/*
NOTE: For use by March 2026 US Realm Connectathon participants for internal use only. Not for use or distribution in commercial products.
*/
library CMS69FHIRPCSBMIScreenAndFollowUp 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 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 Hospice version '7.1.000' called Hospice
include PalliativeCare version '2.1.000' called PalliativeCare
codesystem "ActCode": 'http://terminology.hl7.org/CodeSystem/v3-ActCode'
codesystem "ICD10CM": 'http://hl7.org/fhir/sid/icd-10-cm'
codesystem "LOINC": 'http://loinc.org'
codesystem "ObservationCategoryCodes": 'http://terminology.hl7.org/CodeSystem/observation-category'
valueset "Encounter to Evaluate BMI": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1751'
valueset "Follow Up for Above Normal BMI": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1525'
valueset "Follow Up for Below Normal BMI": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1528'
valueset "Medical Reason": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007'
valueset "Medications for Above Normal BMI": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1561'
valueset "Medications for Below Normal BMI": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1562'
valueset "Overweight or Obese": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1047.502'
valueset "Patient Declined": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1582'
valueset "Pregnancy or Other Related Diagnoses": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1623'
valueset "Referrals Where Weight Assessment May Occur": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1527'
valueset "Underweight": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1563'
code "Body mass index (BMI) [Ratio]": '39156-5' from "LOINC" display 'Body mass index (BMI) [Ratio]'
code "virtual": 'VR' from "ActCode" display 'virtual'
parameter "Measurement Period" Interval<DateTime>
default Interval[@2026-01-01T00:00:00.000Z, @2027-01-01T00:00:00.000Z)
context Patient
define "Initial Population":
exists "Qualifying Encounter During Day Of Measurement Period" QualifyingEncounter
where "AgeInYearsAt"(date from start of QualifyingEncounter.period) >= 18
define "Denominator":
"Initial Population"
define "Denominator Exclusions":
Hospice."Has Hospice Services"
or PalliativeCare."Has Palliative Care in the Measurement Period"
or "Is Pregnant During Measurement Period"
define "Numerator":
exists "High BMI And Follow Up Provided"
or exists "Low BMI And Follow Up Provided"
or "Has Normal BMI"
define "Denominator Exceptions":
exists "Medical Reason For Not Documenting A Follow Up Plan For Low Or High BMI"
or exists "Medical Reason Or Patient Reason For Not Performing BMI Exam"
define "BMI During Measurement Period":
( ( [USCore.BMIProfile] ).isObservationBMI ( ) ) BMI
where BMI.value > 0 'kg/m2'
and BMI.effective.toInterval ( ) during day of "Measurement Period"
define "Documented Low BMI During Measurement Period":
"BMI During Measurement Period" BMI
where BMI.value < 18.5 'kg/m2'
define "Documented High BMI During Measurement Period":
"BMI During Measurement Period" BMI
where BMI.value >= 25 'kg/m2'
define "Has Normal BMI":
exists ( "BMI During Measurement Period" BMI
where BMI.value >= 18.5 'kg/m2'
and BMI.value < 25 'kg/m2'
)
and not ( exists "Documented High BMI During Measurement Period"
or exists "Documented Low BMI During Measurement Period"
)
define "High BMI And Follow Up Provided":
"Documented High BMI During Measurement Period" HighBMI
with ( "High BMI Interventions Ordered"
union "High BMI Interventions Performed" ) HighBMIInterventions
such that Coalesce(HighBMIInterventions.performed.toInterval(), HighBMIInterventions.authoredOn.toInterval()) starts during day of "Measurement Period"
define "High BMI Interventions Ordered":
( ( [ServiceRequest: "Follow Up for Above Normal BMI"]
union [ServiceRequest: "Referrals Where Weight Assessment May Occur"]
union [MedicationRequest: "Medications for Above Normal BMI"] ) HighInterventionsOrdered
where HighInterventionsOrdered.reasonCode in "Overweight or Obese"
or ( // [E-13] base FHIR.Condition retrieve (defect-tracking/engine-issues.md E-13)
// Original:
// exists ( [ConditionProblemsHealthConcerns: "Overweight or Obese"]
// union [ConditionEncounterDiagnosis: "Overweight or Obese"] ) OverweightObese
exists ( [FHIR.Condition: "Overweight or Obese"] ) OverweightObese
where OverweightObese.prevalenceInterval ( ) starts before or on day of HighInterventionsOrdered.authoredOn
)
)
define "High BMI Interventions Performed":
( [Procedure: "Follow Up for Above Normal BMI"] HighInterventionsPerformed
where HighInterventionsPerformed.reasonCode in "Overweight or Obese"
or ( exists [ConditionProblemsHealthConcerns: "Overweight or Obese"] OverweightObese
where OverweightObese.prevalenceInterval ( ) starts before or on day of start of HighInterventionsPerformed.performed.toInterval ( )
and not ( OverweightObese.prevalenceInterval ( ) ends before day of start of HighInterventionsPerformed.performed.toInterval ( ) )
)
)
define "Medical Reason Or Patient Reason For Not Performing BMI Exam":
[ObservationCancelled: "Body mass index (BMI) [Ratio]"] NoBMI
with "Qualifying Encounter During Day Of Measurement Period" QualifyingEncounter
such that NoBMI.effective.toInterval ( ) ends same day as start of QualifyingEncounter.period
where ( NoBMI.notDoneReason ( ) in "Patient Declined"
or NoBMI.notDoneReason ( ) in "Medical Reason"
)
define "Low BMI Interventions Ordered":
( ( [ServiceRequest: "Follow Up for Below Normal BMI"]
union [ServiceRequest: "Referrals Where Weight Assessment May Occur"]
union [MedicationRequest: "Medications for Below Normal BMI"] ) LowInterventionsOrdered
where LowInterventionsOrdered.reasonCode in "Underweight"
or ( // [E-13] base FHIR.Condition retrieve (defect-tracking/engine-issues.md E-13)
// Original:
// exists ( [ConditionProblemsHealthConcerns: "Underweight"]
// union [ConditionEncounterDiagnosis: "Underweight"] ) UnderweightDiagnosis
exists ( [FHIR.Condition: "Underweight"] ) UnderweightDiagnosis
where UnderweightDiagnosis.prevalenceInterval ( ) starts before or on day of LowInterventionsOrdered.authoredOn
and LowInterventionsOrdered.authoredOn during day of "Measurement Period"
)
)
define "Low BMI Interventions Performed":
( [Procedure: "Follow Up for Below Normal BMI"] LowInterventionsPerformed
where LowInterventionsPerformed.reasonCode in "Underweight"
and LowInterventionsPerformed.status = 'completed'
or ( exists [ConditionProblemsHealthConcerns: "Underweight"] UnderweightDiagnosis
where ( UnderweightDiagnosis.isHealthConcern ( ) )
and UnderweightDiagnosis.prevalenceInterval ( ) starts before or on day of start of LowInterventionsPerformed.performed.toInterval ( )
and LowInterventionsPerformed.performed.toInterval ( ) during day of "Measurement Period"
and not ( UnderweightDiagnosis.prevalenceInterval ( ) ends before day of start of LowInterventionsPerformed.performed.toInterval ( ) )
)
)
define "Low BMI And Follow Up Provided":
( "Documented Low BMI During Measurement Period" LowBMI
with ( "Low BMI Interventions Ordered"
union "Low BMI Interventions Performed" ) LowBMIInterventions
such that Coalesce(LowBMIInterventions.performed.toInterval(), LowBMIInterventions.authoredOn.toInterval()) starts during day of "Measurement Period"
)
define "Medical Reason For Not Documenting A Follow Up Plan For Low Or High BMI":
( ( [ServiceNotRequested: "Referrals Where Weight Assessment May Occur"]
union [ServiceNotRequested: "Follow Up for Above Normal BMI"]
union [ServiceNotRequested: "Follow Up for Below Normal BMI"] ) NoBMIFollowUp
with "Qualifying Encounter During Day Of Measurement Period" QualifyingEncounter
such that NoBMIFollowUp.authoredOn same day as start of QualifyingEncounter.period
where NoBMIFollowUp.status ~ 'completed'
and NoBMIFollowUp.reasonRefused ( ) in "Medical Reason"
)
union ( ( [MedicationNotRequested: "Medications for Above Normal BMI"]
union [MedicationNotRequested: "Medications for Below Normal BMI"] ) NoBMIFollowUp
with "Qualifying Encounter During Day Of Measurement Period" QualifyingEncounter
such that NoBMIFollowUp.authoredOn same day as start of QualifyingEncounter.period
where NoBMIFollowUp.status ~ 'completed'
and NoBMIFollowUp.reasonCode in "Medical Reason"
)
define "Is Pregnant During Measurement Period":
exists ( // [E-13] base FHIR.Condition retrieve (defect-tracking/engine-issues.md E-13)
// Original:
// [ConditionProblemsHealthConcerns: "Pregnancy or Other Related Diagnoses"]
// union [ConditionEncounterDiagnosis: "Pregnancy or Other Related Diagnoses"]
[FHIR.Condition: "Pregnancy or Other Related Diagnoses"] PregnancyDiagnosis
where PregnancyDiagnosis.prevalenceInterval ( ) overlaps day of "Measurement Period"
)
or exists ( [USCore.ObservationPregnancyStatusProfile] PregnantObservation
where PregnantObservation.effective.toInterval ( ) overlaps day of "Measurement Period"
and PregnantObservation.status in { 'final', 'amended', 'corrected' }
and ( PregnantObservation.value in "Pregnancy or Other Related Diagnoses" )
)
define "Qualifying Encounter During Day Of Measurement Period":
[Encounter: "Encounter to Evaluate BMI"] BMIEncounter
where BMIEncounter.period during day of "Measurement Period"
and BMIEncounter.class !~ "virtual"
and BMIEncounter.status = 'finished'
define "SDE Ethnicity":
SDE."SDE Ethnicity"
define "SDE Payer":
SDE."SDE Payer"
define "SDE Race":
SDE."SDE Race"
define "SDE Sex":
SDE."SDE Sex"
|