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 2025-08-22 |
{
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" class=\"col-12\">\n <table class=\"narrative-table\">\n <tbody>\n<tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Metadata</th>\n\n\n</tr>\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Title</th>\n\n\n<td class=\"content-container\">Bone Density Evaluation for Patients with Prostate Cancer and Receiving Androgen Deprivation TherapyFHIR</td>\n</tr>\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Version</th>\n\n\n<td class=\"content-container\">1.0.000</td>\n</tr>\n\n\n \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Short Name</th>\n\n\n<td class=\"content-container\">CMS645FHIR</td>\n</tr>\n\n\n\n \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">GUID (Version Independent)</th>\n\n\n<td class=\"content-container\">urn:uuid:299de9c4-755d-4f5a-ac9e-fa74fe34f759</td>\n</tr>\n\n\n\n \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">GUID (Version Specific)</th>\n\n\n<td class=\"content-container\">urn:uuid:5cd769d8-9a63-4637-b18e-76ee9c68cbf9</td>\n</tr>\n\n\n\n \n \n \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">CMS Identifier</th>\n\n\n<td class=\"content-container\">645FHIR</td>\n</tr>\n\n \n\n\n\n\n \n \n \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Effective Period</th>\n\n\n<td class=\"content-container\">2026-01-01 through 2026-12-31</td>\n</tr>\n\n \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Steward (Publisher)</th>\n\n\n<td class=\"content-container\">Oregon Urology</td>\n</tr>\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Developer</th>\n\n\n<td class=\"content-container\">Oregon Urology</td>\n</tr>\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Description</th>\n\n\n<td class=\"content-container\"><p>Percentage of patients determined as having prostate cancer who are currently starting or undergoing androgen deprivation therapy (ADT), for an anticipated period of 12 months or greater and who receive an initial bone density evaluation. The bone density evaluation must be prior to the start of ADT or within 3 months of the start of ADT.</p></td>\n</tr>\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Copyright</th>\n\n\n<td class=\"content-container\"><p>Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Oregon Urology Institute (OUI) and Large Urology Group Practice Association (LUGPA) disclaim all liability for the use or accuracy of third-party codes contained in the specifications.</p>\n<p>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.</p></td>\n</tr>\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Disclaimer</th>\n\n\n<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.</p>\n<p>THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.</p>\n<p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p></td>\n</tr>\n\n\n\n\n\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Rationale</th>\n\n\n<td class=\"content-container\"><p>Androgen suppression as a treatment for prostate cancer can cause osteoporosis (Qaseem, 2008). Patients with prostate cancer undergoing prolonged androgen deprivation therapy (ADT) incur bone loss at a rate higher than menopausal patients (Guise, 2007). In preserving bone health, the goal is to prevent or treat osteopenia/osteoporosis for the patient on ADT and to prevent or delay skeletal-related events. The National Osteoporosis Foundation recommendations include a baseline assessment of bone density with a dual-energy X-ray absorptiometry (DEXA) scan and daily calcium and Vitamin D supplementation (Watts, 2012). The DEXA scan is the gold standard for bone density screening. Patients at risk for adverse bone consequences from chronic ADT do not always receive care according to evidence-based guidelines. These findings call for improved processes that standardize evidence-based practice, including baseline and follow-up bone density assessment (Watts, 2012).</p></td>\n</tr>\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Clinical Recommendation Statement</th>\n\n\n<td class=\"content-container\"><p>Bone density screening should be performed at the start of Androgen Deprivation Therapy (ADT) for prostate cancer. It should also be performed every 2 years for the patient with continued ADT or for patients with known osteoporosis. Current insurance practice is to possibly cover the cost of bone density screening if osteoporosis is known or if there is a high-risk drug. Some patients choose to delay bone density screening until after ADT is started and they therefore have insurance authorization due to the administration of a high-risk drug.</p></td>\n</tr>\n\n\n\n\n<tr>\n \n \n \n \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n \n \n <td class=\"content-container\">\n \n \n \n <p>Cosman, F., deBeur, S.J., LeBoff, M.S., Lewiecki, E. M., Tanner, B., Randall, S., & Lindsay, R. (2014). Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporosis International, 25(10), 2359–2381. https://doi.org/10.1007/s00198-014-2794-2</p>\n \n \n \n \n \n </td>\n</tr>\n\n<tr>\n \n \n \n \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n \n \n <td class=\"content-container\">\n \n \n \n <p>Finkelstein, J., & Yu, E. (2017). Clinical manifestations, diagnosis, and evaluation of osteoporosis in men. Retrieved from https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-evaluation-of-osteoporosis-in-men/print?source=see_link</p>\n \n \n \n \n \n </td>\n</tr>\n\n<tr>\n \n \n \n \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n \n \n <td class=\"content-container\">\n \n \n \n <p>Guise, T.A., Oefelein, M.G., Eastham, J.A., Cookson, M.S., Higano, C.S., & Smith, M.R. (2007). Estrogenic side effects of androgen deprivation therapy. Reviews in urology, 9(4), 163-180.</p>\n \n \n \n \n \n </td>\n</tr>\n\n<tr>\n \n \n \n \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n \n \n <td class=\"content-container\">\n \n \n \n <p>Qaseem, A., Snow, V., Shekelle, P., Hopkins, R., Forciea, M. A., Owens, D. K., & for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians. (2008). Annals of Internal Medicine. Screening for osteoporosis in men: A clinical practice guideline from the American College of Physicians, 2008. Annals of Internal Medicine, 148(9), 680-684. https://doi.org/10.7326/0003-4819-148-9-200805060-00008</p>\n \n \n \n \n \n </td>\n</tr>\n\n<tr>\n \n \n \n \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n \n \n <td class=\"content-container\">\n \n \n \n <p>Ward, R. J., Roberts, C. C., Bencardino, J. T., Arnold, E., Baccei, S. J., Cassidy, R. C., … Weissman, B. N. (2017). ACR Appropriateness Criteria (R) Osteoporosis and Bone Mineral Density. Journal of the American College of Radiology, 14(5), S189–S202. https://doi.org/10.1016/j.jacr.2017.02.018</p>\n \n \n \n \n \n </td>\n</tr>\n\n<tr>\n \n \n \n \n\n<th scope=\"row\" class=\"row-header\">Citation</th>\n\n\n \n \n <td class=\"content-container\">\n \n \n \n <p>Watts, N. B., Adler, R. A., Bilezikian, J. P., Drake, M. T., Eastell, R., Orwoll, E. S., & Finkelstein, J. S. (2012). Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 97(6), 1802–1822. https://doi.org/10.1210/jc.2011-3045</p>\n \n \n \n \n \n </td>\n</tr>\n\n\n\n\n\n\n \n \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Definition</th>\n\n\n<td class=\"content-container\">Dual Energy X-ray Absorptiometry (DEXA): <p>A scan that measures the bone of the spine, hip, or total body and measures bone mineral density. It is considered one of the most accurate measurements.</p></td>\n</tr>\n\n\n \n \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Definition</th>\n\n\n<td class=\"content-container\">First Androgen Deprivation Therapy: <p>The first Androgen Deprivation Therapy (ADT) is measured as the first order or administration of ADT for an anticipated period of 12 months or greater to a patient with prostate cancer.</p></td>\n</tr>\n\n\n \n \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Definition</th>\n\n\n<td class=\"content-container\">Peripheral Dual Energy X-ray Absorptiometry (PDXA): <p>Bone mineral density measurement of the wrist, heel, or finger.</p></td>\n</tr>\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Guidance (Usage)</th>\n\n\n<td class=\"content-container\"><p>In order to capture the practitioner's intent of androgen deprivation therapy (ADT) for a period of 12 months or greater, SNOMEDCT 456381000124102 which is Injection of leuprolide acetate for the twelve-month period (regime/therapy) is the correct code.</p>\n<p>This eCQM is a patient-based measure.</p>\n<p>This FHIR-based measure has been derived from the QDM-based measure CMS645v9. 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).</p></td>\n</tr>\n\n\n\n \n \n <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Group (Rate) (ID: Group_1)</th>\n\n\n</tr>\n \n \n \n \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Basis</th>\n\n\n<td class=\"content-container\">boolean</td>\n</tr>\n\n\n\n \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Scoring</th>\n\n\n<td class=\"content-container\">[http://terminology.hl7.org/CodeSystem/measure-scoring#proportion: 'Proportion']</td>\n</tr>\n\n\n\n\n\n\n\n \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Type</th>\n\n\n<td class=\"content-container\">[http://terminology.hl7.org/CodeSystem/measure-type#process: 'Process']</td>\n</tr>\n\n\n\n\n\n \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Improvement Notation</th>\n\n\n<td class=\"content-container\">[http://terminology.hl7.org/CodeSystem/measure-improvement-notation#increase: 'Increased score indicates improvement']</td>\n</tr>\n\n\n \n \n <tr>\n \n \n\n<th scope=\"row\" class=\"row-header\">Initial Population</th>\n\n\n \n <td class=\"content-container\">\n \n <em>ID</em>: InitialPopulation_1\n <br/>\n \n \n <em>Description</em>:\n <p style=\"white-space: pre-line\" class=\"tab-one\"><p>Patients with a qualifying encounter in the measurement period AND with a diagnosis of prostate cancer AND with an order for ADT or an active medication of ADT with an intent for treatment greater than or equal to 12 months during the measurement period AND order for ADT in 3 months before to 9 months after the start of the measurement period</p></p>\n \n \n \n \n <em>Logic Definition</em>: <a href=\"#primary-cms645fhirbonedensitypcadtherapy-initial-population\">Initial Population</a> \n \n \n </td>\n </tr>\n \n\n \n <tr>\n \n \n\n<th scope=\"row\" class=\"row-header\">Denominator</th>\n\n\n \n <td class=\"content-container\">\n \n <em>ID</em>: Denominator_1\n <br/>\n \n \n <em>Description</em>:\n <p style=\"white-space: pre-line\" class=\"tab-one\"><p>Equals Initial Population</p></p>\n \n \n \n \n <em>Logic Definition</em>: <a href=\"#primary-cms645fhirbonedensitypcadtherapy-denominator\">Denominator</a> \n \n \n </td>\n </tr>\n \n\n \n <tr>\n \n \n\n<th scope=\"row\" class=\"row-header\">Numerator</th>\n\n\n \n <td class=\"content-container\">\n \n <em>ID</em>: Numerator_1\n <br/>\n \n \n <em>Description</em>:\n <p style=\"white-space: pre-line\" class=\"tab-one\"><p>Patients with a bone density evaluation within the two years prior to the start of or less than three months after the start of ADT treatment</p></p>\n \n \n \n \n <em>Logic Definition</em>: <a href=\"#primary-cms645fhirbonedensitypcadtherapy-numerator\">Numerator</a> \n \n \n </td>\n </tr>\n \n\n \n <tr>\n \n \n\n<th scope=\"row\" class=\"row-header\">Denominator Exception</th>\n\n\n \n <td class=\"content-container\">\n \n <em>ID</em>: DenominatorException_1\n <br/>\n \n \n <em>Description</em>:\n <p style=\"white-space: pre-line\" class=\"tab-one\"><p>Patient refused the bone density evaluation at the time ordered or did not have it performed within 3 months after the start of ADT</p></p>\n \n \n \n \n <em>Logic Definition</em>: <a href=\"#primary-cms645fhirbonedensitypcadtherapy-denominator-exception\">Denominator Exception</a> \n \n \n </td>\n </tr>\n \n\n \n\n\n \n \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Supplemental Data Guidance</th>\n\n\n<td class=\"content-container\"><p>For every patient evaluated by this measure also identify payer, race, ethnicity and sex</p></td>\n</tr>\n\n \n\n\n <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Supplemental Data Elements</th>\n\n\n</tr>\n\n\n<tr>\n \n\n<th scope=\"row\" class=\"row-header\">Supplemental Data Element</th>\n\n\n <td class=\"content-container\">\n \n <em>ID</em>: sde-ethnicity\n \n <br/>\n \n \n \n \n \n <em>Usage Code</em>: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]\n \n <br/>\n \n \n \n <em>Description</em>: SDE Ethnicity\n \n \n \n <br/>\n \n <em>Logic Definition</em>: <a href=\"#cms645fhirbonedensitypcadtherapy-sde-ethnicity\">SDE Ethnicity</a> \n \n \n </td>\n</tr>\n\n<tr>\n \n\n<th scope=\"row\" class=\"row-header\">Supplemental Data Element</th>\n\n\n <td class=\"content-container\">\n \n <em>ID</em>: sde-payer\n \n <br/>\n \n \n \n \n \n <em>Usage Code</em>: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]\n \n <br/>\n \n \n \n <em>Description</em>: SDE Payer\n \n \n \n <br/>\n \n <em>Logic Definition</em>: <a href=\"#cms645fhirbonedensitypcadtherapy-sde-payer\">SDE Payer</a> \n \n \n </td>\n</tr>\n\n<tr>\n \n\n<th scope=\"row\" class=\"row-header\">Supplemental Data Element</th>\n\n\n <td class=\"content-container\">\n \n <em>ID</em>: sde-race\n \n <br/>\n \n \n \n \n \n <em>Usage Code</em>: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]\n \n <br/>\n \n \n \n <em>Description</em>: SDE Race\n \n \n \n <br/>\n \n <em>Logic Definition</em>: <a href=\"#cms645fhirbonedensitypcadtherapy-sde-race\">SDE Race</a> \n \n \n </td>\n</tr>\n\n<tr>\n \n\n<th scope=\"row\" class=\"row-header\">Supplemental Data Element</th>\n\n\n <td class=\"content-container\">\n \n <em>ID</em>: sde-sex\n \n <br/>\n \n \n \n \n \n <em>Usage Code</em>: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]\n \n <br/>\n \n \n \n <em>Description</em>: SDE Sex\n \n \n \n <br/>\n \n <em>Logic Definition</em>: <a href=\"#cms645fhirbonedensitypcadtherapy-sde-sex\">SDE Sex</a> \n \n \n </td>\n</tr>\n\n\n<tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Logic</th>\n\n\n</tr>\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Primary Library</th>\n\n\n<td class=\"content-container\">https://madie.cms.gov/Library/CMS645FHIRBoneDensityPCADTherapy</td>\n</tr>\n\n\n\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Contents</th>\n <td class=\"content-container\">\n <em><a href=\"#population-criteria\">Population Criteria</a></em>\n <br/>\n <em><a href=\"#definitions\">Logic Definitions</a></em>\n <br/>\n <em><a href=\"#terminology\">Terminology</a></em>\n <br/>\n <em><a href=\"#dependencies\">Dependencies</a></em>\n <br/>\n <em><a href=\"#data-requirements\">Data Requirements</a></em>\n <br/>\n </td>\n</tr>\n\n\n <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"population-criteria\"> </a>Population Criteria</th>\n\n\n</tr>\n \n \n \n \n \n <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Group (Rate) (ID: Group_1)</th>\n\n\n</tr>\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n <tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"primary-cms645fhirbonedensitypcadtherapy-initial-population\"> </a>\n \n \n Initial Population\n \n </th>\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Initial Population":\n "Has Qualifying Encounter"\n and exists "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period"</code></pre>\n </td>\n\n</tr>\n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n <tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"primary-cms645fhirbonedensitypcadtherapy-denominator\"> </a>\n \n \n Denominator\n \n </th>\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Denominator":\n "Initial Population"</code></pre>\n </td>\n\n</tr>\n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n <tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"primary-cms645fhirbonedensitypcadtherapy-numerator\"> </a>\n \n \n Numerator\n \n </th>\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Numerator":\n "Has Baseline DEXA Scan Two Years Prior to the Start of or Less than Three Months After the Start of ADT"</code></pre>\n </td>\n\n</tr>\n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n <tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"primary-cms645fhirbonedensitypcadtherapy-denominator-exception\"> </a>\n \n \n Denominator Exception\n \n </th>\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Denominator Exception":\n exists ( "No Bone Density Scan Ordered Due to Patient Refusal" )\n or exists ( "No Bone Density Scan Performed Due to Patient Refusal" )</code></pre>\n </td>\n\n</tr>\n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n \n \n\n \n \n\n\n <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"definitions\"> </a>Logic Definitions</th>\n\n\n</tr>\n \n \n \n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"supplementaldataelements-sde-sex\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> SupplementalDataElements</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "SDE Sex":\n case\n when Patient.sex = '248153007' then "Male (finding)"\n when Patient.sex = '248152002' then "Female (finding)"\n else null\n end</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"supplementaldataelements-sde-payer\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> SupplementalDataElements</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "SDE Payer":\n [Coverage: type in "Payer Type"] Payer\n return {\n code: Payer.type,\n period: Payer.period\n }</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"supplementaldataelements-sde-ethnicity\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> SupplementalDataElements</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "SDE Ethnicity":\n Patient.ethnicity E\n return Tuple {\n codes: { E.ombCategory } union E.detailed,\n display: E.text\n }</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"supplementaldataelements-sde-race\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> SupplementalDataElements</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "SDE Race":\n Patient.race R\n return Tuple {\n codes: R.ombCategory union R.detailed,\n display: R.text\n }</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n\n \n \n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"cms645fhirbonedensitypcadtherapy-sde-sex\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "SDE Sex":\n SDE."SDE Sex"</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"cms645fhirbonedensitypcadtherapy-androgen-deprivation-therapy-for-urology-care-medication-active-start-dates\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Androgen Deprivation Therapy for Urology Care Medication Active Start Dates":\n [MedicationRequest: "Androgen Deprivation Therapy for Urology Care"] ADTActive\n let firstMedicationPeriod: First((collapse(ADTActive.dosageInstruction.timing.repeat.bounds DoseTime\n return DoseTime.toInterval()\n )) DrugPeriods\n sort by start of $this\n ),\n\n //get the very first event as interval\n \n firstMedicationEvent: First((ADTActive.dosageInstruction.timing dosageTiming\n //returns first event for the specific dosageTiming\n \n return First(dosageTiming.event dosageTimingEvents\n sort ascending\n )) firstEvents\n sort ascending\n ),\n medicationDateTime: Min({ firstMedicationEvent, start of firstMedicationPeriod, \n end of firstMedicationPeriod }\n )\n where ADTActive.status in { 'active', 'completed' }\n and ADTActive.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n return medicationDateTime</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"cms645fhirbonedensitypcadtherapy-androgen-deprivation-therapy-for-urology-care-medication-order-start-dates\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Androgen Deprivation Therapy for Urology Care Medication Order Start Dates":\n [MedicationRequest: "Androgen Deprivation Therapy for Urology Care"] ADTOrder\n let firstMedicationPeriod: First((collapse(ADTOrder.dosageInstruction.timing.repeat.bounds DoseTime\n return DoseTime.toInterval()\n )) DrugPeriods\n sort by start of $this\n ),\n medicationDateTime: Min({ ADTOrder.authoredOn, start of firstMedicationPeriod, \n end of firstMedicationPeriod }\n )\n where ADTOrder.status in { 'active', 'completed' }\n and ADTOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n return medicationDateTime</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"cms645fhirbonedensitypcadtherapy-prostate-cancer-diagnosis\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Prostate Cancer Diagnosis":\n ( [ConditionProblemsHealthConcerns: "Prostate Cancer"]\n union [ConditionEncounterDiagnosis: "Prostate Cancer"] ) ProstateCancer\n where ProstateCancer.prevalenceInterval ( ) overlaps day of "Measurement Period"\n and ProstateCancer.isVerified ( )</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"cms645fhirbonedensitypcadtherapy-first-adt-in-3-months-before-to-9-months-after-start-of-measurement-period\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "First ADT in 3 Months Before to 9 Months After Start of Measurement Period":\n First(("Androgen Deprivation Therapy for Urology Care Medication Active Start Dates"\n union "Androgen Deprivation Therapy for Urology Care Medication Order Start Dates") ADTDateTime\n with "Prostate Cancer Diagnosis" ProstateCancer\n such that ADTDateTime during day of ProstateCancer.prevalenceInterval()\n and ADTDateTime during day of Interval[start of "Measurement Period" - 3 months, start of "Measurement Period" + 9 months]\n sort ascending\n )</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"cms645fhirbonedensitypcadtherapy-order-for-12-months-of-adt-in-3-months-before-to-9-months-after-start-of-measurement-period\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period":\n [ServiceRequest: "Injection of leuprolide acetate for twelve month period (regime/therapy)"] OrderTwelveMonthADT\n with "First ADT in 3 Months Before to 9 Months After Start of Measurement Period" FirstADTMP\n such that OrderTwelveMonthADT.authoredOn on or after day of FirstADTMP\n and OrderTwelveMonthADT.authoredOn during day of Interval[start of "Measurement Period" - 3 months, start of "Measurement Period" + 9 months]\n and OrderTwelveMonthADT.status in { 'active', 'completed' }\n and OrderTwelveMonthADT.intent = 'order'</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"cms645fhirbonedensitypcadtherapy-has-baseline-dexa-scan-two-years-prior-to-the-start-of-or-less-than-three-months-after-the-start-of-adt\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Has Baseline DEXA Scan Two Years Prior to the Start of or Less than Three Months After the Start of ADT":\n exists ( ( [ServiceRequest: "DEXA Bone Density for Urology Care"] DEXAOrdered\n with "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period" OrderTwelveMonthsADT\n such that DEXAOrdered.authoredOn 3 months or less on or after day of OrderTwelveMonthsADT.authoredOn\n or DEXAOrdered.authoredOn 2 years or less before day of OrderTwelveMonthsADT.authoredOn\n where DEXAOrdered.status in { 'active', 'completed' }\n and DEXAOrdered.intent = 'order'\n )\n union ( [ObservationClinicalResult: "DEXA Bone Density for Urology Care"] DEXAPerformed\n with "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period" OrderTwelveMonthsADT\n such that DEXAPerformed.effective.toInterval ( ) 3 months or less on or after day of OrderTwelveMonthsADT.authoredOn\n or DEXAPerformed.effective.toInterval ( ) 2 years or less before day of OrderTwelveMonthsADT.authoredOn\n where DEXAPerformed.status in { 'final', 'amended', 'corrected' }\n )\n )</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"cms645fhirbonedensitypcadtherapy-numerator\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Numerator":\n "Has Baseline DEXA Scan Two Years Prior to the Start of or Less than Three Months After the Start of ADT"</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"cms645fhirbonedensitypcadtherapy-no-bone-density-scan-ordered-due-to-patient-refusal\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "No Bone Density Scan Ordered Due to Patient Refusal":\n [ServiceNotRequested: "DEXA Bone Density for Urology Care"] DEXANotOrdered\n with "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period" OrderTwelveMonthsADT\n such that DEXANotOrdered.authoredOn 3 months or less on or after day of OrderTwelveMonthsADT.authoredOn\n and DEXANotOrdered.reasonRefused in "Patient Declined"</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"cms645fhirbonedensitypcadtherapy-no-bone-density-scan-performed-due-to-patient-refusal\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "No Bone Density Scan Performed Due to Patient Refusal":\n [ObservationCancelled: "DEXA Bone Density for Urology Care"] DEXANotPerformed\n with "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period" OrderTwelveMonthsADT\n such that DEXANotPerformed.issued 3 months or less on or after day of OrderTwelveMonthsADT.authoredOn\n and DEXANotPerformed.notDoneReason in "Patient Declined"</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"cms645fhirbonedensitypcadtherapy-denominator-exception\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Denominator Exception":\n exists ( "No Bone Density Scan Ordered Due to Patient Refusal" )\n or exists ( "No Bone Density Scan Performed Due to Patient Refusal" )</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"cms645fhirbonedensitypcadtherapy-has-qualifying-encounter\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Has Qualifying Encounter":\n exists ( ["Encounter": "Office Visit"] OfficeVisit\n where OfficeVisit.period during day of "Measurement Period"\n and OfficeVisit.status = 'finished'\n )</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"cms645fhirbonedensitypcadtherapy-initial-population\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Initial Population":\n "Has Qualifying Encounter"\n and exists "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period"</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"cms645fhirbonedensitypcadtherapy-denominator\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "Denominator":\n "Initial Population"</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"cms645fhirbonedensitypcadtherapy-sde-payer\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "SDE Payer":\n SDE."SDE Payer"</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"cms645fhirbonedensitypcadtherapy-sde-ethnicity\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "SDE Ethnicity":\n SDE."SDE Ethnicity"</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"cms645fhirbonedensitypcadtherapy-sde-race\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> CMS645FHIRBoneDensityPCADTherapy</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define "SDE Race":\n SDE."SDE Race"</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n\n \n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"fhirhelpers-tostring\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> FHIRHelpers</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function ToString(value uri): value.value</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"fhirhelpers-tointerval\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> FHIRHelpers</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">/*\n@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)\nvalue to a CQL DateTime Interval\n@comment: If the start value of the given period is unspecified, the starting\nboundary of the resulting interval will be open (meaning the start of the interval\nis unknown, as opposed to interpreted as the beginning of time).\n*/\ndefine function ToInterval(period FHIR.Period):\n if period is null then\n null\n else\n if period."start" is null then\n Interval(period."start".value, period."end".value]\n else\n Interval[period."start".value, period."end".value]</code></pre>\n </td>\n\n</tr>\n\n\n\n \n\n\n<tr>\n <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n \n \n <a name=\"fhirhelpers-tocode\"> </a>\n \n Logic Definition\n </th>\n\n <td class=\"content-container\"><em>Library Name:</em> FHIRHelpers</td>\n\n</tr>\n<tr>\n\n <td>\n <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n if coding is null then\n null\n else\n System.Code {\n code: coding.code.value,\n system: coding.system.value,\n version: coding.version.value,\n display: coding.display.value\n }</code></pre>\n </td>\n\n</tr>\n\n\n\n\n\n \n \n\n\n <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"terminology\"> </a>Terminology</th>\n\n\n</tr>\n \n \n \n\n \n\n \n\n \n\n \n\n\n<tr>\n \n \n \n\n<th scope=\"row\" class=\"row-header\">Code System</th>\n\n\n \n <td class=\"content-container\">\n \n <em>Description</em>: Code system SNOMEDCT\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: http://snomed.info/sct\n <br/>\n <em>Canonical URL</em>: <tt>http://snomed.info/sct</tt>\n \n </td>\n</tr>\n \n\n\n<tr>\n \n \n\n<th scope=\"row\" class=\"row-header\">Value Set</th>\n\n\n \n \n <td class=\"content-container\">\n \n <em>Description</em>: Value set DEXA Bone Density for Urology Care\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.359\n <br/>\n <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.359</tt>\n \n </td>\n</tr>\n \n\n\n<tr>\n \n \n\n<th scope=\"row\" class=\"row-header\">Value Set</th>\n\n\n \n \n <td class=\"content-container\">\n \n <em>Description</em>: Value set Androgen Deprivation Therapy for Urology Care\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.352\n <br/>\n <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.352</tt>\n \n </td>\n</tr>\n \n\n\n<tr>\n \n \n\n<th scope=\"row\" class=\"row-header\">Value Set</th>\n\n\n \n \n <td class=\"content-container\">\n \n <em>Description</em>: Value set Prostate Cancer\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.319\n <br/>\n <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.319</tt>\n \n </td>\n</tr>\n \n\n\n<tr>\n \n \n\n<th scope=\"row\" class=\"row-header\">Value Set</th>\n\n\n \n \n <td class=\"content-container\">\n \n <em>Description</em>: Value set Patient Declined\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1582\n <br/>\n <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1582</tt>\n \n </td>\n</tr>\n \n\n\n<tr>\n \n \n\n<th scope=\"row\" class=\"row-header\">Value Set</th>\n\n\n \n \n <td class=\"content-container\">\n \n <em>Description</em>: Value set Office Visit\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001\n <br/>\n <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001</tt>\n \n </td>\n</tr>\n \n\n\n<tr>\n \n \n\n<th scope=\"row\" class=\"row-header\">Value Set</th>\n\n\n \n \n <td class=\"content-container\">\n \n <em>Description</em>: Value set Payer Type\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591\n <br/>\n <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591</tt>\n \n </td>\n</tr>\n \n\n\n \n <tr>\n <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n <td class=\"content-container\">\n \n <em>Display</em>: Male (finding)\n <br/>\n \n <em>Code</em>: 248153007\n <br/>\n <em>System</em>: <tt>http://snomed.info/sct</tt>\n </td>\n </tr>\n\n <tr>\n <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n <td class=\"content-container\">\n \n <em>Display</em>: Female (finding)\n <br/>\n \n <em>Code</em>: 248152002\n <br/>\n <em>System</em>: <tt>http://snomed.info/sct</tt>\n </td>\n </tr>\n\n <tr>\n <th scope=\"row\" class=\"row-header\">Direct Reference Code</th>\n <td class=\"content-container\">\n \n <em>Display</em>: Injection of leuprolide acetate for twelve month period (regime/therapy)\n <br/>\n \n <em>Code</em>: 456381000124102\n <br/>\n <em>System</em>: <tt>http://snomed.info/sct</tt>\n </td>\n </tr>\n\n \n \n\n\n <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"dependencies\"> </a>Dependencies</th>\n\n\n</tr>\n \n \n \n\n\n<tr>\n \n\n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n\n <td class=\"content-container\">\n \n <em>Description</em>: QICore model information\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: http://hl7.org/fhir/Library/QICore-ModelInfo\n <br/>\n <em>Canonical URL</em>: <tt>http://hl7.org/fhir/Library/QICore-ModelInfo</tt>\n \n </td>\n</tr>\n \n\n\n<tr>\n \n\n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n\n <td class=\"content-container\">\n \n <em>Description</em>: Library SDE\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: https://madie.cms.gov/Library/SupplementalDataElements|5.1.000\n <br/>\n <em>Canonical URL</em>: <tt>https://madie.cms.gov/Library/SupplementalDataElements|5.1.000</tt>\n \n </td>\n</tr>\n \n\n\n<tr>\n \n\n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n\n <td class=\"content-container\">\n \n <em>Description</em>: Library FHIRHelpers\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: https://madie.cms.gov/Library/FHIRHelpers|4.4.000\n <br/>\n <em>Canonical URL</em>: <tt>https://madie.cms.gov/Library/FHIRHelpers|4.4.000</tt>\n \n </td>\n</tr>\n \n\n\n<tr>\n \n\n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n\n <td class=\"content-container\">\n \n <em>Description</em>: Library QICoreCommon\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: https://madie.cms.gov/Library/QICoreCommon|4.0.000\n <br/>\n <em>Canonical URL</em>: <tt>https://madie.cms.gov/Library/QICoreCommon|4.0.000</tt>\n \n </td>\n</tr>\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n\n \n \n\n\n <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"data-requirements\"> </a>Data Requirements</th>\n\n\n</tr>\n \n \n \n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: Patient\n <br/>\n \n <em>Profile(s)</em>: \n \n http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient\n <br/> \n \n \n \n <em>Must Support Elements</em>: extension, url\n <br/>\n \n \n </td>\n</tr>\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: MedicationRequest\n <br/>\n \n <em>Profile(s)</em>: \n \n http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest\n <br/> \n \n \n \n <em>Must Support Elements</em>: medication, dosageInstruction, status, status.value, intent, intent.value, authoredOn, authoredOn.value\n <br/>\n \n \n <em>Code Filter(s)</em>: \n <br/>\n \n \n <span class=\"tab-one\"><em>Path</em>: medication</span>\n <br/>\n \n \n \n <span class=\"tab-one\"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.352\n <br/> \n \n \n \n \n </td>\n</tr>\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: MedicationRequest\n <br/>\n \n <em>Profile(s)</em>: \n \n http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest\n <br/> \n \n \n \n <em>Must Support Elements</em>: medication.reference.value, dosageInstruction, status, status.value, intent, intent.value, authoredOn, authoredOn.value\n <br/>\n \n \n </td>\n</tr>\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: Medication\n <br/>\n \n <em>Profile(s)</em>: \n \n http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication\n <br/> \n \n \n \n <em>Must Support Elements</em>: id.value, code\n <br/>\n \n \n </td>\n</tr>\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: Condition\n <br/>\n \n <em>Profile(s)</em>: \n \n http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns\n <br/> \n \n \n \n <em>Must Support Elements</em>: code\n <br/>\n \n \n <em>Code Filter(s)</em>: \n <br/>\n \n \n <span class=\"tab-one\"><em>Path</em>: code</span>\n <br/>\n \n \n \n <span class=\"tab-one\"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.319\n <br/> \n \n \n \n \n </td>\n</tr>\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: Condition\n <br/>\n \n <em>Profile(s)</em>: \n \n http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis\n <br/> \n \n \n \n <em>Must Support Elements</em>: code\n <br/>\n \n \n <em>Code Filter(s)</em>: \n <br/>\n \n \n <span class=\"tab-one\"><em>Path</em>: code</span>\n <br/>\n \n \n \n <span class=\"tab-one\"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.319\n <br/> \n \n \n \n \n </td>\n</tr>\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: ServiceRequest\n <br/>\n \n <em>Profile(s)</em>: \n \n http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest\n <br/> \n \n \n \n <em>Must Support Elements</em>: code, authoredOn, authoredOn.value, status, status.value, intent, intent.value\n <br/>\n \n \n <em>Code Filter(s)</em>: \n <br/>\n \n \n <span class=\"tab-one\"><em>Path</em>: code</span>\n <br/>\n \n \n \n \n <span class=\"tab-one\"><em>Code(s)</em>: \n \n \n http://snomed.info/sct#456381000124102: 'Injection of leuprolide acetate for twelve month period (regime/therapy)'\n \n \n </span>\n <br/>\n \n \n \n </td>\n</tr>\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: ServiceRequest\n <br/>\n \n <em>Profile(s)</em>: \n \n http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest\n <br/> \n \n \n \n <em>Must Support Elements</em>: code, authoredOn, authoredOn.value, status, status.value, intent, intent.value\n <br/>\n \n \n <em>Code Filter(s)</em>: \n <br/>\n \n \n <span class=\"tab-one\"><em>Path</em>: code</span>\n <br/>\n \n \n \n <span class=\"tab-one\"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.359\n <br/> \n \n \n \n \n </td>\n</tr>\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: Observation\n <br/>\n \n <em>Profile(s)</em>: \n \n http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-clinical-result\n <br/> \n \n \n \n <em>Must Support Elements</em>: code, effective, status, status.value\n <br/>\n \n \n <em>Code Filter(s)</em>: \n <br/>\n \n \n <span class=\"tab-one\"><em>Path</em>: code</span>\n <br/>\n \n \n \n <span class=\"tab-one\"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.359\n <br/> \n \n \n \n \n </td>\n</tr>\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: ServiceRequest\n <br/>\n \n <em>Profile(s)</em>: \n \n http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicenotrequested\n <br/> \n \n \n \n <em>Must Support Elements</em>: code, authoredOn, authoredOn.value, extension\n <br/>\n \n \n <em>Code Filter(s)</em>: \n <br/>\n \n \n <span class=\"tab-one\"><em>Path</em>: code</span>\n <br/>\n \n \n \n <span class=\"tab-one\"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.359\n <br/> \n \n \n \n \n </td>\n</tr>\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: Observation\n <br/>\n \n <em>Profile(s)</em>: \n \n http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observationcancelled\n <br/> \n \n \n \n <em>Must Support Elements</em>: code, issued, issued.value, extension\n <br/>\n \n \n <em>Code Filter(s)</em>: \n <br/>\n \n \n <span class=\"tab-one\"><em>Path</em>: code</span>\n <br/>\n \n \n \n <span class=\"tab-one\"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.359\n <br/> \n \n \n \n \n </td>\n</tr>\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: Encounter\n <br/>\n \n <em>Profile(s)</em>: \n \n http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter\n <br/> \n \n \n \n <em>Must Support Elements</em>: type, period, status, status.value\n <br/>\n \n \n <em>Code Filter(s)</em>: \n <br/>\n \n \n <span class=\"tab-one\"><em>Path</em>: type</span>\n <br/>\n \n \n \n <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\n <br/> \n \n \n \n \n </td>\n</tr>\n\n<tr>\n <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n <td class=\"content-container\">\n <em>Type</em>: Coverage\n <br/>\n \n <em>Profile(s)</em>: \n \n http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage\n <br/> \n \n \n \n <em>Must Support Elements</em>: type, period\n <br/>\n \n \n <em>Code Filter(s)</em>: \n <br/>\n \n \n <span class=\"tab-one\"><em>Path</em>: type</span>\n <br/>\n \n \n \n <span class=\"tab-one\"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591\n <br/> \n \n \n \n \n </td>\n</tr>\n\n \n \n\n<tr>\n <th colspan=\"2\" scope=\"row\" class=\"row-header\">Generated using version 0.4.8 of the sample-content-ig Liquid templates</th>\n</tr>\n\n </tbody>\n </table>\n</div>"
},
"contained" : [
{
"resourceType" : "Library",
"id" : "effective-data-requirements",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "248153007",
"display" : "Male (finding)"
}
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "248152002",
"display" : "Female (finding)"
}
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "456381000124102",
"display" : "Injection of leuprolide acetate for twelve month period (regime/therapy)"
}
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "SupplementalDataElements"
},
{
"url" : "name",
"valueString" : "SDE Sex"
},
{
"url" : "statement",
"valueString" : "define \"SDE Sex\":\n case\n when Patient.sex = '248153007' then \"Male (finding)\"\n when Patient.sex = '248152002' then \"Female (finding)\"\n else null\n end"
},
{
"url" : "displaySequence",
"valueInteger" : 0
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS645FHIRBoneDensityPCADTherapy"
},
{
"url" : "name",
"valueString" : "SDE Sex"
},
{
"url" : "statement",
"valueString" : "define \"SDE Sex\":\n SDE.\"SDE Sex\""
},
{
"url" : "displaySequence",
"valueInteger" : 1
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS645FHIRBoneDensityPCADTherapy"
},
{
"url" : "name",
"valueString" : "Androgen Deprivation Therapy for Urology Care Medication Active Start Dates"
},
{
"url" : "statement",
"valueString" : "define \"Androgen Deprivation Therapy for Urology Care Medication Active Start Dates\":\n [MedicationRequest: \"Androgen Deprivation Therapy for Urology Care\"] ADTActive\n let firstMedicationPeriod: First((collapse(ADTActive.dosageInstruction.timing.repeat.bounds DoseTime\n return DoseTime.toInterval()\n )) DrugPeriods\n sort by start of $this\n ),\n\n //get the very first event as interval\n \n firstMedicationEvent: First((ADTActive.dosageInstruction.timing dosageTiming\n //returns first event for the specific dosageTiming\n \n return First(dosageTiming.event dosageTimingEvents\n sort ascending\n )) firstEvents\n sort ascending\n ),\n medicationDateTime: Min({ firstMedicationEvent, start of firstMedicationPeriod, \n end of firstMedicationPeriod }\n )\n where ADTActive.status in { 'active', 'completed' }\n and ADTActive.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n return medicationDateTime"
},
{
"url" : "displaySequence",
"valueInteger" : 2
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS645FHIRBoneDensityPCADTherapy"
},
{
"url" : "name",
"valueString" : "Androgen Deprivation Therapy for Urology Care Medication Order Start Dates"
},
{
"url" : "statement",
"valueString" : "define \"Androgen Deprivation Therapy for Urology Care Medication Order Start Dates\":\n [MedicationRequest: \"Androgen Deprivation Therapy for Urology Care\"] ADTOrder\n let firstMedicationPeriod: First((collapse(ADTOrder.dosageInstruction.timing.repeat.bounds DoseTime\n return DoseTime.toInterval()\n )) DrugPeriods\n sort by start of $this\n ),\n medicationDateTime: Min({ ADTOrder.authoredOn, start of firstMedicationPeriod, \n end of firstMedicationPeriod }\n )\n where ADTOrder.status in { 'active', 'completed' }\n and ADTOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n return medicationDateTime"
},
{
"url" : "displaySequence",
"valueInteger" : 3
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS645FHIRBoneDensityPCADTherapy"
},
{
"url" : "name",
"valueString" : "Prostate Cancer Diagnosis"
},
{
"url" : "statement",
"valueString" : "define \"Prostate Cancer Diagnosis\":\n ( [ConditionProblemsHealthConcerns: \"Prostate Cancer\"]\n union [ConditionEncounterDiagnosis: \"Prostate Cancer\"] ) ProstateCancer\n where ProstateCancer.prevalenceInterval ( ) overlaps day of \"Measurement Period\"\n and ProstateCancer.isVerified ( )"
},
{
"url" : "displaySequence",
"valueInteger" : 4
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS645FHIRBoneDensityPCADTherapy"
},
{
"url" : "name",
"valueString" : "First ADT in 3 Months Before to 9 Months After Start of Measurement Period"
},
{
"url" : "statement",
"valueString" : "define \"First ADT in 3 Months Before to 9 Months After Start of Measurement Period\":\n First((\"Androgen Deprivation Therapy for Urology Care Medication Active Start Dates\"\n union \"Androgen Deprivation Therapy for Urology Care Medication Order Start Dates\") ADTDateTime\n with \"Prostate Cancer Diagnosis\" ProstateCancer\n such that ADTDateTime during day of ProstateCancer.prevalenceInterval()\n and ADTDateTime during day of Interval[start of \"Measurement Period\" - 3 months, start of \"Measurement Period\" + 9 months]\n sort ascending\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 5
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS645FHIRBoneDensityPCADTherapy"
},
{
"url" : "name",
"valueString" : "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period"
},
{
"url" : "statement",
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}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm"
},
{
"extension" : [
{
"url" : "term",
"valueString" : "First Androgen Deprivation Therapy"
},
{
"url" : "definition",
"valueMarkdown" : "The first Androgen Deprivation Therapy (ADT) is measured as the first order or administration of ADT for an anticipated period of 12 months or greater to a patient with prostate cancer.\n"
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm"
},
{
"extension" : [
{
"url" : "term",
"valueString" : "Peripheral Dual Energy X-ray Absorptiometry (PDXA)"
},
{
"url" : "definition",
"valueMarkdown" : "Bone mineral density measurement of the wrist, heel, or finger.\n"
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm"
},
{
"url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
"valueReference" : {
"reference" : "#effective-data-requirements"
}
}
],
"url" : "https://madie.cms.gov/Measure/CMS645FHIRBoneDensityPCADTherapy",
"identifier" : [
{
"use" : "usual",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
"code" : "short-name",
"display" : "Short Name"
}
]
},
"system" : "https://madie.cms.gov/measure/shortName",
"value" : "CMS645FHIR"
},
{
"use" : "official",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
"code" : "version-independent",
"display" : "Version Independent"
}
]
},
"system" : "urn:ietf:rfc:3986",
"value" : "urn:uuid:299de9c4-755d-4f5a-ac9e-fa74fe34f759"
},
{
"use" : "official",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
"code" : "version-specific",
"display" : "Version Specific"
}
]
},
"system" : "urn:ietf:rfc:3986",
"value" : "urn:uuid:5cd769d8-9a63-4637-b18e-76ee9c68cbf9"
},
{
"use" : "official",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
"code" : "publisher",
"display" : "Publisher"
}
]
},
"system" : "https://madie.cms.gov/measure/cmsId",
"value" : "645FHIR",
"assigner" : {
"display" : "CMS"
}
}
],
"version" : "1.0.000",
"name" : "CMS645FHIRBoneDensityPCADTherapy",
"title" : "Bone Density Evaluation for Patients with Prostate Cancer and Receiving Androgen Deprivation TherapyFHIR\n",
"status" : "active",
"experimental" : false,
"date" : "2025-08-22T18:20:09+00:00",
"publisher" : "Oregon Urology",
"contact" : [
{
"telecom" : [
{
"system" : "url",
"value" : "www.oregonurology.com"
}
]
}
],
"description" : "Percentage of patients determined as having prostate cancer who are currently starting or undergoing androgen deprivation therapy (ADT), for an anticipated period of 12 months or greater and who receive an initial bone density evaluation. The bone density evaluation must be prior to the start of ADT or within 3 months of the start of ADT.\n",
"usage" : "In order to capture the practitioner's intent of androgen deprivation therapy (ADT) for a period of 12 months or greater, SNOMEDCT 456381000124102 which is Injection of leuprolide acetate for the twelve-month period (regime/therapy) is the correct code.\n\nThis eCQM is a patient-based measure.\n\nThis FHIR-based measure has been derived from the QDM-based measure CMS645v9. 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).\n",
"copyright" : "Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Oregon Urology Institute (OUI) and Large Urology Group Practice Association (LUGPA) disclaim all liability for the use or accuracy of third-party codes contained in the specifications.\n\nCPT(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.\n",
"effectivePeriod" : {
"start" : "2026-01-01",
"end" : "2026-12-31"
},
"author" : [
{
"name" : "Oregon Urology",
"telecom" : [
{
"system" : "url",
"value" : "www.oregonurology.com"
}
]
}
],
"relatedArtifact" : [
{
"type" : "citation",
"citation" : "Cosman, F., deBeur, S.J., LeBoff, M.S., Lewiecki, E. M., Tanner, B., Randall, S., \\& Lindsay, R. (2014). Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporosis International, 25(10), 2359--2381. https://doi.org/10.1007/s00198-014-2794-2\n"
},
{
"type" : "citation",
"citation" : "Finkelstein, J., \\& Yu, E. (2017). Clinical manifestations, diagnosis, and evaluation of osteoporosis in men. Retrieved from https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-evaluation-of-osteoporosis-in-men/print?source=see_link\n"
},
{
"type" : "citation",
"citation" : "Guise, T.A., Oefelein, M.G., Eastham, J.A., Cookson, M.S., Higano, C.S., \\& Smith, M.R. (2007). Estrogenic side effects of androgen deprivation therapy. Reviews in urology, 9(4), 163-180.\n"
},
{
"type" : "citation",
"citation" : "Qaseem, A., Snow, V., Shekelle, P., Hopkins, R., Forciea, M. A., Owens, D. K., \\& for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians. (2008). Annals of Internal Medicine. Screening for osteoporosis in men: A clinical practice guideline from the American College of Physicians, 2008. Annals of Internal Medicine, 148(9), 680-684. https://doi.org/10.7326/0003-4819-148-9-200805060-00008\n"
},
{
"type" : "citation",
"citation" : "Ward, R. J., Roberts, C. C., Bencardino, J. T., Arnold, E., Baccei, S. J., Cassidy, R. C., ... Weissman, B. N. (2017). ACR Appropriateness Criteria (R) Osteoporosis and Bone Mineral Density. Journal of the American College of Radiology, 14(5), S189--S202. https://doi.org/10.1016/j.jacr.2017.02.018\n"
},
{
"type" : "citation",
"citation" : "Watts, N. B., Adler, R. A., Bilezikian, J. P., Drake, M. T., Eastell, R., Orwoll, E. S., \\& Finkelstein, J. S. (2012). Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology \\& Metabolism, 97(6), 1802--1822. https://doi.org/10.1210/jc.2011-3045\n"
}
],
"library" : [
🔗 "https://madie.cms.gov/Library/CMS645FHIRBoneDensityPCADTherapy"
],
"disclaimer" : "The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.\n\nTHE MEASURES AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.\n\nDue to technical limitations, registered trademarks are indicated by (R) or \\[R\\] and unregistered trademarks are indicated by (TM) or \\[TM\\].\n",
"rationale" : "Androgen suppression as a treatment for prostate cancer can cause osteoporosis (Qaseem, 2008). Patients with prostate cancer undergoing prolonged androgen deprivation therapy (ADT) incur bone loss at a rate higher than menopausal patients (Guise, 2007). In preserving bone health, the goal is to prevent or treat osteopenia/osteoporosis for the patient on ADT and to prevent or delay skeletal-related events. The National Osteoporosis Foundation recommendations include a baseline assessment of bone density with a dual-energy X-ray absorptiometry (DEXA) scan and daily calcium and Vitamin D supplementation (Watts, 2012). The DEXA scan is the gold standard for bone density screening. Patients at risk for adverse bone consequences from chronic ADT do not always receive care according to evidence-based guidelines. These findings call for improved processes that standardize evidence-based practice, including baseline and follow-up bone density assessment (Watts, 2012).\n",
"clinicalRecommendationStatement" : "Bone density screening should be performed at the start of Androgen Deprivation Therapy (ADT) for prostate cancer. It should also be performed every 2 years for the patient with continued ADT or for patients with known osteoporosis. Current insurance practice is to possibly cover the cost of bone density screening if osteoporosis is known or if there is a high-risk drug. Some patients choose to delay bone density screening until after ADT is started and they therefore have insurance authorization due to the administration of a high-risk drug.\n",
"group" : [
{
"id" : "Group_1",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
"code" : "proportion",
"display" : "Proportion"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
"valueCode" : "boolean"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-type",
"code" : "process",
"display" : "Process"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
"code" : "increase",
"display" : "Increased score indicates improvement"
}
]
}
}
],
"population" : [
{
"id" : "InitialPopulation_1",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "initial-population",
"display" : "Initial Population"
}
]
},
"description" : "Patients with a qualifying encounter in the measurement period AND with a diagnosis of prostate cancer AND with an order for ADT or an active medication of ADT with an intent for treatment greater than or equal to 12 months during the measurement period AND order for ADT in 3 months before to 9 months after the start of the measurement period\n",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Initial Population"
}
},
{
"id" : "Denominator_1",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "denominator",
"display" : "Denominator"
}
]
},
"description" : "Equals Initial Population\n",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Denominator"
}
},
{
"id" : "Numerator_1",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "numerator",
"display" : "Numerator"
}
]
},
"description" : "Patients with a bone density evaluation within the two years prior to the start of or less than three months after the start of ADT treatment\n",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Numerator"
}
},
{
"id" : "DenominatorException_1",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "denominator-exception",
"display" : "Denominator Exception"
}
]
},
"description" : "Patient refused the bone density evaluation at the time ordered or did not have it performed within 3 months after the start of ADT\n",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Denominator Exception"
}
}
]
}
],
"supplementalData" : [
{
"id" : "sde-ethnicity",
"usage" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code" : "supplemental-data"
}
]
}
],
"description" : "SDE Ethnicity\n",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "SDE Ethnicity"
}
},
{
"id" : "sde-payer",
"usage" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code" : "supplemental-data"
}
]
}
],
"description" : "SDE Payer\n",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "SDE Payer"
}
},
{
"id" : "sde-race",
"usage" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code" : "supplemental-data"
}
]
}
],
"description" : "SDE Race\n",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "SDE Race"
}
},
{
"id" : "sde-sex",
"usage" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code" : "supplemental-data"
}
]
}
],
"description" : "SDE Sex\n",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "SDE Sex"
}
}
]
}