/*
NOTE: For use by March 2026 US Realm Connectathon participants for internal use only. Not for use or distribution in commercial products.
*/
library CMS142FHIRCommWithDrManagingDiab 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.USCoreCommon version '2.0.0-ballot' called USCoreCommon
include hl7.fhir.us.cql.USCoreElements version '2.0.0-ballot' called USCoreElements
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 "SNOMEDCT": 'http://snomed.info/sct'
codesystem "ActCode": 'http://terminology.hl7.org/CodeSystem/v3-ActCode'
valueset "Care Services in Long-Term Residential Facility": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014'
valueset "Diabetic Retinopathy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.327'
valueset "Level of Severity of Retinopathy Findings": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1283'
valueset "Macular Edema Findings Present": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1320'
valueset "Macular Exam": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1251'
valueset "Medical Reason": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007'
valueset "Nursing Facility Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012'
valueset "Office Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001'
valueset "Ophthalmological Services": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1285'
valueset "Outpatient Consultation": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008'
valueset "Patient Reason": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1008'
valueset "Macular Edema Findings Absent": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.2.1391'
code "virtual": 'VR' from "ActCode" display 'virtual'
// code "Macular edema absent (situation)": '428341000124108' from "SNOMEDCT" display 'Macular edema absent (situation)'
code "AMB": 'AMB' from "ActCode" display 'Ambulatory'
parameter "Measurement Period" Interval<DateTime>
default Interval[@2026-01-01T00:00:00.000Z, @2027-01-01T00:00:00.000Z)
context Patient
define "SDE Ethnicity":
SDE."SDE Ethnicity"
define "SDE Payer":
SDE."SDE Payer"
define "SDE Race":
SDE."SDE Race"
define "SDE Sex":
SDE."SDE Sex"
define "Initial Population":
AgeInYearsAt(date from start of "Measurement Period") >= 18
and exists "Diabetic Retinopathy Encounter"
define "Denominator":
"Initial Population"
and exists "Macular Exam Performed"
define "Numerator":
exists "Level of Severity of Retinopathy Findings Communicated"
and ( exists "Macular Edema Absence Communicated"
or exists "Macular Edema Presence Communicated"
)
define "Denominator Exceptions":
exists "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy"
or exists "Medical or Patient Reason for Not Communicating Absence of Macular Edema"
or exists "Medical or Patient Reason for Not Communicating Presence of Macular Edema"
define "Qualifying Encounter During Day of Measurement Period":
( ["Encounter": "Office Visit"]
union ["Encounter": "Ophthalmological Services"]
union ["Encounter": "Outpatient Consultation"]
union ["Encounter": "Care Services in Long-Term Residential Facility"]
union ["Encounter": "Nursing Facility Visit"] ) QualifyingEncounter
where QualifyingEncounter.period during day of "Measurement Period"
and QualifyingEncounter.status = 'finished'
and QualifyingEncounter.class !~ "virtual"
define "Diabetic Retinopathy Encounter":
"Qualifying Encounter During Day of Measurement Period" ValidQualifyingEncounter
with (
// [E-13] base FHIR.Condition retrieve (defect-tracking/engine-issues.md E-13)
// Original:
// ( ["ConditionProblemsHealthConcerns": "Diabetic Retinopathy"]
// union ["ConditionEncounterDiagnosis": "Diabetic Retinopathy"] )
[FHIR.Condition: "Diabetic Retinopathy"] ) DiabeticRetinopathy
such that DiabeticRetinopathy.prevalenceInterval ( ) overlaps day of ValidQualifyingEncounter.period
and DiabeticRetinopathy.isVerified ( )
define "Macular Exam Performed":
["ObservationClinicalResult": "Macular Exam"] MacularExam
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that MacularExam.effective.toInterval ( ) during EncounterDiabeticRetinopathy.period
where MacularExam.value is not null
and MacularExam.status in { 'final', 'amended', 'corrected' }
define "Results of Dilated Macular or Fundus Exam Communicated":
exists "Level of Severity of Retinopathy Findings Communicated"
and ( exists "Macular Edema Absence Communicated"
or exists "Macular Edema Presence Communicated"
)
define "Level of Severity of Retinopathy Findings Communicated":
["Communication": category in "Level of Severity of Retinopathy Findings"] LevelOfSeverityCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that LevelOfSeverityCommunicated.sent after start of EncounterDiabeticRetinopathy.period
and LevelOfSeverityCommunicated.sent during day of "Measurement Period"
where LevelOfSeverityCommunicated.status = 'completed'
define "Macular Edema Absence Communicated":
["Communication": category in "Macular Edema Findings Absent"] MacularEdemaAbsentCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that MacularEdemaAbsentCommunicated.sent after start of EncounterDiabeticRetinopathy.period
and MacularEdemaAbsentCommunicated.sent during day of "Measurement Period"
where MacularEdemaAbsentCommunicated.status = 'completed'
define "Macular Edema Presence Communicated":
["Communication": category in "Macular Edema Findings Present"] MacularEdemaPresentCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that MacularEdemaPresentCommunicated.sent after start of EncounterDiabeticRetinopathy.period
and MacularEdemaPresentCommunicated.sent during "Measurement Period"
where MacularEdemaPresentCommunicated.status = 'completed'
define "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy":
[CommunicationNotDone: category in "Level of Severity of Retinopathy Findings"] LevelOfSeverityNotCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that LevelOfSeverityNotCommunicated.recorded () during day of EncounterDiabeticRetinopathy.period
where ( LevelOfSeverityNotCommunicated.statusReason in "Medical Reason"
or LevelOfSeverityNotCommunicated.statusReason in "Patient Reason"
)
define "Medical or Patient Reason for Not Communicating Presence of Macular Edema":
[CommunicationNotDone: category in "Macular Edema Findings Present"] MacularEdemaPresentNotCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that MacularEdemaPresentNotCommunicated.sent during day of EncounterDiabeticRetinopathy.period
where ( MacularEdemaPresentNotCommunicated.statusReason in "Medical Reason"
or MacularEdemaPresentNotCommunicated.statusReason in "Patient Reason"
)
/* Note:
below definition workaround for
https://oncprojectracking.healthit.gov/support/browse/CQLIT-371. Using value set workaround has been applied for now
but when QI Core STU 5 gets in the tool, it may be reverted back to a DRC */
define "Medical or Patient Reason for Not Communicating Absence of Macular Edema":
[CommunicationNotDone: category in "Macular Edema Findings Absent"] MacularEdemaAbsentNotCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that MacularEdemaAbsentNotCommunicated.sent during day of EncounterDiabeticRetinopathy.period
where ( MacularEdemaAbsentNotCommunicated.statusReason in "Medical Reason"
or MacularEdemaAbsentNotCommunicated.statusReason in "Patient Reason"
)
define fluent function isVerified(condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>):
condition.verificationStatus is not null implies ( condition.verificationStatus ~ Status."confirmed"
or condition.verificationStatus ~ Status."unconfirmed"
or condition.verificationStatus ~ Status."provisional"
or condition.verificationStatus ~ Status."differential"
)
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