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 2025-08-20 |
<Measure xmlns="http://hl7.org/fhir">
<id value="CMS142FHIRCommWithDrManagingDiab"/>
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<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml" class="col-12">
<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">Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes 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">CMS142FHIR</td>
</tr>
<tr>
<th scope="row" class="row-header">GUID (Version Independent)</th>
<td class="content-container">urn:uuid:0f55e61f-dc17-4fe4-a604-7f030260618f</td>
</tr>
<tr>
<th scope="row" class="row-header">GUID (Version Specific)</th>
<td class="content-container">urn:uuid:37dd2397-d9cd-401d-b343-28d77fd2f923</td>
</tr>
<tr>
<th scope="row" class="row-header">CMS Identifier</th>
<td class="content-container">142FHIR</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">American Academy of Ophthalmology</td>
</tr>
<tr>
<th scope="row" class="row-header">Developer</th>
<td class="content-container">American Academy of Ophthalmology</td>
</tr>
<tr>
<th scope="row" class="row-header">Developer</th>
<td class="content-container">American Medical Association (AMA)</td>
</tr>
<tr>
<th scope="row" class="row-header">Description</th>
<td class="content-container"><p>Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once during the measurement period</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Copyright</th>
<td class="content-container">Copyright 2025 American Academy of Ophthalmology. All Rights Reserved.</td>
</tr>
<tr>
<th scope="row" class="row-header">Disclaimer</th>
<td class="content-container">The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measure require a license agreement between the user and the American Academy of Ophthalmology (Academy). Neither the Academy, its members, the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor PCPI, nor their members shall be responsible for any use of the Measure. The PCPI’s and AMA’s significant past efforts and contributions to the development and updating of the Measures are acknowledged. The National Committee for Quality Assurance's significant past efforts and contributions to the development and updating of the Measure is acknowledged. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party’s use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measures. Any other use of CPT or other coding by the third party is strictly prohibited. The Academy, the AMA, and former members of the PCPI disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association. LOINC(R) is 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 is copyright 2024 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R].</td>
</tr>
<tr>
<th scope="row" class="row-header">Rationale</th>
<td class="content-container">Diabetic retinopathy is a prevalent complication of diabetes, estimated to affect 28.5% of diabetic patients in the US (Zhang et al., 2010). Diabetic retinopathy is a key indicator of systemic complications of diabetes (Zhang et al., 2010). Coordination of care between the eye care specialist and the physician managing a patient’s ongoing diabetes care is essential in stemming the progression of vision loss. Communication from the eye care specialist to a primary care physician facilitates the exchange of information about the severity and progression of a patient’s diabetic retinopathy, adherence to recommended ocular care, need for follow-up visits, and treatment plans (Storey et al., 2016). Data from the Diabetes Control and Complications Trial showed that diabetic treatment and maintenance of glucose control delays the onset and slows the progression of diabetic retinopathy (Aiello & DCCT/EDIC Research Group, 2014).</td>
</tr>
<tr>
<th scope="row" class="row-header">Clinical Recommendation Statement</th>
<td class="content-container">The ophthalmologist should refer patients with diabetes to a primary care physician or endocrinologist for appropriate management of their systemic condition and should communicate examination results to the physician managing the patient’s ongoing diabetes care (Lim et al., 2025). A goal is to achieve optimal control of blood glucose, blood pressure, and other risk factors through close communication with the patient’s primary care physician on the status of the DR and the need for optimal metabolic control (Lim et al,, 2025). Establishing a close partnership between the ophthalmologist and the primary care physician is an important step to ensure optimal patient care. Furthermore, it is important to help educate patients with diabetes as well as their primary care physician about the ophthalmologic implications of controlling blood glucose (as monitored by HbA1c) to as near to normal as is safely possible (Lim et al., 2025).</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
Aiello, L. P., & DCCT/EDIC Research Group (2014). Diabetic retinopathy and other ocular findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes care, 37(1), 17–23. doi:10.2337/dc13-2251
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
Lim, J.I., Kim, S.J., Bailey, S.T., Kovach, J.L., Vemulakonda, G.A., Ying, G., Flaxel, C.J. and the American Academy of Ophthalmology Preferred Practice Pattern Retina/Vitreous Committee (2025). Diabetic Retinopathy Preferred Practice Pattern. Ophthalmology. 2025 in press. doi: 10.1016/j.ophtha.2024.12.020
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
Storey, P. P., Murchison, A. P., Pizzi, L. T., Hark, L. A., Dai, Y., Leiby, B. E., & Haller, J. A. Impact of physician communication on diabetic eye examination adherence: Results from a Retrospective Cohort Analysis. Retina. 2016 Jan;36(1),20-7. doi:10.1097/IAE.0000000000000652
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
Zhang, X., Saaddine, J. B., Chou, C. F., Cotch, M. F., Cheng, Y. J., Geiss, L. S., … Klein, R. (2010). Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA, 304(6), 649–656. doi:10.1001/jama.2010.1111
</td>
</tr>
<tr>
<th scope="row" class="row-header">Definition</th>
<td class="content-container">Communication: <p>May include documentation in the medical record indicating that the findings of the dilated macular or fundus exam were communicated (e.g., verbally, by letter) with the clinician managing the patient's diabetic care OR a copy of a letter in the medical record to the clinician managing the patient's diabetic care outlining the findings of the dilated macular or fundus exam</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Definition</th>
<td class="content-container">Findings: <p>Includes level of severity of retinopathy (e.g., mild nonproliferative, moderate nonproliferative, severe nonproliferative, very severe nonproliferative, proliferative) AND the presence or absence of macular edema</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Guidance (Usage)</th>
<td class="content-container">The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality. The communication of results, including the level of severity of diabetic retinopathy and presence or absence of macular edema to the primary care physician providing ongoing care of a patient's diabetes should be completed soon after the dilated exam is performed. Eligible clinicians reporting on this measure should note that all data for the measurement period is to be submitted by the deadline established by CMS. Therefore, eligible clinicians who see patients towards the end of the measurement period (i.e., December in particular), should communicate the results of the dilated macular exam as soon as possible in order for those patients to be counted in the measure numerator. Communicating the results as soon as possible after the date of the exam will ensure the data are included in the submission to CMS. This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth. This FHIR-based measure has been derived from the QDM-based measure CMS142v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).</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">boolean</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#process: 'Process']</td>
</tr>
<tr>
<th scope="row" class="row-header">Improvement Notation</th>
<td class="content-container">[http://terminology.hl7.org/CodeSystem/measure-improvement-notation#increase: 'Increased 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 patients aged 18 years and older with a diagnosis of diabetic retinopathy during the measurement period</p></p>
<em>Logic Definition</em>: <a href="#primary-cms142fhircommwithdrmanagingdiab-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 who had a dilated macular or fundus exam performed during the measurement period</p></p>
<em>Logic Definition</em>: <a href="#primary-cms142fhircommwithdrmanagingdiab-denominator">Denominator</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>Patients with documentation, at least once within the measurement period, of the findings of the dilated macular or fundus exam via communication to the physician who manages the patient's diabetic care</p></p>
<em>Logic Definition</em>: <a href="#primary-cms142fhircommwithdrmanagingdiab-numerator">Numerator</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Denominator Exception</th>
<td class="content-container">
<em>ID</em>: DenominatorException_1
<br/>
<em>Description</em>:
<p style="white-space: pre-line" class="tab-one"><ul>
<li><p>Documentation of medical reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes.</p></li>
<li><p>Documentation of patient reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes.</p></li>
</ul></p>
<em>Logic Definition</em>: <a href="#primary-cms142fhircommwithdrmanagingdiab-denominator-exceptions">Denominator Exceptions</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Guidance</th>
<td class="content-container">For every patient evaluated by this measure also identify payer, race, ethnicity and sex</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="#cms142fhircommwithdrmanagingdiab-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="#cms142fhircommwithdrmanagingdiab-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="#cms142fhircommwithdrmanagingdiab-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="#cms142fhircommwithdrmanagingdiab-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/CMS142FHIRCommWithDrManagingDiab</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-cms142fhircommwithdrmanagingdiab-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":
AgeInYearsAt(date from start of "Measurement Period") >= 18
and exists "Diabetic Retinopathy Encounter"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="primary-cms142fhircommwithdrmanagingdiab-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"
and exists "Macular Exam Performed"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="primary-cms142fhircommwithdrmanagingdiab-numerator"> </a>
Numerator
</th>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Numerator":
exists "Level of Severity of Retinopathy Findings Communicated"
and ( exists "Macular Edema Absence Communicated"
or exists "Macular Edema Presence Communicated"
)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="primary-cms142fhircommwithdrmanagingdiab-denominator-exceptions"> </a>
Denominator Exception
</th>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator Exceptions":
exists "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy"
or exists "Medical or Patient Reason for Not Communicating Absence of Macular Edema"
or exists "Medical or Patient Reason for Not Communicating Presence of Macular Edema"</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="cms142fhircommwithdrmanagingdiab-sde-sex"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS142FHIRCommWithDrManagingDiab</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="cms142fhircommwithdrmanagingdiab-qualifying-encounter-during-day-of-measurement-period"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS142FHIRCommWithDrManagingDiab</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Qualifying Encounter During Day of Measurement Period":
( ["Encounter": "Office Visit"]
union ["Encounter": "Ophthalmological Services"]
union ["Encounter": "Outpatient Consultation"]
union ["Encounter": "Care Services in Long-Term Residential Facility"]
union ["Encounter": "Nursing Facility Visit"] ) QualifyingEncounter
where QualifyingEncounter.period during day of "Measurement Period"
and QualifyingEncounter.status = 'finished'
and QualifyingEncounter.class !~ "virtual"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms142fhircommwithdrmanagingdiab-diabetic-retinopathy-encounter"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS142FHIRCommWithDrManagingDiab</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Diabetic Retinopathy Encounter":
"Qualifying Encounter During Day of Measurement Period" ValidQualifyingEncounter
with ( ["ConditionProblemsHealthConcerns": "Diabetic Retinopathy"]
union ["ConditionEncounterDiagnosis": "Diabetic Retinopathy"] ) DiabeticRetinopathy
such that DiabeticRetinopathy.prevalenceInterval ( ) overlaps day of ValidQualifyingEncounter.period
and DiabeticRetinopathy.isVerified ( )</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms142fhircommwithdrmanagingdiab-level-of-severity-of-retinopathy-findings-communicated"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS142FHIRCommWithDrManagingDiab</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Level of Severity of Retinopathy Findings Communicated":
["Communication": category in "Level of Severity of Retinopathy Findings"] LevelOfSeverityCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that LevelOfSeverityCommunicated.sent after start of EncounterDiabeticRetinopathy.period
and LevelOfSeverityCommunicated.sent during day of "Measurement Period"
where LevelOfSeverityCommunicated.status = 'completed'</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms142fhircommwithdrmanagingdiab-macular-edema-absence-communicated"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS142FHIRCommWithDrManagingDiab</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Macular Edema Absence Communicated":
["Communication": category in "Macular Edema Findings Absent"] MacularEdemaAbsentCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that MacularEdemaAbsentCommunicated.sent after start of EncounterDiabeticRetinopathy.period
and MacularEdemaAbsentCommunicated.sent during day of "Measurement Period"
where MacularEdemaAbsentCommunicated.status = 'completed'</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms142fhircommwithdrmanagingdiab-macular-edema-presence-communicated"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS142FHIRCommWithDrManagingDiab</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Macular Edema Presence Communicated":
["Communication": category in "Macular Edema Findings Present"] MacularEdemaPresentCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that MacularEdemaPresentCommunicated.sent after start of EncounterDiabeticRetinopathy.period
and MacularEdemaPresentCommunicated.sent during "Measurement Period"
where MacularEdemaPresentCommunicated.status = 'completed'</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms142fhircommwithdrmanagingdiab-numerator"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS142FHIRCommWithDrManagingDiab</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Numerator":
exists "Level of Severity of Retinopathy Findings Communicated"
and ( exists "Macular Edema Absence Communicated"
or exists "Macular Edema Presence Communicated"
)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms142fhircommwithdrmanagingdiab-initial-population"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS142FHIRCommWithDrManagingDiab</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Initial Population":
AgeInYearsAt(date from start of "Measurement Period") >= 18
and exists "Diabetic Retinopathy Encounter"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms142fhircommwithdrmanagingdiab-macular-exam-performed"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS142FHIRCommWithDrManagingDiab</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Macular Exam Performed":
["ObservationClinicalResult": "Macular Exam"] MacularExam
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that MacularExam.effective.toInterval ( ) during EncounterDiabeticRetinopathy.period
where MacularExam.value is not null
and MacularExam.status in { 'final', 'amended', 'corrected' }</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms142fhircommwithdrmanagingdiab-denominator"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS142FHIRCommWithDrManagingDiab</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator":
"Initial Population"
and exists "Macular Exam Performed"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms142fhircommwithdrmanagingdiab-sde-payer"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS142FHIRCommWithDrManagingDiab</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="cms142fhircommwithdrmanagingdiab-sde-ethnicity"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS142FHIRCommWithDrManagingDiab</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="cms142fhircommwithdrmanagingdiab-sde-race"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS142FHIRCommWithDrManagingDiab</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="cms142fhircommwithdrmanagingdiab-medical-or-patient-reason-for-not-communicating-level-of-severity-of-retinopathy"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS142FHIRCommWithDrManagingDiab</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy":
[CommunicationNotDone: category in "Level of Severity of Retinopathy Findings"] LevelOfSeverityNotCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that LevelOfSeverityNotCommunicated.recorded during day of EncounterDiabeticRetinopathy.period
where ( LevelOfSeverityNotCommunicated.statusReason in "Medical Reason"
or LevelOfSeverityNotCommunicated.statusReason in "Patient Reason"
)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms142fhircommwithdrmanagingdiab-medical-or-patient-reason-for-not-communicating-absence-of-macular-edema"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS142FHIRCommWithDrManagingDiab</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/* Note:
below definition workaround for
https://oncprojectracking.healthit.gov/support/browse/CQLIT-371. Using value set workaround has been applied for now
but when QI Core STU 5 gets in the tool, it may be reverted back to a DRC */
define "Medical or Patient Reason for Not Communicating Absence of Macular Edema":
[CommunicationNotDone: category in "Macular Edema Findings Absent"] MacularEdemaAbsentNotCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that MacularEdemaAbsentNotCommunicated.recorded during day of EncounterDiabeticRetinopathy.period
where ( MacularEdemaAbsentNotCommunicated.statusReason in "Medical Reason"
or MacularEdemaAbsentNotCommunicated.statusReason in "Patient Reason"
)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms142fhircommwithdrmanagingdiab-medical-or-patient-reason-for-not-communicating-presence-of-macular-edema"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS142FHIRCommWithDrManagingDiab</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Medical or Patient Reason for Not Communicating Presence of Macular Edema":
[CommunicationNotDone: category in "Macular Edema Findings Present"] MacularEdemaPresentNotCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that MacularEdemaPresentNotCommunicated.recorded during day of EncounterDiabeticRetinopathy.period
where ( MacularEdemaPresentNotCommunicated.statusReason in "Medical Reason"
or MacularEdemaPresentNotCommunicated.statusReason in "Patient Reason"
)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms142fhircommwithdrmanagingdiab-denominator-exceptions"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS142FHIRCommWithDrManagingDiab</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator Exceptions":
exists "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy"
or exists "Medical or Patient Reason for Not Communicating Absence of Macular Edema"
or exists "Medical or Patient Reason for Not Communicating Presence of Macular Edema"</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-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 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 ActCode
<br/>
<em>Resource</em>: http://terminology.hl7.org/CodeSystem/v3-ActCode
<br/>
<em>Canonical URL</em>: <tt>http://terminology.hl7.org/CodeSystem/v3-ActCode</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Level of Severity of Retinopathy Findings
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1283
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1283</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 Ophthalmological Services
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1285
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1285</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Outpatient Consultation
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Care Services in Long-Term Residential Facility
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Nursing Facility Visit
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Diabetic Retinopathy
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.327
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.327</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Macular Edema Findings Absent
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.2.1391
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.2.1391</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Macular Edema Findings Present
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1320
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1320</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Macular Exam
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1251
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1251</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 Medical Reason
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Patient Reason
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1008
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1008</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>: virtual
<br/>
<em>Code</em>: VR
<br/>
<em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/v3-ActCode</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
<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, class
<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, period, status, status.value, class
<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/2.16.840.1.113883.3.526.3.1285
<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, class
<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/2.16.840.1.113883.3.464.1003.101.12.1008
<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, class
<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/2.16.840.1.113883.3.464.1003.101.12.1014
<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, class
<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/2.16.840.1.113883.3.464.1003.101.12.1012
<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/2.16.840.1.113883.3.526.3.327
<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/2.16.840.1.113883.3.526.3.327
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Communication
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communication
<br/>
<em>Must Support Elements</em>: category, sent, sent.value, status, status.value
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: category</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1283
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Communication
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communication
<br/>
<em>Must Support Elements</em>: category, sent, sent.value, status, status.value
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: category</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.2.1391
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Communication
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communication
<br/>
<em>Must Support Elements</em>: category, sent, sent.value, status, status.value
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: category</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1320
<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-clinical-result
<br/>
<em>Must Support Elements</em>: code, effective, 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/2.16.840.1.113883.3.526.3.1251
<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>: Communication
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communicationnotdone
<br/>
<em>Must Support Elements</em>: category, extension, statusReason
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: category</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1283
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Communication
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communicationnotdone
<br/>
<em>Must Support Elements</em>: category, extension, statusReason
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: category</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.2.1391
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Communication
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communicationnotdone
<br/>
<em>Must Support Elements</em>: category, extension, statusReason
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: category</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1320
<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/v3-ActCode"/>
<code value="VR"/>
<display value="virtual"/>
</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="CMS142FHIRCommWithDrManagingDiab"/>
</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="CMS142FHIRCommWithDrManagingDiab"/>
</extension>
<extension url="name">
<valueString
value="Qualifying Encounter During Day of Measurement Period"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualifying Encounter During Day of Measurement Period":
( ["Encounter": "Office Visit"]
union ["Encounter": "Ophthalmological Services"]
union ["Encounter": "Outpatient Consultation"]
union ["Encounter": "Care Services in Long-Term Residential Facility"]
union ["Encounter": "Nursing Facility Visit"] ) QualifyingEncounter
where QualifyingEncounter.period during day of "Measurement Period"
and QualifyingEncounter.status = 'finished'
and QualifyingEncounter.class !~ "virtual""/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS142FHIRCommWithDrManagingDiab"/>
</extension>
<extension url="name">
<valueString value="Diabetic Retinopathy Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Diabetic Retinopathy Encounter":
"Qualifying Encounter During Day of Measurement Period" ValidQualifyingEncounter
with ( ["ConditionProblemsHealthConcerns": "Diabetic Retinopathy"]
union ["ConditionEncounterDiagnosis": "Diabetic Retinopathy"] ) DiabeticRetinopathy
such that DiabeticRetinopathy.prevalenceInterval ( ) overlaps day of ValidQualifyingEncounter.period
and DiabeticRetinopathy.isVerified ( )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS142FHIRCommWithDrManagingDiab"/>
</extension>
<extension url="name">
<valueString
value="Level of Severity of Retinopathy Findings Communicated"/>
</extension>
<extension url="statement">
<valueString
value="define "Level of Severity of Retinopathy Findings Communicated":
["Communication": category in "Level of Severity of Retinopathy Findings"] LevelOfSeverityCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that LevelOfSeverityCommunicated.sent after start of EncounterDiabeticRetinopathy.period
and LevelOfSeverityCommunicated.sent during day of "Measurement Period"
where LevelOfSeverityCommunicated.status = 'completed'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS142FHIRCommWithDrManagingDiab"/>
</extension>
<extension url="name">
<valueString value="Macular Edema Absence Communicated"/>
</extension>
<extension url="statement">
<valueString
value="define "Macular Edema Absence Communicated":
["Communication": category in "Macular Edema Findings Absent"] MacularEdemaAbsentCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that MacularEdemaAbsentCommunicated.sent after start of EncounterDiabeticRetinopathy.period
and MacularEdemaAbsentCommunicated.sent during day of "Measurement Period"
where MacularEdemaAbsentCommunicated.status = 'completed'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS142FHIRCommWithDrManagingDiab"/>
</extension>
<extension url="name">
<valueString value="Macular Edema Presence Communicated"/>
</extension>
<extension url="statement">
<valueString
value="define "Macular Edema Presence Communicated":
["Communication": category in "Macular Edema Findings Present"] MacularEdemaPresentCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that MacularEdemaPresentCommunicated.sent after start of EncounterDiabeticRetinopathy.period
and MacularEdemaPresentCommunicated.sent during "Measurement Period"
where MacularEdemaPresentCommunicated.status = 'completed'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS142FHIRCommWithDrManagingDiab"/>
</extension>
<extension url="name">
<valueString value="Numerator"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator":
exists "Level of Severity of Retinopathy Findings Communicated"
and ( exists "Macular Edema Absence Communicated"
or exists "Macular Edema Presence Communicated"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS142FHIRCommWithDrManagingDiab"/>
</extension>
<extension url="name">
<valueString value="Initial Population"/>
</extension>
<extension url="statement">
<valueString
value="define "Initial Population":
AgeInYearsAt(date from start of "Measurement Period") >= 18
and exists "Diabetic Retinopathy Encounter""/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS142FHIRCommWithDrManagingDiab"/>
</extension>
<extension url="name">
<valueString value="Macular Exam Performed"/>
</extension>
<extension url="statement">
<valueString
value="define "Macular Exam Performed":
["ObservationClinicalResult": "Macular Exam"] MacularExam
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that MacularExam.effective.toInterval ( ) during EncounterDiabeticRetinopathy.period
where MacularExam.value is not null
and MacularExam.status in { 'final', 'amended', 'corrected' }"/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS142FHIRCommWithDrManagingDiab"/>
</extension>
<extension url="name">
<valueString value="Denominator"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator":
"Initial Population"
and exists "Macular Exam Performed""/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</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="11"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS142FHIRCommWithDrManagingDiab"/>
</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="12"/>
</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="13"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS142FHIRCommWithDrManagingDiab"/>
</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="14"/>
</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="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS142FHIRCommWithDrManagingDiab"/>
</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="16"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS142FHIRCommWithDrManagingDiab"/>
</extension>
<extension url="name">
<valueString
value="Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy"/>
</extension>
<extension url="statement">
<valueString
value="define "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy":
[CommunicationNotDone: category in "Level of Severity of Retinopathy Findings"] LevelOfSeverityNotCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that LevelOfSeverityNotCommunicated.recorded during day of EncounterDiabeticRetinopathy.period
where ( LevelOfSeverityNotCommunicated.statusReason in "Medical Reason"
or LevelOfSeverityNotCommunicated.statusReason in "Patient Reason"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS142FHIRCommWithDrManagingDiab"/>
</extension>
<extension url="name">
<valueString
value="Medical or Patient Reason for Not Communicating Absence of Macular Edema"/>
</extension>
<extension url="statement">
<valueString
value="/* Note:
below definition workaround for
https://oncprojectracking.healthit.gov/support/browse/CQLIT-371. Using value set workaround has been applied for now
but when QI Core STU 5 gets in the tool, it may be reverted back to a DRC */
define "Medical or Patient Reason for Not Communicating Absence of Macular Edema":
[CommunicationNotDone: category in "Macular Edema Findings Absent"] MacularEdemaAbsentNotCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that MacularEdemaAbsentNotCommunicated.recorded during day of EncounterDiabeticRetinopathy.period
where ( MacularEdemaAbsentNotCommunicated.statusReason in "Medical Reason"
or MacularEdemaAbsentNotCommunicated.statusReason in "Patient Reason"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="18"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS142FHIRCommWithDrManagingDiab"/>
</extension>
<extension url="name">
<valueString
value="Medical or Patient Reason for Not Communicating Presence of Macular Edema"/>
</extension>
<extension url="statement">
<valueString
value="define "Medical or Patient Reason for Not Communicating Presence of Macular Edema":
[CommunicationNotDone: category in "Macular Edema Findings Present"] MacularEdemaPresentNotCommunicated
with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
such that MacularEdemaPresentNotCommunicated.recorded during day of EncounterDiabeticRetinopathy.period
where ( MacularEdemaPresentNotCommunicated.statusReason in "Medical Reason"
or MacularEdemaPresentNotCommunicated.statusReason in "Patient Reason"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="19"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS142FHIRCommWithDrManagingDiab"/>
</extension>
<extension url="name">
<valueString value="Denominator Exceptions"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator Exceptions":
exists "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy"
or exists "Medical or Patient Reason for Not Communicating Absence of Macular Edema"
or exists "Medical or Patient Reason for Not Communicating Presence of Macular Edema""/>
</extension>
<extension url="displaySequence">
<valueInteger value="20"/>
</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="21"/>
</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="22"/>
</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="23"/>
</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"/>
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<relatedArtifact>
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<relatedArtifact>
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<display value="Value set Ophthalmological Services"/>
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</relatedArtifact>
<relatedArtifact>
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<relatedArtifact>
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<relatedArtifact>
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<display value="Value set Diabetic Retinopathy"/>
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<relatedArtifact>
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<parameter>
<name value="Denominator Exceptions"/>
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<parameter>
<name value="SDE Sex"/>
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<min value="0"/>
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<type value="Coding"/>
</parameter>
<parameter>
<name value="SDE Payer"/>
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<name value="SDE Ethnicity"/>
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<min value="0"/>
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<parameter>
<name value="SDE Race"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Resource"/>
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<dataRequirement>
<type value="Patient"/>
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<mustSupport value="extension"/>
<mustSupport value="url"/>
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<dataRequirement>
<type value="Encounter"/>
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<mustSupport value="period"/>
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<mustSupport value="period"/>
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<dataRequirement>
<type value="Condition"/>
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<path value="code"/>
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</dataRequirement>
<dataRequirement>
<type value="Communication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communication"/>
<mustSupport value="category"/>
<mustSupport value="sent"/>
<mustSupport value="sent.value"/>
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<path value="category"/>
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<dataRequirement>
<type value="Communication"/>
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<mustSupport value="sent"/>
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<dataRequirement>
<type value="Communication"/>
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<mustSupport value="sent"/>
<mustSupport value="sent.value"/>
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<dataRequirement>
<type value="Observation"/>
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<mustSupport value="effective"/>
<mustSupport value="value"/>
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<dataRequirement>
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<mustSupport value="period"/>
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<dataRequirement>
<type value="Communication"/>
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<dataRequirement>
<type value="Communication"/>
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</Library>
</contained>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" id="supplementalDataGuidance">
<extension url="guidance">
<valueString
value="For every patient evaluated by this measure also identify payer, race, ethnicity and sex"/>
</extension>
<extension url="usage">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
<display value="Supplemental Data"/>
</coding>
<text value="Supplemental Data Guidance"/>
</valueCodeableConcept>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm">
<extension url="term">
<valueString value="Communication"/>
</extension>
<extension url="definition">
<valueMarkdown
value="May include documentation in the medical record indicating that the findings of the dilated macular or fundus exam were communicated (e.g., verbally, by letter) with the clinician managing the patient's diabetic care OR a copy of a letter in the medical record to the clinician managing the patient's diabetic care outlining the findings of the dilated macular or fundus exam
"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm">
<extension url="term">
<valueString value="Findings"/>
</extension>
<extension url="definition">
<valueMarkdown
value="Includes level of severity of retinopathy (e.g., mild nonproliferative, moderate nonproliferative, severe nonproliferative, very severe nonproliferative, proliferative) AND the presence or absence of macular edema
"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements">
<valueReference>
<reference value="#effective-data-requirements"/>
</valueReference>
</extension>
<url
value="https://madie.cms.gov/Measure/CMS142FHIRCommWithDrManagingDiab"/>
<identifier>
<use value="usual"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"/>
<code value="short-name"/>
<display value="Short Name"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/shortName"/>
<value value="CMS142FHIR"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"/>
<code value="version-independent"/>
<display value="Version Independent"/>
</coding>
</type>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:0f55e61f-dc17-4fe4-a604-7f030260618f"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"/>
<code value="version-specific"/>
<display value="Version Specific"/>
</coding>
</type>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:37dd2397-d9cd-401d-b343-28d77fd2f923"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/artifact-identifier-type"/>
<code value="publisher"/>
<display value="Publisher"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/cmsId"/>
<value value="142FHIR"/>
<assigner>
<display value="CMS"/>
</assigner>
</identifier>
<version value="1.0.000"/>
<name value="CMS142FHIRCommWithDrManagingDiab"/>
<title
value="Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes CareFHIR
"/>
<status value="active"/>
<experimental value="false"/>
<date value="2025-08-20T19:55:31+00:00"/>
<publisher value="American Academy of Ophthalmology"/>
<contact>
<telecom>
<system value="url"/>
<value value="www.aao.org"/>
</telecom>
</contact>
<description
value="Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once during the measurement period
"/>
<usage
value="The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality. The communication of results, including the level of severity of diabetic retinopathy and presence or absence of macular edema to the primary care physician providing ongoing care of a patient's diabetes should be completed soon after the dilated exam is performed. Eligible clinicians reporting on this measure should note that all data for the measurement period is to be submitted by the deadline established by CMS. Therefore, eligible clinicians who see patients towards the end of the measurement period (i.e., December in particular), should communicate the results of the dilated macular exam as soon as possible in order for those patients to be counted in the measure numerator. Communicating the results as soon as possible after the date of the exam will ensure the data are included in the submission to CMS. This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth. This FHIR-based measure has been derived from the QDM-based measure CMS142v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).
"/>
<copyright
value="Copyright 2025 American Academy of Ophthalmology. All Rights Reserved.
"/>
<effectivePeriod>
<start value="2026-01-01"/>
<end value="2026-12-31"/>
</effectivePeriod>
<author>
<name value="American Academy of Ophthalmology"/>
<telecom>
<system value="url"/>
<value value="www.aao.org"/>
</telecom>
</author>
<author>
<name value="American Medical Association (AMA)"/>
<telecom>
<system value="url"/>
<value value="https://www.ama-assn.org/"/>
</telecom>
</author>
<relatedArtifact>
<type value="citation"/>
<citation
value="Aiello, L. P., \& DCCT/EDIC Research Group (2014). Diabetic retinopathy and other ocular findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes care, 37(1), 17--23. doi:10.2337/dc13-2251
"/>
</relatedArtifact>
<relatedArtifact>
<type value="citation"/>
<citation
value="Lim, J.I., Kim, S.J., Bailey, S.T., Kovach, J.L., Vemulakonda, G.A., Ying, G., Flaxel, C.J. and the American Academy of Ophthalmology Preferred Practice Pattern Retina/Vitreous Committee (2025). Diabetic Retinopathy Preferred Practice Pattern. Ophthalmology. 2025 in press. doi: 10.1016/j.ophtha.2024.12.020
"/>
</relatedArtifact>
<relatedArtifact>
<type value="citation"/>
<citation
value="Storey, P. P., Murchison, A. P., Pizzi, L. T., Hark, L. A., Dai, Y., Leiby, B. E., \& Haller, J. A. Impact of physician communication on diabetic eye examination adherence: Results from a Retrospective Cohort Analysis. Retina. 2016 Jan;36(1),20-7. doi:10.1097/IAE.0000000000000652
"/>
</relatedArtifact>
<relatedArtifact>
<type value="citation"/>
<citation
value="Zhang, X., Saaddine, J. B., Chou, C. F., Cotch, M. F., Cheng, Y. J., Geiss, L. S., ... Klein, R. (2010). Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA, 304(6), 649--656. doi:10.1001/jama.2010.1111
"/>
</relatedArtifact>
<library
value="https://madie.cms.gov/Library/CMS142FHIRCommWithDrManagingDiab"/>
<disclaimer
value="The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measure require a license agreement between the user and the American Academy of Ophthalmology (Academy). Neither the Academy, its members, the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor PCPI, nor their members shall be responsible for any use of the Measure. The PCPI's and AMA's significant past efforts and contributions to the development and updating of the Measures are acknowledged. The National Committee for Quality Assurance's significant past efforts and contributions to the development and updating of the Measure is acknowledged. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party's use of Current Procedural Terminology (CPT\[R\]) or other proprietary code set contained in the Measures. Any other use of CPT or other coding by the third party is strictly prohibited. The Academy, the AMA, and former members of the PCPI disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association. LOINC(R) is 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 is copyright 2024 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or \[R\].
"/>
<rationale
value="Diabetic retinopathy is a prevalent complication of diabetes, estimated to affect 28.5% of diabetic patients in the US (Zhang et al., 2010). Diabetic retinopathy is a key indicator of systemic complications of diabetes (Zhang et al., 2010). Coordination of care between the eye care specialist and the physician managing a patient's ongoing diabetes care is essential in stemming the progression of vision loss. Communication from the eye care specialist to a primary care physician facilitates the exchange of information about the severity and progression of a patient's diabetic retinopathy, adherence to recommended ocular care, need for follow-up visits, and treatment plans (Storey et al., 2016). Data from the Diabetes Control and Complications Trial showed that diabetic treatment and maintenance of glucose control delays the onset and slows the progression of diabetic retinopathy (Aiello \& DCCT/EDIC Research Group, 2014).
"/>
<clinicalRecommendationStatement
value="The ophthalmologist should refer patients with diabetes to a primary care physician or endocrinologist for appropriate management of their systemic condition and should communicate examination results to the physician managing the patient's ongoing diabetes care (Lim et al., 2025). A goal is to achieve optimal control of blood glucose, blood pressure, and other risk factors through close communication with the patient's primary care physician on the status of the DR and the need for optimal metabolic control (Lim et al,, 2025). Establishing a close partnership between the ophthalmologist and the primary care physician is an important step to ensure optimal patient care. Furthermore, it is important to help educate patients with diabetes as well as their primary care physician about the ophthalmologic implications of controlling blood glucose (as monitored by HbA1c) to as near to normal as is safely possible (Lim et al., 2025).
"/>
<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="boolean"/>
</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="process"/>
<display value="Process"/>
</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="increase"/>
<display value="Increased score indicates improvement"/>
</coding>
</valueCodeableConcept>
</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 patients aged 18 years and older with a diagnosis of diabetic retinopathy during the measurement period
"/>
<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 who had a dilated macular or fundus exam performed during the measurement period
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator"/>
</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="Patients with documentation, at least once within the measurement period, of the findings of the dilated macular or fundus exam via communication to the physician who manages the patient's diabetic care
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator"/>
</criteria>
</population>
<population id="DenominatorException_1">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exception"/>
<display value="Denominator Exception"/>
</coding>
</code>
<description
value="* Documentation of medical reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes.
* Documentation of patient reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes.
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exceptions"/>
</criteria>
</population>
</group>
<supplementalData id="sde-ethnicity">
<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">
<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">
<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">
<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>