Draft dQM CMS Content Implementation Guide
2025.1.0 - CI Build

Draft dQM CMS Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2025.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/dqm-content-cms-2025/ and changes regularly. See the Directory of published versions

## Library: AHAOverall

Official URL: https://madie.cms.gov/Library/AHAOverall | Version: 5.1.000
Active as of 2025-08-22 | Responsible: Telligen | Computable Name: AHAOverall

This version of the AHAOverall library is patterned after HFCommonDefinitionsQDM library version ‘3.0.000’

Metadata
Title | AHAOverall
Version | 5.1.000
Topic | FHIR
Topic | CQL
Steward (Publisher) | Telligen
Description | This version of the AHAOverall library is patterned after HFCommonDefinitionsQDM library version '3.0.000'
Type | logic-library from http://terminology.hl7.org/CodeSystem/library-type
Dependency | Description: Model USQualityCore 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`
Dependency | Description: Library FHIRHelpers Resource: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1 Canonical URL: `http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1`
Dependency | Description: Library FHIRCommon Resource: http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0 Canonical URL: `http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0`
Dependency | Description: Library USQualityCoreCommon Resource: US Quality Core Commonversion: null0.1.0-cibuild) Canonical URL: `https://madie.cms.gov/Library/USQualityCoreCommon|0.1.0-cibuild`
Dependency | Description: Code System SNOMEDCT Resource: SNOMED CT (all versions) Canonical URL: `http://snomed.info/sct`
Dependency | Description: Value Set Care Services in Long Term Residential Facility Resource: Care Services in Long Term Residential Facility Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014`
Dependency | Description: Value Set Ejection Fraction Resource: Ejection Fraction Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1134`
Dependency | Description: Value Set Heart Failure Resource: Heart Failure Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376`
Dependency | Description: Value Set Heart Transplant Resource: Heart Transplant Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.33`
Dependency | Description: Value Set Heart Transplant Complications Resource: Heart Transplant Complications Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.56`
Dependency | Description: Value Set Home Healthcare Services Resource: Home Healthcare Services Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016`
Dependency | Description: Value Set Left Ventricular Assist Device Complications Resource: Left Ventricular Assist Device Complications Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.58`
Dependency | Description: Value Set Left Ventricular Assist Device Placement Resource: Left Ventricular Assist Device Placement Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.61`
Dependency | Description: Value Set Moderate or Severe Resource: Moderate or Severe Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1092`
Dependency | Description: Value Set Moderate or Severe LVSD Resource: Moderate or Severe LVSD Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090`
Dependency | Description: Value Set Nursing Facility Visit Resource: Nursing Facility Visit Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012`
Dependency | Description: Value Set Office Visit Resource: Office Visit Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001`
Dependency | Description: Value Set Outpatient Consultation Resource: Outpatient Consultation Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008`
Dependency | Description: Value Set Patient Provider Interaction Resource: Patient Provider Interaction Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012`
Data Requirement | Type: Encounter Profile(s): Encounter Code Filter(s): Path: type ValueSet: Care Services in Long Term Residential Facility
Data Requirement | Type: Encounter Profile(s): Encounter Code Filter(s): Path: type ValueSet: Home Healthcare Services
Data Requirement | Type: Encounter Profile(s): Encounter Code Filter(s): Path: type ValueSet: Nursing Facility Visit
Data Requirement | Type: Encounter Profile(s): Encounter Code Filter(s): Path: type ValueSet: Office Visit
Data Requirement | Type: Encounter Profile(s): Encounter Code Filter(s): Path: type ValueSet: Outpatient Consultation
Data Requirement | Type: Condition Profile(s): Condition Code Filter(s): Path: code ValueSet: Heart Failure
Data Requirement | Type: Condition Profile(s): Condition Code Filter(s): Path: code ValueSet: Heart Transplant Complications
Data Requirement | Type: Observation Profile(s): `http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-clinical-result` Code Filter(s): Path: code ValueSet: Ejection Fraction
Data Requirement | Type: Condition Profile(s): Condition Code Filter(s): Path: code ValueSet: Moderate or Severe LVSD
Data Requirement | Type: Condition Profile(s): Condition Code Filter(s): Path: code Code(s): SNOMED CT: 134401001 (Left ventricular systolic dysfunction (disorder))
Data Requirement | Type: Procedure Profile(s): Procedure Code Filter(s): Path: code ValueSet: Left Ventricular Assist Device Placement
Data Requirement | Type: Condition Profile(s): Condition Code Filter(s): Path: code ValueSet: Left Ventricular Assist Device Complications
Data Requirement | Type: Encounter Profile(s): Encounter Code Filter(s): Path: type ValueSet: Patient Provider Interaction
Data Requirement | Type: Procedure Profile(s): Procedure Code Filter(s): Path: code ValueSet: Heart Transplant
Data Requirement | Type: Task Profile(s): `http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-taskrejected`
Parameters
Name | Use | Card. | Type | Documentation
Measurement Period | In | 0..1 | Period |
Patient | Out | 0..1 | Resource |
Outpatient Encounter | Out | 0..* | Encounter |
Heart Failure Outpatient Encounter | Out | 0..* | Encounter |
Moderate or Severe LVSD Findings | Out | 0..* | Resource |
Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD | Out | 0..* | Encounter |
Has Heart Transplant Complications | Out | 0..1 | boolean |
Has Left Ventricular Assist Device | Out | 0..1 | boolean |
Has Left Ventricular Assist Device Complications | Out | 0..1 | boolean |
Outpatient Encounter or Patient Provider Interaction | Out | 0..* | Encounter |
Qualifying Outpatient Encounter During Measurement Period | Out | 0..* | Encounter |
Has Heart Transplant | Out | 0..1 | boolean |
Is Adult With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period | Out | 0..1 | boolean |
Library Content
CQL Content |
    /*
    NOTE: For use by March 2026 US Realm Connectathon participants for internal use only. Not for use or distribution in commercial products.
    */
    library AHAOverall version '5.1.000'

    using USQualityCore version '0.1.0-cibuild'
    using USCore version '6.1.0-derived'
    using FHIR version '4.0.1'

    include hl7.fhir.uv.cql.FHIRHelpers version '4.0.1' called FHIRHelpers
    include hl7.fhir.uv.cql.FHIRCommon version '2.0.0' called FHIRCommon

    include USQualityCoreCommon version '0.1.0-cibuild' called USQualityCoreCommon

    codesystem "SNOMEDCT": 'http://snomed.info/sct'

    valueset "Care Services in Long Term Residential Facility": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014'
    valueset "Ejection Fraction": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1134'
    valueset "Heart Failure": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376'
    valueset "Heart Transplant": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.33'
    valueset "Heart Transplant Complications": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.56'
    valueset "Home Healthcare Services": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016'
    valueset "Left Ventricular Assist Device Complications": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.58'
    valueset "Left Ventricular Assist Device Placement": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.61'
    valueset "Moderate or Severe": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1092'
    valueset "Moderate or Severe LVSD": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090'
    valueset "Nursing Facility Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012'
    valueset "Office Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001'
    valueset "Outpatient Consultation": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008'
    valueset "Patient Provider Interaction": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012'

    code "Left ventricular systolic dysfunction (disorder)": '134401001' from "SNOMEDCT" display 'Left ventricular systolic dysfunction (disorder)'

    parameter "Measurement Period" Interval<DateTime>
      default Interval[@2026-01-01T00:00:00.000Z, @2027-01-01T00:00:00.000Z)

    context Patient

    /*
    @description: Returns certain finished encounter types that overlap a Heart Failure condition and are during the measurement period:
                    * care services in long term residential facility (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014)
                    * home healthcare services (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016)
                    * nursing facility visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012)
                    * office visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001)
                    * outpatient consultation (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008)
    */
    define "Heart Failure Outpatient Encounter":
      "Outpatient Encounter" QualifyingEncounter
        with ( [Condition: "Heart Failure"] ) HeartFailure
          such that HeartFailure.prevalenceInterval ( ) overlaps day of QualifyingEncounter.period
            and HeartFailure.isVerified ( )
        where QualifyingEncounter.period during day of "Measurement Period"
          and QualifyingEncounter.isEncounterFinished ( )

    define "Outpatient Encounter":
      ( [Encounter: "Care Services in Long Term Residential Facility"]
          union [Encounter: "Home Healthcare Services"]
          union [Encounter: "Nursing Facility Visit"]
          union [Encounter: "Office Visit"]
          union [Encounter: "Outpatient Consultation"]
      )

    /*
    @description: Returns true if patient has confirmed heart transplant complications that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
    */
    define "Has Heart Transplant Complications":
      exists ( ( [Condition: "Heart Transplant Complications"] ) HeartTransplantComplications
          let diagnosisStart: Coalesce(start of HeartTransplantComplications.prevalenceInterval(), HeartTransplantComplications.recordedDate)
          with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
            such that date from diagnosisStart on or before date from end of ModerateOrSevereLVSDHFOutpatientEncounter.period
          where HeartTransplantComplications.isVerified ( )
      )

    /*
    @description: Returns true if patient has a completed LVAD placement that starts before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
    */
    define "Has Left Ventricular Assist Device":
      exists ( [Procedure: "Left Ventricular Assist Device Placement"] LVADPlacement
          with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
            such that LVADPlacement.performed.toInterval ( ) starts before day of end of ModerateOrSevereLVSDHFOutpatientEncounter.period
          where LVADPlacement.status = 'completed'
      )

    /*
    @description: Returns true if patient has active LVAD complications that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
    */
    define "Has Left Ventricular Assist Device Complications":
      exists ( ( [Condition: "Left Ventricular Assist Device Complications"] ) LVADComplications
          let diagnosisStart: Coalesce(start of LVADComplications.prevalenceInterval(), LVADComplications.recordedDate)
          with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
            such that date from diagnosisStart on or before date from end of ModerateOrSevereLVSDHFOutpatientEncounter.period
          where LVADComplications.isVerified ( )
      )

    /*
    @description: Returns certain finished encounter types that occurred during the measurement period:
                    * office visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001)
                    * outpatient consultation (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008)
                    * nursing facility visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012)
                    * care services in long term residential facility (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014)
                    * home healthcare services (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016)
                    * patient provider interactions (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012)
    */
    define "Qualifying Outpatient Encounter During Measurement Period":
      "Outpatient Encounter or Patient Provider Interaction" ValidEncounter
        where ValidEncounter.period during day of "Measurement Period"
          and ValidEncounter.isEncounterFinished ( )

    define "Outpatient Encounter or Patient Provider Interaction":
      "Outpatient Encounter"
        union [Encounter: "Patient Provider Interaction"]

    /*
    @description: Returns completed heart tansplant procedures that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
    */
    define "Has Heart Transplant":
      exists ( [Procedure: "Heart Transplant"] HeartTransplant
          with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
            such that HeartTransplant.performed.toInterval ( ) starts before end of ModerateOrSevereLVSDHFOutpatientEncounter.period
          where HeartTransplant.status = 'completed'
      )

    /*
    @description: Returns heart failure outpatient encounters that start before the end of a moderate or severe LVSD finding
    */
    define "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD":
      "Heart Failure Outpatient Encounter" HFOutpatientEncounter
        with "Moderate or Severe LVSD Findings" LVSDFindings
          such that Coalesce(LVSDFindings.prevalenceInterval(), LVSDFindings.effective.toInterval()) starts before end of HFOutpatientEncounter.period

    /*
    @description: Returns a union  of the following:
                    * Observations where the final, amended or correction ejection fraction result is <= 40
                    * Moderate or Severe LVSD conditions where the diagnosis has been confirmed as active
    */
    define "Moderate or Severe LVSD Findings":
      ( [ObservationClinicalResult: "Ejection Fraction"] EjectionFraction
          where EjectionFraction.value as Quantity <= 40 '%'
            and EjectionFraction.status in { 'final', 'amended', 'corrected' }
      )
        union ( ( ( [Condition: "Moderate or Severe LVSD"] )
          union ( ( [Condition: "Left ventricular systolic dysfunction (disorder)"] ) LVSDDiagnosis
            where LVSDDiagnosis.severity in "Moderate or Severe"
          ) ) ModerateOrSevereLVSD
          where ModerateOrSevereLVSD.isVerified ( )
        )

    /*
    @description: Returns true if the patient meets the following criteria:
                    * 18 years of age or older,
                    * Has two Qualifying Outpatient Encounters During Measurement Period
                    * Has a Heart Failure Outpatient Encounter
    */
    define "Is Adult With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period":
      AgeInYearsAt(date from start of "Measurement Period") >= 18
        and exists ( "Qualifying Outpatient Encounter During Measurement Period" Encounter1
            with "Qualifying Outpatient Encounter During Measurement Period" Encounter2
              such that Encounter2.id !~ Encounter1.id
        )
        and exists "Heart Failure Outpatient Encounter"

    /*
    @description: Returns true if the given Encounter is finished
    */
    define fluent function isEncounterFinished(Encounter Encounter):
      Encounter.status = 'finished'

    /*
    @description: Returns true if the given MedicationRequest is ordered during the heart failure outpatient encounter with history of moderate or severe LVSD at any point
    */
    define fluent function isOrderedDuringHeartFailureOutpatientEncounter(MedicationRequest MedicationRequest):
      exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
          where MedicationRequest.authoredOn during day of ModerateOrSevereLVSDHFOutpatientEncounter.period
            and MedicationRequest.status in { 'active', 'completed' }
            and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
            and not exists ( ["TaskRejected"] TaskReject
                where TaskReject.focus.references ( MedicationRequest )
                  and TaskReject.code ~ USQualityCoreCommon."Fulfill"
            )
      )

    /*
    @description: Returns true if the given MedicationNotRequested overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
    */
    define fluent function isMedicationNotRequestedOrderedDuringHeartFailureOutpatientEncounter(MedicationRequest MedicationNotRequested):
      exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
          where MedicationRequest.authoredOn during day of ModerateOrSevereLVSDHFOutpatientEncounter.period
            and MedicationRequest.status in { 'completed', 'active' }
            and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
            and not exists ( ["TaskRejected"] TaskReject
                where TaskReject.focus.references ( MedicationRequest )
                  and TaskReject.code ~ USQualityCoreCommon."Fulfill"
            )
      )

    /*
    @description: Returns true if the given Condition overlaps the heart failure outpatient encounter with history of moderate or severe LVSD at any point
    */
    define fluent function overlapsHeartFailureOutpatientEncounter(Condition Condition):
      exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
          where Condition.prevalenceInterval ( ) overlaps day of ModerateOrSevereLVSDHFOutpatientEncounter.period
            and Condition.isVerified ( )
      )

    /*
    @overloaded
    @description: Returns true if the given Condition overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
    */
    define fluent function overlapsAfterHeartFailureOutpatientEncounter(Condition Condition):
      exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
          where Condition.prevalenceInterval ( ) overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
            and Condition.isVerified ( )
      )

    /*
    @overloaded
    @description: Returns true if the given Procedure overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
    */
    define fluent function overlapsAfterHeartFailureOutpatientEncounter(Procedure Procedure):
      exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
          where Procedure.performed.toInterval ( ) overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
            and Procedure.status = 'completed'
      )

    /*
    @overloaded
    @description: Returns true if the given AllergyIntolerance overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
    */
    define fluent function overlapsAfterHeartFailureOutpatientEncounter(AllergyIntolerance AllergyIntolerance):
      exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
          where Interval[start of AllergyIntolerance.onset.toInterval ( ), AllergyIntolerance.lastOccurrence]overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
            and AllergyIntolerance.isVerified ( )
      )

    /*
    @overloaded
    @description: Returns true if the given MedicationRequest overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
    */
    define fluent function overlapsAfterHeartFailureOutpatientEncounter(MedicationRequest MedicationRequest):
      exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
          where First((collapse(MedicationRequest.dosageInstruction.timing.repeat.bounds DoseTime
                return TimingBoundToInterval(MedicationRequest.authoredOn, DoseTime)
            )) DrugPeriods
              sort by start of $this
          ) overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
            and MedicationRequest.status in { 'active', 'completed' }
            and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
            and not exists ( ["TaskRejected"] TaskReject
                where TaskReject.focus.references ( MedicationRequest )
                  and TaskReject.code ~ USQualityCoreCommon."Fulfill"
            )
      )

    /*
    @overloaded
    @description: Returns true if the given HeartRateObservation overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
    */
    define fluent function overlapsAfterHeartFailureOutpatientEncounter(HeartRateObservation USCore.HeartRateProfile):
      exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
          where HeartRateObservation.effective.toInterval ( ) overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
            and HeartRateObservation.status in { 'final', 'amended', 'corrected' }
      )

    /*
    @description: Converts the possible representations of the timing bound to an interval using the given date as an anchor for durations
    */
    define function TimingBoundToInterval(startDate System.DateTime, choice Choice<FHIR.Duration, FHIR.Range, FHIR.Period>):
      case
        when choice is FHIR.Period then
            choice as FHIR.Period
        when choice is FHIR.Range then
            Interval[startDate + (choice.low as Quantity), startDate + (choice.high as Quantity)]
        when choice is FHIR.Duration then
            Interval[startDate, startDate + (choice as FHIR.Duration))
        else
    		null as Interval<DateTime>
    	end
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