dQM QICore Content Implementation Guide
2025.0.0 - CI Build
dQM QICore Content Implementation Guide
2025.0.0 - CI Build
dQM QICore Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2025.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/dqm-content-qicore-2025/ and changes regularly. See the Directory of published versions
| Active as of 2025-08-23 |
<Measure xmlns="http://hl7.org/fhir">
<id value="CMS1173FHIRDiagnosticDelayVTE"/>
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<table class="narrative-table">
<tbody>
<tr>
<th colspan="2" scope="row" class="row-header">Metadata</th>
</tr>
<tr>
<th scope="row" class="row-header">Title</th>
<td class="content-container">Diagnostic Delay of Venous Thromboembolism in Primary CareFHIR</td>
</tr>
<tr>
<th scope="row" class="row-header">Version</th>
<td class="content-container">1.0.000</td>
</tr>
<tr>
<th scope="row" class="row-header">Short Name</th>
<td class="content-container">CMS1173FHIR</td>
</tr>
<tr>
<th scope="row" class="row-header">GUID (Version Independent)</th>
<td class="content-container">urn:uuid:fba2a9e0-d884-4aa0-9f90-184c0be9d41c</td>
</tr>
<tr>
<th scope="row" class="row-header">GUID (Version Specific)</th>
<td class="content-container">urn:uuid:cea80e8b-f5a9-48ce-9918-8f93e042989d</td>
</tr>
<tr>
<th scope="row" class="row-header">CMS Identifier</th>
<td class="content-container">1173FHIR</td>
</tr>
<tr>
<th scope="row" class="row-header">CMS Consensus Based Entity Identifier</th>
<td class="content-container">3749e</td>
</tr>
<tr>
<th scope="row" class="row-header">Effective Period</th>
<td class="content-container">2026-01-01 through 2026-12-31</td>
</tr>
<tr>
<th scope="row" class="row-header">Steward (Publisher)</th>
<td class="content-container">Brigham and Womens Health</td>
</tr>
<tr>
<th scope="row" class="row-header">Developer</th>
<td class="content-container">Brigham and Womens Health</td>
</tr>
<tr>
<th scope="row" class="row-header">Description</th>
<td class="content-container"><p>Percentage of episodes for patients 18 years of age and older with documented Venous Thromboembolism (VTE) symptoms in the primary care setting and who had a diagnosis of VTE that occurs > 24 hours and within 30 days following the index primary care visit where symptoms for the VTE were first present.</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Copyright</th>
<td class="content-container"><p>This electronic Clinical Quality Measure (Measure) and related data specifications are owned and stewarded by the Brigham and Women's Hospital (BWH). BWH is not responsible for any use of the Measure. BWH makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and BWH has no liability to anyone who relies on such measures or specifications.</p>
<p>CPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association.</p>
<p>LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc.</p>
<p>This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation.</p>
<p>ICD-10 copyright 2024 World Health Organization. All Rights Reserved.</p>
<p>Due to technical limitations, registered trademarks are indicated by (R) or [R].</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Disclaimer</th>
<td class="content-container"><p>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.</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Rationale</th>
<td class="content-container"><p>Venous Thromboembolism or VTE disease consists of pulmonary embolism and deep vein thrombosis. VTE is a deadly disease and more timely treatment can improve patient outcomes (Beckman, et al. 2010). Evidence from the literature as well as data from our site support this linkage. According to the Centers for Disease Control and Prevention (CDC) up to 900,000 people in USA are affected by VTE which results is more than 100,000 deaths each year (CDC, 2024). Pulmonary embolism (PE) is an independent predictor of reduced survival for up to 3 months after onset and up to 45% of patients with a PE die within 3 months (Heit JA, 2006). VTE is also associated with increased morbidity, increased health care costs and decreased quality of life (Rathbun S, 2009 and Rabinovich N, 2017). Long term morbidity includes post-thrombotic syndrome (PTS) and pulmonary hypertension (Kahn SR, 2004). PTS is a chronic complication of deep vein thrombosis (DVT) that develops in 20-50% of patients (Rabinovich N, 2017). PTS is associated with chronic venous insufficiency and associated signs and symptoms can impose significant morbidity and have a negative impact on quality of life. VTE can also have an impact on subsequent pregnancies, estrogen use, surgery, life insurance and travel (Tran HA, 2019). The best way to prevent PTS is to prevent the occurrence of DVT, and to provide optimal anticoagulation for the acute phase of DVT once it occurs. The evidence that PE increases morbidity and mortality is robust and DVT is strongly associated with PE.</p>
<p>Traditionally, there has not been a systematic way to measure the incidence of delayed diagnosis of VTE and therefore the estimates in the literature are based on manual record review and vary widely. The DOVE eCQM is an automated tool that quantifies delayed diagnosis that builds a foundation for automated VTE risk assessment and prompt treatment to prevent delayed diagnosis and adverse outcomes.</p>
<p>The American Society of Hematology published VTE diagnosis guidelines to provide an evidence-based strategy to efficiently evaluate patients (Lim, 2018, updated 2022). The goal of these guidelines is to improve diagnostic accuracy by assisting providers with evaluating patients with suspected VTE while reducing unnecessary and more invasive testing (Lim, et al. 2018). While routine use of guidelines in primary care would likely reduce the number of missed or delayed VTE diagnoses, integration into practice is challenging. VTE symptoms are nonspecific and often present as symptoms consistent with an underlying chronic illness. Strategies such as clinical decision support and measurement of diagnostic performance are needed to assist primary care providers with adopting VTE diagnosis guidelines and routinely using them in clinical practice. Currently, there is no way to measure VTE diagnostic performance. Metrics are needed to quantify suboptimal VTE diagnostic performance, improved early recognition of VTE symptoms, and ultimately reducing unfavorable VTE outcomes.</p>
<p>Measuring and reporting delayed VTE diagnosis rates will inform healthcare providers and facilities about opportunities to improve care, strengthen incentives for quality improvement, and ultimately improve the quality of care received by patients.</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Clinical Recommendation Statement</th>
<td class="content-container"><p>Venous Thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant and often fatal condition that affects up to 900,000 individuals in the U.S. each year, resulting in over 100,000 deaths (CDC, 2024). Evidence indicates that prompt diagnosis and timely initiation of treatment can significantly reduce mortality and improve patient outcomes, particularly in primary care where VTE symptoms are frequently under-recognized (Beckman et al., 2010).</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Ageno W, Agnelli G, Imberti D, Moia M, Palareti G, Pistelli R, Rossi R, Verso M, MASTER Investigators. Factors associated with the timing of diagnosis of venous thromboembolism: results from the MASTER registry. Thrombosis research. 2008 Jan 1;121(6):751-6.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Al-Ani F, Shariff S, Siqueira L, Seyam A, Lazo-Langner A. Identifying venous thromboembolism and major bleeding in emergency room discharges using administrative data. Thromb Res. 2015 Dec;136(6):1195-8. doi: 10.1016/j.thromres.2015.10.035. Epub 2015 Oct 29. PMID: 26553020.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Alotaibi GS, Wu C, Senthilselvan A, McMurtry MS. The validity of ICD codes coupled with imaging procedure codes for identifying acute venous thromboembolism using administrative data. Vasc Med. 2015 Aug;20(4):364-8. doi: 10.1177/1358863X15573839. Epub 2015 Apr 1. PMID: 25834115.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Baumgartner C, Go AS, Fan D, Sung SH, Witt DM, Schmelzer JR, Williams MS, Yale SH, VanWormer JJ, Fang MC. Administrative codes inaccurately identify recurrent venous thromboembolism: The CVRN VTE study. Thromb Res. 2020 May;189:112-118. doi: 10.1016/j.thromres.2020.02.023. Epub 2020 Mar 5. PMID: 32199174; PMCID: PMC7335977.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous thromboembolism: a public health concern. Am J Prev Med. 2010 Apr;38(4 Suppl):S495-501. doi: 10.1016/j.amepre.2009.12.017. PMID: 20331949.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Büller HR, Ten Cate-Hoek AJ, Hoes AW, Joore MA, Moons KG, Oudega R, Prins MH, Stoffers HE, Toll DB, van der Velde EF, van Weert HC; AMUSE (Amsterdam Maastricht Utrecht Study on thromboEmbolism) Investigators. Safely ruling out deep venous thrombosis in primary care. Ann Intern Med. 2009 Feb 17;150(4):229-35. PMID: 19221374.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Casez P, Labarère J, Sevestre MA, Haddouche M, Courtois X, Mercier S, Lewandowski E, Fauconnier J, François P, Bosson JL. ICD-10 hospital discharge diagnosis codes were sensitive for identifying pulmonary embolism but not deep vein thrombosis. J Clin Epidemiol. 2010 Jul;63(7):790-7. doi: 10.1016/j.jclinepi.2009.09.002. Epub 2009 Dec 2. PMID: 19959332.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Chopard R, Albertsen IE, Piazza G. Diagnosis and Treatment of Lower Extremity Venous Thromboembolism: A Review. JAMA. 2020 Nov 3;324(17):1765-1776. doi: 10.1001/jama.2020.17272. PMID: 33141212.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Dalen JE. Pulmonary embolism: what have we learned since virchow?: natural history, pathophysiology, and diagnosis. Chest. 2002 Oct 1;122(4):1440-56.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Fang MC, Fan D, Sung SH, Witt DM, Schmelzer JR, Steinhubl SR, Yale SH, Go AS. Validity of Using Inpatient and Outpatient Administrative Codes to Identify Acute Venous Thromboembolism: The CVRN VTE Study. Med Care. 2017 Dec;55(12):e137-e143. doi: 10.1097/MLR.0000000000000524. PMID: 29135777; PMCID: PMC5125903.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Heit JA. The epidemiology of venous thromboembolism in the community: implications for prevention and management. J Thromb Thrombolysis. 2006 Feb;21(1):23-9. doi: 10.1007/s11239-006-5572-y. PMID: 16475038.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Kahn SR, Ginsberg JS. Relationship between deep venous thrombosis and the postthrombotic syndrome. Archives of internal medicine. 2004 Jan 12;164(1):17-26.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Kearon C. Diagnosis of suspected venous thromboembolism. Hematology Am Soc Hematol Educ Program. 2016 Dec 2;2016(1):397-403. doi: 10.1182/asheducation-2016.1.397. PMID: 27913507; PMCID: PMC6142443.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Li T, Curtin-Bowen M, Pullman A, Lipsitz S, Syrowatka A, Sainlaire M, Thai T, Businger A, Davis A, Lieberman JR, Blanchfield B, Bates DW, Dykes PC. Testing of a Risk-Standardized Major Bleeding and Venous Thromboembolism Electronic Clinical Quality Measure for Elective Total Hip and/or Knee Arthroplasties. AMIA Annu Symp Proc. 2022 Feb 21;2021:736-743. PMID: 35308961; PMCID: PMC8861692.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Monaghan TF, Rahman SN, Agudelo CW, et al. Foundational Statistical Principles in Medical Research: Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value. Medicina (Kaunas). 2021;57(5):503. Published 2021 May 16. doi:10.3390/medicina57050503</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Ozsu S, Oztuna F, Bulbul Y, Topbas M, Ozlu T, Kosucu P, Ozsu A. The role of risk factors in delayed diagnosis of pulmonary embolism. The American journal of emergency medicine. 2011 Jan 1;29(1):26-32.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Pellathy T, Saul M, Clermont G, Dubrawski AW, Pinsky MR, Hravnak M. Accuracy of identifying hospital acquired venous thromboembolism by administrative coding: implications for big data and machine learning research. Journal of Clinical Monitoring and Computing. 2021 Feb 8:1-9.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Rabinovich A, Kahn SR. The postthrombotic syndrome: current evidence and future challenges. J Thromb Haemost. 2017 Feb;15(2):230-241. doi: 10.1111/jth.13569. Epub 2017 Jan 23. PMID: 27860129.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Rathbun S. Cardiology patient pages. The Surgeon General's call to action to prevent deep vein thrombosis and pulmonary embolism. Circulation. 2009 Apr 21;119(15):e480-2. doi: 10.1161/CIRCULATIONAHA.108.841403. PMID: 19380627.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Righini M, Le Gal G, Bounameaux H. Venous thromboembolism diagnosis: unresolved issues. Thromb Haemost. 2015 Jun;113(6):1184-92. doi: 10.1160/TH14-06-0530. Epub 2014 Dec 11. PMID: 25503584.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Schiff GD, Hasan O, Kim S, Abrams R, Cosby K, Lambert BL, Elstein AS, Hasler S, Kabongo ML, Krosnjar N, Odwazny R, Wisniewski MF, McNutt RA. Diagnostic error in medicine: analysis of 583 physician-reported errors. Arch Intern Med. 2009 Nov 9;169(20):1881-7. doi: 10.1001/archinternmed.2009.333. PMID: 19901140.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Tran HA, Gibbs H, Merriman E, Curnow JL, Young L, Bennett A, Tan CW, Chunilal SD, Ward CM, Baker R, Nandurkar H. New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism. Med J Aust. 2019 Mar;210(5):227-235. doi: 10.5694/mja2.50004. Epub 2019 Feb 10. Erratum in: Med J Aust. 2019 Jul;211(2):94. doi: 10.5694/mja2.50260.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Uhland H, Goldberg LM. Pulmonary Embolism: A Commonly Missed Clinical Entity EMBOLISM. Dis Chest. 1964 May;45:533-6. doi: 10.1378/chest.45.5.533. PMID: 14147480</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Van Maanen R, Kingma AEC, Oudega R, Rutten FH, Moons K, Geersing GJ. Real-life impact of clinical prediction rules for venous thromboembolism in primary care: a cross-sectional cohort study. BMJ Open. 2020 Dec 28;10(12):e039913. doi: 10.1136/bmjopen-2020-039913. PMID: 33372074; PMCID: PMC7772307.</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Documentation</th>
<td class="content-container">
<em>Citation</em>: <p>CDC 2024: Data and Statistics on Venous Thromboembolism | Venous Thromboembolism (Blood Clots) | CDC, Accessed July 31, 2024. https://www.cdc.gov/blood-clots/data-research/facts-stats/index.html</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Documentation</th>
<td class="content-container">
<em>Citation</em>: <p>Wendy Lim, Grégoire Le Gal, Shannon M. Bates, Marc Righini, Linda B. Haramati, Eddy Lang, Jeffrey A. Kline, Sonja Chasteen, Marcia Snyder, Payal Patel, Meha Bhatt, Parth Patel, Cody Braun, Housne Begum, Wojtek Wiercioch, Holger J. Schünemann, Reem A. Mustafa; American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv 2018; 2 (22): 3226–3256. doi: https://doi.org/10.1182/bloodadvances.2018024828</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Definition</th>
<td class="content-container">Qualified VTE Encounter Definition: <p>A Qualified VTE Encounter is an encounter performed by a qualified provider types with VTE diagnosis code (ICD10) for which a VTE-related imaging scan is performed within 30 days of the index PCP visit where VTE symptoms are reported and an anticoagulant medication is ordered within 12 hours of the imaging scan result.</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Guidance (Usage)</th>
<td class="content-container"><p>This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 18 years and older at the start of the Qualified VTE Encounter during the measurement period. This measure is to be reported for every eligible encounter during the measurement period.</p>
<p>This eCQM is intended to be reported by integrated health systems with access to both ambulatory and inpatient documentation. The VTE symptoms can be captured through structured, coded data (see “VTE Symptoms” value set). Reporters of the eCQM can also opt to use clinical notes and a Natural Language Processing (NLP) platform that can be freely licensed from Brigham and Women’s Hospital (BWH). This platform, VTExt, is part of the MTERMS platform of Python NLP tools (proprietary to the BWH MTERMS lab). For access to the full MTERMS VTExt tool, please contact the MTERMS lab at BWHMTERMS@bwh.harvard.edu. When using NLP, the MTERMS VTExt tool is not required; however, the expectation for the eCQM is to use the same rule-based approach implemented by BWH. Reporters of the eCQM can use their own code to better suit their organization’s database / note structure / formatting, but such code should use the same rule-based NLP approach as VTExt (i.e., regular expressions).</p>
<p>This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.</p></td>
</tr>
<tr>
<th colspan="2" scope="row" class="row-header">Measure Group (Rate) (ID: Group_1)</th>
</tr>
<tr>
<th scope="row" class="row-header">Basis</th>
<td class="content-container">Encounter</td>
</tr>
<tr>
<th scope="row" class="row-header">Scoring</th>
<td class="content-container">[http://terminology.hl7.org/CodeSystem/measure-scoring#proportion: 'Proportion']</td>
</tr>
<tr>
<th scope="row" class="row-header">Type</th>
<td class="content-container">[http://terminology.hl7.org/CodeSystem/measure-type#intermediate-outcome: 'Intermediate Outcome']</td>
</tr>
<tr>
<th scope="row" class="row-header">Improvement Notation</th>
<td class="content-container">[http://terminology.hl7.org/CodeSystem/measure-improvement-notation#decrease: 'Decreased score indicates improvement']</td>
</tr>
<tr>
<th scope="row" class="row-header">Initial Population</th>
<td class="content-container">
<em>ID</em>: InitialPopulation_1
<br/>
<em>Description</em>:
<p style="white-space: pre-line" class="tab-one"><p>All Qualified VTE Encounters in which the patient was aged 18 or older at the start of the Qualified VTE Encounter.</p></p>
<em>Logic Definition</em>: <a href="#primary-cms1173fhirdiagnosticdelayvte-initial-population">Initial Population</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Denominator</th>
<td class="content-container">
<em>ID</em>: Denominator_1
<br/>
<em>Description</em>:
<p style="white-space: pre-line" class="tab-one"><p>Equals Initial Population.</p></p>
<em>Logic Definition</em>: <a href="#primary-cms1173fhirdiagnosticdelayvte-denominator">Denominator</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Denominator Exclusion</th>
<td class="content-container">
<em>ID</em>: DenominatorExclusion_1
<br/>
<em>Description</em>:
<p style="white-space: pre-line" class="tab-one"><p>Exclude qualified VTE encounter with a hospice care service documented within previous 90 Days Exclude qualified VTE encounter with a palliative care service documented within previous 90 Days Exclude qualified VTE encounter with another qualified VTE encounter documented within previous 6 months</p></p>
<em>Logic Definition</em>: <a href="#primary-cms1173fhirdiagnosticdelayvte-denominator-exclusions">Denominator Exclusions</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Numerator</th>
<td class="content-container">
<em>ID</em>: Numerator_1
<br/>
<em>Description</em>:
<p style="white-space: pre-line" class="tab-one"><p>All qualified VTE encounters in which the VTE diagnosis occurs greater than 24 hours and within 30 days following the index PCP visit</p></p>
<em>Logic Definition</em>: <a href="#primary-cms1173fhirdiagnosticdelayvte-numerator">Numerator</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Guidance</th>
<td class="content-container"><p>For every patient evaluated by this measure also identify payer, race, ethnicity and sex</p></td>
</tr>
<tr>
<th colspan="2" scope="row" class="row-header">Supplemental Data Elements</th>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Element</th>
<td class="content-container">
<em>ID</em>: sde-ethnicity
<br/>
<em>Usage Code</em>: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
<br/>
<em>Description</em>: SDE Ethnicity
<br/>
<em>Logic Definition</em>: <a href="#cms1173fhirdiagnosticdelayvte-sde-ethnicity">SDE Ethnicity</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Element</th>
<td class="content-container">
<em>ID</em>: sde-payer
<br/>
<em>Usage Code</em>: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
<br/>
<em>Description</em>: SDE Payer
<br/>
<em>Logic Definition</em>: <a href="#cms1173fhirdiagnosticdelayvte-sde-payer">SDE Payer</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Element</th>
<td class="content-container">
<em>ID</em>: sde-race
<br/>
<em>Usage Code</em>: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
<br/>
<em>Description</em>: SDE Race
<br/>
<em>Logic Definition</em>: <a href="#cms1173fhirdiagnosticdelayvte-sde-race">SDE Race</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Element</th>
<td class="content-container">
<em>ID</em>: sde-sex
<br/>
<em>Usage Code</em>: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
<br/>
<em>Description</em>: SDE Sex
<br/>
<em>Logic Definition</em>: <a href="#cms1173fhirdiagnosticdelayvte-sde-sex">SDE Sex</a>
</td>
</tr>
<tr>
<th colspan="2" scope="row" class="row-header">Measure Logic</th>
</tr>
<tr>
<th scope="row" class="row-header">Primary Library</th>
<td class="content-container">https://madie.cms.gov/Library/CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<th scope="row" class="row-header">Contents</th>
<td class="content-container">
<em><a href="#population-criteria">Population Criteria</a></em>
<br/>
<em><a href="#definitions">Logic Definitions</a></em>
<br/>
<em><a href="#terminology">Terminology</a></em>
<br/>
<em><a href="#dependencies">Dependencies</a></em>
<br/>
<em><a href="#data-requirements">Data Requirements</a></em>
<br/>
</td>
</tr>
<tr>
<th colspan="2" scope="row" class="row-header"><a name="population-criteria"> </a>Population Criteria</th>
</tr>
<tr>
<th colspan="2" scope="row" class="row-header">Measure Group (Rate) (ID: Group_1)</th>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="primary-cms1173fhirdiagnosticdelayvte-initial-population"> </a>
Initial Population
</th>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Initial Population":
/***
* Includes all Qualified VTE Encounters in which the patient was aged 18 or older at the start of the qualified VTE encounter.
***/
"Qualified VTE Encounters During Measurement Period" QualifiedEncounter
where AgeInYearsAt(date from start of QualifiedEncounter.period) >= 18</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="primary-cms1173fhirdiagnosticdelayvte-denominator"> </a>
Denominator
</th>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="primary-cms1173fhirdiagnosticdelayvte-denominator-exclusions"> </a>
Denominator Exclusion
</th>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator Exclusions":
"Qualified VTE Encounter With Hospice Services Within Previous 90 Days"
union "Qualified VTE Encounter With Palliative Care Within Previous 90 Days"
union "Qualified VTE Encounter With Other Qualified VTE Encounter Documented Within Previous 6 Months"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="primary-cms1173fhirdiagnosticdelayvte-numerator"> </a>
Numerator
</th>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Numerator":
/***
* Includes all qualified VTE encounters in which the VTE diagnosis started greater than 24 hours after a qualifying PCP visit.
****/
"Qualifying Delayed VTE Encounter"</code></pre>
</td>
</tr>
<tr>
<th colspan="2" scope="row" class="row-header"><a name="definitions"> </a>Logic Definitions</th>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="supplementaldataelements-sde-sex"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> SupplementalDataElements</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "SDE Sex":
case
when Patient.sex = '248153007' then "Male (finding)"
when Patient.sex = '248152002' then "Female (finding)"
else null
end</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="supplementaldataelements-sde-payer"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> SupplementalDataElements</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "SDE Payer":
[Coverage: type in "Payer Type"] Payer
return {
code: Payer.type,
period: Payer.period
}</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="supplementaldataelements-sde-ethnicity"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> SupplementalDataElements</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "SDE Ethnicity":
Patient.ethnicity E
return Tuple {
codes: { E.ombCategory } union E.detailed,
display: E.text
}</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="supplementaldataelements-sde-race"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> SupplementalDataElements</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "SDE Race":
Patient.race R
return Tuple {
codes: R.ombCategory union R.detailed,
display: R.text
}</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="fhirhelpers-tostring"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> FHIRHelpers</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function ToString(value uri): value.value</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="fhirhelpers-tointerval"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> FHIRHelpers</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@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]</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="fhirhelpers-toconcept"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> FHIRHelpers</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@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
}</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="fhirhelpers-tocode"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> FHIRHelpers</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@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
}</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-sde-sex"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "SDE Sex":
SDE."SDE Sex"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-qualifying-performed-encounters"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Qualifying Performed Encounters":
( ["Encounter": "Office Visit"]
union ["Encounter": "Outpatient Encounter"]
union ["Encounter": "Encounter Inpatient"] ) Encounter
where Encounter.status = 'finished'
and Encounter.period starts during day of Interval[start of "Measurement Period" - 180 days, end of "Measurement Period"]</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-qualifying-performed-vte-encounters"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Qualifying Performed VTE Encounters":
"Qualifying Performed Encounters" VTEEncounter
where VTEEncounter.reasonCode in "VTE Diagnoses"
or exists ( [ConditionEncounterDiagnosis: "VTE Diagnoses"] VTECondition
where VTECondition.isConfirmedCondition ( )
and VTEEncounter.reasonReference.references ( VTECondition )
)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-qualifying-performed-pcp-visits"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Qualifying Performed PCP Visits":
( ["Encounter": "Outpatient Encounter"]
union ["Encounter": "Office Visit"] ) PCPVisit
where PCPVisit.status = 'finished'
and PCPVisit.period ends during day of Interval[start of "Measurement Period" - 210 days, end of "Measurement Period"]</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-qualifying-performed-pcp-visits-with-vte-symptom"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Qualifying Performed PCP Visits With VTE Symptom":
"Qualifying Performed PCP Visits" IndexPCPVisit
where IndexPCPVisit.reasonCode in "VTE Symptoms"
or exists ( [ConditionEncounterDiagnosis: "VTE Symptoms"] VTESymptomCondition
where VTESymptomCondition.isVerified ( )
and IndexPCPVisit.reasonReference.references ( VTESymptomCondition )
)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-qualifying-vte-imaging-diagnostic-report"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Qualifying VTE Imaging Diagnostic Report":
["DiagnosticReportNote": "Imaging Related to VTE"] VTEDiagnosticReport
where VTEDiagnosticReport.status in { 'final', 'amended', 'corrected' }</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-anticoagulant-therapy-ordered"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "AntiCoagulant Therapy Ordered":
["MedicationRequest": "Anticoagulant Medications"] AntiCoagulant
where AntiCoagulant.status in { 'active', 'completed' }
and AntiCoagulant.intent = 'order'</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-qualified-vte-encounters"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Qualified VTE Encounters":
from
"Qualifying Performed VTE Encounters" VTEEncounter,
"Qualifying Performed PCP Visits With VTE Symptom" IndexPCP,
"Qualifying VTE Imaging Diagnostic Report" VTEStudy,
"AntiCoagulant Therapy Ordered" AntiCoagulantOrdered
where VTEStudy.effective.toInterval ( ) starts during day of VTEEncounter.period
and ( AntiCoagulantOrdered.authoredOn 12 hours or less before VTEStudy.effective
or AntiCoagulantOrdered.authoredOn 12 hours or less after VTEStudy.effective
)
and IndexPCP.period starts 30 days or less on or before VTEStudy.effective
return VTEEncounter</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-qualified-vte-encounters-during-measurement-period"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Qualified VTE Encounters During Measurement Period":
"Qualified VTE Encounters" QualifiedVTEEncounter
where QualifiedVTEEncounter.period starts during day of "Measurement Period"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-qualifying-delayed-vte-encounter"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Qualifying Delayed VTE Encounter":
"Qualified VTE Encounters During Measurement Period" DelayedVTEEncounter
with "Qualifying Performed PCP Visits With VTE Symptom" IndexPCPVisit
such that DelayedVTEEncounter.period starts during day of Interval[end of IndexPCPVisit.period + 2 day, end of IndexPCPVisit.period + 30 days]</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-numerator"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Numerator":
/***
* Includes all qualified VTE encounters in which the VTE diagnosis started greater than 24 hours after a qualifying PCP visit.
****/
"Qualifying Delayed VTE Encounter"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-initial-population"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Initial Population":
/***
* Includes all Qualified VTE Encounters in which the patient was aged 18 or older at the start of the qualified VTE encounter.
***/
"Qualified VTE Encounters During Measurement Period" QualifiedEncounter
where AgeInYearsAt(date from start of QualifiedEncounter.period) >= 18</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-denominator"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-sde-payer"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "SDE Payer":
SDE."SDE Payer"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-sde-ethnicity"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "SDE Ethnicity":
SDE."SDE Ethnicity"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-qualified-vte-encounter-with-hospice-services-within-previous-90-days"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Qualified VTE Encounter With Hospice Services Within Previous 90 Days":
from
"Qualified VTE Encounters" QualifiedVTEEncounter
let NinetyDaysBeforeVTEEncounter: Interval[start of QualifiedVTEEncounter.period - 90 days, end of QualifiedVTEEncounter.period]
where exists ( ["Encounter": "Encounter Inpatient"] 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 NinetyDaysBeforeVTEEncounter
and InpatientEncounter.status = 'finished'
)
or exists ( ["Encounter": "Hospice Encounter"] HospiceEncounter
where HospiceEncounter.period overlaps day of NinetyDaysBeforeVTEEncounter
)
or exists ( ( [ObservationScreeningAssessment: "Hospice care [Minimum Data Set]"] ) HospiceAssessment
where HospiceAssessment.value ~ "Yes (qualifier value)"
and HospiceAssessment.effective.toInterval ( ) overlaps day of NinetyDaysBeforeVTEEncounter
)
or exists ( ( [ServiceRequest: "Hospice Care Ambulatory"] ) HospiceOrder
where HospiceOrder.authoredOn during day of NinetyDaysBeforeVTEEncounter
and HospiceOrder.status in { 'active', 'completed' }
)
or exists ( ( [Procedure: "Hospice Care Ambulatory"] ) HospicePerformed
where HospicePerformed.performed.toInterval ( ) overlaps day of NinetyDaysBeforeVTEEncounter
)
or exists ( ( [ConditionEncounterDiagnosis: "Hospice Diagnosis"] ) HospiceCareDiagnosis
where HospiceCareDiagnosis.prevalenceInterval ( ) overlaps day of NinetyDaysBeforeVTEEncounter
and HospiceCareDiagnosis.isVerified ( )
)
or exists ( ( [ConditionProblemsHealthConcerns: "Hospice Diagnosis"] ) HospiceCareConcern
where HospiceCareConcern.prevalenceInterval ( ) overlaps day of NinetyDaysBeforeVTEEncounter
and HospiceCareConcern.isVerified ( )
)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-qualified-vte-encounter-with-palliative-care-within-previous-90-days"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Qualified VTE Encounter With Palliative Care Within Previous 90 Days":
from
"Qualified VTE Encounters" QualifiedVTEEncounter
let NinetyDaysBeforeVTEEncounter: Interval[start of QualifiedVTEEncounter.period - 90 days, end of QualifiedVTEEncounter.period]
where exists ( ( [ObservationScreeningAssessment: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"] ) PalliativeAssessment
where PalliativeAssessment.effective.toInterval ( ) overlaps day of NinetyDaysBeforeVTEEncounter
and PalliativeAssessment.status in { 'final', 'amended', 'corrected' }
)
or exists ( ( ( [ConditionEncounterDiagnosis: "Palliative Care Diagnosis"] ) ) PalliativeCareDiagnosis
where PalliativeCareDiagnosis.prevalenceInterval ( ) overlaps day of NinetyDaysBeforeVTEEncounter
and PalliativeCareDiagnosis.isVerified ( )
)
or exists ( ( [ConditionProblemsHealthConcerns: "Palliative Care Diagnosis"] ) PalliativeCareConcern
where PalliativeCareConcern.prevalenceInterval ( ) overlaps day of NinetyDaysBeforeVTEEncounter
and PalliativeCareConcern.isVerified ( )
)
or exists ( ( [Encounter: "Palliative Care Encounter"] ) PalliativeEncounter
where PalliativeEncounter.period overlaps day of NinetyDaysBeforeVTEEncounter
)
or exists ( ( [Procedure: "Palliative Care Intervention"] ) PalliativeIntervention
where PalliativeIntervention.performed.toInterval ( ) overlaps day of NinetyDaysBeforeVTEEncounter
)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-qualified-vte-encounter-with-other-qualified-vte-encounter-documented-within-previous-6-months"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Qualified VTE Encounter With Other Qualified VTE Encounter Documented Within Previous 6 Months":
"Qualified VTE Encounters" CurrentQualifiedVTE
with "Qualified VTE Encounters" PreviousQualifiedVTE
such that PreviousQualifiedVTE.period starts 6 months or less before start of CurrentQualifiedVTE.period</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-denominator-exclusions"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator Exclusions":
"Qualified VTE Encounter With Hospice Services Within Previous 90 Days"
union "Qualified VTE Encounter With Palliative Care Within Previous 90 Days"
union "Qualified VTE Encounter With Other Qualified VTE Encounter Documented Within Previous 6 Months"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-sde-race"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "SDE Race":
SDE."SDE Race"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-isconfirmedcondition"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
/*
@description: Returns true if the given Condition is confirmed
*/
define fluent function isConfirmedCondition(condition ConditionEncounterDiagnosis):
condition.verificationStatus ~ QICoreCommon."confirmed"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms1173fhirdiagnosticdelayvte-isverified"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS1173FHIRDiagnosticDelayVTE</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns true if the given condition either has no verification status or has a verification status of confirmed, unconfirmed, provisional, or differential
*/
define fluent function isVerified(condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>):
condition.verificationStatus is not null implies ( condition.verificationStatus ~ QICoreCommon."confirmed"
or condition.verificationStatus ~ QICoreCommon."unconfirmed"
or condition.verificationStatus ~ QICoreCommon."provisional"
or condition.verificationStatus ~ QICoreCommon."differential"
)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="qicorecommon-references"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> QICoreCommon</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns true if any of the given references are to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(references List<Reference>, resource Resource):
exists (references R where R.references(resource))</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="qicorecommon-references"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> QICoreCommon</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@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 Reference, resource Resource):
resource.id = Last(Split(reference.reference, '/'))</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="qicorecommon-tointerval"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> QICoreCommon</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> 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 QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
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 Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
case
when choice is DateTime then
Interval[choice as DateTime, choice as DateTime]
when choice is Interval<DateTime> then
choice as Interval<DateTime>
when choice is Quantity then
Interval[Patient.birthDate + (choice as Quantity),
Patient.birthDate + (choice as Quantity) + 1 year)
when choice is Interval<Quantity> then
Interval[Patient.birthDate + (choice.low as Quantity),
Patient.birthDate + (choice.high as Quantity) + 1 year)
when choice is Timing then
Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
else
null as Interval<DateTime>
end</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="qicorecommon-prevalenceinterval"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> QICoreCommon</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
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]</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="qicorecommon-abatementinterval"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> QICoreCommon</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns an interval representing the normalized abatement of a given Condition.
@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.
*/
define fluent function abatementInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
if condition.abatement is DateTime then
Interval[condition.abatement as DateTime, condition.abatement as DateTime]
else if condition.abatement is Quantity then
Interval[Patient.birthDate + (condition.abatement as Quantity),
Patient.birthDate + (condition.abatement as Quantity) + 1 year)
else if condition.abatement is Interval<Quantity> then
Interval[Patient.birthDate + (condition.abatement.low as Quantity),
Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)
else if condition.abatement is Interval<DateTime> then
Interval[condition.abatement.low, condition.abatement.high)
else null as Interval<DateTime></code></pre>
</td>
</tr>
<tr>
<th colspan="2" scope="row" class="row-header"><a name="terminology"> </a>Terminology</th>
</tr>
<tr>
<th scope="row" class="row-header">Code System</th>
<td class="content-container">
<em>Description</em>: Code system SNOMEDCT
<br/>
<em>Resource</em>: http://snomed.info/sct
<br/>
<em>Canonical URL</em>: <tt>http://snomed.info/sct</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Code System</th>
<td class="content-container">
<em>Description</em>: Code system ConditionVerificationStatusCodes
<br/>
<em>Resource</em>: http://terminology.hl7.org/CodeSystem/condition-ver-status
<br/>
<em>Canonical URL</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-ver-status</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Code System</th>
<td class="content-container">
<em>Description</em>: Code system LOINC
<br/>
<em>Resource</em>: http://loinc.org
<br/>
<em>Canonical URL</em>: <tt>http://loinc.org</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Code System</th>
<td class="content-container">
<em>Description</em>: Code system ConditionClinicalStatusCodes
<br/>
<em>Resource</em>: http://terminology.hl7.org/CodeSystem/condition-clinical
<br/>
<em>Canonical URL</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-clinical</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Office Visit
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Outpatient Encounter
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1087
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1087</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Encounter Inpatient
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set VTE Diagnoses
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1206.49
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1206.49</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set VTE Symptoms
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1206.51
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1206.51</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Imaging Related to VTE
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1206.47
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1206.47</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Anticoagulant Medications
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1206.19
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1206.19</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Payer Type
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Hospice Encounter
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Hospice Care Ambulatory
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Hospice Diagnosis
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Palliative Care Diagnosis
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Palliative Care Encounter
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Palliative Care Intervention
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Direct Reference Code</th>
<td class="content-container">
<em>Display</em>: Male (finding)
<br/>
<em>Code</em>: 248153007
<br/>
<em>System</em>: <tt>http://snomed.info/sct</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Direct Reference Code</th>
<td class="content-container">
<em>Display</em>: Female (finding)
<br/>
<em>Code</em>: 248152002
<br/>
<em>System</em>: <tt>http://snomed.info/sct</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Direct Reference Code</th>
<td class="content-container">
<em>Display</em>: Confirmed
<br/>
<em>Code</em>: confirmed
<br/>
<em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-ver-status</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Direct Reference Code</th>
<td class="content-container">
<em>Display</em>: Unconfirmed
<br/>
<em>Code</em>: unconfirmed
<br/>
<em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-ver-status</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Direct Reference Code</th>
<td class="content-container">
<em>Display</em>: Provisional
<br/>
<em>Code</em>: provisional
<br/>
<em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-ver-status</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Direct Reference Code</th>
<td class="content-container">
<em>Display</em>: Differential
<br/>
<em>Code</em>: differential
<br/>
<em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-ver-status</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Direct Reference Code</th>
<td class="content-container">
<em>Display</em>: Discharge to home for hospice care (procedure)
<br/>
<em>Code</em>: 428361000124107
<br/>
<em>System</em>: <tt>http://snomed.info/sct</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Direct Reference Code</th>
<td class="content-container">
<em>Display</em>: Discharge to healthcare facility for hospice care (procedure)
<br/>
<em>Code</em>: 428371000124100
<br/>
<em>System</em>: <tt>http://snomed.info/sct</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Direct Reference Code</th>
<td class="content-container">
<em>Display</em>: Hospice care [Minimum Data Set]
<br/>
<em>Code</em>: 45755-6
<br/>
<em>System</em>: <tt>http://loinc.org</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Direct Reference Code</th>
<td class="content-container">
<em>Display</em>: Yes (qualifier value)
<br/>
<em>Code</em>: 373066001
<br/>
<em>System</em>: <tt>http://snomed.info/sct</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Direct Reference Code</th>
<td class="content-container">
<em>Display</em>: Active
<br/>
<em>Code</em>: active
<br/>
<em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-clinical</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Direct Reference Code</th>
<td class="content-container">
<em>Display</em>: Recurrence
<br/>
<em>Code</em>: recurrence
<br/>
<em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-clinical</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Direct Reference Code</th>
<td class="content-container">
<em>Display</em>: Relapse
<br/>
<em>Code</em>: relapse
<br/>
<em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/condition-clinical</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Direct Reference Code</th>
<td class="content-container">
<em>Display</em>: Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)
<br/>
<em>Code</em>: 71007-9
<br/>
<em>System</em>: <tt>http://loinc.org</tt>
</td>
</tr>
<tr>
<th colspan="2" scope="row" class="row-header"><a name="dependencies"> </a>Dependencies</th>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: QICore model information
<br/>
<em>Resource</em>: http://hl7.org/fhir/Library/QICore-ModelInfo
<br/>
<em>Canonical URL</em>: <tt>http://hl7.org/fhir/Library/QICore-ModelInfo</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Library SDE
<br/>
<em>Resource</em>: https://madie.cms.gov/Library/SupplementalDataElements|5.1.000
<br/>
<em>Canonical URL</em>: <tt>https://madie.cms.gov/Library/SupplementalDataElements|5.1.000</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Library FHIRHelpers
<br/>
<em>Resource</em>: https://madie.cms.gov/Library/FHIRHelpers|4.4.000
<br/>
<em>Canonical URL</em>: <tt>https://madie.cms.gov/Library/FHIRHelpers|4.4.000</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Library QICoreCommon
<br/>
<em>Resource</em>: https://madie.cms.gov/Library/QICoreCommon|4.0.000
<br/>
<em>Canonical URL</em>: <tt>https://madie.cms.gov/Library/QICoreCommon|4.0.000</tt>
</td>
</tr>
<tr>
<th colspan="2" scope="row" class="row-header"><a name="data-requirements"> </a>Data Requirements</th>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Patient
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
<br/>
<em>Must Support Elements</em>: extension, url, birthDate, birthDate.value
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Encounter
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
<br/>
<em>Must Support Elements</em>: type, status, status.value, period, reasonCode, reasonReference
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: type</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1087
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Encounter
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
<br/>
<em>Must Support Elements</em>: type, status, status.value, period, reasonCode, reasonReference
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: type</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Encounter
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
<br/>
<em>Must Support Elements</em>: type, status, status.value, period, reasonCode, reasonReference, hospitalization, hospitalization.dischargeDisposition
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: type</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Encounter
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
<br/>
<em>Must Support Elements</em>: type, period, status, status.value, reasonCode, reasonReference
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: type</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Encounter
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
<br/>
<em>Must Support Elements</em>: type, period, status, status.value, reasonCode, reasonReference
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: type</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Condition
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
<br/>
<em>Must Support Elements</em>: verificationStatus
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Condition
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
<br/>
<em>Must Support Elements</em>: code
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1206.49
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Condition
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
<br/>
<em>Must Support Elements</em>: code
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1206.51
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Condition
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
<br/>
<em>Must Support Elements</em>: code
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Condition
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
<br/>
<em>Must Support Elements</em>: code
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Resource
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/StructureDefinition/Resource
<br/>
<em>Must Support Elements</em>: id, id.value
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: DiagnosticReport
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-diagnosticreport-note
<br/>
<em>Must Support Elements</em>: code, status, status.value, effective
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1206.47
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: MedicationRequest
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest
<br/>
<em>Must Support Elements</em>: medication, status, status.value, intent, intent.value, authoredOn, authoredOn.value
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: medication</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1206.19
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: MedicationRequest
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest
<br/>
<em>Must Support Elements</em>: medication.reference.value, status, status.value, intent, intent.value, authoredOn, authoredOn.value
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Medication
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication
<br/>
<em>Must Support Elements</em>: id.value, code
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Coverage
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage
<br/>
<em>Must Support Elements</em>: type, period
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: type</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Observation
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment
<br/>
<em>Must Support Elements</em>: code, value, effective
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>Code(s)</em>:
http://loinc.org#45755-6: 'Hospice care [Minimum Data Set]'
</span>
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Observation
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment
<br/>
<em>Must Support Elements</em>: code, effective, status, status.value
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>Code(s)</em>:
http://loinc.org#71007-9: 'Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)'
</span>
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: ServiceRequest
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest
<br/>
<em>Must Support Elements</em>: code, authoredOn, authoredOn.value, status, status.value
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Procedure
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
<br/>
<em>Must Support Elements</em>: code, performed
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Procedure
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
<br/>
<em>Must Support Elements</em>: code, performed
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Condition
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns
<br/>
<em>Must Support Elements</em>: code
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Condition
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns
<br/>
<em>Must Support Elements</em>: code
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167
<br/>
</td>
</tr>
<tr>
<th colspan="2" scope="row" class="row-header">Generated using version 0.4.8 of the sample-content-ig Liquid templates</th>
</tr>
</tbody>
</table>
</div>
</text>
<contained>
<Library>
<id value="effective-data-requirements"/>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="248153007"/>
<display value="Male (finding)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="248152002"/>
<display value="Female (finding)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
<code value="confirmed"/>
<display value="Confirmed"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
<code value="unconfirmed"/>
<display value="Unconfirmed"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
<code value="provisional"/>
<display value="Provisional"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
<code value="differential"/>
<display value="Differential"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="428361000124107"/>
<display value="Discharge to home for hospice care (procedure)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="428371000124100"/>
<display
value="Discharge to healthcare facility for hospice care (procedure)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://loinc.org"/>
<code value="45755-6"/>
<display value="Hospice care [Minimum Data Set]"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="373066001"/>
<display value="Yes (qualifier value)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="active"/>
<display value="Active"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="recurrence"/>
<display value="Recurrence"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="relapse"/>
<display value="Relapse"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://loinc.org"/>
<code value="71007-9"/>
<display
value="Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Sex"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Sex":
case
when Patient.sex = '248153007' then "Male (finding)"
when Patient.sex = '248152002' then "Female (finding)"
else null
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString value="SDE Sex"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Sex":
SDE."SDE Sex""/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString value="Qualifying Performed Encounters"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualifying Performed Encounters":
( ["Encounter": "Office Visit"]
union ["Encounter": "Outpatient Encounter"]
union ["Encounter": "Encounter Inpatient"] ) Encounter
where Encounter.status = 'finished'
and Encounter.period starts during day of Interval[start of "Measurement Period" - 180 days, end of "Measurement Period"]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString value="Qualifying Performed VTE Encounters"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualifying Performed VTE Encounters":
"Qualifying Performed Encounters" VTEEncounter
where VTEEncounter.reasonCode in "VTE Diagnoses"
or exists ( [ConditionEncounterDiagnosis: "VTE Diagnoses"] VTECondition
where VTECondition.isConfirmedCondition ( )
and VTEEncounter.reasonReference.references ( VTECondition )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString value="Qualifying Performed PCP Visits"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualifying Performed PCP Visits":
( ["Encounter": "Outpatient Encounter"]
union ["Encounter": "Office Visit"] ) PCPVisit
where PCPVisit.status = 'finished'
and PCPVisit.period ends during day of Interval[start of "Measurement Period" - 210 days, end of "Measurement Period"]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString
value="Qualifying Performed PCP Visits With VTE Symptom"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualifying Performed PCP Visits With VTE Symptom":
"Qualifying Performed PCP Visits" IndexPCPVisit
where IndexPCPVisit.reasonCode in "VTE Symptoms"
or exists ( [ConditionEncounterDiagnosis: "VTE Symptoms"] VTESymptomCondition
where VTESymptomCondition.isVerified ( )
and IndexPCPVisit.reasonReference.references ( VTESymptomCondition )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString value="Qualifying VTE Imaging Diagnostic Report"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualifying VTE Imaging Diagnostic Report":
["DiagnosticReportNote": "Imaging Related to VTE"] VTEDiagnosticReport
where VTEDiagnosticReport.status in { 'final', 'amended', 'corrected' }"/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString value="AntiCoagulant Therapy Ordered"/>
</extension>
<extension url="statement">
<valueString
value="define "AntiCoagulant Therapy Ordered":
["MedicationRequest": "Anticoagulant Medications"] AntiCoagulant
where AntiCoagulant.status in { 'active', 'completed' }
and AntiCoagulant.intent = 'order'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString value="Qualified VTE Encounters"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualified VTE Encounters":
from
"Qualifying Performed VTE Encounters" VTEEncounter,
"Qualifying Performed PCP Visits With VTE Symptom" IndexPCP,
"Qualifying VTE Imaging Diagnostic Report" VTEStudy,
"AntiCoagulant Therapy Ordered" AntiCoagulantOrdered
where VTEStudy.effective.toInterval ( ) starts during day of VTEEncounter.period
and ( AntiCoagulantOrdered.authoredOn 12 hours or less before VTEStudy.effective
or AntiCoagulantOrdered.authoredOn 12 hours or less after VTEStudy.effective
)
and IndexPCP.period starts 30 days or less on or before VTEStudy.effective
return VTEEncounter"/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString
value="Qualified VTE Encounters During Measurement Period"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualified VTE Encounters During Measurement Period":
"Qualified VTE Encounters" QualifiedVTEEncounter
where QualifiedVTEEncounter.period starts during day of "Measurement Period""/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString value="Qualifying Delayed VTE Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualifying Delayed VTE Encounter":
"Qualified VTE Encounters During Measurement Period" DelayedVTEEncounter
with "Qualifying Performed PCP Visits With VTE Symptom" IndexPCPVisit
such that DelayedVTEEncounter.period starts during day of Interval[end of IndexPCPVisit.period + 2 day, end of IndexPCPVisit.period + 30 days]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString value="Numerator"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator":
/***
* Includes all qualified VTE encounters in which the VTE diagnosis started greater than 24 hours after a qualifying PCP visit.
****/
"Qualifying Delayed VTE Encounter""/>
</extension>
<extension url="displaySequence">
<valueInteger value="11"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString value="Initial Population"/>
</extension>
<extension url="statement">
<valueString
value="define "Initial Population":
/***
* Includes all Qualified VTE Encounters in which the patient was aged 18 or older at the start of the qualified VTE encounter.
***/
"Qualified VTE Encounters During Measurement Period" QualifiedEncounter
where AgeInYearsAt(date from start of QualifiedEncounter.period) >= 18"/>
</extension>
<extension url="displaySequence">
<valueInteger value="12"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString value="Denominator"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator":
"Initial Population""/>
</extension>
<extension url="displaySequence">
<valueInteger value="13"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Payer"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Payer":
[Coverage: type in "Payer Type"] Payer
return {
code: Payer.type,
period: Payer.period
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString value="SDE Payer"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Payer":
SDE."SDE Payer""/>
</extension>
<extension url="displaySequence">
<valueInteger value="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Ethnicity"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Ethnicity":
Patient.ethnicity E
return Tuple {
codes: { E.ombCategory } union E.detailed,
display: E.text
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="16"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString value="SDE Ethnicity"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Ethnicity":
SDE."SDE Ethnicity""/>
</extension>
<extension url="displaySequence">
<valueInteger value="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString
value="Qualified VTE Encounter With Hospice Services Within Previous 90 Days"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualified VTE Encounter With Hospice Services Within Previous 90 Days":
from
"Qualified VTE Encounters" QualifiedVTEEncounter
let NinetyDaysBeforeVTEEncounter: Interval[start of QualifiedVTEEncounter.period - 90 days, end of QualifiedVTEEncounter.period]
where exists ( ["Encounter": "Encounter Inpatient"] 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 NinetyDaysBeforeVTEEncounter
and InpatientEncounter.status = 'finished'
)
or exists ( ["Encounter": "Hospice Encounter"] HospiceEncounter
where HospiceEncounter.period overlaps day of NinetyDaysBeforeVTEEncounter
)
or exists ( ( [ObservationScreeningAssessment: "Hospice care [Minimum Data Set]"] ) HospiceAssessment
where HospiceAssessment.value ~ "Yes (qualifier value)"
and HospiceAssessment.effective.toInterval ( ) overlaps day of NinetyDaysBeforeVTEEncounter
)
or exists ( ( [ServiceRequest: "Hospice Care Ambulatory"] ) HospiceOrder
where HospiceOrder.authoredOn during day of NinetyDaysBeforeVTEEncounter
and HospiceOrder.status in { 'active', 'completed' }
)
or exists ( ( [Procedure: "Hospice Care Ambulatory"] ) HospicePerformed
where HospicePerformed.performed.toInterval ( ) overlaps day of NinetyDaysBeforeVTEEncounter
)
or exists ( ( [ConditionEncounterDiagnosis: "Hospice Diagnosis"] ) HospiceCareDiagnosis
where HospiceCareDiagnosis.prevalenceInterval ( ) overlaps day of NinetyDaysBeforeVTEEncounter
and HospiceCareDiagnosis.isVerified ( )
)
or exists ( ( [ConditionProblemsHealthConcerns: "Hospice Diagnosis"] ) HospiceCareConcern
where HospiceCareConcern.prevalenceInterval ( ) overlaps day of NinetyDaysBeforeVTEEncounter
and HospiceCareConcern.isVerified ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="18"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString
value="Qualified VTE Encounter With Palliative Care Within Previous 90 Days"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualified VTE Encounter With Palliative Care Within Previous 90 Days":
from
"Qualified VTE Encounters" QualifiedVTEEncounter
let NinetyDaysBeforeVTEEncounter: Interval[start of QualifiedVTEEncounter.period - 90 days, end of QualifiedVTEEncounter.period]
where exists ( ( [ObservationScreeningAssessment: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"] ) PalliativeAssessment
where PalliativeAssessment.effective.toInterval ( ) overlaps day of NinetyDaysBeforeVTEEncounter
and PalliativeAssessment.status in { 'final', 'amended', 'corrected' }
)
or exists ( ( ( [ConditionEncounterDiagnosis: "Palliative Care Diagnosis"] ) ) PalliativeCareDiagnosis
where PalliativeCareDiagnosis.prevalenceInterval ( ) overlaps day of NinetyDaysBeforeVTEEncounter
and PalliativeCareDiagnosis.isVerified ( )
)
or exists ( ( [ConditionProblemsHealthConcerns: "Palliative Care Diagnosis"] ) PalliativeCareConcern
where PalliativeCareConcern.prevalenceInterval ( ) overlaps day of NinetyDaysBeforeVTEEncounter
and PalliativeCareConcern.isVerified ( )
)
or exists ( ( [Encounter: "Palliative Care Encounter"] ) PalliativeEncounter
where PalliativeEncounter.period overlaps day of NinetyDaysBeforeVTEEncounter
)
or exists ( ( [Procedure: "Palliative Care Intervention"] ) PalliativeIntervention
where PalliativeIntervention.performed.toInterval ( ) overlaps day of NinetyDaysBeforeVTEEncounter
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="19"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString
value="Qualified VTE Encounter With Other Qualified VTE Encounter Documented Within Previous 6 Months"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualified VTE Encounter With Other Qualified VTE Encounter Documented Within Previous 6 Months":
"Qualified VTE Encounters" CurrentQualifiedVTE
with "Qualified VTE Encounters" PreviousQualifiedVTE
such that PreviousQualifiedVTE.period starts 6 months or less before start of CurrentQualifiedVTE.period"/>
</extension>
<extension url="displaySequence">
<valueInteger value="20"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString value="Denominator Exclusions"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator Exclusions":
"Qualified VTE Encounter With Hospice Services Within Previous 90 Days"
union "Qualified VTE Encounter With Palliative Care Within Previous 90 Days"
union "Qualified VTE Encounter With Other Qualified VTE Encounter Documented Within Previous 6 Months""/>
</extension>
<extension url="displaySequence">
<valueInteger value="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Race"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Race":
Patient.race R
return Tuple {
codes: R.ombCategory union R.detailed,
display: R.text
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="22"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString value="SDE Race"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Race":
SDE."SDE Race""/>
</extension>
<extension url="displaySequence">
<valueInteger value="23"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value uri): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="24"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@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]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="25"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToConcept"/>
</extension>
<extension url="statement">
<valueString
value="/*
@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
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="26"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToCode"/>
</extension>
<extension url="statement">
<valueString
value="/*
@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
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="27"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString value="isConfirmedCondition"/>
</extension>
<extension url="statement">
<valueString
value="/*
/*
@description: Returns true if the given Condition is confirmed
*/
define fluent function isConfirmedCondition(condition ConditionEncounterDiagnosis):
condition.verificationStatus ~ QICoreCommon."confirmed""/>
</extension>
<extension url="displaySequence">
<valueInteger value="28"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="references"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns true if any of the given references are to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(references List<Reference>, resource Resource):
exists (references R where R.references(resource))"/>
</extension>
<extension url="displaySequence">
<valueInteger value="29"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="references"/>
</extension>
<extension url="statement">
<valueString
value="/*
@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 Reference, resource Resource):
resource.id = Last(Split(reference.reference, '/'))"/>
</extension>
<extension url="displaySequence">
<valueInteger value="30"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS1173FHIRDiagnosticDelayVTE"/>
</extension>
<extension url="name">
<valueString value="isVerified"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns true if the given condition either has no verification status or has a verification status of confirmed, unconfirmed, provisional, or differential
*/
define fluent function isVerified(condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>):
condition.verificationStatus is not null implies ( condition.verificationStatus ~ QICoreCommon."confirmed"
or condition.verificationStatus ~ QICoreCommon."unconfirmed"
or condition.verificationStatus ~ QICoreCommon."provisional"
or condition.verificationStatus ~ QICoreCommon."differential"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="31"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="toInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> 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 QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
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 Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
case
when choice is DateTime then
Interval[choice as DateTime, choice as DateTime]
when choice is Interval<DateTime> then
choice as Interval<DateTime>
when choice is Quantity then
Interval[Patient.birthDate + (choice as Quantity),
Patient.birthDate + (choice as Quantity) + 1 year)
when choice is Interval<Quantity> then
Interval[Patient.birthDate + (choice.low as Quantity),
Patient.birthDate + (choice.high as Quantity) + 1 year)
when choice is Timing then
Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
else
null as Interval<DateTime>
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="32"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="prevalenceInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
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]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="33"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="abatementInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns an interval representing the normalized abatement of a given Condition.
@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.
*/
define fluent function abatementInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
if condition.abatement is DateTime then
Interval[condition.abatement as DateTime, condition.abatement as DateTime]
else if condition.abatement is Quantity then
Interval[Patient.birthDate + (condition.abatement as Quantity),
Patient.birthDate + (condition.abatement as Quantity) + 1 year)
else if condition.abatement is Interval<Quantity> then
Interval[Patient.birthDate + (condition.abatement.low as Quantity),
Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)
else if condition.abatement is Interval<DateTime> then
Interval[condition.abatement.low, condition.abatement.high)
else null as Interval<DateTime>"/>
</extension>
<extension url="displaySequence">
<valueInteger value="34"/>
</extension>
</extension>
<name value="EffectiveDataRequirements"/>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="QICore model information"/>
<resource value="http://hl7.org/fhir/Library/QICore-ModelInfo"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library SDE"/>
<resource
value="https://madie.cms.gov/Library/SupplementalDataElements|5.1.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource value="https://madie.cms.gov/Library/FHIRHelpers|4.4.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library QICoreCommon"/>
<resource value="https://madie.cms.gov/Library/QICoreCommon|4.0.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system SNOMEDCT"/>
<resource value="http://snomed.info/sct"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ConditionVerificationStatusCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system LOINC"/>
<resource value="http://loinc.org"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ConditionClinicalStatusCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Office Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Outpatient Encounter"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1087"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Encounter Inpatient"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set VTE Diagnoses"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1206.49"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set VTE Symptoms"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1206.51"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Imaging Related to VTE"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1206.47"/>
</relatedArtifact>
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<valueString
value="<p>For every patient evaluated by this measure also identify payer, race, ethnicity and sex</p>"/>
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<valueMarkdown
value="A Qualified VTE Encounter is an encounter performed by a qualified provider types with VTE diagnosis code (ICD10) for which a VTE-related imaging scan is performed within 30 days of the index PCP visit where VTE symptoms are reported and an anticoagulant medication is ordered within 12 hours of the imaging scan result.
"/>
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<display value="CMS"/>
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<version value="1.0.000"/>
<name value="CMS1173FHIRDiagnosticDelayVTE"/>
<title
value="Diagnostic Delay of Venous Thromboembolism in Primary CareFHIR
"/>
<status value="active"/>
<experimental value="false"/>
<date value="2025-08-23T13:40:35+00:00"/>
<publisher value="Brigham and Womens Health"/>
<contact>
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<value value="https://www.brighamandwomens.org/"/>
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</contact>
<description
value="Percentage of episodes for patients 18 years of age and older with documented Venous Thromboembolism (VTE) symptoms in the primary care setting and who had a diagnosis of VTE that occurs \> 24 hours and within 30 days following the index primary care visit where symptoms for the VTE were first present.
"/>
<usage
value="This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 18 years and older at the start of the Qualified VTE Encounter during the measurement period. This measure is to be reported for every eligible encounter during the measurement period.
This eCQM is intended to be reported by integrated health systems with access to both ambulatory and inpatient documentation. The VTE symptoms can be captured through structured, coded data (see "VTE Symptoms" value set). Reporters of the eCQM can also opt to use clinical notes and a Natural Language Processing (NLP) platform that can be freely licensed from Brigham and Women's Hospital (BWH). This platform, VTExt, is part of the MTERMS platform of Python NLP tools (proprietary to the BWH MTERMS lab). For access to the full MTERMS VTExt tool, please contact the MTERMS lab at BWHMTERMS@bwh.harvard.edu. When using NLP, the MTERMS VTExt tool is not required; however, the expectation for the eCQM is to use the same rule-based approach implemented by BWH. Reporters of the eCQM can use their own code to better suit their organization's database / note structure / formatting, but such code should use the same rule-based NLP approach as VTExt (i.e., regular expressions).
This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.
"/>
<copyright
value="This electronic Clinical Quality Measure (Measure) and related data specifications are owned and stewarded by the Brigham and Women's Hospital (BWH). BWH is not responsible for any use of the Measure. BWH makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and BWH has no liability to anyone who relies on such measures or specifications.
CPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association.
LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc.
This material contains SNOMED Clinical Terms(R) (SNOMED CT\[R\]) copyright 2004-2024 International Health Terminology Standards Development Organisation.
ICD-10 copyright 2024 World Health Organization. All Rights Reserved.
Due to technical limitations, registered trademarks are indicated by (R) or \[R\].
"/>
<effectivePeriod>
<start value="2026-01-01"/>
<end value="2026-12-31"/>
</effectivePeriod>
<author>
<name value="Brigham and Womens Health"/>
<telecom>
<system value="url"/>
<value value="https://www.brighamandwomens.org/"/>
</telecom>
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<citation
value="Ageno W, Agnelli G, Imberti D, Moia M, Palareti G, Pistelli R, Rossi R, Verso M, MASTER Investigators. Factors associated with the timing of diagnosis of venous thromboembolism: results from the MASTER registry. Thrombosis research. 2008 Jan 1;121(6):751-6.
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<relatedArtifact>
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<relatedArtifact>
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<relatedArtifact>
<type value="citation"/>
<citation
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<library
value="https://madie.cms.gov/Library/CMS1173FHIRDiagnosticDelayVTE"/>
<disclaimer
value="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.
"/>
<rationale
value="Venous Thromboembolism or VTE disease consists of pulmonary embolism and deep vein thrombosis. VTE is a deadly disease and more timely treatment can improve patient outcomes (Beckman, et al. 2010). Evidence from the literature as well as data from our site support this linkage. According to the Centers for Disease Control and Prevention (CDC) up to 900,000 people in USA are affected by VTE which results is more than 100,000 deaths each year (CDC, 2024). Pulmonary embolism (PE) is an independent predictor of reduced survival for up to 3 months after onset and up to 45% of patients with a PE die within 3 months (Heit JA, 2006). VTE is also associated with increased morbidity, increased health care costs and decreased quality of life (Rathbun S, 2009 and Rabinovich N, 2017). Long term morbidity includes post-thrombotic syndrome (PTS) and pulmonary hypertension (Kahn SR, 2004). PTS is a chronic complication of deep vein thrombosis (DVT) that develops in 20-50% of patients (Rabinovich N, 2017). PTS is associated with chronic venous insufficiency and associated signs and symptoms can impose significant morbidity and have a negative impact on quality of life. VTE can also have an impact on subsequent pregnancies, estrogen use, surgery, life insurance and travel (Tran HA, 2019). The best way to prevent PTS is to prevent the occurrence of DVT, and to provide optimal anticoagulation for the acute phase of DVT once it occurs. The evidence that PE increases morbidity and mortality is robust and DVT is strongly associated with PE.
Traditionally, there has not been a systematic way to measure the incidence of delayed diagnosis of VTE and therefore the estimates in the literature are based on manual record review and vary widely. The DOVE eCQM is an automated tool that quantifies delayed diagnosis that builds a foundation for automated VTE risk assessment and prompt treatment to prevent delayed diagnosis and adverse outcomes.
The American Society of Hematology published VTE diagnosis guidelines to provide an evidence-based strategy to efficiently evaluate patients (Lim, 2018, updated 2022). The goal of these guidelines is to improve diagnostic accuracy by assisting providers with evaluating patients with suspected VTE while reducing unnecessary and more invasive testing (Lim, et al. 2018). While routine use of guidelines in primary care would likely reduce the number of missed or delayed VTE diagnoses, integration into practice is challenging. VTE symptoms are nonspecific and often present as symptoms consistent with an underlying chronic illness. Strategies such as clinical decision support and measurement of diagnostic performance are needed to assist primary care providers with adopting VTE diagnosis guidelines and routinely using them in clinical practice. Currently, there is no way to measure VTE diagnostic performance. Metrics are needed to quantify suboptimal VTE diagnostic performance, improved early recognition of VTE symptoms, and ultimately reducing unfavorable VTE outcomes.
Measuring and reporting delayed VTE diagnosis rates will inform healthcare providers and facilities about opportunities to improve care, strengthen incentives for quality improvement, and ultimately improve the quality of care received by patients.
"/>
<clinicalRecommendationStatement
value="Venous Thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant and often fatal condition that affects up to 900,000 individuals in the U.S. each year, resulting in over 100,000 deaths (CDC, 2024). Evidence indicates that prompt diagnosis and timely initiation of treatment can significantly reduce mortality and improve patient outcomes, particularly in primary care where VTE symptoms are frequently under-recognized (Beckman et al., 2010).
"/>
<group id="Group_1">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
<valueCode value="Encounter"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="intermediate-outcome"/>
<display value="Intermediate Outcome"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
<code value="decrease"/>
<display value="Decreased score indicates improvement"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-improvementNotationGuidance">
<valueMarkdown
value="A lower score (expressed as a percentage) is indicative of higher quality care.
"/>
</extension>
<population id="InitialPopulation_1">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</code>
<description
value="All Qualified VTE Encounters in which the patient was aged 18 or older at the start of the Qualified VTE Encounter.
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
</criteria>
</population>
<population id="Denominator_1">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator"/>
<display value="Denominator"/>
</coding>
</code>
<description value="Equals Initial Population.
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator"/>
</criteria>
</population>
<population id="DenominatorExclusion_1">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exclusion"/>
<display value="Denominator Exclusion"/>
</coding>
</code>
<description
value="Exclude qualified VTE encounter with a hospice care service documented within previous 90 Days Exclude qualified VTE encounter with a palliative care service documented within previous 90 Days Exclude qualified VTE encounter with another qualified VTE encounter documented within previous 6 months
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exclusions"/>
</criteria>
</population>
<population id="Numerator_1">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator"/>
<display value="Numerator"/>
</coding>
</code>
<description
value="All qualified VTE encounters in which the VTE diagnosis occurs greater than 24 hours and within 30 days following the index PCP visit
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator"/>
</criteria>
</population>
</group>
<supplementalData id="sde-ethnicity">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="individual"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="subject-list"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="summary"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="data-collection"/>
</extension>
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Ethnicity
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Ethnicity"/>
</criteria>
</supplementalData>
<supplementalData id="sde-payer">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="individual"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="subject-list"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="summary"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="data-collection"/>
</extension>
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Payer
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Payer"/>
</criteria>
</supplementalData>
<supplementalData id="sde-race">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="individual"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="subject-list"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="summary"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="data-collection"/>
</extension>
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Race
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Race"/>
</criteria>
</supplementalData>
<supplementalData id="sde-sex">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="individual"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="subject-list"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="summary"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="data-collection"/>
</extension>
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Sex
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Sex"/>
</criteria>
</supplementalData>
</Measure>