/*
NOTE: For use by March 2026 US Realm Connectathon participants for internal use only. Not for use or distribution in commercial products.
*/
library CMS154FHIRAppropriateTxforURI 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 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
include Antibiotic version '2.1.000' called Antibiotic
codesystem "CPT": 'http://www.ama-assn.org/go/cpt'
valueset "Acute Pharyngitis": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011'
valueset "Acute Tonsillitis": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012'
valueset "Antibiotic Medications for Upper Respiratory Infection": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001'
valueset "Comorbid Conditions for Respiratory Conditions": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1025'
valueset "Competing Conditions for Respiratory Conditions": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1017'
valueset "Emergency Department Evaluation and Management Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010'
valueset "Home Healthcare Services": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016'
valueset "Medical Disability Exam": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1073'
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 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 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, 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 "Telephone Visits": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080'
valueset "Upper Respiratory Infection": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1022'
valueset "Virtual Encounter": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089'
code "Unlisted preventive medicine service": '99429' from "CPT" display 'Unlisted preventive medicine service'
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":
"Encounter with Upper Respiratory Infection" EncounterWithURI
where AgeInMonthsAt(date from start of "Measurement Period") >= 3
return EncounterWithURI
define "Encounters and Assessments with Hospice Patient":
"Initial Population" EligibleEncounters
where Hospice."Has Hospice Services"
define "Denominator":
"Initial Population"
define "Denominator Exclusions":
"Encounters and Assessments with Hospice Patient"
union Antibiotic."Encounter with Comorbid Condition History" ( "Encounter with Upper Respiratory Infection", ( [ConditionEncounterDiagnosis: "Comorbid Conditions for Respiratory Conditions"] ).verified ( ) )
union Antibiotic."Encounter with Antibiotic Medication History" ( "Encounter with Upper Respiratory Infection", ( [MedicationRequest: "Antibiotic Medications for Upper Respiratory Infection"] ).isMedicationActive ( ) )
union Antibiotic."Encounter with Competing Diagnosis History" ( "Encounter with Upper Respiratory Infection", ( [ConditionEncounterDiagnosis: "Competing Conditions for Respiratory Conditions"]
union [ConditionEncounterDiagnosis: "Acute Pharyngitis"]
union [ConditionEncounterDiagnosis: "Acute Tonsillitis"]
).verified ( ) )
define "Encounter with Upper Respiratory Infection":
from
"Qualifying Encounters" QualifyingEncounters,
( ( [ConditionEncounterDiagnosis: "Upper Respiratory Infection"] ).verified ( ) ) URI
where URI.prevalenceInterval ( ) starts during day of QualifyingEncounters.period
or URI.prevalenceInterval ( ) overlaps before QualifyingEncounters.period
return QualifyingEncounters
define "Qualifying Encounters":
( ( [Encounter: "Emergency Department Evaluation and Management Visit"]
union [Encounter: "Home Healthcare Services"]
union [Encounter: "Medical Disability Exam"]
union [Encounter: "Office Visit"]
union [Encounter: "Outpatient Consultation"]
union [Encounter: "Preventive Care Services Group Counseling"]
union [Encounter: "Preventive Care Services Individual Counseling"]
union [Encounter: "Preventive Care Services, Initial Office Visit, 0 to 17"]
union [Encounter: "Preventive Care, Established Office Visit, 0 to 17"]
union [Encounter: "Preventive Care Services Established Office Visit, 18 and Up"]
union [Encounter: "Preventive Care Services Initial Office Visit, 18 and Up"]
union [Encounter: "Telephone Visits"]
union [Encounter: "Virtual Encounter"]
union ( [Encounter] E
where exists ( ( E.type ) T
where T ~ "Unlisted preventive medicine service"
)
)
).isEncounterPerformed ( ) ) ValidEncounter
where ValidEncounter.period ends during day of Interval[( start of "Measurement Period" ), ( end of "Measurement Period" ) - 3 days]
define "Numerator":
"Encounter with Upper Respiratory Infection" EncounterWithURI
without ( ( [MedicationRequest: "Antibiotic Medications for Upper Respiratory Infection"] ).isMedicationOrder ( ) ) OrderedAntibiotic
such that OrderedAntibiotic.authoredOn 3 days or less on or after start of EncounterWithURI.period
return EncounterWithURI
define "Stratification 1":
"Encounter with Upper Respiratory Infection" EncounterWithURI
where AgeInMonthsAt(date from start of "Measurement Period") >= 3
and AgeInYearsAt(date from start of "Measurement Period") <= 17
return EncounterWithURI
define "Stratification 2":
"Encounter with Upper Respiratory Infection" EncounterWithURI
where AgeInYearsAt(date from start of "Measurement Period") in Interval[18, 64]
return EncounterWithURI
define "Stratification 3":
"Encounter with Upper Respiratory Infection" EncounterWithURI
where AgeInYearsAt(date from start of "Measurement Period") >= 65
return EncounterWithURI
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