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 |
<Measure xmlns="http://hl7.org/fhir">
<id value="CMS646FHIRIntravesicalBCGTherapy"/>
<meta>
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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">Intravesical Bacillus-Calmette-Guerin for Non-Muscle Invasive Bladder CancerFHIR</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">CMS646FHIR</td>
</tr>
<tr>
<th scope="row" class="row-header">GUID (Version Independent)</th>
<td class="content-container">urn:uuid:907ead5a-2f8f-468e-b774-309ea8aa6182</td>
</tr>
<tr>
<th scope="row" class="row-header">GUID (Version Specific)</th>
<td class="content-container">urn:uuid:67c8554c-9288-4de2-b8dc-45ae4673e032</td>
</tr>
<tr>
<th scope="row" class="row-header">CMS Identifier</th>
<td class="content-container">646FHIR</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">Oregon Urology</td>
</tr>
<tr>
<th scope="row" class="row-header">Developer</th>
<td class="content-container">Oregon Urology</td>
</tr>
<tr>
<th scope="row" class="row-header">Description</th>
<td class="content-container"><p>Percentage of patients initially diagnosed with non-muscle invasive bladder cancer and who received intravesical Bacillus-Calmette-Guerin (BCG) within 6 months of bladder cancer staging</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Copyright</th>
<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>
<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>
</tr>
<tr>
<th scope="row" class="row-header">Disclaimer</th>
<td class="content-container"><p>The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.</p>
<p>THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.</p>
<p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by TM or [TM].</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Rationale</th>
<td class="content-container"><p>Bladder cancer is ranked 10th for new cancer cases in 2020 and is the ninth leading cause of cancer death in the United States. There are 81,400 estimated new cases in 2020 and 17,980 estimated deaths in 2020. In 2016, an estimated 699,450 people were living with bladder cancer in the United States. Early detection (discovery of cancer in situ or localized to the primary site) is found in 85% of the patients, and with these there is a five-year survival rate of 95.8% for In Situ and 69.2% for Localized. Bladder cancer is rarely found in patients under age 20, with the median age of diagnosis being 73 (NIH, 2020).</p>
<p>National Comprehensive Cancer Network (NCCN) Guidelines for Bladder Cancer (version 6.2021) defines intravesical BCG as Category 1 Treatment for T1, Tis and Ta - high grade, non-muscle invasive bladder cancer. Most public data reflects prophylactic or adjuvant use of intravesical therapy to prevent recurrence or delay progression to a higher grade or stage. BCG has been shown to be effective as prophylaxis to prevent bladder cancer recurrences following TURBT. The NCCN Bladder Cancer Panel Members recommend BCG as the preferred option over Mitomycin C for adjuvant treatment of high-grade lesions (Ta). BCG is also standard therapy for Primary Tis. Most T1 lesions are high-risk and are similarly treated with adjuvant intravesical therapy, with BCG being a Category 1 recommendation (NCCN, 2021).</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Clinical Recommendation Statement</th>
<td class="content-container"><p>Intravesical BCG should be administered within 6 months of the initial diagnosis of non-muscle invasive bladder cancer. It may be administered 3-4 weeks after resection, but there needs to be pathological tumor confirmation and must be withheld if there is traumatic catheterization, bacteriuria, persistent gross hematuria, persistent severe local symptoms or systemic symptoms. The normal induction course is 6 weekly instillations of intravesical BCG (AUA Non-Muscle Invasive Bladder Cancer and American Urological Association (AUA) Guideline for the Management of Non-muscle Invasive Bladder Cancer: Stages T1, TIS, and Ta High Risk).</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Chamie, K., Saigal, C.S., Lai, J., Hanley, J.M., Setodji, C.M., Konety, B.R., ... Urologic Diseases in America Project (2011). Compliance with Guidelines for Patients with Bladder Cancer: Variation in the Delivery of Care. Cancer.2011 Dec 1: 117(23): 5392-5401. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206145/</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Chang, S.S., Boorjian, S.A., Chou, R., Clark, P.E., Daneshmand, S., Konety, B.R., ... Mckiernan, J. M., (2016) American Urological Association. Non-Muscle Invasive Bladder Cancer. https://www.auanet.org/guidelines-and-quality/guidelines/bladder-cancer-non-muscle-invasive-guideline</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Hall, M.C., Chang, S.S., Dalbagni, G., Pruthi, R.S., Schellhammer, P.F., Seigne, J.D., ... Wolf, S., (2016). American Urological Association. Guideline for the Management of Non-muscle Invasive Bladder Cancer (Stages Ta, T1, and Tis): Update 2016. https://www.auajournals.org/doi/10.1016/j.juro.2007.09.003</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Kassouf, W., Black, P., (2016) Treatment of primary non-muscle invasive urothelial bladder cancer. Literature review current through Dec. 2016. https://www.uptodate.com/contents/treatment-of-primary-non-muscle-invasive-urothelial-bladder-cancer?source=search_result&search=Treatment%20of%20primary%20non-muscle%20invasive%20urothelial%20bladder%20cancer&selectedTitle=1~150 T of primary</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>National Cancer Institute. (2020). SEER Cancer Stat Facts: Bladder Cancer. Surveillance, Epidemiology, and End Results Program. U.S. Department of Health and Human Services, National Institutes of Health. https://seer.cancer.gov/statfacts/html/urinb.html</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). (2021). Bladder Cancer. Version 6.2021. https://www.nccn.org/professionals/physician_gls/pdf/bladder.pdf</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Citation</th>
<td class="content-container">
<p>Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University. (2016). PCORI Topic Brief. Comparative Effectiveness of Treatments for Non-Muscle-Invasive Bladder Cancer http://www.pcori.org/sites/default/files/PCORI-Assessment-Options-Advisory-Panel-Fall-2016-Topic-Brief-Non-Muscle-Invasive-Bladder-Cancer.pdf</p>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Definition</th>
<td class="content-container">Bacillus Calmette-Guerin (BCG) : <p>A live attenuated strain of <em>Mycobacterium bovis</em>, first indicated as a tuberculosis vaccine, has had widespread use in intravesical immunotherapy since the 1970s</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Definition</th>
<td class="content-container">Histology: <p>Urothelial carcinoma</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Definition</th>
<td class="content-container">Intravesical: <p>Within the urinary bladder</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Definition</th>
<td class="content-container">Primary Tumor (T) Stage - T1: <p>The tumor invades subepithelial connective tissue (high grade or low grade)</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Definition</th>
<td class="content-container">Primary Tumor (T) Stage - Ta: <p>Noninvasive and high grade</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Definition</th>
<td class="content-container">Primary Tumor (T) Stage - Tis: <p>Carcinoma in situ: "flat tumor"</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Definition</th>
<td class="content-container">Tumor Location: <p>Urinary bladder</p></td>
</tr>
<tr>
<th scope="row" class="row-header">Guidance (Usage)</th>
<td class="content-container"><p>Ta bladder cancer must be high grade Ta only and is supported by the 2016 AUA guidelines and 2018 NCCN guidelines.</p>
<p>The BCG dose can be full or partial and can be from any lot or manufacturer.</p>
<p>This eCQM is a patient-based measure.</p>
<p>Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.</p>
<p>This FHIR-based measure has been derived from the QDM-based measure CMS646v6. 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>
</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 initially diagnosed with T1, Tis or high grade Ta non-muscle invasive bladder cancer with bladder cancer staging within 6 months before to 6 months after the start of the measurement period and a qualified encounter in the measurement period</p></p>
<em>Logic Definition</em>: <a href="#primary-cms646fhirintravesicalbcgtherapy-initial-population">Initial Population</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Denominator</th>
<td class="content-container">
<em>ID</em>: Denominator_1
<br/>
<em>Description</em>:
<p style="white-space: pre-line" class="tab-one"><p>Equals Initial Population</p></p>
<em>Logic Definition</em>: <a href="#primary-cms646fhirintravesicalbcgtherapy-denominator">Denominator</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Denominator Exclusion</th>
<td class="content-container">
<em>ID</em>: DenominatorExclusion_1
<br/>
<em>Description</em>:
<p style="white-space: pre-line" class="tab-one"><p>Immunosuppressed patients, includes HIV and immunocompromised state, with a diagnosis prior to Bladder Cancer Staging.</p>
<p>Immunosuppressive drug therapy starting on or before Bladder Cancer Staging.</p>
<p>Active Tuberculosis diagnosis during the Bladder Cancer Staging.</p>
<p>Mixed histology urothelial cell carcinoma including micropapillary, plasmacytoid, sarcomatoid, adenocarcinoma and squamous disease prior to Bladder Cancer Staging.</p>
<p>Patients who undergo cystectomy, chemotherapy or radiation within 6 months prior to Bladder Cancer Staging.</p></p>
<em>Logic Definition</em>: <a href="#primary-cms646fhirintravesicalbcgtherapy-denominator-exclusion">Denominator Exclusion</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>Intravesical Bacillus-Calmette Guerin (BCG) instillation for initial dose or series: BCG is initiated within 6 months of the bladder cancer staging</p></p>
<em>Logic Definition</em>: <a href="#primary-cms646fhirintravesicalbcgtherapy-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"><p>Unavailability of BCG within 6 months after Bladder Cancer Staging</p></p>
<em>Logic Definition</em>: <a href="#primary-cms646fhirintravesicalbcgtherapy-denominator-exception">Denominator Exception</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Guidance</th>
<td class="content-container"><p>For every patient evaluated by this measure also identify payer, race, ethnicity and sex</p></td>
</tr>
<tr>
<th colspan="2" scope="row" class="row-header">Supplemental Data Elements</th>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Element</th>
<td class="content-container">
<em>ID</em>: sde-ethnicity
<br/>
<em>Usage Code</em>: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
<br/>
<em>Description</em>: SDE Ethnicity
<br/>
<em>Logic Definition</em>: <a href="#cms646fhirintravesicalbcgtherapy-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="#cms646fhirintravesicalbcgtherapy-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="#cms646fhirintravesicalbcgtherapy-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="#cms646fhirintravesicalbcgtherapy-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/CMS646FHIRIntravesicalBCGTherapy</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-cms646fhirintravesicalbcgtherapy-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":
"Has Most Recent Bladder Cancer Tumor Staging is T1, Tis, Ta HG"
and "Has Qualifying Encounter"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="primary-cms646fhirintravesicalbcgtherapy-denominator"> </a>
Denominator
</th>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="primary-cms646fhirintravesicalbcgtherapy-denominator-exclusion"> </a>
Denominator Exclusion
</th>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator Exclusion":
exists "Acute Tuberculosis Diagnosis"
or exists "Immunosuppressive Drugs"
or exists "Cystectomy Done"
or "Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging"
or "Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="primary-cms646fhirintravesicalbcgtherapy-numerator"> </a>
Numerator
</th>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Numerator":
"First BCG Administered" is not null</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="primary-cms646fhirintravesicalbcgtherapy-denominator-exception"> </a>
Denominator Exception
</th>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator Exception":
exists "BCG Not Available Within 6 Months After Bladder Cancer Staging"</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="cms646fhirintravesicalbcgtherapy-sde-sex"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</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="cms646fhirintravesicalbcgtherapy-bladder-cancer-diagnosis"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Bladder Cancer Diagnosis":
( [ConditionProblemsHealthConcerns: "Bladder Cancer for Urology Care"]
union [ConditionEncounterDiagnosis: "Bladder Cancer for Urology Care"] ) BladderCancer
where ( BladderCancer.prevalenceInterval ( ) starts before day of end of "Measurement Period"
or BladderCancer.onset.toInterval ( ) before day of end of "Measurement Period"
)
and BladderCancer.isVerified ( )</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-first-bladder-cancer-staging-procedure"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "First Bladder Cancer Staging Procedure":
First([Procedure: "Tumor staging (tumor staging)"] BladderCancerStaging
with "Bladder Cancer Diagnosis" BladderCancer
such that BladderCancerStaging.performed.toInterval() starts on or before day of start of BladderCancer.prevalenceInterval()
where BladderCancerStaging.status = 'completed'
sort by start of performed.toInterval()
)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-first-bcg-administered"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "First BCG Administered":
First([MedicationAdministration: "Bacillus Calmette Guerin for Urology Care"] BCG
with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
such that BCG.effective.toInterval() starts 6 months or less after day of start of FirstBladderCancerStaging.performed.toInterval()
and BCG.effective.toInterval() starts during day of "Measurement Period"
where BCG.status in { 'in-progress', 'completed' }
sort by start of effective.toInterval()
)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-numerator"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Numerator":
"First BCG Administered" is not null</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-bcg-not-available-within-6-months-after-bladder-cancer-staging"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "BCG Not Available Within 6 Months After Bladder Cancer Staging":
[MedicationAdministrationNotDone: "Bacillus Calmette Guerin for Urology Care"] BCGNotGiven
with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
such that BCGNotGiven.recorded 6 months or less after day of start of FirstBladderCancerStaging.performed.toInterval ( )
where BCGNotGiven.statusReason in "Unavailability of Bacillus Calmette Guerin for Urology Care"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-denominator-exception"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator Exception":
exists "BCG Not Available Within 6 Months After Bladder Cancer Staging"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-july-1-of-year-prior-to-the-measurement-period"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "July 1 of Year Prior to the Measurement Period":
Date((year from start of "Measurement Period" - 1), 7, 1)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-june-30-of-the-measurement-period"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "June 30 of the Measurement Period":
Date((year from start of "Measurement Period"), 6, 30)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-first-bladder-cancer-staging-procedure-during-6-months-prior-to-measurement-period-through-the-first-6-months-of-measurement-period"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period":
"First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
where FirstBladderCancerStaging.performed.toInterval ( ) during day of Interval["July 1 of Year Prior to the Measurement Period", "June 30 of the Measurement Period"]</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-has-most-recent-bladder-cancer-tumor-staging-is-t1,-tis,-ta-hg"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*Ta High Grade only to be included. Ta low grade is to be excluded from this measure.*/
define "Has Most Recent Bladder Cancer Tumor Staging is T1, Tis, Ta HG":
exists ( [LaboratoryResultObservation] StagingObservation
where StagingObservation.getStagingProcedure ( ) is not null
and ( StagingObservation.value as Concept ~ "American Joint Committee on Cancer cT1 (qualifier value)"
or StagingObservation.value as Concept ~ "American Joint Committee on Cancer cTis (qualifier value)"
or StagingObservation.value as Concept ~ "American Joint Committee on Cancer cTa (qualifier value)"
or StagingObservation.value as Concept ~ "Carcinoma in situ of bladder"
)
and StagingObservation.status in { 'final', 'amended', 'corrected' }
)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-has-qualifying-encounter"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Has Qualifying Encounter":
exists ( [Encounter: "Office Visit"] ValidEncounter
where ValidEncounter.period during day of "Measurement Period"
and ValidEncounter.class !~ "virtual"
and ValidEncounter.status = 'finished'
)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-initial-population"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Initial Population":
"Has Most Recent Bladder Cancer Tumor Staging is T1, Tis, Ta HG"
and "Has Qualifying Encounter"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-denominator"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-sde-payer"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</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="cms646fhirintravesicalbcgtherapy-sde-ethnicity"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</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="cms646fhirintravesicalbcgtherapy-acute-tuberculosis-diagnosis"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Acute Tuberculosis Diagnosis":
( [ConditionProblemsHealthConcerns: "Tuberculosis for Urology Care"]
union [ConditionEncounterDiagnosis: "Tuberculosis for Urology Care"] ) ActiveTuberculosis
with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
such that ( ( ActiveTuberculosis.prevalenceInterval ( ) overlaps after day of FirstBladderCancerStaging.performed.toInterval ( ) )
or ( ActiveTuberculosis.onset.toInterval ( ) overlaps after day of FirstBladderCancerStaging.performed.toInterval ( )
and ( ( ActiveTuberculosis.abatement.toInterval ( ) overlaps after day of FirstBladderCancerStaging.performed.toInterval ( ) )
or ( ActiveTuberculosis.abatement is null )
)
)
)
where ActiveTuberculosis.isVerified ( )</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-immunosuppressive-drugs"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Immunosuppressive Drugs":
[MedicationRequest: "Immunosuppressive Drugs for Urology Care"] ImmunosuppressiveDrugs
let firstMedicationPeriod: First((collapse(ImmunosuppressiveDrugs.dosageInstruction.timing.repeat.bounds DoseTime
return DoseTime.toInterval()
)) DrugPeriods
sort by start of $this
),
//get the very first event
firstMedicationEvent: First((ImmunosuppressiveDrugs.dosageInstruction.timing dosageTiming
//return first event for the specific dosageTiming
return First(dosageTiming.event dosageTimingEvents
sort ascending
)) firstEvents
sort ascending
),
medicationPeriod: Coalesce(firstMedicationEvent.toInterval(), firstMedicationPeriod)
with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
such that medicationPeriod starts on or before day of start of FirstBladderCancerStaging.performed.toInterval ( )
where ImmunosuppressiveDrugs.status in { 'active', 'completed' }
and ImmunosuppressiveDrugs.intent = 'order'</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-cystectomy-done"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Cystectomy Done":
[Procedure: "Cystectomy for Urology Care"] Cystectomy
with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
such that Cystectomy.performed.toInterval ( ) 6 months or less before day of start of FirstBladderCancerStaging.performed.toInterval ( )
where Cystectomy.status = 'completed'</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-has-excluding-hiv,-immunocompromised-conditions-or-mixed-histology-before-staging"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging":
exists ( ( ( [ConditionProblemsHealthConcerns: "HIV"]
union [ConditionEncounterDiagnosis: "HIV"]
)
union ( [ConditionProblemsHealthConcerns: "Immunocompromised Conditions"]
union [ConditionEncounterDiagnosis: "Immunocompromised Conditions"]
)
union ( [ConditionProblemsHealthConcerns: "Mixed Histology Urothelial Cell Carcinoma for Urology Care"]
union [ConditionEncounterDiagnosis: "Mixed Histology Urothelial Cell Carcinoma for Urology Care"]
) ) ExclusionDiagnosis
with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
such that ( ( ExclusionDiagnosis.prevalenceInterval ( ) starts on or before day of start of FirstBladderCancerStaging.performed.toInterval ( ) )
or ( ExclusionDiagnosis.onset.toInterval ( ) starts on or before day of start of FirstBladderCancerStaging.performed.toInterval ( ) )
)
where ExclusionDiagnosis.isVerified ( )
)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-has-excluding-chemotherapy-or-radiotherapy-procedure-before-staging"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging":
exists ( ( [MedicationRequest: "Chemotherapy Agents for Advanced Cancer"] ExclusionMed
let firstMedicationPeriod: First((collapse(ExclusionMed.dosageInstruction.timing.repeat.bounds DoseTime
return DoseTime.toInterval()
)) DrugPeriods
sort by start of $this
)
with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
such that firstMedicationPeriod starts 6 months or less before FirstBladderCancerStaging.performed.toInterval ( )
where ExclusionMed.status in { 'active', 'completed' }
and ExclusionMed.intent = 'order'
)
union ( [Procedure: "Combined radiotherapy (procedure)"] ExclusionProcedure
with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
such that ExclusionProcedure.performed.toInterval ( ) starts 6 months or less before FirstBladderCancerStaging.performed.toInterval ( )
where ExclusionProcedure.status in { 'completed', 'in-progress' }
)
)</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-denominator-exclusion"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Denominator Exclusion":
exists "Acute Tuberculosis Diagnosis"
or exists "Immunosuppressive Drugs"
or exists "Cystectomy Done"
or "Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging"
or "Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cms646fhirintravesicalbcgtherapy-sde-race"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</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="cms646fhirintravesicalbcgtherapy-getstagingprocedure"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CMS646FHIRIntravesicalBCGTherapy</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define fluent function getStagingProcedure(StagingObservation LaboratoryResultObservation):
StagingObservation.partOf StagingReference
return "First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period" FirstBladderCancerStagingMP
where FirstBladderCancerStagingMP.id = StagingReference.reference.getId ( )</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="qicorecommon-tointerval"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> QICoreCommon</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
case
when choice is DateTime then
Interval[choice as DateTime, choice as DateTime]
when choice is Interval<DateTime> then
choice as Interval<DateTime>
when choice is Quantity then
Interval[Patient.birthDate + (choice as Quantity),
Patient.birthDate + (choice as Quantity) + 1 year)
when choice is Interval<Quantity> then
Interval[Patient.birthDate + (choice.low as Quantity),
Patient.birthDate + (choice.high as Quantity) + 1 year)
when choice is Timing then
Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
else
null as Interval<DateTime>
end</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="qicorecommon-getid"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> QICoreCommon</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).
@comment: This function can be used to determine the logical id of a given resource. It can be used in
a single-server environment to trace references. However, this function does not attempt to resolve
or distinguish the base of the given url, and so cannot be used safely in multi-server environments.
*/
define fluent function getId(uri String):
Last(Split(uri, '/'))</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-toconcept"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> FHIRHelpers</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
if concept is null then
null
else
System.Concept {
codes: concept.coding C return ToCode(C),
display: concept.text.value
}</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="fhirhelpers-tocode"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> FHIRHelpers</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
if coding is null then
null
else
System.Code {
code: coding.code.value,
system: coding.system.value,
version: coding.version.value,
display: coding.display.value
}</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="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 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 ICD10CM
<br/>
<em>Resource</em>: http://hl7.org/fhir/sid/icd-10-cm
<br/>
<em>Canonical URL</em>: <tt>http://hl7.org/fhir/sid/icd-10-cm</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 Bacillus Calmette Guerin for Urology Care
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.353
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.353</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Bladder Cancer for Urology Care
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.354
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.354</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Unavailability of Bacillus Calmette Guerin for Urology Care
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.369
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.369</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 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 Tuberculosis for Urology Care
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.351
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.351</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Immunosuppressive Drugs for Urology Care
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.364
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.364</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Cystectomy for Urology Care
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.358
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.358</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set HIV
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Immunocompromised Conditions
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.363
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.363</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Mixed Histology Urothelial Cell Carcinoma for Urology Care
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.365
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.365</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Value Set</th>
<td class="content-container">
<em>Description</em>: Value set Chemotherapy Agents for Advanced Cancer
<br/>
<em>Resource</em>: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.355
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.355</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>: Tumor staging (tumor staging)
<br/>
<em>Code</em>: 254292007
<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>: American Joint Committee on Cancer cT1 (qualifier value)
<br/>
<em>Code</em>: 1228889001
<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>: American Joint Committee on Cancer cTis (qualifier value)
<br/>
<em>Code</em>: 1228884006
<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>: American Joint Committee on Cancer cTa (qualifier value)
<br/>
<em>Code</em>: 1228883000
<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>: Carcinoma in situ of bladder
<br/>
<em>Code</em>: D09.0
<br/>
<em>System</em>: <tt>http://hl7.org/fhir/sid/icd-10-cm</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 scope="row" class="row-header">Direct Reference Code</th>
<td class="content-container">
<em>Display</em>: Combined radiotherapy (procedure)
<br/>
<em>Code</em>: 169331000
<br/>
<em>System</em>: <tt>http://snomed.info/sct</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, birthDate, birthDate.value, url
<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/2.16.840.1.113762.1.4.1248.354
<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/2.16.840.1.113762.1.4.1248.351
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Condition
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns
<br/>
<em>Must Support Elements</em>: code
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003
<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/2.16.840.1.113762.1.4.1248.363
<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/2.16.840.1.113762.1.4.1248.365
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Condition
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
<br/>
<em>Must Support Elements</em>: code
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.354
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Condition
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
<br/>
<em>Must Support Elements</em>: code
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.351
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Condition
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
<br/>
<em>Must Support Elements</em>: code
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Condition
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
<br/>
<em>Must Support Elements</em>: code
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.363
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Condition
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
<br/>
<em>Must Support Elements</em>: code
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.365
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Procedure
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
<br/>
<em>Must Support Elements</em>: code, performed, status, status.value, id, id.value
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>Code(s)</em>:
http://snomed.info/sct#254292007: 'Tumor staging (tumor staging)'
</span>
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Procedure
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
<br/>
<em>Must Support Elements</em>: code, performed, status, status.value, id, id.value
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.358
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Procedure
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
<br/>
<em>Must Support Elements</em>: code, performed, status, status.value, id, id.value
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: code</span>
<br/>
<span class="tab-one"><em>Code(s)</em>:
http://snomed.info/sct#169331000: 'Combined radiotherapy (procedure)'
</span>
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: MedicationAdministration
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration
<br/>
<em>Must Support Elements</em>: medication, effective, status, status.value
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: medication</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.353
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: MedicationAdministration
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration
<br/>
<em>Must Support Elements</em>: medication.reference.value, effective, status, status.value
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Medication
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication
<br/>
<em>Must Support Elements</em>: id.value, code
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: MedicationAdministration
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministrationnotdone
<br/>
<em>Must Support Elements</em>: medication, extension, statusReason
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: medication</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.353
<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-lab
<br/>
<em>Must Support Elements</em>: value, status, status.value, reference, reference.value
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Encounter
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
<br/>
<em>Must Support Elements</em>: type, period, class, status, status.value
<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>: 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>: MedicationRequest
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest
<br/>
<em>Must Support Elements</em>: medication, dosageInstruction, status, status.value, intent, intent.value
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: medication</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.364
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: MedicationRequest
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest
<br/>
<em>Must Support Elements</em>: medication, dosageInstruction, status, status.value, intent, intent.value
<br/>
<em>Code Filter(s)</em>:
<br/>
<span class="tab-one"><em>Path</em>: medication</span>
<br/>
<span class="tab-one"><em>ValueSet</em>:</span> http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.355
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: MedicationRequest
<br/>
<em>Profile(s)</em>:
http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest
<br/>
<em>Must Support Elements</em>: medication.reference.value, dosageInstruction, status, status.value, intent, intent.value
<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://snomed.info/sct"/>
<code value="254292007"/>
<display value="Tumor staging (tumor staging)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="1228889001"/>
<display
value="American Joint Committee on Cancer cT1 (qualifier value)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="1228884006"/>
<display
value="American Joint Committee on Cancer cTis (qualifier value)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="1228883000"/>
<display
value="American Joint Committee on Cancer cTa (qualifier value)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/sid/icd-10-cm"/>
<code value="D09.0"/>
<display value="Carcinoma in situ of bladder"/>
</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-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="169331000"/>
<display value="Combined radiotherapy (procedure)"/>
</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="CMS646FHIRIntravesicalBCGTherapy"/>
</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="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString value="Bladder Cancer Diagnosis"/>
</extension>
<extension url="statement">
<valueString
value="define "Bladder Cancer Diagnosis":
( [ConditionProblemsHealthConcerns: "Bladder Cancer for Urology Care"]
union [ConditionEncounterDiagnosis: "Bladder Cancer for Urology Care"] ) BladderCancer
where ( BladderCancer.prevalenceInterval ( ) starts before day of end of "Measurement Period"
or BladderCancer.onset.toInterval ( ) before day of end of "Measurement Period"
)
and BladderCancer.isVerified ( )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString value="First Bladder Cancer Staging Procedure"/>
</extension>
<extension url="statement">
<valueString
value="define "First Bladder Cancer Staging Procedure":
First([Procedure: "Tumor staging (tumor staging)"] BladderCancerStaging
with "Bladder Cancer Diagnosis" BladderCancer
such that BladderCancerStaging.performed.toInterval() starts on or before day of start of BladderCancer.prevalenceInterval()
where BladderCancerStaging.status = 'completed'
sort by start of performed.toInterval()
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString value="First BCG Administered"/>
</extension>
<extension url="statement">
<valueString
value="define "First BCG Administered":
First([MedicationAdministration: "Bacillus Calmette Guerin for Urology Care"] BCG
with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
such that BCG.effective.toInterval() starts 6 months or less after day of start of FirstBladderCancerStaging.performed.toInterval()
and BCG.effective.toInterval() starts during day of "Measurement Period"
where BCG.status in { 'in-progress', 'completed' }
sort by start of effective.toInterval()
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString value="Numerator"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator":
"First BCG Administered" is not null"/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString
value="BCG Not Available Within 6 Months After Bladder Cancer Staging"/>
</extension>
<extension url="statement">
<valueString
value="define "BCG Not Available Within 6 Months After Bladder Cancer Staging":
[MedicationAdministrationNotDone: "Bacillus Calmette Guerin for Urology Care"] BCGNotGiven
with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
such that BCGNotGiven.recorded 6 months or less after day of start of FirstBladderCancerStaging.performed.toInterval ( )
where BCGNotGiven.statusReason in "Unavailability of Bacillus Calmette Guerin for Urology Care""/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString value="Denominator Exception"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator Exception":
exists "BCG Not Available Within 6 Months After Bladder Cancer Staging""/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString
value="July 1 of Year Prior to the Measurement Period"/>
</extension>
<extension url="statement">
<valueString
value="define "July 1 of Year Prior to the Measurement Period":
Date((year from start of "Measurement Period" - 1), 7, 1)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString value="June 30 of the Measurement Period"/>
</extension>
<extension url="statement">
<valueString
value="define "June 30 of the Measurement Period":
Date((year from start of "Measurement Period"), 6, 30)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString
value="First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period"/>
</extension>
<extension url="statement">
<valueString
value="define "First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period":
"First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
where FirstBladderCancerStaging.performed.toInterval ( ) during day of Interval["July 1 of Year Prior to the Measurement Period", "June 30 of the Measurement Period"]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString
value="Has Most Recent Bladder Cancer Tumor Staging is T1, Tis, Ta HG"/>
</extension>
<extension url="statement">
<valueString
value="/*Ta High Grade only to be included. Ta low grade is to be excluded from this measure.*/
define "Has Most Recent Bladder Cancer Tumor Staging is T1, Tis, Ta HG":
exists ( [LaboratoryResultObservation] StagingObservation
where StagingObservation.getStagingProcedure ( ) is not null
and ( StagingObservation.value as Concept ~ "American Joint Committee on Cancer cT1 (qualifier value)"
or StagingObservation.value as Concept ~ "American Joint Committee on Cancer cTis (qualifier value)"
or StagingObservation.value as Concept ~ "American Joint Committee on Cancer cTa (qualifier value)"
or StagingObservation.value as Concept ~ "Carcinoma in situ of bladder"
)
and StagingObservation.status in { 'final', 'amended', 'corrected' }
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="11"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString value="Has Qualifying Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Qualifying Encounter":
exists ( [Encounter: "Office Visit"] ValidEncounter
where ValidEncounter.period during day of "Measurement Period"
and ValidEncounter.class !~ "virtual"
and ValidEncounter.status = 'finished'
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="12"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString value="Initial Population"/>
</extension>
<extension url="statement">
<valueString
value="define "Initial Population":
"Has Most Recent Bladder Cancer Tumor Staging is T1, Tis, Ta HG"
and "Has Qualifying Encounter""/>
</extension>
<extension url="displaySequence">
<valueInteger value="13"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString value="Denominator"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator":
"Initial Population""/>
</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 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="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</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="16"/>
</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="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</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="18"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString value="Acute Tuberculosis Diagnosis"/>
</extension>
<extension url="statement">
<valueString
value="define "Acute Tuberculosis Diagnosis":
( [ConditionProblemsHealthConcerns: "Tuberculosis for Urology Care"]
union [ConditionEncounterDiagnosis: "Tuberculosis for Urology Care"] ) ActiveTuberculosis
with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
such that ( ( ActiveTuberculosis.prevalenceInterval ( ) overlaps after day of FirstBladderCancerStaging.performed.toInterval ( ) )
or ( ActiveTuberculosis.onset.toInterval ( ) overlaps after day of FirstBladderCancerStaging.performed.toInterval ( )
and ( ( ActiveTuberculosis.abatement.toInterval ( ) overlaps after day of FirstBladderCancerStaging.performed.toInterval ( ) )
or ( ActiveTuberculosis.abatement is null )
)
)
)
where ActiveTuberculosis.isVerified ( )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="19"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString value="Immunosuppressive Drugs"/>
</extension>
<extension url="statement">
<valueString
value="define "Immunosuppressive Drugs":
[MedicationRequest: "Immunosuppressive Drugs for Urology Care"] ImmunosuppressiveDrugs
let firstMedicationPeriod: First((collapse(ImmunosuppressiveDrugs.dosageInstruction.timing.repeat.bounds DoseTime
return DoseTime.toInterval()
)) DrugPeriods
sort by start of $this
),
//get the very first event
firstMedicationEvent: First((ImmunosuppressiveDrugs.dosageInstruction.timing dosageTiming
//return first event for the specific dosageTiming
return First(dosageTiming.event dosageTimingEvents
sort ascending
)) firstEvents
sort ascending
),
medicationPeriod: Coalesce(firstMedicationEvent.toInterval(), firstMedicationPeriod)
with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
such that medicationPeriod starts on or before day of start of FirstBladderCancerStaging.performed.toInterval ( )
where ImmunosuppressiveDrugs.status in { 'active', 'completed' }
and ImmunosuppressiveDrugs.intent = 'order'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="20"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString value="Cystectomy Done"/>
</extension>
<extension url="statement">
<valueString
value="define "Cystectomy Done":
[Procedure: "Cystectomy for Urology Care"] Cystectomy
with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
such that Cystectomy.performed.toInterval ( ) 6 months or less before day of start of FirstBladderCancerStaging.performed.toInterval ( )
where Cystectomy.status = 'completed'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString
value="Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging":
exists ( ( ( [ConditionProblemsHealthConcerns: "HIV"]
union [ConditionEncounterDiagnosis: "HIV"]
)
union ( [ConditionProblemsHealthConcerns: "Immunocompromised Conditions"]
union [ConditionEncounterDiagnosis: "Immunocompromised Conditions"]
)
union ( [ConditionProblemsHealthConcerns: "Mixed Histology Urothelial Cell Carcinoma for Urology Care"]
union [ConditionEncounterDiagnosis: "Mixed Histology Urothelial Cell Carcinoma for Urology Care"]
) ) ExclusionDiagnosis
with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
such that ( ( ExclusionDiagnosis.prevalenceInterval ( ) starts on or before day of start of FirstBladderCancerStaging.performed.toInterval ( ) )
or ( ExclusionDiagnosis.onset.toInterval ( ) starts on or before day of start of FirstBladderCancerStaging.performed.toInterval ( ) )
)
where ExclusionDiagnosis.isVerified ( )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="22"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString
value="Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging":
exists ( ( [MedicationRequest: "Chemotherapy Agents for Advanced Cancer"] ExclusionMed
let firstMedicationPeriod: First((collapse(ExclusionMed.dosageInstruction.timing.repeat.bounds DoseTime
return DoseTime.toInterval()
)) DrugPeriods
sort by start of $this
)
with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
such that firstMedicationPeriod starts 6 months or less before FirstBladderCancerStaging.performed.toInterval ( )
where ExclusionMed.status in { 'active', 'completed' }
and ExclusionMed.intent = 'order'
)
union ( [Procedure: "Combined radiotherapy (procedure)"] ExclusionProcedure
with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
such that ExclusionProcedure.performed.toInterval ( ) starts 6 months or less before FirstBladderCancerStaging.performed.toInterval ( )
where ExclusionProcedure.status in { 'completed', 'in-progress' }
)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="23"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString value="Denominator Exclusion"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator Exclusion":
exists "Acute Tuberculosis Diagnosis"
or exists "Immunosuppressive Drugs"
or exists "Cystectomy Done"
or "Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging"
or "Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging""/>
</extension>
<extension url="displaySequence">
<valueInteger value="24"/>
</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="25"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</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="26"/>
</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="27"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="toInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
case
when choice is DateTime then
Interval[choice as DateTime, choice as DateTime]
when choice is Interval<DateTime> then
choice as Interval<DateTime>
when choice is Quantity then
Interval[Patient.birthDate + (choice as Quantity),
Patient.birthDate + (choice as Quantity) + 1 year)
when choice is Interval<Quantity> then
Interval[Patient.birthDate + (choice.low as Quantity),
Patient.birthDate + (choice.high as Quantity) + 1 year)
when choice is Timing then
Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
else
null as Interval<DateTime>
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="28"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToConcept"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
if concept is null then
null
else
System.Concept {
codes: concept.coding C return ToCode(C),
display: concept.text.value
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="29"/>
</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="30"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="CMS646FHIRIntravesicalBCGTherapy"/>
</extension>
<extension url="name">
<valueString value="getStagingProcedure"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function getStagingProcedure(StagingObservation LaboratoryResultObservation):
StagingObservation.partOf StagingReference
return "First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period" FirstBladderCancerStagingMP
where FirstBladderCancerStagingMP.id = StagingReference.reference.getId ( )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="31"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="getId"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).
@comment: This function can be used to determine the logical id of a given resource. It can be used in
a single-server environment to trace references. However, this function does not attempt to resolve
or distinguish the base of the given url, and so cannot be used safely in multi-server environments.
*/
define fluent function getId(uri String):
Last(Split(uri, '/'))"/>
</extension>
<extension url="displaySequence">
<valueInteger value="32"/>
</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="33"/>
</extension>
</extension>
<name value="EffectiveDataRequirements"/>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="QICore model information"/>
<resource value="http://hl7.org/fhir/Library/QICore-ModelInfo"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library SDE"/>
<resource
value="https://madie.cms.gov/Library/SupplementalDataElements|5.1.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource value="https://madie.cms.gov/Library/FHIRHelpers|4.4.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library QICoreCommon"/>
<resource value="https://madie.cms.gov/Library/QICoreCommon|4.0.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system SNOMEDCT"/>
<resource value="http://snomed.info/sct"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ICD10CM"/>
<resource value="http://hl7.org/fhir/sid/icd-10-cm"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ActCode"/>
<resource value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Bacillus Calmette Guerin for Urology Care"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.353"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Bladder Cancer for Urology Care"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.354"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Unavailability of Bacillus Calmette Guerin for Urology Care"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.369"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Office Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Payer Type"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Tuberculosis for Urology Care"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.351"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Immunosuppressive Drugs for Urology Care"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.364"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Cystectomy for Urology Care"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.358"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set HIV"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Immunocompromised Conditions"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.363"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Mixed Histology Urothelial Cell Carcinoma for Urology Care"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.365"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Chemotherapy Agents for Advanced Cancer"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.355"/>
</relatedArtifact>
<parameter>
<name value="Measurement Period"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="Period"/>
</parameter>
<parameter>
<name value="Numerator"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Denominator Exception"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Denominator"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Initial Population"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Denominator Exclusion"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="SDE Sex"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Coding"/>
</parameter>
<parameter>
<name value="SDE Payer"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="SDE Ethnicity"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="SDE Race"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Resource"/>
</parameter>
<dataRequirement>
<type value="Patient"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
<mustSupport value="extension"/>
<mustSupport value="birthDate"/>
<mustSupport value="birthDate.value"/>
<mustSupport value="url"/>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.354"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.351"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.363"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.365"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.354"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.351"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.363"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.365"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
<mustSupport value="code"/>
<mustSupport value="performed"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://snomed.info/sct"/>
<code value="254292007"/>
<display value="Tumor staging (tumor staging)"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
<mustSupport value="code"/>
<mustSupport value="performed"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.358"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
<mustSupport value="code"/>
<mustSupport value="performed"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://snomed.info/sct"/>
<code value="169331000"/>
<display value="Combined radiotherapy (procedure)"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration"/>
<mustSupport value="medication"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.353"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration"/>
<mustSupport value="medication.reference.value"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id.value"/>
<mustSupport value="code"/>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministrationnotdone"/>
<mustSupport value="medication"/>
<mustSupport value="extension"/>
<mustSupport value="statusReason"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.353"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministrationnotdone"/>
<mustSupport value="medication"/>
<mustSupport value="extension"/>
<mustSupport value="statusReason"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.353"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab"/>
<mustSupport value="value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="reference"/>
<mustSupport value="reference.value"/>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<mustSupport value="class"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Coverage"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"/>
<mustSupport value="medication"/>
<mustSupport value="dosageInstruction"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="intent"/>
<mustSupport value="intent.value"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.364"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"/>
<mustSupport value="medication"/>
<mustSupport value="dosageInstruction"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="intent"/>
<mustSupport value="intent.value"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.355"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"/>
<mustSupport value="medication.reference.value"/>
<mustSupport value="dosageInstruction"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="intent"/>
<mustSupport value="intent.value"/>
</dataRequirement>
</Library>
</contained>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" id="supplementalDataGuidance">
<extension url="guidance">
<valueString
value="<p>For every patient evaluated by this measure also identify payer, race, ethnicity and sex</p>"/>
</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="Bacillus Calmette-Guerin (BCG) "/>
</extension>
<extension url="definition">
<valueMarkdown
value="A live attenuated strain of *Mycobacterium bovis*, first indicated as a tuberculosis vaccine, has had widespread use in intravesical immunotherapy since the 1970s
"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm">
<extension url="term">
<valueString value="Histology"/>
</extension>
<extension url="definition">
<valueMarkdown value="Urothelial carcinoma
"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm">
<extension url="term">
<valueString value="Intravesical"/>
</extension>
<extension url="definition">
<valueMarkdown value="Within the urinary bladder
"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm">
<extension url="term">
<valueString value="Primary Tumor (T) Stage - T1"/>
</extension>
<extension url="definition">
<valueMarkdown
value="The tumor invades subepithelial connective tissue (high grade or low grade)
"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm">
<extension url="term">
<valueString value="Primary Tumor (T) Stage - Ta"/>
</extension>
<extension url="definition">
<valueMarkdown value="Noninvasive and high grade
"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm">
<extension url="term">
<valueString value="Primary Tumor (T) Stage - Tis"/>
</extension>
<extension url="definition">
<valueMarkdown value="Carcinoma in situ: "flat tumor"
"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm">
<extension url="term">
<valueString value="Tumor Location"/>
</extension>
<extension url="definition">
<valueMarkdown value="Urinary bladder
"/>
</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/CMS646FHIRIntravesicalBCGTherapy"/>
<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="CMS646FHIR"/>
</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:907ead5a-2f8f-468e-b774-309ea8aa6182"/>
</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:67c8554c-9288-4de2-b8dc-45ae4673e032"/>
</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="646FHIR"/>
<assigner>
<display value="CMS"/>
</assigner>
</identifier>
<version value="1.0.000"/>
<name value="CMS646FHIRIntravesicalBCGTherapy"/>
<title
value="Intravesical Bacillus-Calmette-Guerin for Non-Muscle Invasive Bladder CancerFHIR
"/>
<status value="active"/>
<experimental value="false"/>
<date value="2025-08-22T18:32:05+00:00"/>
<publisher value="Oregon Urology"/>
<contact>
<telecom>
<system value="url"/>
<value value="www.oregonurology.com"/>
</telecom>
</contact>
<description
value="Percentage of patients initially diagnosed with non-muscle invasive bladder cancer and who received intravesical Bacillus-Calmette-Guerin (BCG) within 6 months of bladder cancer staging
"/>
<usage
value="Ta bladder cancer must be high grade Ta only and is supported by the 2016 AUA guidelines and 2018 NCCN guidelines.
The BCG dose can be full or partial and can be from any lot or manufacturer.
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 CMS646v6. 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="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.
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.
"/>
<effectivePeriod>
<start value="2026-01-01"/>
<end value="2026-12-31"/>
</effectivePeriod>
<author>
<name value="Oregon Urology"/>
<telecom>
<system value="url"/>
<value value="www.oregonurology.com"/>
</telecom>
</author>
<relatedArtifact>
<type value="citation"/>
<citation
value="Chamie, K., Saigal, C.S., Lai, J., Hanley, J.M., Setodji, C.M., Konety, B.R., ... Urologic Diseases in America Project (2011). Compliance with Guidelines for Patients with Bladder Cancer: Variation in the Delivery of Care. Cancer.2011 Dec 1: 117(23): 5392-5401. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206145/
"/>
</relatedArtifact>
<relatedArtifact>
<type value="citation"/>
<citation
value="Chang, S.S., Boorjian, S.A., Chou, R., Clark, P.E., Daneshmand, S., Konety, B.R., ... Mckiernan, J. M., (2016) American Urological Association. Non-Muscle Invasive Bladder Cancer. https://www.auanet.org/guidelines-and-quality/guidelines/bladder-cancer-non-muscle-invasive-guideline
"/>
</relatedArtifact>
<relatedArtifact>
<type value="citation"/>
<citation
value="Hall, M.C., Chang, S.S., Dalbagni, G., Pruthi, R.S., Schellhammer, P.F., Seigne, J.D., ... Wolf, S., (2016). American Urological Association. Guideline for the Management of Non-muscle Invasive Bladder Cancer (Stages Ta, T1, and Tis): Update 2016. https://www.auajournals.org/doi/10.1016/j.juro.2007.09.003
"/>
</relatedArtifact>
<relatedArtifact>
<type value="citation"/>
<citation
value="Kassouf, W., Black, P., (2016) Treatment of primary non-muscle invasive urothelial bladder cancer. Literature review current through Dec. 2016. https://www.uptodate.com/contents/treatment-of-primary-non-muscle-invasive-urothelial-bladder-cancer?source=search_result\&search=Treatment%20of%20primary%20non-muscle%20invasive%20urothelial%20bladder%20cancer\&selectedTitle=1\~150 T of primary
"/>
</relatedArtifact>
<relatedArtifact>
<type value="citation"/>
<citation
value="National Cancer Institute. (2020). SEER Cancer Stat Facts: Bladder Cancer. Surveillance, Epidemiology, and End Results Program. U.S. Department of Health and Human Services, National Institutes of Health. https://seer.cancer.gov/statfacts/html/urinb.html
"/>
</relatedArtifact>
<relatedArtifact>
<type value="citation"/>
<citation
value="NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). (2021). Bladder Cancer. Version 6.2021. https://www.nccn.org/professionals/physician_gls/pdf/bladder.pdf
"/>
</relatedArtifact>
<relatedArtifact>
<type value="citation"/>
<citation
value="Pacific Northwest Evidence-based Practice Center, Oregon Health \& Science University. (2016). PCORI Topic Brief. Comparative Effectiveness of Treatments for Non-Muscle-Invasive Bladder Cancer http://www.pcori.org/sites/default/files/PCORI-Assessment-Options-Advisory-Panel-Fall-2016-Topic-Brief-Non-Muscle-Invasive-Bladder-Cancer.pdf
"/>
</relatedArtifact>
<library
value="https://madie.cms.gov/Library/CMS646FHIRIntravesicalBCGTherapy"/>
<disclaimer
value="The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.
THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
Due to technical limitations, registered trademarks are indicated by (R) or \[R\] and unregistered trademarks are indicated by TM or \[TM\].
"/>
<rationale
value="Bladder cancer is ranked 10th for new cancer cases in 2020 and is the ninth leading cause of cancer death in the United States. There are 81,400 estimated new cases in 2020 and 17,980 estimated deaths in 2020. In 2016, an estimated 699,450 people were living with bladder cancer in the United States. Early detection (discovery of cancer in situ or localized to the primary site) is found in 85% of the patients, and with these there is a five-year survival rate of 95.8% for In Situ and 69.2% for Localized. Bladder cancer is rarely found in patients under age 20, with the median age of diagnosis being 73 (NIH, 2020).
National Comprehensive Cancer Network (NCCN) Guidelines for Bladder Cancer (version 6.2021) defines intravesical BCG as Category 1 Treatment for T1, Tis and Ta - high grade, non-muscle invasive bladder cancer. Most public data reflects prophylactic or adjuvant use of intravesical therapy to prevent recurrence or delay progression to a higher grade or stage. BCG has been shown to be effective as prophylaxis to prevent bladder cancer recurrences following TURBT. The NCCN Bladder Cancer Panel Members recommend BCG as the preferred option over Mitomycin C for adjuvant treatment of high-grade lesions (Ta). BCG is also standard therapy for Primary Tis. Most T1 lesions are high-risk and are similarly treated with adjuvant intravesical therapy, with BCG being a Category 1 recommendation (NCCN, 2021).
"/>
<clinicalRecommendationStatement
value="Intravesical BCG should be administered within 6 months of the initial diagnosis of non-muscle invasive bladder cancer. It may be administered 3-4 weeks after resection, but there needs to be pathological tumor confirmation and must be withheld if there is traumatic catheterization, bacteriuria, persistent gross hematuria, persistent severe local symptoms or systemic symptoms. The normal induction course is 6 weekly instillations of intravesical BCG (AUA Non-Muscle Invasive Bladder Cancer and American Urological Association (AUA) Guideline for the Management of Non-muscle Invasive Bladder Cancer: Stages T1, TIS, and Ta High Risk).
"/>
<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 initially diagnosed with T1, Tis or high grade Ta non-muscle invasive bladder cancer with bladder cancer staging within 6 months before to 6 months after the start of the measurement period and a qualified encounter in 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
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator"/>
</criteria>
</population>
<population id="DenominatorExclusion_1">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exclusion"/>
<display value="Denominator Exclusion"/>
</coding>
</code>
<description
value="Immunosuppressed patients, includes HIV and immunocompromised state, with a diagnosis prior to Bladder Cancer Staging.
Immunosuppressive drug therapy starting on or before Bladder Cancer Staging.
Active Tuberculosis diagnosis during the Bladder Cancer Staging.
Mixed histology urothelial cell carcinoma including micropapillary, plasmacytoid, sarcomatoid, adenocarcinoma and squamous disease prior to Bladder Cancer Staging.
Patients who undergo cystectomy, chemotherapy or radiation within 6 months prior to Bladder Cancer Staging.
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exclusion"/>
</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="Intravesical Bacillus-Calmette Guerin (BCG) instillation for initial dose or series: BCG is initiated within 6 months of the bladder cancer staging
"/>
<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="Unavailability of BCG within 6 months after Bladder Cancer Staging
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exception"/>
</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>