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 34
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "QICoreCommon"
      },
      {
        "url" : "name",
        "valueString" : "abatementInterval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns an interval representing the normalized abatement of a given Condition.\n@comment: If the abatement element of the Condition is represented as a DateTime, the result\nis an interval beginning and ending on that DateTime.\nIf the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The\nresult is an interval from the date the patient turned that age to immediately before one year later.\nIf the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during\nwhich the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately\nbefore one year later than the date the patient turned the ending age of the quantity interval.\n*/\ndefine fluent function abatementInterval(condition Condition):\n\tif condition.abatement is DateTime then\n\t  Interval[condition.abatement as DateTime, condition.abatement as DateTime]\n\telse if condition.abatement is Quantity then\n\t\tInterval[Patient.birthDate + (condition.abatement as Quantity),\n\t\t\tPatient.birthDate + (condition.abatement as Quantity) + 1 year)\n\telse if condition.abatement is Interval<Quantity> then\n\t  Interval[Patient.birthDate + (condition.abatement.low as Quantity),\n\t\t  Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)\n\telse if condition.abatement is Interval<DateTime> then\n\t  Interval[condition.abatement.low, condition.abatement.high)\n\telse null as Interval<DateTime>"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 35
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isDeviceOrder"
      },
      {
        "url" : "statement",
        "valueString" : "//Device, Order - Personal Use Devices: active and completed only\ndefine fluent function isDeviceOrder(DeviceRequest List<DeviceRequest>):\n  DeviceRequest D\n    where D.status in { 'active', 'completed' }\n      and D.intent = 'order'"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 36
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "QICoreCommon"
      },
      {
        "url" : "name",
        "valueString" : "doNotPerform"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns true if the given DeviceRequest is a negation (i.e. do not perform this order)\n*/\ndefine fluent function doNotPerform(deviceRequest DeviceRequest):\n  singleton from (\n    deviceRequest.modifierExtension E\n      where E.url = 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-doNotPerform'\n      return E.value as Boolean\n  )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 37
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isSymptom"
      },
      {
        "url" : "statement",
        "valueString" : "//Symptom\ndefine fluent function isSymptom(Obs List<Observation>):\n  Obs O\n    where O.status in { 'preliminary', 'final', 'amended', 'corrected' }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 38
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isMedicationActive"
      },
      {
        "url" : "statement",
        "valueString" : "//Medication, Active\ndefine fluent function isMedicationActive(MedicationRequest List<MedicationRequest>):\n  MedicationRequest M\n    where M.status = 'active'\n      and M.intent = 'order'"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 39
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CumulativeMedicationDuration"
      },
      {
        "url" : "name",
        "valueString" : "medicationRequestPeriod"
      },
      {
        "url" : "statement",
        "valueString" : "define fluent function medicationRequestPeriod(Request \"MedicationRequest\"):\n  Request R\n    let\n      dosage: singleton from R.dosageInstruction,\n      doseAndRate: singleton from dosage.doseAndRate,\n      timing: dosage.timing,\n      frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),\n      period: Quantity(timing.repeat.period, timing.repeat.periodUnit),\n      doseRange: doseAndRate.dose,\n      doseQuantity: doseAndRate.dose,\n      dose: Coalesce(end of doseRange, doseQuantity),\n      dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),\n      boundsPeriod: timing.repeat.bounds as Interval<DateTime>,\n      daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value,\n      quantity: R.dispenseRequest.quantity,\n      refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),\n      startDate:\n        Coalesce(\n          date from start of boundsPeriod,\n          date from R.authoredOn,\n          date from start of R.dispenseRequest.validityPeriod\n        ),\n      totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills)\n    return\n      if startDate is not null and totalDaysSupplied is not null then\n        Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ]\n      else if startDate is not null and boundsPeriod.\"high\" is not null then\n        Interval[startDate, date from end of boundsPeriod]\n      else\n        null"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 40
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CumulativeMedicationDuration"
      },
      {
        "url" : "name",
        "valueString" : "Quantity"
      },
      {
        "url" : "statement",
        "valueString" : "/**********************************************************************/\n/* Functions in this region are copied from opioid-mme-r4             */\n/**********************************************************************/\n\ndefine function Quantity(value Decimal, unit String):\n  if value is not null then\n    System.Quantity { value: value, unit: unit }\n  else\n    null"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 41
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CumulativeMedicationDuration"
      },
      {
        "url" : "name",
        "valueString" : "ToDaily"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n Goal is to get to number of days\n Two broad approaches to the calculation:\n  1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered\n  2) Based on relevant period, determine a covered interval and calculate the length of that interval in days\nThis topic covers several use cases and illustrates how to calculate Cumulative\nMedication Duration for each type of medication resource using the supply and\nfrequency approach.\n*/\n\n/*\n  For the first approach, we need to get from frequency to a frequency/day\n  So we define ToDaily\n*/\n\n/*\n  Calculates daily frequency given frequency within a period\n*/\ndefine function ToDaily(frequency System.Integer, period System.Quantity):\n  case period.unit\n    when 'h' then frequency * (24.0 / period.value)\n    when 'min' then frequency * (24.0 / period.value) * 60\n    when 's' then frequency * (24.0 / period.value) * 60 * 60\n    when 'd' then frequency * (24.0 / period.value) / 24\n    when 'wk' then frequency * (24.0 / period.value) / (24 * 7)\n    when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n    when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n    when 'hour' then frequency * (24.0 / period.value)\n    when 'minute' then frequency * (24.0 / period.value) * 60\n    when 'second' then frequency * (24.0 / period.value) * 60 * 60\n    when 'day' then frequency * (24.0 / period.value) / 24\n    when 'week' then frequency * (24.0 / period.value) / (24 * 7)\n    when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n    when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n    when 'hours' then frequency * (24.0 / period.value)\n    when 'minutes' then frequency * (24.0 / period.value) * 60\n    when 'seconds' then frequency * (24.0 / period.value) * 60 * 60\n    when 'days' then frequency * (24.0 / period.value) / 24\n    when 'weeks' then frequency * (24.0 / period.value) / (24 * 7)\n    when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n    when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n    else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit)\n  end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 42
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    }],
    "name" : "EffectiveDataRequirements",
    "status" : "active",
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/library-type",
        "code" : "module-definition"
      }]
    },
    "relatedArtifact" : [{
      "type" : "depends-on",
      "display" : "QICore model information",
      "resource" : "http://hl7.org/fhir/us/qicore/Library/QICore-ModelInfo|4.1.1"
    },
    {
      "type" : "depends-on",
      "display" : "Library Status",
      "resource" : "https://madie.cms.gov/Library/Status|1.8.000"
    },
    {
      "type" : "depends-on",
      "display" : "Library FHIRHelpers",
      "resource" : "https://madie.cms.gov/Library/FHIRHelpers|4.4.000"
    },
    {
      "type" : "depends-on",
      "display" : "Library QICoreCommon",
      "resource" : "https://madie.cms.gov/Library/QICoreCommon|2.1.000"
    },
    {
      "type" : "depends-on",
      "display" : "Library AdultOutpatientEncounters",
      "resource" : "https://madie.cms.gov/Library/AdultOutpatientEncounters|4.11.000"
    },
    {
      "type" : "depends-on",
      "display" : "Library Hospice",
      "resource" : "https://madie.cms.gov/Library/Hospice|6.12.000"
    },
    {
      "type" : "depends-on",
      "display" : "Library AIFrailLTCF",
      "resource" : "https://madie.cms.gov/Library/AdvancedIllnessandFrailty|1.16.000"
    },
    {
      "type" : "depends-on",
      "display" : "Library CMD",
      "resource" : "https://madie.cms.gov/Library/CumulativeMedicationDuration|4.1.000"
    },
    {
      "type" : "depends-on",
      "display" : "Library PalliativeCare",
      "resource" : "https://madie.cms.gov/Library/PalliativeCare|1.11.000"
    },
    {
      "type" : "depends-on",
      "display" : "Code system ObservationCategoryCodes",
      "resource" : "http://terminology.hl7.org/CodeSystem/observation-category"
    },
    {
      "type" : "depends-on",
      "display" : "Code system SNOMEDCT",
      "resource" : "http://snomed.info/sct"
    },
    {
      "type" : "depends-on",
      "display" : "Code system LOINC",
      "resource" : "http://loinc.org"
    },
    {
      "type" : "depends-on",
      "display" : "Code system ConditionClinicalStatusCodes",
      "resource" : "http://terminology.hl7.org/CodeSystem/condition-clinical"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Fecal Occult Blood Test (FOBT)",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011"
    },
    {
      "type" : "depends-on",
      "display" : "Value set sDNA FIT Test",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Flexible Sigmoidoscopy",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010"
    },
    {
      "type" : "depends-on",
      "display" : "Value set CT Colonography",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Colonoscopy",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Office Visit",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Annual Wellness Visit",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Preventive Care Services Established Office Visit, 18 and Up",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Preventive Care Services Initial Office Visit, 18 and Up",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Home Healthcare Services",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Virtual Encounter",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Telephone Visits",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Encounter Inpatient",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Hospice Encounter",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Hospice Care Ambulatory",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Hospice Diagnosis",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Malignant Neoplasm of Colon",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Total Colectomy",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Frailty Device",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.118.12.1300"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Frailty Diagnosis",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1074"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Frailty Encounter",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1088"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Frailty Symptom",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1075"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Advanced Illness",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1082"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Dementia Medications",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1510"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Palliative Care Diagnosis",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Palliative Care Encounter",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Palliative Care Intervention",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135"
    }],
    "parameter" : [{
      "name" : "Measurement Period",
      "use" : "in",
      "min" : 0,
      "max" : "1",
      "type" : "Period"
    },
    {
      "name" : "ErrorLevel",
      "use" : "in",
      "min" : 0,
      "max" : "1",
      "type" : "string"
    },
    {
      "name" : "Numerator",
      "use" : "out",
      "min" : 0,
      "max" : "1",
      "type" : "boolean"
    },
    {
      "name" : "Stratification 2",
      "use" : "out",
      "min" : 0,
      "max" : "1",
      "type" : "boolean"
    },
    {
      "name" : "Stratification 1",
      "use" : "out",
      "min" : 0,
      "max" : "1",
      "type" : "boolean"
    },
    {
      "name" : "Denominator",
      "use" : "out",
      "min" : 0,
      "max" : "1",
      "type" : "boolean"
    },
    {
      "name" : "Initial Population",
      "use" : "out",
      "min" : 0,
      "max" : "1",
      "type" : "boolean"
    },
    {
      "name" : "Denominator Exclusion",
      "use" : "out",
      "min" : 0,
      "max" : "1",
      "type" : "boolean"
    }],
    "dataRequirement" : [{
      "type" : "Observation",
      "profile" : ["http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"],
      "mustSupport" : ["code", "value", "effective", "status", "status.value", "category"],
      "codeFilter" : [{
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    },
    {
      "type" : "MedicationRequest",
      "profile" : ["http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"],
      "mustSupport" : ["medication",
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  }],
  "extension" : [{
    "url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
    "valueCanonical" : "#effective-data-requirements"
  }],
  "url" : "https://madie.cms.gov/Measure/ColonCancerScreeningFHIR",
  "identifier" : [{
    "use" : "usual",
    "type" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
        "code" : "short-name"
      }]
    },
    "system" : "https://madie.cms.gov/measure/shortName",
    "value" : "CMS130FHIR"
  },
  {
    "use" : "official",
    "type" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
        "code" : "version-independent"
      }]
    },
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:uuid:627c6e27-5c46-4412-941a-ca387492bbaa"
  },
  {
    "use" : "official",
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        "code" : "version-specific"
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    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:uuid:3ff5ff28-e118-4433-8467-15d0a585b45d"
  },
  {
    "use" : "official",
    "type" : {
      "coding" : [{
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        "code" : "publisher"
      }]
    },
    "system" : "https://madie.cms.gov/measure/cmsId",
    "value" : "130FHIR",
    "assigner" : {
      "display" : "CMS"
    }
  }],
  "version" : "0.1.000",
  "name" : "ColonCancerScreeningFHIR",
  "title" : "Colorectal Cancer ScreeningFHIR",
  "status" : "draft",
  "experimental" : false,
  "date" : "2026-03-13T01:50:41+00:00",
  "publisher" : "National Committee for Quality Assurance",
  "contact" : [{
    "telecom" : [{
      "system" : "url",
      "value" : "https://www.ncqa.org/"
    }]
  }],
  "description" : "Percentage of adults 45-75 years of age who had appropriate screening for colorectal cancer",
  "purpose" : "UNKNOWN",
  "usage" : "Do not count digital rectal exams (DRE), fecal occult blood tests (FOBTs) performed in an office setting or performed on a sample collected via DRE.  Please note the measure may include screenings performed outside the age range of patients referenced in the initial population. Screenings that occur prior to the measurement period are valid to meet measure criteria.  This eCQM is a patient-based measure.  This FHIR-based measure has been derived from the QDM-based measure: CMS130v13.  Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).",
  "copyright" : "This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2024 National Committee for Quality Assurance. All Rights Reserved.  Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications.  CPT(R) codes, descriptions and other data are copyright 2024. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use.  Some measure specifications contain coding from LOINC(R) (http://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use.  This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation.  ICD-10 copyright 2024 World Health Organization. All Rights Reserved.  Some measures use RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the measures and does not endorse or recommend this or any other product.  “HL7” is the registered trademark of Health Level Seven International.",
  "effectivePeriod" : {
    "start" : "2025-01-01",
    "end" : "2025-12-31"
  },
  "author" : [{
    "name" : "National Committee for Quality Assurance",
    "telecom" : [{
      "system" : "url",
      "value" : "https://www.ncqa.org/"
    }]
  }],
  "library" : ["https://madie.cms.gov/Library/ColonCancerScreeningFHIR"],
  "disclaimer" : "The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.   Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
  "scoring" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
      "code" : "proportion",
      "display" : "Proportion"
    }]
  },
  "rationale" : "Colorectal cancer represents eight percent of all new cancer cases in the United States. In 2020, there were an estimated 147,950 new cases of colorectal cancer and an estimated 53,200 deaths attributed to it. According to the National Cancer Institute, about 4.2 percent of men and women will be diagnosed with colorectal cancer at some point during their lifetimes. For most adults, older age is the most important risk factor for colorectal cancer, although being male and black are also associated with higher incidence and mortality. Colorectal cancer is most frequently diagnosed among people 65 to 74 years old (Howlader et al., 2020).  Screening can be effective for finding precancerous lesions (polyps) that could later become malignant, and for detecting early cancers that can be more easily and effectively treated. Precancerous polyps usually take about 10 to 15 years to develop into colorectal cancer, and most can be found and removed before turning into cancer. The five-year relative survival rate for people whose colorectal cancer is found in the early stage before it has spread is about 90 percent (SEER, 2022).",
  "clinicalRecommendationStatement" : "The U.S. Preventive Services Task Force (2021) recommends screening for colorectal cancer in adults aged 45 to 49 years. This is a Grade B recommendation (U.S. Preventive Services Task Force, 2021).   The U.S. Preventive Services Task Force (2021) recommends screening for colorectal cancer in adults aged 50 to 75 years. This is a Grade A recommendation (U.S. Preventive Services Task Force, 2021).  Appropriate screenings are defined by any one of the following: - Fecal occult blood test (annually) - Stool DNA (sDNA) with FIT test (every 3 years) - Flexible sigmoidoscopy (every 5 years) - Computed tomographic (CT) colonography (every 5 years) - Colonoscopy (every 10 years)",
  "group" : [{
    "id" : "654a405f78418140875e351c",
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      "valueCodeableConcept" : {
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          "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
          "code" : "proportion",
          "display" : "Proportion"
        }]
      }
    },
    {
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
      "valueCode" : "boolean"
    },
    {
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-type",
          "code" : "process",
          "display" : "Process"
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      }
    },
    {
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
      "valueCode" : "None"
    },
    {
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
          "code" : "decrease",
          "display" : "increase"
        }]
      }
    }],
    "population" : [{
      "id" : "7423DF07-8C1A-4B0C-89EA-64932F943566",
      "code" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "initial-population",
          "display" : "Initial Population"
        }]
      },
      "description" : "Patients 46-75 years of age by the end of the measurement period with a visit during the measurement period",
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "Initial Population"
      }
    },
    {
      "id" : "EB843F58-5BA6-4B74-BA7D-2D313E9C1F94",
      "code" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "denominator",
          "display" : "Denominator"
        }]
      },
      "description" : "Equals Initial Population",
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "Denominator"
      }
    },
    {
      "id" : "4a91dd44-46af-44ee-bcee-2bdc0e811188",
      "code" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "denominator-exclusion",
          "display" : "Denominator Exclusion"
        }]
      },
      "description" : "Exclude patients who are in hospice care for any part of the measurement period.  Exclude patients with a diagnosis or past history of total colectomy or colorectal cancer.  Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness diagnosis during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior  Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period.  Exclude patients receiving palliative care for any part of the measurement period.",
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "Denominator Exclusion"
      }
    },
    {
      "id" : "AA394954-274E-4BAD-99FA-5B188C962903",
      "code" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "numerator",
          "display" : "Numerator"
        }]
      },
      "description" : "Patients with one or more screenings for colorectal cancer. Appropriate screenings are defined by any one of the following criteria:  - Fecal occult blood test (FOBT) during the measurement period - Stool DNA (sDNA) with FIT test during the measurement period or the two years prior to the measurement period - Flexible sigmoidoscopy during the measurement period or the four years prior to the measurement period - CT Colonography during the measurement period or the four years prior to the measurement period - Colonoscopy during the measurement period or the nine years prior to the measurement period",
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "Numerator"
      }
    }],
    "stratifier" : [{
      "id" : "736a0ff4-9544-4c88-88dd-76274cc3d540",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
        "valueCodeableConcept" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
            "code" : "initial-population",
            "display" : "Initial Population"
          }]
        }
      }],
      "description" : "Patients age 46-49 by the end of the measurement period",
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "Stratification 1"
      }
    },
    {
      "id" : "426f0691-b064-459c-9661-88dadc8d3f7b",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
        "valueCodeableConcept" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
            "code" : "initial-population",
            "display" : "Initial Population"
          }]
        }
      }],
      "description" : "Patients age 50-75 by the end of the measurement period",
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "Stratification 2"
      }
    }]
  }]
}

```
