/*
NOTE: For use by March 2026 US Realm Connectathon participants for internal use only. Not for use or distribution in commercial products.
*/
library CMS136FHIRChildADHDMedFollowUp version '1.1.000'
using USQualityCore version '0.1.0-cibuild'
using USCore version '6.1.0-derived'
using FHIR version '4.0.1'
include hl7.fhir.uv.cql.FHIRHelpers version '4.0.1' called FHIRHelpers
include hl7.fhir.uv.cql.FHIRCommon version '2.0.0' called FHIRCommon
include hl7.fhir.us.cql.CumulativeMedicationDuration version '2.0.0-ballot' called CMD
include hl7.fhir.us.cql.USCoreCommon version '2.0.0-ballot' called USCoreCommon
include hl7.fhir.us.cql.USCoreElements version '2.0.0-ballot' called USCoreElements
include Hospice version '7.1.000' called Hospice
include CQMCommon version '5.1.000' called CQMCommon
include USQualityCoreCommon version '0.1.0-cibuild' called USQualityCoreCommon
include SupplementalDataElements version '6.1.000' called SDE
include Status version '2.1.000' called Status
codesystem "RXNORM": 'http://www.nlm.nih.gov/research/umls/rxnorm'
valueset "Ambulatory": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.122.12.1003'
valueset "Atomoxetine": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1170'
valueset "Behavioral Health Follow up Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1054'
valueset "Clonidine": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1171'
valueset "Dexmethylphenidate": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1172'
valueset "Dextroamphetamine": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1173'
valueset "Encounter Inpatient": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307'
valueset "Guanfacine Medications": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.11.1252'
valueset "Home Healthcare Services": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016'
valueset "Lisdexamfetamine": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1174'
valueset "Mental Behavioral and Neurodevelopmental Disorders": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1203'
valueset "Methylphenidate": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1176'
valueset "Narcolepsy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.114.12.1011'
valueset "Office Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001'
valueset "Outpatient Consultation": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008'
valueset "Preventive Care Services Group Counseling": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1027'
valueset "Preventive Care Services Individual Counseling": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1026'
valueset "Preventive Care Services, Initial Office Visit, 0 to 17": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022'
valueset "Preventive Care, Established Office Visit, 0 to 17": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024'
valueset "Psych Visit Diagnostic Evaluation": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1492'
valueset "Psych Visit Psychotherapy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1496'
valueset "Psychotherapy and Pharmacologic Management": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1055'
valueset "Telephone Visits": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080'
valueset "Viloxazine": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1260'
valueset "Virtual Encounter": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089'
code "methamphetamine hydrochloride 5 MG Oral Tablet": '977860' from "RXNORM" display 'methamphetamine hydrochloride 5 MG Oral Tablet'
parameter "Measurement Period" Interval<DateTime>
default Interval[@2026-01-01T00:00:00.000Z, @2027-01-01T00:00:00.000Z)
context Patient
define "Initial Population 1":
AgeInYearsAt(date from start of "Intake Period") >= 6
and AgeInYearsAt(date from
end of "Intake Period"
) <= 12
and exists "Qualifying Encounter"
and "First ADHD Medication Prescribed During Intake Period" is not null
and not exists "Inpatient Stay with Qualifying Diagnosis During Initiation Phase"
define "Intake Period":
Interval["March 1 of Year Prior to Measurement Period", "Last Calendar Day of February of Measurement Period"]
define "Last Calendar Day of February of Measurement Period":
( DateTime(year from start of "Measurement Period", 3, 1, 23, 59, 59, 0, 0) ) - 1 day
define "March 1 of Year Prior to Measurement Period":
DateTime((year from start of "Measurement Period" - 1), 3, 1, 0, 0, 0, 0, 0)
define "Qualifying Encounter":
( ( [Encounter: "Office Visit"]
union [Encounter: "Home Healthcare Services"]
union [Encounter: "Preventive Care, Established Office Visit, 0 to 17"]
union [Encounter: "Preventive Care Services, Initial Office Visit, 0 to 17"]
).isEncounterPerformed ( ) ) ValidEncounters
where CQMCommon."ToDateInterval" ( ValidEncounters.period ) during day of Interval["IPSD" - 6 months, "IPSD"]
/*Index Prescription Start Date (IPSD)*/
define "IPSD":
"First ADHD Medication Prescribed During Intake Period"
define "First ADHD Medication Prescribed During Intake Period":
First("ADHD Medication Prescribed During Intake Period and Not Previously on ADHD Medication".startDate)
define "ADHD Medication Prescribed During Intake Period and Not Previously on ADHD Medication":
( ( ( ( [MedicationRequest: "Atomoxetine"]
union [MedicationRequest: "Clonidine"]
union [MedicationRequest: "Dexmethylphenidate"]
union [MedicationRequest: "Dextroamphetamine"]
union [MedicationRequest: "Lisdexamfetamine"]
union [MedicationRequest: "methamphetamine hydrochloride 5 MG Oral Tablet"]
union [MedicationRequest: "Methylphenidate"]
union [MedicationRequest: "Guanfacine Medications"]
union [MedicationRequest: "Viloxazine"]
).isMedicationOrder ( ) ) ADHDMedications
where ADHDMedications.medicationRequestPeriod ( ) starts during "Intake Period" ) ADHDMedicationOrder
without ( ( [MedicationRequest: "Atomoxetine"]
union [MedicationRequest: "Clonidine"]
union [MedicationRequest: "Dexmethylphenidate"]
union [MedicationRequest: "Dextroamphetamine"]
union [MedicationRequest: "Lisdexamfetamine"]
union [MedicationRequest: "methamphetamine hydrochloride 5 MG Oral Tablet"]
union [MedicationRequest: "Methylphenidate"]
union [MedicationRequest: "Guanfacine Medications"]
union [MedicationRequest: "Viloxazine"]
).isMedicationActive ( ) ) ActiveADHDMedication
such that ActiveADHDMedication.medicationRequestPeriod ( ) overlaps Interval[date from start of ADHDMedicationOrder.medicationRequestPeriod ( ) - 120 days, date from start of ADHDMedicationOrder.medicationRequestPeriod ( ) ) ) QualifyingMed
return all {
startDate: start of QualifyingMed.medicationRequestPeriod ( )
}
sort by startDate asc
define "Inpatient Stay with Qualifying Diagnosis During Initiation Phase":
"Inpatient Stay with Qualifying Diagnosis" InpatientStay
where CQMCommon."ToDateInterval" ( InpatientStay.period ) starts 30 days or less after day of "IPSD"
define "Inpatient Stay with Qualifying Diagnosis":
( ( [Encounter: "Encounter Inpatient"] ).isEncounterPerformed ( ) ) InpatientStay
where InpatientStay.hasPrincipalDiagnosisOf ( "Mental Behavioral and Neurodevelopmental Disorders" )
define "Denominator 1":
"Initial Population 1"
define "Denominator Exclusions":
Hospice."Has Hospice Services"
or exists "Narcolepsy Exclusion"
define "Narcolepsy Exclusion":
// [E-13] base FHIR.Condition retrieve (defect-tracking/engine-issues.md E-13)
// Original:
// [ConditionProblemsHealthConcerns: "Narcolepsy"]
// union [ConditionEncounterDiagnosis: "Narcolepsy"]
( ( [FHIR.Condition: "Narcolepsy"] ).verified ( ) ) NarcolepsyDx
where NarcolepsyDx.prevalenceInterval ( ) starts on or before end of "Measurement Period"
define "Numerator 1":
exists "Encounter During Initiation Phase"
define "Encounter During Initiation Phase":
( "Qualifying Numerator Encounter".isEncounterPerformed ( ) ) ValidNumeratorEncounter
where CQMCommon."ToDateInterval" ( ValidNumeratorEncounter.period ) starts 30 days or less after day of "IPSD"
define "Qualifying Numerator Encounter":
[Encounter: "Office Visit"]
union [Encounter: "Preventive Care Services Group Counseling"]
union [Encounter: "Behavioral Health Follow up Visit"]
union [Encounter: "Preventive Care Services Individual Counseling"]
union ( [Encounter: "Psychotherapy and Pharmacologic Management"] PsychPharmManagement
where exists ( PsychPharmManagement.location Location
where CQMCommon."GetLocation" ( Location.location ).type in "Ambulatory"
)
)
union [Encounter: "Outpatient Consultation"]
union [Encounter: "Home Healthcare Services"]
union [Encounter: "Preventive Care Services, Initial Office Visit, 0 to 17"]
union [Encounter: "Preventive Care, Established Office Visit, 0 to 17"]
union [Encounter: "Psych Visit Diagnostic Evaluation"]
union [Encounter: "Psych Visit Psychotherapy"]
union [Encounter: "Telephone Visits"]
define "Initial Population 2":
AgeInYearsAt(date from start of "Intake Period") >= 6
and AgeInYearsAt(date from
end of "Intake Period"
) <= 12
and exists "Qualifying Encounter"
and "First ADHD Medication Prescribed During Intake Period" is not null
and "Has ADHD Cumulative Medication Duration Greater Than or Equal to 210 Days"
and not exists "Inpatient Stay with Qualifying Diagnosis During Continuation and Maintenance Phase"
define "Has ADHD Cumulative Medication Duration Greater Than or Equal to 210 Days":
"ADHD Cumulative Medication Duration" >= 210
define "ADHD Cumulative Medication Duration":
( "ADHD Medications Taken on IPSD or During Continuation and Maintenance Phase" ).cumulativeDuration ( )
define "Inpatient Stay with Qualifying Diagnosis During Continuation and Maintenance Phase":
"Inpatient Stay with Qualifying Diagnosis" InpatientStay
where CQMCommon."ToDateInterval" ( InpatientStay.period ) starts 300 days or less after day of "IPSD"
define "ADHD Medications Taken on IPSD or During Continuation and Maintenance Phase":
( ( ( ( ( ( [MedicationRequest: "Atomoxetine"] ).isMedicationOrder ( ) ) AtomoxetineMed
return all {
period: AtomoxetineMed.medicationRequestPeriod ( ),
periodStart: start of AtomoxetineMed.medicationRequestPeriod ( )
}
sort by periodStart
).period
).rolloutIntervals ( )
)
union ( ( ( ( ( [MedicationRequest: "Clonidine"] ).isMedicationOrder ( ) ) ClonidineMed
return all {
period: ClonidineMed.medicationRequestPeriod ( ),
periodStart: start of ClonidineMed.medicationRequestPeriod ( )
}
sort by periodStart
).period
).rolloutIntervals ( )
)
union ( ( ( ( ( [MedicationRequest: "Dexmethylphenidate"] ).isMedicationOrder ( ) ) DexmethylphenidateMed
return all {
period: DexmethylphenidateMed.medicationRequestPeriod ( ),
periodStart: start of DexmethylphenidateMed.medicationRequestPeriod ( )
}
sort by periodStart
).period
).rolloutIntervals ( )
)
union ( ( ( ( ( [MedicationRequest: "Dextroamphetamine"] ).isMedicationOrder ( ) ) DextroamphetamineMed
return all {
period: DextroamphetamineMed.medicationRequestPeriod ( ),
periodStart: start of DextroamphetamineMed.medicationRequestPeriod ( )
}
sort by periodStart
).period
).rolloutIntervals ( )
)
union ( ( ( ( ( [MedicationRequest: "Lisdexamfetamine"] ).isMedicationOrder ( ) ) LisdexamfetamineMed
return all {
period: LisdexamfetamineMed.medicationRequestPeriod ( ),
periodStart: start of LisdexamfetamineMed.medicationRequestPeriod ( )
}
sort by periodStart
).period
).rolloutIntervals ( )
)
union ( ( ( ( ( [MedicationRequest: "Methylphenidate"] ).isMedicationOrder ( ) ) MethylphenidateMed
return all {
period: MethylphenidateMed.medicationRequestPeriod ( ),
periodStart: start of MethylphenidateMed.medicationRequestPeriod ( )
}
sort by periodStart
).period
).rolloutIntervals ( )
)
union ( ( ( ( ( [MedicationRequest: "Guanfacine Medications"] ).isMedicationOrder ( ) ) GuanfacineMed
return all {
period: GuanfacineMed.medicationRequestPeriod ( ),
periodStart: start of GuanfacineMed.medicationRequestPeriod ( )
}
sort by periodStart
).period
).rolloutIntervals ( )
)
union ( ( ( ( ( [MedicationRequest: "methamphetamine hydrochloride 5 MG Oral Tablet"] ).isMedicationOrder ( ) ) MethamphetamineMed
return all {
period: MethamphetamineMed.medicationRequestPeriod ( ),
periodStart: start of MethamphetamineMed.medicationRequestPeriod ( )
}
sort by periodStart
).period
).rolloutIntervals ( )
)
union ( ( ( ( ( [MedicationRequest: "Viloxazine"] ).isMedicationOrder ( ) ) ViloxazineMed
return all {
period: ViloxazineMed.medicationRequestPeriod ( ),
periodStart: start of ViloxazineMed.medicationRequestPeriod ( )
}
sort by periodStart
).period
).rolloutIntervals ( )
) ) ADHDMedication
let IPSDAndContinuationMaintenancePhase: Interval["IPSD", "IPSD" + 300 days]
return all ADHDMedication
intersect IPSDAndContinuationMaintenancePhase
define "Denominator 2":
"Initial Population 2"
define "Numerator 2":
exists "Encounter During Initiation Phase"
and ( "Two or More Encounters 31 to 300 Days into Continuation and Maintenance Phase"
or ( exists "Encounter 31 to 300 Days into Continuation and Maintenance Phase" Encounter1
with "Virtual Encounter 31 to 300 Days into Continuation and Maintenance Phase" Encounter2
such that Encounter1 is not null
and Encounter2 is not null
and Encounter1 !~ Encounter2
)
)
define "Two or More Encounters 31 to 300 Days into Continuation and Maintenance Phase":
Count("Encounter 31 to 300 Days into Continuation and Maintenance Phase") >= 2
define "Encounter 31 to 300 Days into Continuation and Maintenance Phase":
( "Qualifying Numerator Encounter".isEncounterPerformed ( ) ) ValidNumeratorEncounter
where CQMCommon."ToDateInterval" ( ValidNumeratorEncounter.period ) starts during day of Interval["IPSD" + 31 days, "IPSD" + 300 days]
return date from start of ValidNumeratorEncounter.period
define "Virtual Encounter 31 to 300 Days into Continuation and Maintenance Phase":
( ( [Encounter: "Virtual Encounter"] ).isEncounterPerformed ( ) ) VirtualEnc
where CQMCommon."ToDateInterval" ( VirtualEnc.period ) starts during day of Interval["IPSD" + 31 days, "IPSD" + 300 days]
return date from start of VirtualEnc.period
define "SDE Ethnicity":
SDE."SDE Ethnicity"
define "SDE Payer":
SDE."SDE Payer"
define "SDE Race":
SDE."SDE Race"
define "SDE Sex":
SDE."SDE Sex"
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