/*
NOTE: For use by March 2026 US Realm Connectathon participants for internal use only. Not for use or distribution in commercial products.
*/
library CMS153FHIRChlamydiaScreening 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 "LOINC": 'http://loinc.org'
codesystem "SNOMEDCT": 'http://snomed.info/sct'
valueset "Chlamydia Screening": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1052'
valueset "Complications of Pregnancy, Childbirth and the Puerperium": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.111.12.1012'
valueset "Contraceptive Medications": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1080'
valueset "Diagnoses Used to Indicate Sexual Activity": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.111.12.1018'
valueset "Diagnostic Studies During Pregnancy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.111.12.1008'
valueset "HIV": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003'
valueset "Home Healthcare Services": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016'
valueset "Isotretinoin": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1143'
valueset "Lab Tests During Pregnancy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.111.12.1007'
valueset "Lab Tests for Sexually Transmitted Infections": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1051'
valueset "Office Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001'
valueset "Virtual Encounter": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089'
valueset "Pap Test": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1017'
valueset "Pregnancy Test": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.111.12.1011'
valueset "Preventive Care Services Established Office Visit, 18 and Up": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025'
valueset "Preventive Care Services Initial Office Visit, 18 and Up": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023'
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 "Procedures Used to Indicate Sexual Activity": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.111.12.1017'
valueset "Telephone Visits": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080'
valueset "XRay Study": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1034'
code "Female (finding)": '248152002' from "SNOMEDCT" display 'Female (finding)'
code "Have you ever had vaginal intercourse [PhenX]": '64728-9' from "LOINC" display 'Have you ever had vaginal intercourse [PhenX]'
code "Yes (qualifier value)": '373066001' from "SNOMEDCT" display 'Yes (qualifier value)'
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
end of "Measurement Period"
) in Interval[16, 24]
and Patient.sex ( ) = '248152002'
and exists ( "Qualifying Encounters" )
and ( ( "Has Assessments Identifying Sexual Activity" )
or ( "Has Diagnoses Identifying Sexual Activity" )
or ( "Has Active Contraceptive Medications" )
or ( "Has Ordered Contraceptive Medications" )
or ( "Has Laboratory Tests Identifying Sexual Activity" )
or ( "Has Diagnostic Studies Identifying Sexual Activity" )
or ( "Has Procedures Identifying Sexual Activity" )
)
define "Qualifying Encounters":
( ( [Encounter: "Office 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: "Preventive Care Services, Initial Office Visit, 0 to 17"]
union [Encounter: "Preventive Care, Established Office Visit, 0 to 17"]
union [Encounter: "Home Healthcare Services"]
union [Encounter: "Telephone Visits"]
union [Encounter: "Virtual Encounter"]
).isEncounterPerformed ( ) ) ValidEncounters
where ValidEncounters.period during day of "Measurement Period"
define "Has Diagnoses Identifying Sexual Activity":
// [E-13] base FHIR.Condition retrieve (defect-tracking/engine-issues.md E-13)
// Original:
// [ConditionEncounterDiagnosis: "Diagnoses Used to Indicate Sexual Activity"]
// union [ConditionProblemsHealthConcerns: "Diagnoses Used to Indicate Sexual Activity"]
// union [ConditionEncounterDiagnosis: "HIV"]
// union [ConditionProblemsHealthConcerns: "HIV"]
// union [ConditionEncounterDiagnosis: "Complications of Pregnancy, Childbirth and the Puerperium"]
// union [ConditionProblemsHealthConcerns: "Complications of Pregnancy, Childbirth and the Puerperium"]
exists ( ( ( [FHIR.Condition: "Diagnoses Used to Indicate Sexual Activity"]
union [FHIR.Condition: "HIV"]
union [FHIR.Condition: "Complications of Pregnancy, Childbirth and the Puerperium"]
).verified ( ) ) SexualActivityDiagnosis
where SexualActivityDiagnosis.prevalenceInterval ( ) overlaps "Measurement Period"
)
define "Has Active Contraceptive Medications":
exists ( ( [MedicationRequest: "Contraceptive Medications"] ).isMedicationActive ( ) ) ActiveContraceptives
where ActiveContraceptives.medicationRequestPeriod ( ) overlaps "Measurement Period"
define "Has Ordered Contraceptive Medications":
exists ( ( [MedicationRequest: "Contraceptive Medications"] ).isMedicationOrder ( ) ) OrderedContraceptives
where OrderedContraceptives.authoredOn.toInterval ( ) during day of "Measurement Period"
define "Has Laboratory Tests Identifying Sexual Activity But Not Pregnancy":
exists ( ( [ServiceRequest: "Pap Test"]
union [ServiceRequest: "Lab Tests During Pregnancy"]
union [ServiceRequest: "Lab Tests for Sexually Transmitted Infections"]
).isLaboratoryTestOrder ( ) ) LabOrders
where LabOrders.authoredOn.toInterval ( ) during day of "Measurement Period"
define "Has Laboratory Tests Identifying Sexual Activity":
exists ( ( ( [ServiceRequest: "Pregnancy Test"] ).isLaboratoryTestOrder ( ) ) PregnancyTest
where PregnancyTest.authoredOn.toInterval ( ) during day of "Measurement Period"
)
or "Has Laboratory Tests Identifying Sexual Activity But Not Pregnancy"
define "Has Diagnostic Studies Identifying Sexual Activity":
exists ( ( [ServiceRequest: "Diagnostic Studies During Pregnancy"] ).isDiagnosticStudyOrder ( ) ) SexualActivityDiagnostics
where SexualActivityDiagnostics.authoredOn.toInterval ( ) during day of "Measurement Period"
define "Has Procedures Identifying Sexual Activity":
exists ( ( [Procedure: "Procedures Used to Indicate Sexual Activity"] ).isProcedurePerformed ( ) ) ProceduresForSexualActivity
where ProceduresForSexualActivity.performed.toInterval ( ) during day of "Measurement Period"
define "Denominator":
"Initial Population"
define "Denominator Exclusions":
Hospice."Has Hospice Services"
or ( ( "Has Pregnancy Test Exclusion" )
and not ( "Has Assessments Identifying Sexual Activity" )
and not ( "Has Diagnoses Identifying Sexual Activity" )
and not ( "Has Active Contraceptive Medications" )
and not ( "Has Ordered Contraceptive Medications" )
and not ( "Has Laboratory Tests Identifying Sexual Activity But Not Pregnancy" )
and not ( "Has Diagnostic Studies Identifying Sexual Activity" )
and not ( "Has Procedures Identifying Sexual Activity" )
)
define "Has Pregnancy Test Exclusion":
exists ( ( ( ( [ServiceRequest: "Pregnancy Test"] ).isLaboratoryTestOrder ( ) ) PregnancyTest
with ( ( [ServiceRequest: "XRay Study"] ).isDiagnosticStudyOrder ( ) ) XrayOrder
such that XrayOrder.authoredOn.toInterval ( ) occurs 6 days or less on or after day of PregnancyTest.authoredOn.toInterval ( )
where PregnancyTest.authoredOn.toInterval ( ) during "Measurement Period"
)
union ( ( [ServiceRequest: "Pregnancy Test"] ).isLaboratoryTestOrder ( ) ) PregnancyTestOrder
with ( ( [MedicationRequest: "Isotretinoin"] ).isMedicationOrder ( ) ) AccutaneOrder
such that AccutaneOrder.authoredOn.toInterval ( ) occurs 6 days or less on or after day of PregnancyTestOrder.authoredOn.toInterval ( )
where PregnancyTestOrder.authoredOn.toInterval ( ) during "Measurement Period"
)
define "Numerator":
exists ( ( ( [LaboratoryResultObservation: "Chlamydia Screening"] ).isLaboratoryTestPerformed ( ) ) ChlamydiaTest
where ChlamydiaTest.effective.latest ( ) during day of "Measurement Period"
and ChlamydiaTest.value is not null
)
define "Stratification 1":
AgeInYearsAt(date from
end of "Measurement Period"
) in Interval[16, 20]
define "Stratification 2":
AgeInYearsAt(date from
end of "Measurement Period"
) in Interval[21, 24]
define "Has Assessments Identifying Sexual Activity":
exists ( ( ( [ObservationScreeningAssessment: "Have you ever had vaginal intercourse [PhenX]"] ).isAssessmentPerformed ( ) ) SexualActivityAssessment
where SexualActivityAssessment.value ~ "Yes (qualifier value)"
and SexualActivityAssessment.effective.toInterval ( ) on or before end of "Measurement Period"
)
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