# Controlling High Blood PressureFHIR - Draft dQM CMS Content Implementation Guide v2025.1.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **Controlling High Blood PressureFHIR**

## Measure: Controlling High Blood PressureFHIR 

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| *Official URL*:https://madie.cms.gov/Measure/CMS165FHIRControllingHighBP | *Version*:1.1.000 | |
| Active as of 2026-01-16 | *Responsible:*[National Committee for Quality Assurance](https://www.ncqa.org/) | *Computable Name*:CMS165FHIRControllingHighBP |
| *Other Identifiers:*Short Name: CMS165FHIR (use: usual, ), UUID:9017d914-6748-45a9-bff1-8392ed644a7b (use: official, ), UUID:6f830f33-ed81-4f34-ba8e-97f3810563bd (use: official, ), Publisher: 165FHIR (use: official, ) | | |
| **Copyright/Legal**: This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties or endorsements about the quality of any product, test or protocol identified as numerator compliant or otherwise identified as meeting the requirements of the measure or specification. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure may be used for internal, noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. All other uses, including a commercial use (including but not limited to vendors using or embedding the measures and specifications into any product or service to calculate measure results for customers for any purpose), must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2025 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications. CPT(R) codes, descriptions and other data are copyright 2025. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use. Some measure specifications contain coding from LOINC(R) (https://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2025 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at https://loinc.org/kb/license/. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2025 World Health Organization. All Rights Reserved. Some measures use RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the measures and does not endorse or recommend this or any other product. “HL7” is the registered trademark of Health Level Seven International. | | |

 
Percentage of patients 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (<140/90 mmHg) during the measurement period 

* Metadata: Title
  * ?: Controlling High Blood PressureFHIR
* Metadata: Version
  * ?: 1.1.000
* Metadata: Short Name
  * ?: CMS165FHIR
* Metadata: GUID (Version Independent)
  * ?: urn:uuid:9017d914-6748-45a9-bff1-8392ed644a7b
* Metadata: GUID (Version Specific)
  * ?: urn:uuid:6f830f33-ed81-4f34-ba8e-97f3810563bd
* Metadata: CMS Identifier
  * ?: 165FHIR
* Metadata: Effective Period
  * ?: 2026-01-01 through 2026-12-31
* Metadata: Steward (Publisher)
  * ?: National Committee for Quality Assurance
* Metadata: Developer
  * ?: National Committee for Quality Assurance
* Metadata: Description
  * ?: Percentage of patients 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (<140/90 mmHg) during the measurement period
* Metadata: Copyright
  * ?: This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties or endorsements about the quality of any product, test or protocol identified as numerator compliant or otherwise identified as meeting the requirements of the measure or specification. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure may be used for internal, noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. All other uses, including a commercial use (including but not limited to vendors using or embedding the measures and specifications into any product or service to calculate measure results for customers for any purpose), must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2025 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications. CPT(R) codes, descriptions and other data are copyright 2025. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use. Some measure specifications contain coding from LOINC(R) (https://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2025 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at https://loinc.org/kb/license/. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2025 World Health Organization. All Rights Reserved. Some measures use RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the measures and does not endorse or recommend this or any other product. “HL7” is the registered trademark of Health Level Seven International.
* Metadata: Disclaimer
  * ?: The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
* Metadata: Rationale
  * ?: High blood pressure (HBP), also known as hypertension, is when the pressure in blood vessels is higher than normal (Centers for Disease Control and Prevention [CDC], 2023). The causes of hypertension are multiple and multifaceted and can be based on genetic predisposition, environmental risk factors, being overweight and obese, sodium intake, potassium intake, physical activity, and alcohol use. High blood pressure is common; according to the American Heart Association, between 2013-2016, approximately 121.5 million US adults >= 20 years of age had HBP and the prevalence of hypertension among US adults 65 and older was 77.0 percent (Virani et al., 2021). In an analysis of adults with hypertension in National Health and Nutrition Examination Survey (NHANES), the estimated age-adjusted proportion with controlled blood pressure (BP) increased from 31.8 percent in 1999 to 53.8 percent in 2014. However, that proportion declined to 43.7 percent in 2017 to 2018 (Tsao et al., 2022). HBP increases risks of heart disease and stroke which are two of the leading causes of death in the US (CDC, 2023). A person who has HBP is four times more likely to die from a stroke and three times more likely to die from heart disease (CDC, 2021). The National Center for Health Statistics reported that in 2020 there were over 670,000 deaths with HBP as a primary or contributing cause (CDC, 2022). Between 2009 and 2019 the number of deaths due to HBP rose by 65.3 percent (Tsao et al., 2022). Managing and treating HBP would reduce cardiovascular disease mortality for males and females by 30.4 percent and 38.0 percent, respectively (Patel et al., 2015). Age-adjusted death rates attributable to HBP in 2019 were more than twice as high in non-Hispanic Black males (56.7 percent) when compared to rates for non-Hispanic White males (25.7 percent) (Tsao et al., 2022). HBP costs the U.S. approximately 131 billion dollars each year, averaged over 12 years from 2003 to 2014 (Kirkland et al., 2018). A study on cost-effectiveness on treating hypertension found that controlling HBP in patients with cardiovascular disease and systolic blood pressures (SBP) of >= 160 mmHg could be effective and cost-saving (Moran et al., 2015). Many studies have shown that controlling high blood pressure reduces cardiovascular events and mortality. The Systolic Blood Pressure Intervention Trial (SPRINT) investigated the impact of obtaining a SBP goal of <120 mmHg compared to a SBP goal of <140 mmHg among patients 50 and older with established cardiovascular disease and found that the patients with the former goal had reduced cardiovascular events and mortality (SPRINT Research Group et al., 2015). Controlling HBP will significantly reduce the risks of cardiovascular disease mortality and lead to better health outcomes like reduction of heart attacks, stroke, and kidney disease (James et al., 2014). Thus, the relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established.
* Metadata: Clinical Recommendation Statement
  * ?: U.S. Preventive Services Task Force (USPSTF) (2021): - The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. This is a grade A recommendation. American College of Cardiology/American Heart Association (2017): - For adults with confirmed hypertension and known cardiovascular disease (CVD) or 10-year atherosclerotic cardiovascular disease (ASCVD) event risk of 10 percent or higher, a blood pressure target of less than 130/80 mmHg is recommended (Level of evidence: B-R (for systolic blood pressures), Level of evidence: C-EO (for diastolic blood pressure)) - For adults with confirmed hypertension, without additional markers of increased CVD risk, a blood pressure target of less than 130/80 mmHg may be reasonable (Note: clinical trial evidence is strongest for a target blood pressure of 140/90 mmHg in this population. However, observational studies suggest that these individuals often have a high lifetime risk and would benefit from blood pressure control earlier in life) (Level of evidence: B-NR (for systolic blood pressure), Level of evidence: C-EO (for diastolic blood pressure)). American Academy of Family Physicians (2022): - Treat adults who have hypertension to a standard blood pressure target (less than 140/90 mm Hg) to reduce the risk of all-cause and cardiovascular mortality (strong recommendation; high-quality evidence). Treating to a lower blood pressure target (less than 135/85 mm Hg) does not provide additional benefit at preventing mortality; however, a lower blood pressure target could be considered based on patient preferences and values. (Grade: strong recommendation, Quality of evidence: high) - Consider treating adults who have hypertension to a lower blood pressure target (less than 135/85 mm Hg) to reduce risk of myocardial infarction (weak recommendation; moderate-quality evidence). Although treatment to a standard blood pressure target (less than 140/90 mm Hg) reduced the risk of myocardial infarction, there was a small additional benefit observed with a lower blood pressure target. There was no observed additional benefit in preventing stroke with the lower blood pressure target. (Grade: weak recommendation, Quality of evidence: low) American Diabetes Association (2022): - For individuals with diabetes and hypertension at higher cardiovascular risk (existing atherosclerotic cardiovascular disease or 10-year atherosclerotic cardiovascular disease risk >=15 percent), a blood pressure target of <130/80 mmHg may be appropriate, if it can be safely attained (Level of evidence: B) - For individuals with diabetes and hypertension at lower risk for cardiovascular disease (10-year atherosclerotic cardiovascular disease risk <15 percent), treat to a blood pressure target of <140/90 mmHg (Level of evidence: A)
* Metadata: Citation
  * ?: American Diabetes Association. (2022). 10. Cardiovascular disease and risk management: Standards of medical care in diabetes—2022. Diabetes Care 2022, 44(Suppl. 1), S144-S175. https://doi.org/10.2337/dc22-S010
* Metadata: Citation
  * ?: Centers for Disease Control and Prevention, National Center for Health Statistics. (2022). About Multiple Cause of Death, 1999–2020. CDC WONDER Online Database website. Atlanta, GA: Centers for Disease Control and Prevention. Available from http://www.cdc.gov/nchs/data_access/Vitalstatsonline.htm#Mortality_Multiple
* Metadata: Citation
  * ?: Centers for Disease Control and Prevention. (2021). Team-based care for high blood pressure. Retrieved from https://www.cdc.gov/policy/polaris/healthtopics/highbloodpressure/tbctool.html
* Metadata: Citation
  * ?: Centers for Disease Control and Prevention. (2023). Facts about hypertension. Retrieved from https://www.cdc.gov/bloodpressure/facts.htm
* Metadata: Citation
  * ?: Coles, S., Fisher, L., Lin, K. W., Lyon, C., Vosooney, A. A., & Bird, M. D. (2022). Blood Pressure Targets in Adults With Hypertension: A Clinical Practice Guideline From the AAFP. American family physician, 106(6). Retrieved from https://www.aafp.org/pubs/afp/issues/2022/1200/practice-guidelines-aafp-hypertension-full-guideline.html
* Metadata: Citation
  * ?: James, P.A., Oparil, S., Carter, B.L., et al. (2014). 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. doi: 10.1001/jama.2013.284427
* Metadata: Citation
  * ?: Kirkland, E. B., Heincelman, M., Bishu, K. G., Schumann, S. O., Schreiner, A., Axon, R. N.,...Moran, W. P. (2018). Trends in Healthcare Expenditures Among US Adults With Hypertension: National Estimates, 2003–2014. Journal of the American Heart Association, 7(11), e008731. https://doi.org/10.1161/JAHA.118.008731
* Metadata: Citation
  * ?: Moran, A. E., Odden, M. C., Thanataveerat, A., et al. (2015). Cost-effectiveness of hypertension therapy according to 2014 guidelines. [published correction appears in N Engl J. Med. 2015;372:1677]. New England Journal of Medicine. 2015;372, 447-455. doi: 10.1056/NEJMsa1406751. [published correction appears on page 1677]
* Metadata: Citation
  * ?: Patel, S. A., Winkel, M., Ali, M. K., et al. (2015). Cardiovascular mortality associated with 5 leading risk factors: National and state preventable fractions estimated from survey data. Annals of Internal Medicine, 163(4), 245-253. doi: 10.7326/M14-1753
* Metadata: Citation
  * ?: Qaseem, A., Wilt, T. J., Rich, R., et al. (2017). Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Annals of Internal Medicine, 166(6), 430-437. Retrieved from https://annals.org/aim/fullarticle/2598413/pharmacologic-treatment-hypertension-adults-aged-60-years-older-higher-versus
* Metadata: Citation
  * ?: SPRINT Research Group, Wright, J. T., Jr., Williamson, J. D., et al. (2015). A randomized trial of intensive versus standard blood-pressure control. New England Journal of Medicine, 373(22), 2103–2116.
* Metadata: Citation
  * ?: Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Alonso, A., Beaton, A. Z., Bittencourt, M. S.,...Kissela, B. M. (2022). Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association. Circulation, 145(8), e153–e639. https://doi.org/10.1161/CIR.0000000000001052
* Metadata: Citation
  * ?: U.S. Preventive Services Task Force. Screening for hypertension in adults: U.S. Preventive Services Task Force reaffirmation recommendation statement. JAMA, 325(16), 1650. Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hypertension-in-adults-screening
* Metadata: Citation
  * ?: Virani, S.S., Alonso, A., Aparicio, H.J., et al.; on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2021). Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation. 2021;143:e254–e743. doi: 10.1161/CIR.0000000000000950
* Metadata: Citation
  * ?: Whelton, P. K., Carey, R. M., Aronow, W. S., et al. (2017). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. Hypertension. 71(6). https://doi.org/10.1161/HYP.0000000000000065
* Metadata: Guidance (Usage)
  * ?: In reference to the numerator element, only blood pressure readings performed by a clinician or an automated blood pressure monitor or device are acceptable for numerator compliance with this measure. This includes blood pressures taken in person by a clinician and blood pressures measured remotely by electronic monitoring devices capable of transmitting the blood pressure data to the clinician. Blood pressure readings taken by an automated blood pressure monitor or device and conveyed by the patient to the clinician are also acceptable. It is the clinician’s responsibility and discretion to confirm the automated blood pressure monitor or device used to obtain the blood pressure is considered acceptable and reliable and whether the blood pressure reading is considered accurate before documenting it in the patient’s medical record. Do not include BP readings taken during an acute inpatient stay or an emergency department (ED) visit. If no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed "not controlled". If there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading. Ranges and thresholds do not meet criteria for this measure. A distinct numeric result for both the systolic and diastolic BP reading is required for numerator compliance. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS165v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6. (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).
* Metadata: Measure Group (Rate) (ID: Group_1)
* Metadata: Basis
  * ?: boolean
* Metadata: Scoring
  * ?: Proportion
* Metadata: Improvement Notation
  * ?: Increased score indicates improvement
* Metadata: Type
  * ?: Intermediate Outcome
* Metadata: Rate Aggregation
  * ?: None
* Metadata: Initial Population
  * ?: **ID**: InitialPopulation_1**Description**:Patients 18-85 years of age by the end of the measurement period who had a visit during the measurement period and diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period**Criteria**:[Initial Population](#Group_1-InitialPopulation_1)
* Metadata: Denominator
  * ?: **ID**: Denominator_1**Description**:Equals Initial Population**Criteria**:[Denominator](#Group_1-Denominator_1)
* Metadata: Denominator Exclusion
  * ?: **ID**: DenominatorExclusion_1**Description**:Exclude patients who are in hospice care for any part of the measurement period. Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period. Exclude patients 66-80 by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness diagnosis during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients 81 and older by the end of the measurement period with an indication of frailty for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients receiving palliative care for any part of the measurement period.**Criteria**:[Denominator Exclusions](#Group_1-DenominatorExclusion_1)
* Metadata: Numerator
  * ?: **ID**: Numerator_1**Description**:Patients whose most recent blood pressure is adequately controlled (systolic blood pressure &lt; 140 mmHg and diastolic blood pressure &lt; 90 mmHg) during the measurement period**Criteria**:[Numerator](#Group_1-Numerator_1)
* Metadata: Supplemental Data Guidance Guidance
  * ?: For every patient evaluated by this measure also identify payer, race, ethnicity and sex
* Metadata: Supplemental Data Elements
* Metadata: Supplemental Data Element
  * ?: **ID**: sde-sex**Usage Code**:Supplemental Data**Description**: SDE Sex**Logic Definition**:[SDE Sex](#cms165fhircontrollinghighbp-sde-sex)
* Metadata: Supplemental Data Element
  * ?: **ID**: sde-race**Usage Code**:Supplemental Data**Description**: SDE Race**Logic Definition**:[SDE Race](#cms165fhircontrollinghighbp-sde-race)
* Metadata: Supplemental Data Element
  * ?: **ID**: sde-payer**Usage Code**:Supplemental Data**Description**: SDE Payer**Logic Definition**:[SDE Payer](#cms165fhircontrollinghighbp-sde-payer)
* Metadata: Supplemental Data Element
  * ?: **ID**: sde-ethnicity**Usage Code**:Supplemental Data**Description**: SDE Ethnicity**Logic Definition**:[SDE Ethnicity](#cms165fhircontrollinghighbp-sde-ethnicity)
* Metadata: Measure Logic
* Metadata: Primary Library
  * ?: [CMS165FHIRControllingHighBP](Library-CMS165FHIRControllingHighBP.md)
* Metadata: Contents
  * ?: **[Population Criteria](#population-criteria)****[Logic Definitions](#definitions)****[Terminology](#terminology)****[Dependencies](#dependencies)****[Data Requirements](#data-requirements)****[Parameters](#parameters)**
* Metadata:  Population Criteria
* Metadata: Measure Group (Rate) (ID: Group_1)
* Metadata: Initial Population
* Metadata:  ````define "Initial Population": AgeInYearsAt(date from end of "Measurement Period" ) in Interval[18, 85] and exists "Essential Hypertension Diagnosis" and exists AdultOutpatientEncounters."Qualifying Encounters"````[**Definition**](#cms165fhircontrollinghighbp-initial-population)
* Metadata: Denominator
* Metadata:  ````define "Denominator": "Initial Population"````[**Definition**](#cms165fhircontrollinghighbp-denominator)
* Metadata: Denominator Exclusion
* Metadata:  ````define "Denominator Exclusions": Hospice."Has Hospice Services" or exists ( "Pregnancy or Renal Diagnosis" ) or exists ( "End Stage Renal Disease Procedures" ) or exists ( "End Stage Renal Disease Encounter" ) or AIFrailLTCF."Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty" or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home" or PalliativeCare."Has Palliative Care in the Measurement Period"````[**Definition**](#cms165fhircontrollinghighbp-denominator-exclusions)
* Metadata: Numerator
* Metadata:  ````define "Numerator": "Has Systolic Blood Pressure Less Than 140" and "Has Diastolic Blood Pressure Less Than 90"````[**Definition**](#cms165fhircontrollinghighbp-numerator)
* Metadata:  Logic Definitions
* Metadata: Logic Definition
  * ?: **Library Name:**AdultOutpatientEncounters
* Metadata:  ````// NOTE: The USQualityCore encounter here is not introducing any constraints, and so could be expressed directly using US Core define "Qualifying Encounters": ( ( [USQualityCore.Encounter: "Office Visit"] union [USQualityCore.Encounter: "Annual Wellness Visit"] union [USQualityCore.Encounter: "Preventive Care Services Established Office Visit, 18 and Up"] union [USQualityCore.Encounter: "Preventive Care Services Initial Office Visit, 18 and Up"] union [USQualityCore.Encounter: "Home Healthcare Services"] union [USQualityCore.Encounter: "Virtual Encounter"] union [USQualityCore.Encounter: "Telephone Visits"] ).isEncounterPerformed() ) ValidEncounter where ValidEncounter.period during day of "Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**Hospice
* Metadata:  ````define "Has Hospice Services": exists ((([USQualityCore.Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)" or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)" ) and InpatientEncounter.period ends during day of "Measurement Period" ) or exists ((([USQualityCore.Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter where HospiceEncounter.period overlaps day of "Measurement Period" ) // TODO: Shouldn't need to specify a code path here (see https://jira.hl7.org/browse/FHIR-53941) or exists ((([USQualityCore.ObservationScreeningAssessment: code ~ "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment where HospiceAssessment.value ~ "Yes (qualifier value)" and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period" ) or exists ((([USQualityCore.ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder where HospiceOrder.authoredOn during day of "Measurement Period" ) or exists ((([USQualityCore.Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period" ) // TODO: Consider whether to keep this as the union of Problems and EncounterDiagnosis or exists ((([FHIR.Condition: "Hospice Diagnosis"]).verified()) HospiceCareDiagnosis where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" )````
* Metadata: Logic Definition
  * ?: **Library Name:**AdvancedIllnessandFrailty
* Metadata:  ````define "Has Criteria Indicating Frailty": exists ( (([USQualityCore.DeviceRequest: "Frailty Device"]).isDeviceOrderPersonalUseDevices()) FrailtyDeviceOrder where FrailtyDeviceOrder.authoredOn.toInterval() during day of "Measurement Period" ) or exists ( (([ObservationScreeningAssessment: "Medical equipment used"]).isAssessmentPerformed()) EquipmentUsed where EquipmentUsed.value as CodeableConcept in "Frailty Device" and EquipmentUsed.effective.toInterval() ends during day of "Measurement Period" ) // TODO: Consider whether to keep this as the union of problems and encounter diagnoses or exists ( (([FHIR.Condition: "Frailty Diagnosis"]).verified()) FrailtyDiagnosis where FrailtyDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" ) or exists ( (([USQualityCore.Encounter: "Frailty Encounter"]).isEncounterPerformed()) FrailtyEncounter where FrailtyEncounter.period overlaps day of "Measurement Period" ) or exists ( (([USQualityCore.SimpleObservation: "Frailty Symptom"]).isSymptom()) FrailtySymptom where FrailtySymptom.effective.toInterval() overlaps day of "Measurement Period" )````
* Metadata: Logic Definition
  * ?: **Library Name:**AdvancedIllnessandFrailty
* Metadata:  ````define "Has Advanced Illness in Year Before or During Measurement Period": // TODO: Consider whether to keep this as the union of problems and encounter diagnoses exists ((([Condition: "Advanced Illness"]).verified()) AdvancedIllnessDiagnosis where AdvancedIllnessDiagnosis.prevalenceInterval() starts during day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"])````
* Metadata: Logic Definition
  * ?: **Library Name:**AdvancedIllnessandFrailty
* Metadata:  ````define "Has Dementia Medications in Year Before or During Measurement Period": exists (( ([FHIR.MedicationRequest: "Dementia Medications"]).isMedicationActive()) DementiaMedication where DementiaMedication.medicationRequestPeriod() overlaps day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"] )````
* Metadata: Logic Definition
  * ?: **Library Name:**AdvancedIllnessandFrailty
* Metadata:  ````define "Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty": ( AgeInYearsAt(date from end of "Measurement Period") in Interval[66, 80] and "Has Criteria Indicating Frailty" and ( "Has Advanced Illness in Year Before or During Measurement Period" or "Has Dementia Medications in Year Before or During Measurement Period" ) ) or ( AgeInYearsAt(date from end of "Measurement Period")>= 81 and "Has Criteria Indicating Frailty" )````
* Metadata: Logic Definition
  * ?: **Library Name:**AdvancedIllnessandFrailty
* Metadata:  ````define "Is Age 66 or Older Living Long Term in a Nursing Home": AgeInYearsAt(date from end of "Measurement Period") >= 66 and ( ( Last( (([ObservationScreeningAssessment: "Housing status"]).isAssessmentPerformed()) HousingStatus where HousingStatus.effective.toInterval() ends on or before day of end of "Measurement Period" sort by end of effective.toInterval() asc )) LastHousingStatus where LastHousingStatus.value ~ "Lives in nursing home (finding)" ) is not null````
* Metadata: Logic Definition
  * ?: **Library Name:**PalliativeCare
* Metadata:  ````define "Has Palliative Care in the Measurement Period": // TODO: Shouldn't need to specify a code path here (see https://jira.hl7.org/browse/FHIR-53941) exists ((([USQualityCore.ObservationScreeningAssessment: code ~ "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period" ) // TODO: Consider whether to keep this as the union of the problems and encounter diagnosis list? Anything enforced by the profiles that is expected but isn't stated here? or exists ((([FHIR.Condition: "Palliative Care Diagnosis"]).verified()) PalliativeDiagnosis where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period" ) or exists ((([USQualityCore.Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter where PalliativeEncounter.period overlaps day of "Measurement Period" ) or exists ((([USQualityCore.Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement Period" )````
* Metadata: Logic Definition
  * ?: **Library Name:**SupplementalDataElements
* Metadata:  ````define "SDE Sex": case when Patient.sex() = '248153007' then "Male (finding)" when Patient.sex() = '248152002' then "Female (finding)" else null end````
* Metadata: Logic Definition
  * ?: **Library Name:**SupplementalDataElements
* Metadata:  ````define "SDE Payer": [USQualityCore.Coverage: type in "Payer Type"] Payer return { code: Payer.type, period: Payer.period }````
* Metadata: Logic Definition
  * ?: **Library Name:**SupplementalDataElements
* Metadata:  ````define "SDE Ethnicity": (Patient.ethnicity()) E return Tuple { codes: { E.ombCategory } union E.detailed, display: E.text }````
* Metadata: Logic Definition
  * ?: **Library Name:**SupplementalDataElements
* Metadata:  ````define "SDE Race": (Patient.race()) R return Tuple { codes: R.ombCategory union R.detailed, display: R.text }````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "SDE Sex": SDE."SDE Sex"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "Qualifying Blood Pressure Reading": ( ( ( [USCore.BloodPressureProfile] ).isObservationBP ( ) ) BloodPressure without ( ( [Encounter: "Encounter Inpatient"] union [Encounter: "Emergency Department Evaluation and Management Visit"] ).isEncounterPerformed ( ) ) DisqualifyingEncounter such that BloodPressure.effective.latest ( ) during day of DisqualifyingEncounter.period where BloodPressure.effective.latest ( ) during day of "Measurement Period" ) union ( ( ( [USCore.BloodPressureProfile] ).isObservationBP ( ) ) BloodPressure where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) ) and BloodPressure.effective.latest ( ) during day of "Measurement Period" )````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "Blood Pressure Days": "Qualifying Blood Pressure Reading" BPExam return date from BPExam.effective.latest ( )````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "Most Recent Blood Pressure Day": Last("Blood Pressure Days" BPDays sort asc )````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "Lowest Systolic Reading on Most Recent Blood Pressure Day": First("Qualifying Blood Pressure Reading" BPReading where BPReading.effective.latest() same day as "Most Recent Blood Pressure Day" return singleton from(BPReading.component BPComponent where BPComponent.code ~ "Systolic blood pressure" return BPComponent.value as Quantity ) sort asc )````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "Has Systolic Blood Pressure Less Than 140": "Lowest Systolic Reading on Most Recent Blood Pressure Day" < 140 'mm[Hg]'````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "Lowest Diastolic Reading on Most Recent Blood Pressure Day": First("Qualifying Blood Pressure Reading" BPReading where BPReading.effective.latest() same day as "Most Recent Blood Pressure Day" return singleton from(BPReading.component BPComponent where BPComponent.code ~ "Diastolic blood pressure" return BPComponent.value as Quantity ) sort asc )````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "Has Diastolic Blood Pressure Less Than 90": "Lowest Diastolic Reading on Most Recent Blood Pressure Day" < 90 'mm[Hg]'````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "Numerator": "Has Systolic Blood Pressure Less Than 140" and "Has Diastolic Blood Pressure Less Than 90"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "Essential Hypertension Diagnosis": ( ( [Condition: "Essential Hypertension"] ).verified ( ) ) Hypertension where Hypertension.prevalenceInterval ( ) overlaps Interval[start of "Measurement Period", start of "Measurement Period" + 6 months )````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "Initial Population": AgeInYearsAt(date from end of "Measurement Period" ) in Interval[18, 85] and exists "Essential Hypertension Diagnosis" and exists AdultOutpatientEncounters."Qualifying Encounters"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "Denominator": "Initial Population"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "SDE Payer": SDE."SDE Payer"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "SDE Ethnicity": SDE."SDE Ethnicity"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "Pregnancy or Renal Diagnosis": ( ( [Condition: "Pregnancy"] union [Condition: "End Stage Renal Disease"] union [Condition: "Kidney Transplant Recipient"] union [Condition: "Chronic Kidney Disease, Stage 5"] ).verified ( ) ) PregnancyESRDDiagnosis where PregnancyESRDDiagnosis.prevalenceInterval ( ) overlaps "Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "End Stage Renal Disease Procedures": ( ( [Procedure: "Kidney Transplant"] union [Procedure: "Dialysis Services"] ).isProcedurePerformed ( ) ) ESRDProcedure where ESRDProcedure.performed.toInterval ( ) ends on or before end of "Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "End Stage Renal Disease Encounter": ( ( [Encounter: "ESRD Monthly Outpatient Services"] ).isEncounterPerformed ( ) ) ESRDEncounter where ESRDEncounter.period starts on or before end of "Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "Denominator Exclusions": Hospice."Has Hospice Services" or exists ( "Pregnancy or Renal Diagnosis" ) or exists ( "End Stage Renal Disease Procedures" ) or exists ( "End Stage Renal Disease Encounter" ) or AIFrailLTCF."Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty" or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home" or PalliativeCare."Has Palliative Care in the Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define "SDE Race": SDE."SDE Race"````
* Metadata: Logic Definition
  * ?: **Library Name:**CMS165FHIRControllingHighBP
* Metadata:  ````define fluent function getEncounter(reference Reference): singleton from ( [Encounter] E where reference.references(E) )````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @description: Returns the single extension (if present) on the given resource with the specified url. @comment: This function uses singleton from to ensure that a run-time exception is thrown if there is more than one extension on the given resource with the specified url. */ define fluent function ext(domainResource DomainResource, url String): singleton from domainResource.exts(url)````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @description: Returns any extensions defined on the given resource with the specified url */ define fluent function exts(domainResource DomainResource, url String): domainResource.extension E where E.url = url return E````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @description: Given an interval, returns the ending point if the interval has an ending boundary specified, otherwise, returns the starting point */ define fluent function latest(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Age, FHIR.Range>): (choice.toInterval()) period return if (period.hasEnd()) then end of period else start of period````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval @comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible representations for timing-valued elements in FHIR, allowing this function to be used across any resource. The input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range. The intent of this function is to provide a clear and concise mechanism to treat single elements that have multiple possible representations as intervals so that logic doesn't have to account for the variability. More complex calculations (such as medication request period or dispense period calculation) need specific guidance and consideration. That guidance may make use of this function, but the focus of this function is on single element calculations where the semantics are unambiguous. If the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime. If the input is a Period, the result is a DateTime Interval. If the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing. If the input is an instant, the result is a DateTime Interval beginning and ending on that instant. If the input is a string, an error is raised indicating a single interval cannot be computed from a string. If the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age, and ending immediately prior to when the patient was the given Age plus one year. If the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given by the low end of the Range, and ending immediately prior to when the patient was the Age given by the high end of the Range plus one year. NOTE: Due to the complexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used with a Timing or String. */ define fluent function toInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>): case when choice is FHIR.dateTime then Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)] when choice is FHIR.Period then FHIRHelpers.ToInterval(choice as FHIR.Period) when choice is FHIR.instant then Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)] when choice is FHIR.Age then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year) when choice is FHIR.Range then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year) when choice is FHIR.Timing then Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') when choice is FHIR.string then Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported') else null as Interval<DateTime> end````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @description: Given an interval, returns true if the interval has an ending boundary specified (i.e. the end of the interval is not null and not the maximum DateTime value) */ define fluent function hasEnd(period Interval<DateTime>): not ( end of period is null or end of period = maximum DateTime )````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @description: Returns true if the given reference is to the given resource @comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference. NOTE: This function assumes resources from the same source server. */ define fluent function references(reference FHIR.Reference, resource FHIR.Resource): resource.id = Last(Split(reference.reference, '/'))````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @description: Returns conditions in the given list that either have no verification status or have a verification status of confirmed, unconfirmed, provisional, or differential */ define fluent function verified(conditions List<FHIR.Condition>): conditions C where C.verificationStatus is not null implies (C.verificationStatus ~ "confirmed" or C.verificationStatus ~ "unconfirmed" or C.verificationStatus ~ "provisional" or C.verificationStatus ~ "differential" )````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @description: Returns an interval representing the normalized prevalence period of a given Condition resource. @comment: Uses the toInterval and toAbatementInterval functions to determine the widest potential interval from onset to abatement as specified in the given Condition. */ define fluent function prevalenceInterval(condition Condition): if condition.clinicalStatus ~ "active" or condition.clinicalStatus ~ "recurrence" or condition.clinicalStatus ~ "relapse" then Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()] else (end of condition.abatementInterval()) abatementDate return if abatementDate is null then Interval[start of condition.onset.toInterval(), abatementDate) else Interval[start of condition.onset.toInterval(), abatementDate]````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @description: Returns an interval representing the normalized Abatement of a given Condition resource. @comment: @comment: If the abatement element of the Condition is represented as a DateTime, the result is an interval beginning and ending on that DateTime. If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The result is an interval from the date the patient turned that age to immediately before one year later. If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately before one year later than the date the patient turned the ending age of the quantity interval. NOTE: Due to the complexity of determining an interval from a String, this function will throw a run-time exception if used with a Condition instance that has a String as the abatement value. */ define fluent function abatementInterval(condition Condition): if condition.abatement is FHIR.dateTime then Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)] else if condition.abatement is FHIR.Period then FHIRHelpers.ToInterval(condition.abatement as FHIR.Period) else if condition.abatement is FHIR.string then Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported') else if condition.abatement is FHIR.Age then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year) else if condition.abatement is FHIR.Range then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year) else if condition.abatement is FHIR.boolean then Interval[end of condition.onset.toInterval(), condition.recordedDate) else null````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @description: Returns the single extension (if present) on the given element with the specified url. @comment: This function uses singleton from to ensure that a run-time exception is thrown if there is more than one extension on the given element with the specified url. */ define fluent function ext(element Element, url String): singleton from element.exts(url)````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRCommon
* Metadata:  ````/* @description: Returns any extensions defined on the given element with the specified url. */ define fluent function exts(element Element, url String): element.extension E where E.url = url return E````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Observation Vital Signs define fluent function isObservationBP(Obs List<BloodPressureProfile>): Obs O where O.status in { 'final', 'amended', 'corrected' }````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Encounter, Performed //General usage unless required otherwise by measure intent (e.g., follow-up encounters) define fluent function isEncounterPerformed(Enc List<FHIR.Encounter>): Enc E where E.status = 'finished'````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Assessment, Performed define fluent function isAssessmentPerformed(Obs List<ObservationScreeningAssessment>): Obs O where O.status in { 'final', 'amended', 'corrected' }````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Intervention, Order define fluent function isInterventionOrder(ServiceRequest List<FHIR.ServiceRequest>): ServiceRequest S where S.status in { 'active', 'completed' } and S.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Intervention, Performed define fluent function isInterventionPerformed(Proc List<FHIR.Procedure>): Proc P where P.status ~ 'completed'````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Procedure, Performed define fluent function isProcedurePerformed(Proc List<FHIR.Procedure>): Proc P where P.status ~ 'completed'````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Device, Order - Personal Use Devices define fluent function isDeviceOrderPersonalUseDevices(DeviceRequest List<FHIR.DeviceRequest>): DeviceRequest D where D.status in { 'active', 'completed' } and D.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Symptom define fluent function isSymptom(Obs List<SimpleObservation>): Obs O where O.status in { 'preliminary', 'final', 'amended', 'corrected' }````
* Metadata: Logic Definition
  * ?: **Library Name:**Status
* Metadata:  ````//Medication, Active define fluent function isMedicationActive(MedicationRequest List<FHIR.MedicationRequest>): MedicationRequest M where M.status = 'active' and M.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}````
* Metadata: Logic Definition
  * ?: **Library Name:**CumulativeMedicationDuration
* Metadata:  ````/* Calculates the Medication Period for a single MedicationRequest. MedicationRequest instances provided to this function are expected to conform to the [MMEMedicationRequest](http://build.fhir.org/ig/cqframework/opioid-mme-r4/StructureDefinition-mmemedicationrequest.html) profile, which expects: * 1 and only 1 dosageInstruction, multiple dosageInstruction elements will result in an error * 1 and only 1 doseAndRate, multiple doseAndRate elements will result in an error * 1 timing with 1 repeat, missing timing or repeat elements will result in a null * frequency, frequencyMax, defaulting to 1 * period, periodUnit, defaulting to 1 'd' * timeOfDay * doseQuantity or doseRange, missing doseQuantity and doseRange will result in a null Note that MedicationRequest status is not considered by this calculation, as the list of MedicationRequest instances provided to this function should already have considered appropriate statuses, depending on the use case, typically `completed`. NOTE: Updated return to use "date from end of boundsPeriod" to ensure result is Interval<Date> */ define fluent function medicationRequestPeriod(Request MedicationRequest): Request R let dosage: singleton from R.dosageInstruction, doseAndRate: singleton from dosage.doseAndRate, timing: dosage.timing, frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency), period: Quantity(timing.repeat.period, timing.repeat.periodUnit), doseRange: doseAndRate.dose as FHIR.Range, doseQuantity: doseAndRate.dose as FHIR.SimpleQuantity, dose: Coalesce(end of doseRange, doseQuantity), dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0), boundsPeriod: timing.repeat.bounds as Period, // TODO: this isn't working as expected, convert results in null //daysSupply: (convert(R.dispenseRequest.expectedSupplyDuration) to days).value, daysSupply: (R.dispenseRequest.expectedSupplyDuration).value, quantity: R.dispenseRequest.quantity, refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0), startDate: Coalesce( date from start of boundsPeriod, date from R.authoredOn, date from start of R.dispenseRequest.validityPeriod ), totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills) return if startDate is not null and totalDaysSupplied is not null then Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ] else if startDate is not null and boundsPeriod."end" is not null then Interval[startDate, date from end of boundsPeriod] else null````
* Metadata: Logic Definition
  * ?: **Library Name:**CumulativeMedicationDuration
* Metadata:  ````/**********************************************************************/ /* Functions in this region are copied from opioid-mme-r4 */ /**********************************************************************/ define function Quantity(value Decimal, unit String): if value is not null then System.Quantity { value: value, unit: unit } else null````
* Metadata: Logic Definition
  * ?: **Library Name:**CumulativeMedicationDuration
* Metadata:  ````/* Goal is to get to number of days Two broad approaches to the calculation: 1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered 2) Based on relevant period, determine a covered interval and calculate the length of that interval in days This topic covers several use cases and illustrates how to calculate Cumulative Medication Duration for each type of medication resource using the supply and frequency approach. */ /* For the first approach, we need to get from frequency to a frequency/day So we define ToDaily */ /* Calculates daily frequency given frequency within a period */ define function ToDaily(frequency System.Integer, period System.Quantity): case period.unit when 'h' then frequency * (24.0 / period.value) when 'min' then frequency * (24.0 / period.value) * 60 when 's' then frequency * (24.0 / period.value) * 60 * 60 when 'd' then frequency * (24.0 / period.value) / 24 when 'wk' then frequency * (24.0 / period.value) / (24 * 7) when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ when 'hour' then frequency * (24.0 / period.value) when 'minute' then frequency * (24.0 / period.value) * 60 when 'second' then frequency * (24.0 / period.value) * 60 * 60 when 'day' then frequency * (24.0 / period.value) / 24 when 'week' then frequency * (24.0 / period.value) / (24 * 7) when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ when 'hours' then frequency * (24.0 / period.value) when 'minutes' then frequency * (24.0 / period.value) * 60 when 'seconds' then frequency * (24.0 / period.value) * 60 * 60 when 'days' then frequency * (24.0 / period.value) / 24 when 'weeks' then frequency * (24.0 / period.value) / (24 * 7) when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit) end````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value string): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value uri): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) value to a CQL Quantity @comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity has a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`) an error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used. @seealso: ToCalendarUnit */ define function ToQuantity(quantity FHIR.Quantity): case when quantity is null then null when quantity.value is null then null when quantity.comparator is not null then Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.') when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org' or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) } else Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')') end````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @description: Converts a UCUM definite duration unit to a CQL calendar duration unit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities) topic of the CQL specification. @comment: Note that for durations above days (or weeks), the conversion is understood to be approximate */ define function ToCalendarUnit(unit System.String): case unit when 'ms' then 'millisecond' when 's' then 'second' when 'min' then 'minute' when 'h' then 'hour' when 'd' then 'day' when 'wk' then 'week' when 'mo' then 'month' when 'a' then 'year' else unit end````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value ObservationStatus): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value EncounterStatus): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToDateTime(value dateTime): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period) value to a CQL DateTime Interval @comment: If the start value of the given period is unspecified, the starting boundary of the resulting interval will be open (meaning the start of the interval is unknown, as opposed to interpreted as the beginning of time). */ define function ToInterval(period FHIR.Period): if period is null then null else if period."start" is null then Interval(period."start".value, period."end".value] else Interval[period."start".value, period."end".value]````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToDateTime(value instant): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToDate(value date): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept. */ define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value }````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code. */ define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value }````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value ServiceRequestStatus): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value ServiceRequestIntent): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value ProcedureStatus): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value DeviceRequestStatus): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value RequestIntent): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value MedicationRequestStatus): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value MedicationRequestIntent): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToDecimal(value decimal): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value UnitsOfTime): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @description: Converts the given FHIR [Range](https://hl7.org/fhir/datatypes.html#Range) value to a CQL Interval of Quantity */ define function ToInterval(range FHIR.Range): if range is null then null else Interval[ToQuantity(range.low), ToQuantity(range.high)]````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToInteger(value integer): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**USCoreCommon
* Metadata:  ````/* @description: Returns the sex element as defined for the USCore patient profile */ define fluent function sex(patient Patient): patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex').value as FHIR.code````
* Metadata: Logic Definition
  * ?: **Library Name:**USCoreCommon
* Metadata:  ````define fluent function ethnicity(patient Patient): (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity')) E return { ombCategory: E.ext('ombCategory').value as FHIR.Coding, detailed: (E.exts('detailed')) d return d.value as FHIR.Coding, text: E.ext('text').value as FHIR.string }````
* Metadata: Logic Definition
  * ?: **Library Name:**USCoreCommon
* Metadata:  ````define fluent function race(patient Patient): (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-race')) E return { ombCategory: (E.exts('ombCategory')) o return o.value as FHIR.Coding, detailed: (E.exts('detailed')) d return d.value as FHIR.Coding, text: E.ext('text').value as FHIR.string }````
* Metadata:  Terminology
* Metadata: Code System
  * ?: **Description**: Code system SNOMEDCT**Resource**:[SNOMED CT (all versions)](http://hl7.org/fhir/R4/codesystem-snomedct.html)**Canonical URL**:http://snomed.info/sct
* Metadata: Code System
  * ?: **Description**: Code system LOINC**Resource**:[Logical Observation Identifiers, Names and Codes (LOINC)](http://terminology.hl7.org/6.5.0/CodeSystem-v3-loinc.html)**Canonical URL**:http://loinc.org
* Metadata: Code System
  * ?: **Description**: Code system ConditionVerificationStatusCodes**Resource**:[ConditionVerificationStatus](http://terminology.hl7.org/7.1.0/CodeSystem-condition-ver-status.html)**Canonical URL**:http://terminology.hl7.org/CodeSystem/condition-ver-status
* Metadata: Code System
  * ?: **Description**: Code system ConditionClinicalStatusCodes**Resource**:[Condition Clinical Status Codes](http://terminology.hl7.org/7.1.0/CodeSystem-condition-clinical.html)**Canonical URL**:http://terminology.hl7.org/CodeSystem/condition-clinical
* Metadata: Value Set
  * ?: **Description**: Value set Encounter Inpatient**Resource**:[Encounter Inpatient](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
* Metadata: Value Set
  * ?: **Description**: Value set Emergency Department Evaluation and Management Visit**Resource**:[Emergency Department Evaluation and Management Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010
* Metadata: Value Set
  * ?: **Description**: Value set Essential Hypertension**Resource**:[Essential Hypertension](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.104.12.1011/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.104.12.1011
* Metadata: Value Set
  * ?: **Description**: Value set Office Visit**Resource**:[Office Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
* Metadata: Value Set
  * ?: **Description**: Value set Annual Wellness Visit**Resource**:[Annual Wellness Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240
* Metadata: Value Set
  * ?: **Description**: Value set Preventive Care Services Established Office Visit, 18 and Up**Resource**:[Preventive Care Services Established Office Visit, 18 and Up](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025
* Metadata: Value Set
  * ?: **Description**: Value set Preventive Care Services Initial Office Visit, 18 and Up**Resource**:[Preventive Care Services Initial Office Visit, 18 and Up](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
* Metadata: Value Set
  * ?: **Description**: Value set Home Healthcare Services**Resource**:[Home Healthcare Services](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016
* Metadata: Value Set
  * ?: **Description**: Value set Virtual Encounter**Resource**:[Virtual Encounter](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1089/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089
* Metadata: Value Set
  * ?: **Description**: Value set Telephone Visits**Resource**:[Telephone Visits](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080
* Metadata: Value Set
  * ?: **Description**: Value set Payer Type**Resource**:[Payer Type](https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
* Metadata: Value Set
  * ?: **Description**: Value set Hospice Encounter**Resource**:[Hospice Encounter](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003
* Metadata: Value Set
  * ?: **Description**: Value set Hospice Care Ambulatory**Resource**:[Hospice Care Ambulatory](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584
* Metadata: Value Set
  * ?: **Description**: Value set Hospice Diagnosis**Resource**:[Hospice Diagnosis](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165
* Metadata: Value Set
  * ?: **Description**: Value set Pregnancy**Resource**:[Pregnancy](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.378/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.378
* Metadata: Value Set
  * ?: **Description**: Value set End Stage Renal Disease**Resource**:[End Stage Renal Disease](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.353/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.353
* Metadata: Value Set
  * ?: **Description**: Value set Kidney Transplant Recipient**Resource**:[Kidney Transplant Recipient](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.109.12.1029/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1029
* Metadata: Value Set
  * ?: **Description**: Value set Chronic Kidney Disease, Stage 5**Resource**:[Chronic Kidney Disease, Stage 5](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1002/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1002
* Metadata: Value Set
  * ?: **Description**: Value set Kidney Transplant**Resource**:[Kidney Transplant](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.109.12.1012/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1012
* Metadata: Value Set
  * ?: **Description**: Value set Dialysis Services**Resource**:[Dialysis Services](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.109.12.1013/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1013
* Metadata: Value Set
  * ?: **Description**: Value set ESRD Monthly Outpatient Services**Resource**:[ESRD Monthly Outpatient Services](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.109.12.1014/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1014
* Metadata: Value Set
  * ?: **Description**: Value set Frailty Device**Resource**:[Frailty Device](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.118.12.1300/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.118.12.1300
* Metadata: Value Set
  * ?: **Description**: Value set Frailty Diagnosis**Resource**:[Frailty Diagnosis](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.113.12.1074/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1074
* Metadata: Value Set
  * ?: **Description**: Value set Frailty Encounter**Resource**:[Frailty Encounter](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1088/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1088
* Metadata: Value Set
  * ?: **Description**: Value set Frailty Symptom**Resource**:[Frailty Symptom](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.113.12.1075/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1075
* Metadata: Value Set
  * ?: **Description**: Value set Advanced Illness**Resource**:[Advanced Illness](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1082/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1082
* Metadata: Value Set
  * ?: **Description**: Value set Dementia Medications**Resource**:[Dementia Medications](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1510/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1510
* Metadata: Value Set
  * ?: **Description**: Value set Palliative Care Diagnosis**Resource**:[Palliative Care Diagnosis](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1167/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167
* Metadata: Value Set
  * ?: **Description**: Value set Palliative Care Encounter**Resource**:[Palliative Care Encounter](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1090/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090
* Metadata: Value Set
  * ?: **Description**: Value set Palliative Care Intervention**Resource**:[Palliative Care Intervention](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1135/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135
* Metadata: Direct Reference Code
  * ?: **Display**: Male (finding)**Code**: 248153007**System**:http://snomed.info/sct
* Metadata: Direct Reference Code
  * ?: **Display**: Female (finding)**Code**: 248152002**System**:http://snomed.info/sct
* Metadata: Direct Reference Code
  * ?: **Display**: Systolic blood pressure**Code**: 8480-6**System**:http://loinc.org
* Metadata: Direct Reference Code
  * ?: **Display**: Diastolic blood pressure**Code**: 8462-4**System**:http://loinc.org
* Metadata: Direct Reference Code
  * ?: **Code**: confirmed**System**:http://terminology.hl7.org/CodeSystem/condition-ver-status
* Metadata: Direct Reference Code
  * ?: **Code**: unconfirmed**System**:http://terminology.hl7.org/CodeSystem/condition-ver-status
* Metadata: Direct Reference Code
  * ?: **Code**: provisional**System**:http://terminology.hl7.org/CodeSystem/condition-ver-status
* Metadata: Direct Reference Code
  * ?: **Code**: differential**System**:http://terminology.hl7.org/CodeSystem/condition-ver-status
* Metadata: Direct Reference Code
  * ?: **Code**: active**System**:http://terminology.hl7.org/CodeSystem/condition-clinical
* Metadata: Direct Reference Code
  * ?: **Code**: recurrence**System**:http://terminology.hl7.org/CodeSystem/condition-clinical
* Metadata: Direct Reference Code
  * ?: **Code**: relapse**System**:http://terminology.hl7.org/CodeSystem/condition-clinical
* Metadata: Direct Reference Code
  * ?: **Display**: Discharge to home for hospice care (procedure)**Code**: 428361000124107**System**:http://snomed.info/sct
* Metadata: Direct Reference Code
  * ?: **Display**: Discharge to healthcare facility for hospice care (procedure)**Code**: 428371000124100**System**:http://snomed.info/sct
* Metadata: Direct Reference Code
  * ?: **Display**: Yes (qualifier value)**Code**: 373066001**System**:http://snomed.info/sct
* Metadata: Direct Reference Code
  * ?: **Display**: Hospice care [Minimum Data Set]**Code**: 45755-6**System**:http://loinc.org
* Metadata: Direct Reference Code
  * ?: **Display**: Medical equipment used**Code**: 98181-1**System**:http://loinc.org
* Metadata: Direct Reference Code
  * ?: **Display**: Housing status**Code**: 71802-3**System**:http://loinc.org
* Metadata: Direct Reference Code
  * ?: **Display**: Lives in nursing home (finding)**Code**: 160734000**System**:http://snomed.info/sct
* Metadata: Direct Reference Code
  * ?: **Display**: Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)**Code**: 71007-9**System**:http://loinc.org
* Metadata:  Dependencies
* Metadata: Dependency
  * ?: **Description**: USQualityCore model information**Resource**:`https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild`**Canonical URL**:https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild
* Metadata: Dependency
  * ?: **Description**: USCore model information**Resource**:[http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived](https://build.fhir.org/ig/HL7/us-cql-ig/Library-USCore-ModelInfo.html)**Canonical URL**:http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived
* Metadata: Dependency
  * ?: **Description**: FHIR model information**Resource**:[http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1](http://hl7.org/fhir/uv/cql/STU2/Library-FHIR-ModelInfo.html)**Canonical URL**:http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1
* Metadata: Dependency
  * ?: **Description**: Library SDE**Resource**:[SupplementalDataElementsversion: null6.1.000)](Library-SupplementalDataElements.md)**Canonical URL**:https://madie.cms.gov/Library/SupplementalDataElements|6.1.000
* Metadata: Dependency
  * ?: **Description**: Library FHIRHelpers**Resource**:[http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1](http://hl7.org/fhir/uv/cql/STU2/Library-FHIRHelpers.html)**Canonical URL**:http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1
* Metadata: Dependency
  * ?: **Description**: Library USCommon**Resource**:[http://hl7.org/fhir/us/cql/Library/USCoreCommon|2.0.0-ballot](https://build.fhir.org/ig/HL7/us-cql-ig/Library-USCoreCommon.html)**Canonical URL**:http://hl7.org/fhir/us/cql/Library/USCoreCommon|2.0.0-ballot
* Metadata: Dependency
  * ?: **Description**: Library FHIRCommon**Resource**:[http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0](http://hl7.org/fhir/uv/cql/STU2/Library-FHIRCommon.html)**Canonical URL**:http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0
* Metadata: Dependency
  * ?: **Description**: Library Status**Resource**:[Statusversion: null2.1.000)](Library-Status.md)**Canonical URL**:https://madie.cms.gov/Library/Status|2.1.000
* Metadata: Dependency
  * ?: **Description**: Library AdultOutpatientEncounters**Resource**:[AdultOutpatientEncountersversion: null5.1.000)](Library-AdultOutpatientEncounters.md)**Canonical URL**:https://madie.cms.gov/Library/AdultOutpatientEncounters|5.1.000
* Metadata: Dependency
  * ?: **Description**: Library Hospice**Resource**:[Hospiceversion: null7.1.000)](Library-Hospice.md)**Canonical URL**:https://madie.cms.gov/Library/Hospice|7.1.000
* Metadata: Dependency
  * ?: **Description**: Library AIFrailLTCF**Resource**:[AdvancedIllnessandFrailtyversion: null2.1.000)](Library-AdvancedIllnessandFrailty.md)**Canonical URL**:https://madie.cms.gov/Library/AdvancedIllnessandFrailty|2.1.000
* Metadata: Dependency
  * ?: **Description**: Library CMD**Resource**:[http://hl7.org/fhir/us/cql/Library/CumulativeMedicationDuration|2.0.0-ballot](https://build.fhir.org/ig/HL7/us-cql-ig/Library-CumulativeMedicationDuration.html)**Canonical URL**:http://hl7.org/fhir/us/cql/Library/CumulativeMedicationDuration|2.0.0-ballot
* Metadata: Dependency
  * ?: **Description**: Library PalliativeCare**Resource**:[PalliativeCareversion: null2.1.000)](Library-PalliativeCare.md)**Canonical URL**:https://madie.cms.gov/Library/PalliativeCare|2.1.000
* Metadata:  Data Requirements
* Metadata: Data Requirement
  * ?: **Type**: Patient**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient`**Must Support Elements**: ombCategory, detailed, text
* Metadata: Data Requirement
  * ?: **Type**: Patient**Profile(s)**:[Patient](http://hl7.org/fhir/R4/patient.html)**Must Support Elements**: birthDate
* Metadata: Data Requirement
  * ?: **Type**: Resource**Profile(s)**:[Resource](http://hl7.org/fhir/R4/resource.html)**Must Support Elements**: id
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: status, period
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: type, status, period**Code Filter(s)**:**Path**: type**ValueSet**:[Encounter Inpatient](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: type, status, period**Code Filter(s)**:**Path**: type**ValueSet**:[Emergency Department Evaluation and Management Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: type, period, status**Code Filter(s)**:**Path**: type**ValueSet**:[ESRD Monthly Outpatient Services](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.109.12.1014/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:[US Core Blood Pressure Profile](http://hl7.org/fhir/us/core/STU7/StructureDefinition-us-core-blood-pressure.html)**Must Support Elements**: effective, status, component, encounter, encounter.class, encounter.class.code
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[Condition](http://hl7.org/fhir/R4/condition.html)**Must Support Elements**: abatement, verificationStatus, onset, recordedDate, clinicalStatus
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[Condition](http://hl7.org/fhir/R4/condition.html)**Must Support Elements**: code, verificationStatus**Code Filter(s)**:**Path**: code**ValueSet**:[Essential Hypertension](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.104.12.1011/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[Condition](http://hl7.org/fhir/R4/condition.html)**Must Support Elements**: code, verificationStatus**Code Filter(s)**:**Path**: code**ValueSet**:[Hospice Diagnosis](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[Condition](http://hl7.org/fhir/R4/condition.html)**Must Support Elements**: code, verificationStatus**Code Filter(s)**:**Path**: code**ValueSet**:[Pregnancy](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.378/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[Condition](http://hl7.org/fhir/R4/condition.html)**Must Support Elements**: code, verificationStatus**Code Filter(s)**:**Path**: code**ValueSet**:[End Stage Renal Disease](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.353/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[Condition](http://hl7.org/fhir/R4/condition.html)**Must Support Elements**: code, verificationStatus**Code Filter(s)**:**Path**: code**ValueSet**:[Kidney Transplant Recipient](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.109.12.1029/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[Condition](http://hl7.org/fhir/R4/condition.html)**Must Support Elements**: code, verificationStatus**Code Filter(s)**:**Path**: code**ValueSet**:[Chronic Kidney Disease, Stage 5](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1002/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[Condition](http://hl7.org/fhir/R4/condition.html)**Must Support Elements**: code, verificationStatus**Code Filter(s)**:**Path**: code**ValueSet**:[Frailty Diagnosis](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.113.12.1074/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[Condition](http://hl7.org/fhir/R4/condition.html)**Must Support Elements**: code, verificationStatus**Code Filter(s)**:**Path**: code**ValueSet**:[Advanced Illness](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.110.12.1082/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[Condition](http://hl7.org/fhir/R4/condition.html)**Must Support Elements**: code, verificationStatus**Code Filter(s)**:**Path**: code**ValueSet**:[Palliative Care Diagnosis](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1167/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter`**Must Support Elements**: type, period**Code Filter(s)**:**Path**: type**ValueSet**:[Office Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter`**Must Support Elements**: type, period**Code Filter(s)**:**Path**: type**ValueSet**:[Annual Wellness Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter`**Must Support Elements**: type, period**Code Filter(s)**:**Path**: type**ValueSet**:[Preventive Care Services Established Office Visit, 18 and Up](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter`**Must Support Elements**: type, period**Code Filter(s)**:**Path**: type**ValueSet**:[Preventive Care Services Initial Office Visit, 18 and Up](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter`**Must Support Elements**: type, period**Code Filter(s)**:**Path**: type**ValueSet**:[Home Healthcare Services](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter`**Must Support Elements**: type, period**Code Filter(s)**:**Path**: type**ValueSet**:[Virtual Encounter](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1089/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter`**Must Support Elements**: type, period**Code Filter(s)**:**Path**: type**ValueSet**:[Telephone Visits](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter`**Must Support Elements**: type, hospitalization, hospitalization.dischargeDisposition, period**Code Filter(s)**:**Path**: type**ValueSet**:[Encounter Inpatient](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter`**Must Support Elements**: type, period**Code Filter(s)**:**Path**: type**ValueSet**:[Hospice Encounter](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter`**Must Support Elements**: type, period**Code Filter(s)**:**Path**: type**ValueSet**:[Frailty Encounter](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1088/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-encounter`**Must Support Elements**: type, period**Code Filter(s)**:**Path**: type**ValueSet**:[Palliative Care Encounter](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1090/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Coverage**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-coverage`**Must Support Elements**: type, period**Code Filter(s)**:**Path**: type**ValueSet**:[Payer Type](https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-screening-assessment`**Must Support Elements**: code, value, effective, status**Code Filter(s)**:**Path**: code**Code(s)**: [LOINC: 45755-6](https://loinc.org/45755-6) (Hospice care [Minimum Data Set]) **Path**: value
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-screening-assessment`**Must Support Elements**: code, value, effective, status**Code Filter(s)**:**Path**: code**Code(s)**: [LOINC: 98181-1](https://loinc.org/98181-1) (Medical equipment used) **Path**: value**ValueSet**:[Frailty Device](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.118.12.1300/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-screening-assessment`**Must Support Elements**: code, effective, status**Code Filter(s)**:**Path**: code**Code(s)**: [LOINC: 71802-3](https://loinc.org/71802-3) (Housing status) 
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-screening-assessment`**Must Support Elements**: code, effective, value, status**Code Filter(s)**:**Path**: code**Code(s)**: [LOINC: 71802-3](https://loinc.org/71802-3) (Housing status) **Path**: value
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-screening-assessment`**Must Support Elements**: code, effective, status**Code Filter(s)**:**Path**: code**Code(s)**: [LOINC: 71007-9](https://loinc.org/71007-9) (Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)) 
* Metadata: Data Requirement
  * ?: **Type**: ServiceRequest**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-servicerequest`**Must Support Elements**: code, authoredOn**Code Filter(s)**:**Path**: code**ValueSet**:[Hospice Care Ambulatory](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Procedure**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-procedure`**Must Support Elements**: code, performed**Code Filter(s)**:**Path**: code**ValueSet**:[Hospice Care Ambulatory](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Procedure**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-procedure`**Must Support Elements**: code, performed**Code Filter(s)**:**Path**: code**ValueSet**:[Palliative Care Intervention](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1135/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Procedure**Profile(s)**:[Procedure](http://hl7.org/fhir/R4/procedure.html)**Must Support Elements**: code, status, performed**Code Filter(s)**:**Path**: code**ValueSet**:[Kidney Transplant](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.109.12.1012/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Procedure**Profile(s)**:[Procedure](http://hl7.org/fhir/R4/procedure.html)**Must Support Elements**: code, status, performed**Code Filter(s)**:**Path**: code**ValueSet**:[Dialysis Services](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.109.12.1013/expansion)
* Metadata: Data Requirement
  * ?: **Type**: DeviceRequest**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-devicerequest`**Must Support Elements**: code, authoredOn**Code Filter(s)**:**Path**: code**ValueSet**:[Frailty Device](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.118.12.1300/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:`http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-simple-observation`**Must Support Elements**: code, effective, status**Code Filter(s)**:**Path**: code**ValueSet**:[Frailty Symptom](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.113.12.1075/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Medication**Profile(s)**:[Medication](http://hl7.org/fhir/R4/medication.html)**Must Support Elements**: id, code**Code Filter(s)**:**Path**: code**ValueSet**:[Dementia Medications](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1510/expansion)
* Metadata: Data Requirement
  * ?: **Type**: MedicationRequest**Profile(s)**:[MedicationRequest](http://hl7.org/fhir/R4/medicationrequest.html)**Must Support Elements**: medication.reference, status, intent, dosageInstruction, dispenseRequest, dispenseRequest.expectedSupplyDuration, dispenseRequest.expectedSupplyDuration.value, dispenseRequest.quantity, dispenseRequest.numberOfRepeatsAllowed, authoredOn, dispenseRequest.validityPeriod
* Metadata: Data Requirement
  * ?: **Type**: MedicationRequest**Profile(s)**:[MedicationRequest](http://hl7.org/fhir/R4/medicationrequest.html)**Must Support Elements**: medication, status, intent, dosageInstruction, dispenseRequest, dispenseRequest.expectedSupplyDuration, dispenseRequest.expectedSupplyDuration.value, dispenseRequest.quantity, dispenseRequest.numberOfRepeatsAllowed, authoredOn, dispenseRequest.validityPeriod**Code Filter(s)**:**Path**: medication**ValueSet**:[Dementia Medications](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1510/expansion)
* Metadata:  Parameters
* Metadata: 
  * ?: 
| | | | | |
| :--- | :--- | :--- | :--- | :--- |
| **Name** | **Use** | **Card.** | **Type** | **Documentation** |
| Measurement Period | In | 0..1 | Period |  |
| ErrorLevel | In | 0..1 | string |  |
| SDE Sex | Out | 0..1 | Coding |  |
| Numerator | Out | 0..1 | boolean |  |
| Denominator | Out | 0..1 | boolean |  |
| SDE Payer | Out | 0..* | Resource |  |
| Initial Population | Out | 0..1 | boolean |  |
| SDE Ethnicity | Out | 0..1 | Resource |  |
| Denominator Exclusions | Out | 0..1 | boolean |  |
| SDE Race | Out | 0..1 | Resource |  |

* Metadata: Generated using version 0.5.4 of the sample-content-ig Liquid templates



## Resource Content

```json
{
  "resourceType" : "Measure",
  "id" : "CMS165FHIRControllingHighBP",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareablemeasure",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cql-measure-cqfm",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/elm-measure-cqfm",
    "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"]
  },
  "contained" : [{
    "resourceType" : "Library",
    "id" : "effective-data-requirements",
    "extension" : [{
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "248153007",
        "display" : "Male (finding)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "248152002",
        "display" : "Female (finding)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://loinc.org",
        "code" : "8480-6",
        "display" : "Systolic blood pressure"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://loinc.org",
        "code" : "8462-4",
        "display" : "Diastolic blood pressure"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
        "code" : "confirmed"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
        "code" : "unconfirmed"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
        "code" : "provisional"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
        "code" : "differential"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
        "code" : "active"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
        "code" : "recurrence"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
        "code" : "relapse"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "428361000124107",
        "display" : "Discharge to home for hospice care (procedure)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "428371000124100",
        "display" : "Discharge to healthcare facility for hospice care (procedure)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "373066001",
        "display" : "Yes (qualifier value)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://loinc.org",
        "code" : "45755-6",
        "display" : "Hospice care [Minimum Data Set]"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://loinc.org",
        "code" : "98181-1",
        "display" : "Medical equipment used"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://loinc.org",
        "code" : "71802-3",
        "display" : "Housing status"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "code" : "160734000",
        "display" : "Lives in nursing home (finding)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://loinc.org",
        "code" : "71007-9",
        "display" : "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"
      }
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "SupplementalDataElements"
      },
      {
        "url" : "name",
        "valueString" : "SDE Sex"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Sex\":\n  case\n    when Patient.sex() = '248153007' then \"Male (finding)\"\n    when Patient.sex() = '248152002' then \"Female (finding)\"\n    else null\n  end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 0
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "SDE Sex"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 1
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "Qualifying Blood Pressure Reading"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Qualifying Blood Pressure Reading\":\n  ( ( ( [USCore.BloodPressureProfile] ).isObservationBP ( ) ) BloodPressure\n      without ( ( [Encounter: \"Encounter Inpatient\"]\n          union [Encounter: \"Emergency Department Evaluation and Management Visit\"]\n      ).isEncounterPerformed ( ) ) DisqualifyingEncounter\n        such that BloodPressure.effective.latest ( ) during day of DisqualifyingEncounter.period\n      where BloodPressure.effective.latest ( ) during day of \"Measurement Period\"\n  )\n    union ( ( ( [USCore.BloodPressureProfile] ).isObservationBP ( ) ) BloodPressure\n        where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) )\n          and BloodPressure.effective.latest ( ) during day of \"Measurement Period\"\n    )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 2
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "Blood Pressure Days"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Blood Pressure Days\":\n  \"Qualifying Blood Pressure Reading\" BPExam\n    return date from BPExam.effective.latest ( )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 3
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "Most Recent Blood Pressure Day"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Most Recent Blood Pressure Day\":\n  Last(\"Blood Pressure Days\" BPDays\n      sort asc\n  )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 4
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "Lowest Systolic Reading on Most Recent Blood Pressure Day"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Lowest Systolic Reading on Most Recent Blood Pressure Day\":\n  First(\"Qualifying Blood Pressure Reading\" BPReading\n      where BPReading.effective.latest() same day as \"Most Recent Blood Pressure Day\"\n      return singleton from(BPReading.component BPComponent\n          where BPComponent.code ~ \"Systolic blood pressure\"\n          return BPComponent.value as Quantity\n      )\n      sort asc\n  )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 5
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "Has Systolic Blood Pressure Less Than 140"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Systolic Blood Pressure Less Than 140\":\n  \"Lowest Systolic Reading on Most Recent Blood Pressure Day\" < 140 'mm[Hg]'"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 6
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "Lowest Diastolic Reading on Most Recent Blood Pressure Day"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Lowest Diastolic Reading on Most Recent Blood Pressure Day\":\n  First(\"Qualifying Blood Pressure Reading\" BPReading\n      where BPReading.effective.latest() same day as \"Most Recent Blood Pressure Day\"\n      return singleton from(BPReading.component BPComponent\n          where BPComponent.code ~ \"Diastolic blood pressure\"\n          return BPComponent.value as Quantity\n      )\n      sort asc\n  )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 7
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "Has Diastolic Blood Pressure Less Than 90"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Diastolic Blood Pressure Less Than 90\":\n  \"Lowest Diastolic Reading on Most Recent Blood Pressure Day\" < 90 'mm[Hg]'"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 8
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "Numerator"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Numerator\":\n  \"Has Systolic Blood Pressure Less Than 140\"\n    and \"Has Diastolic Blood Pressure Less Than 90\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 9
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "Essential Hypertension Diagnosis"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Essential Hypertension Diagnosis\":\n  ( ( [Condition: \"Essential Hypertension\"] ).verified ( ) ) Hypertension\n    where Hypertension.prevalenceInterval ( ) overlaps Interval[start of \"Measurement Period\", start of \"Measurement Period\" + 6 months )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 10
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdultOutpatientEncounters"
      },
      {
        "url" : "name",
        "valueString" : "Qualifying Encounters"
      },
      {
        "url" : "statement",
        "valueString" : "// NOTE: The USQualityCore encounter here is not introducing any constraints, and so could be expressed directly using US Core\ndefine \"Qualifying Encounters\":\n  ( ( \n    [USQualityCore.Encounter: \"Office Visit\"]\n      union [USQualityCore.Encounter: \"Annual Wellness Visit\"]\n      union [USQualityCore.Encounter: \"Preventive Care Services Established Office Visit, 18 and Up\"]\n      union [USQualityCore.Encounter: \"Preventive Care Services Initial Office Visit, 18 and Up\"]\n      union [USQualityCore.Encounter: \"Home Healthcare Services\"]\n      union [USQualityCore.Encounter: \"Virtual Encounter\"]\n      union [USQualityCore.Encounter: \"Telephone Visits\"] \n    ).isEncounterPerformed() \n  ) ValidEncounter\n    where ValidEncounter.period during day of \"Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 11
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "Initial Population"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Initial Population\":\n  AgeInYearsAt(date from \n    end of \"Measurement Period\"\n  ) in Interval[18, 85]\n    and exists \"Essential Hypertension Diagnosis\"\n    and exists AdultOutpatientEncounters.\"Qualifying Encounters\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 12
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "Denominator"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Denominator\":\n  \"Initial Population\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 13
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "SupplementalDataElements"
      },
      {
        "url" : "name",
        "valueString" : "SDE Payer"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Payer\":\n  [USQualityCore.Coverage: type in \"Payer Type\"] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 14
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "SDE Payer"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 15
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "SupplementalDataElements"
      },
      {
        "url" : "name",
        "valueString" : "SDE Ethnicity"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Ethnicity\":\n  (Patient.ethnicity()) E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 16
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "SDE Ethnicity"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 17
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Hospice"
      },
      {
        "url" : "name",
        "valueString" : "Has Hospice Services"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Hospice Services\":\n  exists ((([USQualityCore.Encounter: \"Encounter Inpatient\"]).isEncounterPerformed()) InpatientEncounter\n      where (InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n          or InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\"\n      )\n        and InpatientEncounter.period ends during day of \"Measurement Period\"\n  )\n    or exists ((([USQualityCore.Encounter: \"Hospice Encounter\"]).isEncounterPerformed()) HospiceEncounter\n        where HospiceEncounter.period overlaps day of \"Measurement Period\"\n    )\n    // TODO: Shouldn't need to specify a code path here (see https://jira.hl7.org/browse/FHIR-53941)\n    or exists ((([USQualityCore.ObservationScreeningAssessment: code ~ \"Hospice care [Minimum Data Set]\"]).isAssessmentPerformed()) HospiceAssessment\n        where HospiceAssessment.value ~ \"Yes (qualifier value)\"\n          and HospiceAssessment.effective.toInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists ((([USQualityCore.ServiceRequest: \"Hospice Care Ambulatory\"]).isInterventionOrder()) HospiceOrder\n        where HospiceOrder.authoredOn during day of \"Measurement Period\"\n    )\n    or exists ((([USQualityCore.Procedure: \"Hospice Care Ambulatory\"]).isInterventionPerformed()) HospicePerformed\n        where HospicePerformed.performed.toInterval() overlaps day of \"Measurement Period\"\n    )\n    // TODO: Consider whether to keep this as the union of Problems and EncounterDiagnosis\n    or exists ((([FHIR.Condition: \"Hospice Diagnosis\"]).verified()) HospiceCareDiagnosis\n        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"\n    )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 18
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "Pregnancy or Renal Diagnosis"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Pregnancy or Renal Diagnosis\":\n  ( ( [Condition: \"Pregnancy\"]\n      union [Condition: \"End Stage Renal Disease\"]\n      union [Condition: \"Kidney Transplant Recipient\"]\n      union [Condition: \"Chronic Kidney Disease, Stage 5\"]\n  ).verified ( ) ) PregnancyESRDDiagnosis\n    where PregnancyESRDDiagnosis.prevalenceInterval ( ) overlaps \"Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 19
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "End Stage Renal Disease Procedures"
      },
      {
        "url" : "statement",
        "valueString" : "define \"End Stage Renal Disease Procedures\":\n  ( ( [Procedure: \"Kidney Transplant\"]\n      union [Procedure: \"Dialysis Services\"]\n  ).isProcedurePerformed ( ) ) ESRDProcedure\n    where ESRDProcedure.performed.toInterval ( ) ends on or before end of \"Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 20
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "End Stage Renal Disease Encounter"
      },
      {
        "url" : "statement",
        "valueString" : "define \"End Stage Renal Disease Encounter\":\n  ( ( [Encounter: \"ESRD Monthly Outpatient Services\"] ).isEncounterPerformed ( ) ) ESRDEncounter\n    where ESRDEncounter.period starts on or before end of \"Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 21
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdvancedIllnessandFrailty"
      },
      {
        "url" : "name",
        "valueString" : "Has Criteria Indicating Frailty"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Criteria Indicating Frailty\":\n  exists ( (([USQualityCore.DeviceRequest: \"Frailty Device\"]).isDeviceOrderPersonalUseDevices()) FrailtyDeviceOrder\n      where FrailtyDeviceOrder.authoredOn.toInterval() during day of \"Measurement Period\"\n  )\n    or exists ( (([ObservationScreeningAssessment: \"Medical equipment used\"]).isAssessmentPerformed()) EquipmentUsed\n        where EquipmentUsed.value as CodeableConcept in \"Frailty Device\" \n        and EquipmentUsed.effective.toInterval() ends during day of \"Measurement Period\"\n    )\n    // TODO: Consider whether to keep this as the union of problems and encounter diagnoses\n    or exists ( (([FHIR.Condition: \"Frailty Diagnosis\"]).verified()) FrailtyDiagnosis\n        where FrailtyDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists ( (([USQualityCore.Encounter: \"Frailty Encounter\"]).isEncounterPerformed()) FrailtyEncounter\n        where FrailtyEncounter.period overlaps day of \"Measurement Period\"\n    )\n    or exists ( (([USQualityCore.SimpleObservation: \"Frailty Symptom\"]).isSymptom()) FrailtySymptom\n        where FrailtySymptom.effective.toInterval() overlaps day of \"Measurement Period\"\n    )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 22
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdvancedIllnessandFrailty"
      },
      {
        "url" : "name",
        "valueString" : "Has Advanced Illness in Year Before or During Measurement Period"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Advanced Illness in Year Before or During Measurement Period\":\n// TODO: Consider whether to keep this as the union of problems and encounter diagnoses\nexists ((([Condition: \"Advanced Illness\"]).verified()) AdvancedIllnessDiagnosis\nwhere AdvancedIllnessDiagnosis.prevalenceInterval() starts during day of Interval[start of \"Measurement Period\" - 1 year, end of \"Measurement Period\"])"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 23
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdvancedIllnessandFrailty"
      },
      {
        "url" : "name",
        "valueString" : "Has Dementia Medications in Year Before or During Measurement Period"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Dementia Medications in Year Before or During Measurement Period\":\n  exists (( ([FHIR.MedicationRequest: \"Dementia Medications\"]).isMedicationActive()) DementiaMedication\n      where DementiaMedication.medicationRequestPeriod() overlaps day of Interval[start of \"Measurement Period\" - 1 year, \n        end of \"Measurement Period\"]\n  )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 24
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdvancedIllnessandFrailty"
      },
      {
        "url" : "name",
        "valueString" : "Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty\":\n  ( AgeInYearsAt(date from end of \"Measurement Period\") in Interval[66, 80]\n      and \"Has Criteria Indicating Frailty\"\n      and ( \"Has Advanced Illness in Year Before or During Measurement Period\"\n          or \"Has Dementia Medications in Year Before or During Measurement Period\"\n      )\n  )\n    or ( AgeInYearsAt(date from end of \"Measurement Period\")>= 81\n        and \"Has Criteria Indicating Frailty\"\n    )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 25
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdvancedIllnessandFrailty"
      },
      {
        "url" : "name",
        "valueString" : "Is Age 66 or Older Living Long Term in a Nursing Home"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Is Age 66 or Older Living Long Term in a Nursing Home\":\n  AgeInYearsAt(date from end of \"Measurement Period\") >= 66\n    and ( ( Last( (([ObservationScreeningAssessment: \"Housing status\"]).isAssessmentPerformed()) HousingStatus    \n          where HousingStatus.effective.toInterval() ends on or before \n          day of end of \"Measurement Period\"\n          sort by \n          end of effective.toInterval() asc\n      )) LastHousingStatus\n        where LastHousingStatus.value ~ \"Lives in nursing home (finding)\"\n    ) is not null"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 26
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "PalliativeCare"
      },
      {
        "url" : "name",
        "valueString" : "Has Palliative Care in the Measurement Period"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Palliative Care in the Measurement Period\":\n  // TODO: Shouldn't need to specify a code path here (see https://jira.hl7.org/browse/FHIR-53941)\n  exists ((([USQualityCore.ObservationScreeningAssessment: code ~ \"Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)\"]).isAssessmentPerformed()) PalliativeAssessment\n      where PalliativeAssessment.effective.toInterval() overlaps day of \"Measurement Period\"\n  )\n    // TODO: Consider whether to keep this as the union of the problems and encounter diagnosis list? Anything enforced by the profiles that is expected but isn't stated here?\n    or exists ((([FHIR.Condition: \"Palliative Care Diagnosis\"]).verified()) PalliativeDiagnosis\n        where PalliativeDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists ((([USQualityCore.Encounter: \"Palliative Care Encounter\"]).isEncounterPerformed()) PalliativeEncounter\n        where PalliativeEncounter.period overlaps day of \"Measurement Period\"\n    )\n    or exists ((([USQualityCore.Procedure: \"Palliative Care Intervention\"]).isInterventionPerformed()) PalliativeIntervention\n        where PalliativeIntervention.performed.toInterval() overlaps day of \"Measurement Period\"\n    )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 27
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "Denominator Exclusions"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Denominator Exclusions\":\n  Hospice.\"Has Hospice Services\"\n    or exists ( \"Pregnancy or Renal Diagnosis\" )\n    or exists ( \"End Stage Renal Disease Procedures\" )\n    or exists ( \"End Stage Renal Disease Encounter\" )\n    or AIFrailLTCF.\"Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty\"\n    or AIFrailLTCF.\"Is Age 66 or Older Living Long Term in a Nursing Home\"\n    or PalliativeCare.\"Has Palliative Care in the Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 28
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "SupplementalDataElements"
      },
      {
        "url" : "name",
        "valueString" : "SDE Race"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Race\":\n  (Patient.race()) R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 29
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "SDE Race"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Race\":\n  SDE.\"SDE Race\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 30
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value string): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 31
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "USCoreCommon"
      },
      {
        "url" : "name",
        "valueString" : "sex"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns the sex element as defined for the USCore patient profile\n*/\ndefine fluent function sex(patient Patient):\n  patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex').value as FHIR.code"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 32
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "ext"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns the single extension (if present) on the given resource with the specified url.\n@comment: This function uses singleton from to ensure that a run-time exception is thrown if there\nis more than one extension on the given resource with the specified url.\n*/\ndefine fluent function ext(domainResource DomainResource, url String):\n  singleton from domainResource.exts(url)"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 33
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "exts"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns any extensions defined on the given resource with the specified url\n*/\ndefine fluent function exts(domainResource DomainResource, url String):\n  domainResource.extension E\n    where E.url = url\n    return E"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 34
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value uri): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 35
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToQuantity"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) \nvalue to a CQL Quantity\n@comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity\nhas a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`)\nan error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used.\n@seealso: ToCalendarUnit\n*/\ndefine function ToQuantity(quantity FHIR.Quantity):\n    case\n        when quantity is null then null\n        when quantity.value is null then null\n        when quantity.comparator is not null then\n            Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')\n        when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'\n              or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then\n            System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }\n        else\n            Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')\n    end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 36
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToCalendarUnit"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts a UCUM definite duration unit to a CQL calendar duration\nunit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities) \ntopic of the CQL specification.\n@comment: Note that for durations above days (or weeks), the conversion is understood to be approximate\n*/\ndefine function ToCalendarUnit(unit System.String):\n    case unit\n        when 'ms' then 'millisecond'\n        when 's' then 'second'\n        when 'min' then 'minute'\n        when 'h' then 'hour'\n        when 'd' then 'day'\n        when 'wk' then 'week'\n        when 'mo' then 'month'\n        when 'a' then 'year'\n        else unit\n    end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 37
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isObservationBP"
      },
      {
        "url" : "statement",
        "valueString" : "//Observation Vital Signs\ndefine fluent function isObservationBP(Obs List<BloodPressureProfile>):\n  Obs O\n    where O.status in { 'final', 'amended', 'corrected' }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 38
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value ObservationStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 39
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isEncounterPerformed"
      },
      {
        "url" : "statement",
        "valueString" : "//Encounter, Performed\n//General usage unless required otherwise by measure intent (e.g., follow-up encounters)\ndefine fluent function isEncounterPerformed(Enc List<FHIR.Encounter>):\n  Enc E\n    where E.status = 'finished'"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 40
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value EncounterStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 41
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "latest"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Given an interval, returns the ending point if the interval has an ending boundary specified,\notherwise, returns the starting point\n*/\ndefine fluent function latest(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Age, FHIR.Range>):\n  (choice.toInterval()) period\n    return\n      if (period.hasEnd()) then end of period\n      else start of period"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 42
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "toInterval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in FHIR, allowing this function to be used across any resource.\n\nThe input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime.\nIf the input is a Period, the result is a DateTime Interval.\nIf the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing.\nIf the input is an instant, the result is a DateTime Interval beginning and ending on that instant.\nIf the input is a string, an error is raised indicating a single interval cannot be computed from a string.\nIf the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age,\nand ending immediately prior to when the patient was the given Age plus one year.\nIf the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given\nby the low end of the Range, and ending immediately prior to when the patient was the Age given by the\nhigh end of the Range plus one year.\n\nNOTE: Due to the\ncomplexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used\nwith a Timing or String.\n*/\ndefine fluent function toInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>):\n  case\n    when choice is FHIR.dateTime then\n      Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]\n    when choice is FHIR.Period then\n      FHIRHelpers.ToInterval(choice as FHIR.Period)\n    when choice is FHIR.instant then\n      Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]\n    when choice is FHIR.Age then\n      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),\n        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)\n    when choice is FHIR.Range then\n      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),\n        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)\n    when choice is FHIR.Timing then\n      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported')\n    when choice is FHIR.string then\n      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')\n    else\n      null as Interval<DateTime>\n  end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 43
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToDateTime"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToDateTime(value dateTime): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 44
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToInterval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)\nvalue to a CQL DateTime Interval\n@comment: If the start value of the given period is unspecified, the starting\nboundary of the resulting interval will be open (meaning the start of the interval\nis unknown, as opposed to interpreted as the beginning of time).\n*/\ndefine function ToInterval(period FHIR.Period):\n    if period is null then\n        null\n    else\n        if period.\"start\" is null then\n            Interval(period.\"start\".value, period.\"end\".value]\n        else\n            Interval[period.\"start\".value, period.\"end\".value]"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 45
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToDateTime"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToDateTime(value instant): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 46
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToDate"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToDate(value date): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 47
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "hasEnd"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Given an interval, returns true if the interval has an ending boundary specified\n(i.e. the end of the interval is not null and not the maximum DateTime value)\n*/\ndefine fluent function hasEnd(period Interval<DateTime>):\n  not (\n    end of period is null\n      or end of period = maximum DateTime\n  )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 48
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CMS165FHIRControllingHighBP"
      },
      {
        "url" : "name",
        "valueString" : "getEncounter"
      },
      {
        "url" : "statement",
        "valueString" : "define fluent function getEncounter(reference Reference):\n  singleton from ( [Encounter] E\n    where reference.references(E)\n  )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 49
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "references"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns true if the given reference is to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(reference FHIR.Reference, resource FHIR.Resource):\n  resource.id = Last(Split(reference.reference, '/'))"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 50
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToConcept"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 51
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToCode"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 52
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "verified"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns conditions in the given list that either have no verification status or have a verification status of confirmed, unconfirmed, provisional, or differential\n*/\ndefine fluent function verified(conditions List<FHIR.Condition>):\n  conditions C\n    where C.verificationStatus is not null implies\n      (C.verificationStatus ~ \"confirmed\"\n        or C.verificationStatus ~ \"unconfirmed\"\n        or C.verificationStatus ~ \"provisional\"\n        or C.verificationStatus ~ \"differential\"\n      )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 53
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "prevalenceInterval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition resource.\n@comment: Uses the toInterval and toAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ \"active\"\n  or condition.clinicalStatus ~ \"recurrence\"\n  or condition.clinicalStatus ~ \"relapse\" then\n  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n  (end of condition.abatementInterval()) abatementDate\n    return \n\t  if abatementDate is null then\n        Interval[start of condition.onset.toInterval(), abatementDate)\n      else\n        Interval[start of condition.onset.toInterval(), abatementDate]"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 54
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "abatementInterval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns an interval representing the normalized Abatement of a given Condition resource.\n@comment: @comment: If the abatement element of the Condition is represented as a DateTime, the result\nis an interval beginning and ending on that DateTime.\nIf the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The\nresult is an interval from the date the patient turned that age to immediately before one year later.\nIf the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during\nwhich the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately\nbefore one year later than the date the patient turned the ending age of the quantity interval.\n\nNOTE: Due to the complexity of determining an interval from a String, this function will throw\na run-time exception if used with a Condition instance that has a String as the abatement value.\n*/\ndefine fluent function abatementInterval(condition Condition):\n  if condition.abatement is FHIR.dateTime then\n    Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)]\n  else if condition.abatement is FHIR.Period then\n    FHIRHelpers.ToInterval(condition.abatement as FHIR.Period)\n  else if condition.abatement is FHIR.string then\n    Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')\n  else if condition.abatement is FHIR.Age then\n    Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age),\n      FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year)\n  else if condition.abatement is FHIR.Range then\n    Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low),\n      FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year)\n  else if condition.abatement is FHIR.boolean then\n    Interval[end of condition.onset.toInterval(), condition.recordedDate)\n  else \n    null"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 55
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "USCoreCommon"
      },
      {
        "url" : "name",
        "valueString" : "ethnicity"
      },
      {
        "url" : "statement",
        "valueString" : "define fluent function ethnicity(patient Patient):\n  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity')) E\n    return {\n      ombCategory: E.ext('ombCategory').value as FHIR.Coding,\n      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,\n      text: E.ext('text').value as FHIR.string\n    }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 56
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "ext"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns the single extension (if present) on the given element with the specified url.\n@comment: This function uses singleton from to ensure that a run-time exception is thrown if there\nis more than one extension on the given element with the specified url.\n*/\ndefine fluent function ext(element Element, url String):\n  singleton from element.exts(url)"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 57
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRCommon"
      },
      {
        "url" : "name",
        "valueString" : "exts"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Returns any extensions defined on the given element with the specified url.\n*/\ndefine fluent function exts(element Element, url String):\n  element.extension E\n    where E.url = url\n    return E"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 58
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isAssessmentPerformed"
      },
      {
        "url" : "statement",
        "valueString" : "//Assessment, Performed\ndefine fluent function isAssessmentPerformed(Obs List<ObservationScreeningAssessment>):\n  Obs O\n    where O.status in { 'final', 'amended', 'corrected' }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 59
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isInterventionOrder"
      },
      {
        "url" : "statement",
        "valueString" : "//Intervention, Order\ndefine fluent function isInterventionOrder(ServiceRequest List<FHIR.ServiceRequest>):\n  ServiceRequest S\n    where S.status in { 'active', 'completed' }\n      and S.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 60
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value ServiceRequestStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 61
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value ServiceRequestIntent): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 62
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isInterventionPerformed"
      },
      {
        "url" : "statement",
        "valueString" : "//Intervention, Performed\ndefine fluent function isInterventionPerformed(Proc List<FHIR.Procedure>):\n  Proc P\n    where P.status ~ 'completed'"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 63
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value ProcedureStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 64
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isProcedurePerformed"
      },
      {
        "url" : "statement",
        "valueString" : "//Procedure, Performed\ndefine fluent function isProcedurePerformed(Proc List<FHIR.Procedure>):\n  Proc P\n    where P.status ~ 'completed'"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 65
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isDeviceOrderPersonalUseDevices"
      },
      {
        "url" : "statement",
        "valueString" : "//Device, Order - Personal Use Devices\ndefine fluent function isDeviceOrderPersonalUseDevices(DeviceRequest List<FHIR.DeviceRequest>):\n  DeviceRequest D\n    where D.status in { 'active', 'completed' }\n      and D.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 66
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value DeviceRequestStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 67
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value RequestIntent): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 68
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isSymptom"
      },
      {
        "url" : "statement",
        "valueString" : "//Symptom\ndefine fluent function isSymptom(Obs List<SimpleObservation>):\n  Obs O\n    where O.status in { 'preliminary', 'final', 'amended', 'corrected' }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 69
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Status"
      },
      {
        "url" : "name",
        "valueString" : "isMedicationActive"
      },
      {
        "url" : "statement",
        "valueString" : "//Medication, Active\ndefine fluent function isMedicationActive(MedicationRequest List<FHIR.MedicationRequest>):\n  MedicationRequest M\n    where M.status = 'active'\n      and M.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 70
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value MedicationRequestStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 71
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value MedicationRequestIntent): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 72
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CumulativeMedicationDuration"
      },
      {
        "url" : "name",
        "valueString" : "medicationRequestPeriod"
      },
      {
        "url" : "statement",
        "valueString" : "/*\nCalculates the Medication Period for a single MedicationRequest.\nMedicationRequest instances provided to this function are expected\nto conform to the [MMEMedicationRequest](http://build.fhir.org/ig/cqframework/opioid-mme-r4/StructureDefinition-mmemedicationrequest.html)\nprofile, which expects:\n* 1 and only 1 dosageInstruction, multiple dosageInstruction elements will result in an error\n* 1 and only 1 doseAndRate, multiple doseAndRate elements will result in an error\n* 1 timing with 1 repeat, missing timing or repeat elements will result in a null\n* frequency, frequencyMax, defaulting to 1\n* period, periodUnit, defaulting to 1 'd'\n* timeOfDay\n* doseQuantity or doseRange, missing doseQuantity and doseRange will result in a null\nNote that MedicationRequest status is not considered by this calculation, as the\nlist of MedicationRequest instances provided to this function should already have\nconsidered appropriate statuses, depending on the use case, typically `completed`.\n\nNOTE: Updated return to use \"date from end of boundsPeriod\" to ensure result is Interval<Date>\n*/\ndefine fluent function medicationRequestPeriod(Request MedicationRequest):\n  Request R\n    let\n      dosage: singleton from R.dosageInstruction,\n      doseAndRate: singleton from dosage.doseAndRate,\n      timing: dosage.timing,\n      frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),\n      period: Quantity(timing.repeat.period, timing.repeat.periodUnit),\n      doseRange: doseAndRate.dose as FHIR.Range,\n      doseQuantity: doseAndRate.dose as FHIR.SimpleQuantity,\n\n      dose: Coalesce(end of doseRange, doseQuantity),\n      dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),\n      boundsPeriod: timing.repeat.bounds as Period,\n      // TODO: this isn't working as expected, convert results in null\n      //daysSupply: (convert(R.dispenseRequest.expectedSupplyDuration) to days).value,\n      daysSupply: (R.dispenseRequest.expectedSupplyDuration).value,\n      quantity: R.dispenseRequest.quantity,\n      refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),\n      startDate:\n        Coalesce(\n          date from start of boundsPeriod,\n          date from R.authoredOn,\n          date from start of R.dispenseRequest.validityPeriod\n        ),\n      totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills)\n    return\n      if startDate is not null and totalDaysSupplied is not null then\n        Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ]\n      else if startDate is not null and boundsPeriod.\"end\" is not null then\n        Interval[startDate, date from end of boundsPeriod]\n      else\n        null"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 73
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CumulativeMedicationDuration"
      },
      {
        "url" : "name",
        "valueString" : "Quantity"
      },
      {
        "url" : "statement",
        "valueString" : "/**********************************************************************/\n/* Functions in this region are copied from opioid-mme-r4             */\n/**********************************************************************/\n\ndefine function Quantity(value Decimal, unit String):\n  if value is not null then\n    System.Quantity { value: value, unit: unit }\n  else\n    null"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 74
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToDecimal"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToDecimal(value decimal): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 75
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value UnitsOfTime): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 76
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToInterval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given FHIR [Range](https://hl7.org/fhir/datatypes.html#Range) value to a CQL Interval of Quantity\n*/\ndefine function ToInterval(range FHIR.Range):\n    if range is null then\n        null\n    else\n        Interval[ToQuantity(range.low), ToQuantity(range.high)]"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 77
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "CumulativeMedicationDuration"
      },
      {
        "url" : "name",
        "valueString" : "ToDaily"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n Goal is to get to number of days\n Two broad approaches to the calculation:\n  1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered\n  2) Based on relevant period, determine a covered interval and calculate the length of that interval in days\n\nThis topic covers several use cases and illustrates how to calculate Cumulative\nMedication Duration for each type of medication resource using the supply and\nfrequency approach.\n*/\n\n/*\n  For the first approach, we need to get from frequency to a frequency/day\n  So we define ToDaily\n*/\n\n/*\n  Calculates daily frequency given frequency within a period\n*/\ndefine function ToDaily(frequency System.Integer, period System.Quantity):\n  case period.unit\n    when 'h' then frequency * (24.0 / period.value)\n    when 'min' then frequency * (24.0 / period.value) * 60\n    when 's' then frequency * (24.0 / period.value) * 60 * 60\n    when 'd' then frequency * (24.0 / period.value) / 24\n    when 'wk' then frequency * (24.0 / period.value) / (24 * 7)\n    when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n    when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n    when 'hour' then frequency * (24.0 / period.value)\n    when 'minute' then frequency * (24.0 / period.value) * 60\n    when 'second' then frequency * (24.0 / period.value) * 60 * 60\n    when 'day' then frequency * (24.0 / period.value) / 24\n    when 'week' then frequency * (24.0 / period.value) / (24 * 7)\n    when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n    when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n    when 'hours' then frequency * (24.0 / period.value)\n    when 'minutes' then frequency * (24.0 / period.value) * 60\n    when 'seconds' then frequency * (24.0 / period.value) * 60 * 60\n    when 'days' then frequency * (24.0 / period.value) / 24\n    when 'weeks' then frequency * (24.0 / period.value) / (24 * 7)\n    when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n    when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n    else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit)\n  end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 78
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToInteger"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToInteger(value integer): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 79
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "USCoreCommon"
      },
      {
        "url" : "name",
        "valueString" : "race"
      },
      {
        "url" : "statement",
        "valueString" : "define fluent function race(patient Patient):\n  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-race')) E\n    return {\n      ombCategory: (E.exts('ombCategory')) o return o.value as FHIR.Coding,\n      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,\n      text: E.ext('text').value as FHIR.string\n    }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 80
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    }],
    "name" : "EffectiveDataRequirements",
    "status" : "active",
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/library-type",
        "code" : "module-definition"
      }]
    },
    "relatedArtifact" : [{
      "type" : "depends-on",
      "display" : "USQualityCore model information",
      "resource" : "https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild"
    },
    {
      "type" : "depends-on",
      "display" : "USCore model information",
      "resource" : "http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived"
    },
    {
      "type" : "depends-on",
      "display" : "FHIR model information",
      "resource" : "http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1"
    },
    {
      "type" : "depends-on",
      "display" : "Library SDE",
      "resource" : "https://madie.cms.gov/Library/SupplementalDataElements|6.1.000"
    },
    {
      "type" : "depends-on",
      "display" : "Library FHIRHelpers",
      "resource" : "http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1"
    },
    {
      "type" : "depends-on",
      "display" : "Library USCommon",
      "resource" : "http://hl7.org/fhir/us/cql/Library/USCoreCommon|2.0.0-ballot"
    },
    {
      "type" : "depends-on",
      "display" : "Library FHIRCommon",
      "resource" : "http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0"
    },
    {
      "type" : "depends-on",
      "display" : "Library Status",
      "resource" : "https://madie.cms.gov/Library/Status|2.1.000"
    },
    {
      "type" : "depends-on",
      "display" : "Library AdultOutpatientEncounters",
      "resource" : "https://madie.cms.gov/Library/AdultOutpatientEncounters|5.1.000"
    },
    {
      "type" : "depends-on",
      "display" : "Library Hospice",
      "resource" : "https://madie.cms.gov/Library/Hospice|7.1.000"
    },
    {
      "type" : "depends-on",
      "display" : "Library AIFrailLTCF",
      "resource" : "https://madie.cms.gov/Library/AdvancedIllnessandFrailty|2.1.000"
    },
    {
      "type" : "depends-on",
      "display" : "Library CMD",
      "resource" : "http://hl7.org/fhir/us/cql/Library/CumulativeMedicationDuration|2.0.0-ballot"
    },
    {
      "type" : "depends-on",
      "display" : "Library PalliativeCare",
      "resource" : "https://madie.cms.gov/Library/PalliativeCare|2.1.000"
    },
    {
      "type" : "depends-on",
      "display" : "Code system SNOMEDCT",
      "resource" : "http://snomed.info/sct"
    },
    {
      "type" : "depends-on",
      "display" : "Code system LOINC",
      "resource" : "http://loinc.org"
    },
    {
      "type" : "depends-on",
      "display" : "Code system ConditionVerificationStatusCodes",
      "resource" : "http://terminology.hl7.org/CodeSystem/condition-ver-status"
    },
    {
      "type" : "depends-on",
      "display" : "Code system ConditionClinicalStatusCodes",
      "resource" : "http://terminology.hl7.org/CodeSystem/condition-clinical"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Encounter Inpatient",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Emergency Department Evaluation and Management Visit",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Essential Hypertension",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.104.12.1011"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Office Visit",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Annual Wellness Visit",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Preventive Care Services Established Office Visit, 18 and Up",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Preventive Care Services Initial Office Visit, 18 and Up",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Home Healthcare Services",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Virtual Encounter",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Telephone Visits",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Payer Type",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Hospice Encounter",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Hospice Care Ambulatory",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Hospice Diagnosis",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Pregnancy",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.378"
    },
    {
      "type" : "depends-on",
      "display" : "Value set End Stage Renal Disease",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.353"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Kidney Transplant Recipient",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1029"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Chronic Kidney Disease, Stage 5",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1002"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Kidney Transplant",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1012"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Dialysis Services",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1013"
    },
    {
      "type" : "depends-on",
      "display" : "Value set ESRD Monthly Outpatient Services",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1014"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Frailty Device",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.118.12.1300"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Frailty Diagnosis",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1074"
    },
    {
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  "url" : "https://madie.cms.gov/Measure/CMS165FHIRControllingHighBP",
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  "version" : "1.1.000",
  "name" : "CMS165FHIRControllingHighBP",
  "title" : "Controlling High Blood PressureFHIR",
  "status" : "active",
  "experimental" : false,
  "date" : "2026-01-16T18:18:13+00:00",
  "publisher" : "National Committee for Quality Assurance",
  "contact" : [{
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  "description" : "Percentage of patients 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (&lt;140/90 mmHg) during the measurement period",
  "usage" : "In reference to the numerator element, only blood pressure readings performed by a clinician or an automated blood pressure monitor or device are acceptable for numerator compliance with this measure. This includes blood pressures taken in person by a clinician and blood pressures measured remotely by electronic monitoring devices capable of transmitting the blood pressure data to the clinician. Blood pressure readings taken by an automated blood pressure monitor or device and conveyed by the patient to the clinician are also acceptable. It is the clinician’s responsibility and discretion to confirm the automated blood pressure monitor or device used to obtain the blood pressure is considered acceptable and reliable and whether the blood pressure reading is considered accurate before documenting it in the patient’s medical record. Do not include BP readings taken during an acute inpatient stay or an emergency department (ED) visit. If no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed \"not controlled\". If there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading. Ranges and thresholds do not meet criteria for this measure. A distinct numeric result for both the systolic and diastolic BP reading is required for numerator compliance. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS165v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6. (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).",
  "copyright" : "This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties or endorsements about the quality of any product, test or protocol identified as numerator compliant or otherwise identified as meeting the requirements of the measure or specification. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure may be used for internal, noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. All other uses, including a commercial use (including but not limited to vendors using or embedding the measures and specifications into any product or service to calculate measure results for customers for any purpose), must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2025 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications. CPT(R) codes, descriptions and other data are copyright 2025. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use. Some measure specifications contain coding from LOINC(R) (https://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2025 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at https://loinc.org/kb/license/. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2025 World Health Organization. All Rights Reserved. Some measures use RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the measures and does not endorse or recommend this or any other product. “HL7” is the registered trademark of Health Level Seven International.",
  "effectivePeriod" : {
    "start" : "2026-01-01",
    "end" : "2026-12-31"
  },
  "author" : [{
    "name" : "National Committee for Quality Assurance",
    "telecom" : [{
      "system" : "url",
      "value" : "https://www.ncqa.org/"
    }]
  }],
  "relatedArtifact" : [{
    "type" : "citation",
    "citation" : "American Diabetes Association. (2022). 10. Cardiovascular disease and risk management: Standards of medical care in diabetes—2022. Diabetes Care 2022, 44(Suppl. 1), S144-S175. https://doi.org/10.2337/dc22-S010"
  },
  {
    "type" : "citation",
    "citation" : "Centers for Disease Control and Prevention, National Center for Health Statistics. (2022). About Multiple Cause of Death, 1999–2020. CDC WONDER Online Database website. Atlanta, GA: Centers for Disease Control and Prevention. Available from http://www.cdc.gov/nchs/data_access/Vitalstatsonline.htm#Mortality_Multiple"
  },
  {
    "type" : "citation",
    "citation" : "Centers for Disease Control and Prevention. (2021). Team-based care for high blood pressure. Retrieved from https://www.cdc.gov/policy/polaris/healthtopics/highbloodpressure/tbctool.html"
  },
  {
    "type" : "citation",
    "citation" : "Centers for Disease Control and Prevention. (2023). Facts about hypertension. Retrieved from https://www.cdc.gov/bloodpressure/facts.htm"
  },
  {
    "type" : "citation",
    "citation" : "Coles, S., Fisher, L., Lin, K. W., Lyon, C., Vosooney, A. A., &amp; Bird, M. D. (2022). Blood Pressure Targets in Adults With Hypertension: A Clinical Practice Guideline From the AAFP. American family physician, 106(6). Retrieved from https://www.aafp.org/pubs/afp/issues/2022/1200/practice-guidelines-aafp-hypertension-full-guideline.html"
  },
  {
    "type" : "citation",
    "citation" : "James, P.A., Oparil, S., Carter, B.L., et al. (2014). 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. doi: 10.1001/jama.2013.284427"
  },
  {
    "type" : "citation",
    "citation" : "Kirkland, E. B., Heincelman, M., Bishu, K. G., Schumann, S. O., Schreiner, A., Axon, R. N.,...Moran, W. P. (2018). Trends in Healthcare Expenditures Among US Adults With Hypertension: National Estimates, 2003–2014. Journal of the American Heart Association, 7(11), e008731. https://doi.org/10.1161/JAHA.118.008731"
  },
  {
    "type" : "citation",
    "citation" : "Moran, A. E., Odden, M. C., Thanataveerat, A., et al. (2015). Cost-effectiveness of hypertension therapy according to 2014 guidelines. [published correction appears in N Engl J. Med. 2015;372:1677]. New England Journal of Medicine. 2015;372, 447-455. doi: 10.1056/NEJMsa1406751. [published correction appears on page 1677]"
  },
  {
    "type" : "citation",
    "citation" : "Patel, S. A., Winkel, M., Ali, M. K., et al. (2015). Cardiovascular mortality associated with 5 leading risk factors: National and state preventable fractions estimated from survey data. Annals of Internal Medicine, 163(4), 245-253. doi: 10.7326/M14-1753"
  },
  {
    "type" : "citation",
    "citation" : "Qaseem, A., Wilt, T. J., Rich, R., et al. (2017). Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Annals of Internal Medicine, 166(6), 430-437. Retrieved from https://annals.org/aim/fullarticle/2598413/pharmacologic-treatment-hypertension-adults-aged-60-years-older-higher-versus"
  },
  {
    "type" : "citation",
    "citation" : "SPRINT Research Group, Wright, J. T., Jr., Williamson, J. D., et al. (2015). A randomized trial of intensive versus standard blood-pressure control. New England Journal of Medicine, 373(22), 2103–2116."
  },
  {
    "type" : "citation",
    "citation" : "Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Alonso, A., Beaton, A. Z., Bittencourt, M. S.,...Kissela, B. M. (2022). Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association. Circulation, 145(8), e153–e639. https://doi.org/10.1161/CIR.0000000000001052"
  },
  {
    "type" : "citation",
    "citation" : "U.S. Preventive Services Task Force. Screening for hypertension in adults: U.S. Preventive Services Task Force reaffirmation recommendation statement. JAMA, 325(16), 1650. Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hypertension-in-adults-screening"
  },
  {
    "type" : "citation",
    "citation" : "Virani, S.S., Alonso, A., Aparicio, H.J., et al.; on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2021). Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation. 2021;143:e254–e743. doi: 10.1161/CIR.0000000000000950"
  },
  {
    "type" : "citation",
    "citation" : "Whelton, P. K., Carey, R. M., Aronow, W. S., et al. (2017). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. Hypertension. 71(6). https://doi.org/10.1161/HYP.0000000000000065"
  }],
  "library" : ["https://madie.cms.gov/Library/CMS165FHIRControllingHighBP"],
  "disclaimer" : "The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
  "rationale" : "High blood pressure (HBP), also known as hypertension, is when the pressure in blood vessels is higher than normal (Centers for Disease Control and Prevention [CDC], 2023). The causes of hypertension are multiple and multifaceted and can be based on genetic predisposition, environmental risk factors, being overweight and obese, sodium intake, potassium intake, physical activity, and alcohol use. High blood pressure is common; according to the American Heart Association, between 2013-2016, approximately 121.5 million US adults &gt;= 20 years of age had HBP and the prevalence of hypertension among US adults 65 and older was 77.0 percent (Virani et al., 2021). In an analysis of adults with hypertension in National Health and Nutrition Examination Survey (NHANES), the estimated age-adjusted proportion with controlled blood pressure (BP) increased from 31.8 percent in 1999 to 53.8 percent in 2014. However, that proportion declined to 43.7 percent in 2017 to 2018 (Tsao et al., 2022). HBP increases risks of heart disease and stroke which are two of the leading causes of death in the US (CDC, 2023). A person who has HBP is four times more likely to die from a stroke and three times more likely to die from heart disease (CDC, 2021). The National Center for Health Statistics reported that in 2020 there were over 670,000 deaths with HBP as a primary or contributing cause (CDC, 2022). Between 2009 and 2019 the number of deaths due to HBP rose by 65.3 percent (Tsao et al., 2022). Managing and treating HBP would reduce cardiovascular disease mortality for males and females by 30.4 percent and 38.0 percent, respectively (Patel et al., 2015). Age-adjusted death rates attributable to HBP in 2019 were more than twice as high in non-Hispanic Black males (56.7 percent) when compared to rates for non-Hispanic White males (25.7 percent) (Tsao et al., 2022). HBP costs the U.S. approximately 131 billion dollars each year, averaged over 12 years from 2003 to 2014 (Kirkland et al., 2018). A study on cost-effectiveness on treating hypertension found that controlling HBP in patients with cardiovascular disease and systolic blood pressures (SBP) of &gt;= 160 mmHg could be effective and cost-saving (Moran et al., 2015). Many studies have shown that controlling high blood pressure reduces cardiovascular events and mortality. The Systolic Blood Pressure Intervention Trial (SPRINT) investigated the impact of obtaining a SBP goal of &lt;120 mmHg compared to a SBP goal of &lt;140 mmHg among patients 50 and older with established cardiovascular disease and found that the patients with the former goal had reduced cardiovascular events and mortality (SPRINT Research Group et al., 2015). Controlling HBP will significantly reduce the risks of cardiovascular disease mortality and lead to better health outcomes like reduction of heart attacks, stroke, and kidney disease (James et al., 2014). Thus, the relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established.",
  "clinicalRecommendationStatement" : "U.S. Preventive Services Task Force (USPSTF) (2021): - The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. This is a grade A recommendation. American College of Cardiology/American Heart Association (2017): - For adults with confirmed hypertension and known cardiovascular disease (CVD) or 10-year atherosclerotic cardiovascular disease (ASCVD) event risk of 10 percent or higher, a blood pressure target of less than 130/80 mmHg is recommended (Level of evidence: B-R (for systolic blood pressures), Level of evidence: C-EO (for diastolic blood pressure)) - For adults with confirmed hypertension, without additional markers of increased CVD risk, a blood pressure target of less than 130/80 mmHg may be reasonable (Note: clinical trial evidence is strongest for a target blood pressure of 140/90 mmHg in this population. However, observational studies suggest that these individuals often have a high lifetime risk and would benefit from blood pressure control earlier in life) (Level of evidence: B-NR (for systolic blood pressure), Level of evidence: C-EO (for diastolic blood pressure)). American Academy of Family Physicians (2022): - Treat adults who have hypertension to a standard blood pressure target (less than 140/90 mm Hg) to reduce the risk of all-cause and cardiovascular mortality (strong recommendation; high-quality evidence). Treating to a lower blood pressure target (less than 135/85 mm Hg) does not provide additional benefit at preventing mortality; however, a lower blood pressure target could be considered based on patient preferences and values. (Grade: strong recommendation, Quality of evidence: high) - Consider treating adults who have hypertension to a lower blood pressure target (less than 135/85 mm Hg) to reduce risk of myocardial infarction (weak recommendation; moderate-quality evidence). Although treatment to a standard blood pressure target (less than 140/90 mm Hg) reduced the risk of myocardial infarction, there was a small additional benefit observed with a lower blood pressure target. There was no observed additional benefit in preventing stroke with the lower blood pressure target. (Grade: weak recommendation, Quality of evidence: low) American Diabetes Association (2022): - For individuals with diabetes and hypertension at higher cardiovascular risk (existing atherosclerotic cardiovascular disease or 10-year atherosclerotic cardiovascular disease risk &gt;=15 percent), a blood pressure target of &lt;130/80 mmHg may be appropriate, if it can be safely attained (Level of evidence: B) - For individuals with diabetes and hypertension at lower risk for cardiovascular disease (10-year atherosclerotic cardiovascular disease risk &lt;15 percent), treat to a blood pressure target of &lt;140/90 mmHg (Level of evidence: A)",
  "group" : [{
    "id" : "Group_1",
    "extension" : [{
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
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          "code" : "proportion",
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          "code" : "initial-population",
          "display" : "Initial Population"
        }]
      },
      "description" : "Patients 18-85 years of age by the end of the measurement period who had a visit during the measurement period and diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period",
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          "code" : "denominator-exclusion",
          "display" : "Denominator Exclusion"
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      },
      "description" : "Exclude patients who are in hospice care for any part of the measurement period. Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period. Exclude patients 66-80 by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness diagnosis during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients 81 and older by the end of the measurement period with an indication of frailty for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients receiving palliative care for any part of the measurement period.",
      "criteria" : {
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        "expression" : "Denominator Exclusions"
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    {
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      },
      "description" : "Patients whose most recent blood pressure is adequately controlled (systolic blood pressure &lt; 140 mmHg and diastolic blood pressure &lt; 90 mmHg) during the measurement period",
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        "expression" : "Numerator"
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    }],
    "description" : "SDE Sex",
    "criteria" : {
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  },
  {
    "id" : "sde-race",
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    }],
    "description" : "SDE Race",
    "criteria" : {
      "language" : "text/cql-identifier",
      "expression" : "SDE Race"
    }
  },
  {
    "id" : "sde-payer",
    "usage" : [{
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    "description" : "SDE Payer",
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      "expression" : "SDE Payer"
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  },
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    "id" : "sde-ethnicity",
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        "code" : "supplemental-data"
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    }],
    "description" : "SDE Ethnicity",
    "criteria" : {
      "language" : "text/cql-identifier",
      "expression" : "SDE Ethnicity"
    }
  }]
}

```
