eCQM QICore Content Subset Implementation Guide
2024.0.0 - CI Build
eCQM QICore Content Subset Implementation Guide
2024.0.0 - CI Build
eCQM QICore Content Subset Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2024.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/ecqm-content-qicore-2024-subset/ and changes regularly. See the Directory of published versions
| Active as of 2024-09-09 |
<Measure xmlns="http://hl7.org/fhir">
<id value="HybridHospitalWideMortalityFHIR"/>
<meta>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"/>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"/>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<table class="narrative-table">
<tbody>
<tr>
<th colspan="2" scope="row" class="row-header">Knowledge Artifact Metadata</th>
</tr>
<tr>
<th scope="row" class="row-header">Name (machine-readable)</th>
<td class="content-container">HybridHospitalWideMortalityFHIR</td>
</tr>
<tr>
<th scope="row" class="row-header">Title (human-readable)</th>
<td class="content-container">Core Clinical Data Elements for the Hybrid Hospital Wide All Condition All Procedure Risk Standardized Mortality Measure HWMFHIR</td>
</tr>
<tr>
<th scope="row" class="row-header">Status</th>
<td class="content-container">Active</td>
</tr>
<tr>
<th scope="row" class="row-header">Experimental</th>
<td class="content-container">true</td>
</tr>
<tr>
<th scope="row" class="row-header">Description</th>
<td class="content-container"><div><p>This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from hospitalizations for adult Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) patients admitted to acute care hospitals.</p>
</div></td>
</tr>
<tr>
<th scope="row" class="row-header">Purpose</th>
<td class="content-container"><div><p>UNKNOWN</p>
</div></td>
</tr>
<tr>
<th scope="row" class="row-header">Clinical Usage</th>
<td class="content-container">These specifications are for use for data with discharges that occur between July 1, 2025 and June 30, 2026. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2027. This logic guides the user to extract the FIRST resulted HWM-specific CCDEs for all Medicare FFS and MA hospitalizations for patients aged 65 through 94 years (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area, such as the emergency department or hospital outpatient location. The logic supports extraction of the FIRST set of HWM-specific CCDEs in two different ways, depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility: 1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs (physical exams) within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission. 2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for core clinical data element values related to a patient who is subsequently admitted. Value sets for the laboratory tests are represented using Logical Observation Identifiers Names and Codes (LOINC) currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements. NOTE: It is recommended hospitals only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. Hospitals may also choose to report ALL values on an encounter during their entire admission; however, only the first resulted values are utilized in the logic for measure calculation. For each CCDE, it is recommended that hospitals report the below Unified Code for Units of Measure (UCUM) units, however, any unit may be submitted. Where the reported unit is not easily converted to the requested UCUM units, the value will be set to missing and multiple imputation will be used to impute a value based on the characteristics of the CCDE reported. CCDE UCUM Unit: Bicarbonate--------------------------------------meq/L mmol/L Creatinine-----------------------------------------mg/dL Heart rate-----------------------------------------{Beats}/min Hematocrit ---------------------------------------% Oxygen saturation (by pulse oximetry)----% Platelet--------------------------------------------10*3/uL Sodium--------------------------------------------meq/L mmol/L Systolic blood pressure-----------------------mm[Hg] Temperature-------------------------------------Cel [degF] White blood cell count -----------------------{Cells}/uL 10*3/uL 10*9/L For each hospitalization please also submit the following Linking Variables: CMS Certification Number (CCN); National Provider Identifier (NPI) for MA patients; Medicare Beneficiary Identifier (MBI); Inpatient Admission Date; and Discharge Date. The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This FHIR-based measure has been derived from the QDM-based measure: CMS844v5. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).</td>
</tr>
<tr>
<th scope="row" class="row-header">Effective Period</th>
<td class="content-container">2025-07-01..2026-06-30</td>
</tr>
<tr>
<th scope="row" class="row-header">Use Context</th>
<td class="content-container">Setting (Details: Extended Usage Context Type Codes code setting = ' Setting ', stated as ' Setting '): <span title="Codes:{http://terminology.hl7.org/CodeSystem/intended-care-setting-codes hospital}">Hospital</span></td>
</tr>
<tr>
<th scope="row" class="row-header">Measure Developer</th>
<td class="content-container">Lantana Consulting Group: <a href="https://www.lantanagroup.com/">https://www.lantanagroup.com/</a></td>
</tr>
<tr>
<th scope="row" class="row-header">Measure Developer</th>
<td class="content-container">Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation: <a href="https://medicine.yale.edu/core/">https://medicine.yale.edu/core/</a></td>
</tr>
<tr>
<th scope="row" class="row-header">Measure Steward</th>
<td class="content-container">Centers for Medicare & Medicaid Services (CMS)</td>
</tr>
<tr>
<th scope="row" class="row-header">Steward Contact Details</th>
<td class="content-container"><a href="https://www.cms.gov/">https://www.cms.gov/</a></td>
</tr>
<tr>
<th scope="row" class="row-header">Copyright</th>
<td class="content-container"><div><p>Limited proprietary coding is contained in these specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. All rights reserved. LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc.</p>
</div></td>
</tr>
<tr>
<th colspan="2" scope="row" class="row-header">Measure Metadata</th>
</tr>
<tr>
<th scope="row" class="row-header">Short Name Identifier</th>
<td class="content-container">CMS844FHIR</td>
</tr>
<tr>
<th scope="row" class="row-header">Version Independent Identifier</th>
<td class="content-container">urn:uuid:965255e9-dfeb-42d0-8416-2c4b7ecc5109</td>
</tr>
<tr>
<th scope="row" class="row-header">Version Specific Identifier</th>
<td class="content-container">urn:uuid:9a5510d6-6e1b-48a6-8aa3-7540ce826466</td>
</tr>
<tr>
<th scope="row" class="row-header">Publisher (CMS) Identifier</th>
<td class="content-container">844FHIR</td>
</tr>
<tr>
<th scope="row" class="row-header">Identifier</th>
<td class="content-container">Endorser/3502 (use: official, )</td>
</tr>
<tr>
<th scope="row" class="row-header">Version Number</th>
<td class="content-container">0.0.001</td>
</tr>
<tr>
<th scope="row" class="row-header">Measure Scoring</th>
<td class="content-container"><span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-scoring cohort}">Cohort</span></td>
</tr>
<tr>
<th scope="row" class="row-header">Rationale</th>
<td class="content-container"><div><p>The intent of this logic is to extract the FIRST set of clinical data elements from hospital electronic health records (EHRs) for all qualifying hospitalizations. The data will be linked with administrative claims to risk adjust the Hybrid HWM outcome measure. This work addresses stakeholder concerns that clinical data garnered from patients and used by clinicians to guide diagnostic decisions and treatment, are preferable to administrative claims data when profiling hospitals’ case mix. We are calling the list of data elements for extraction the "HWM-specific core clinical data elements" (CCDE). The CCDEs are the first set of vital signs and basic laboratory tests resulted from hospitalizations for adult Medicare FFS and MA patients, age 65 through 94 years (Initial Population), after they arrive at the hospital to which they are subsequently admitted. For example, this first set of data values are often captured in the emergency department or in the pre-operative area, sometimes hours before a patient is admitted to that same facility. Hospitalizations over the age of 94 years are not included to avoid holding hospitals responsible for the survival of the oldest elderly patients, who may be less likely to have survival as a primary goal. While we acknowledge that many elderly patients do have survival beyond 30 days as a primary goal for their hospitalization, with input from our Technical Expert Panel and work groups, we decided to only include hospitalizations between 65 and 94 years of age. These CCDEs were selected because they: 1. reflect patients' clinical status when they first present to the hospital; 2. are clinically and statistically relevant to patient outcomes; 3. are consistently obtained during adult inpatient hospitalizations based on current clinical practice; 4. are captured with a standard definition and recorded in a standard format across providers; and 5. are entered in structured fields that are feasibly retrieved from current EHR systems (YNHHSC/CORE, 2015). Additional data called Linking Variables are used to link EHR data files with administrative claims data for CMS to calculate results for the Hybrid HWM measure, which are: CMS Certification Number (CCN); National Provider Identifier (NPI) for MA patients; Medicare Beneficiary Identifier (MBI); Date of Birth; Sex; Inpatient Admission Date; and Discharge Date.</p>
</div></td>
</tr>
<tr>
<th scope="row" class="row-header">Clinical Recommendation Statement</th>
<td class="content-container"><div><p>The logic is not meant to guide or alter the care patients receive. The purpose of this CCDE logic is to extract clinical data that are already routinely captured in EHRs from hospitalizations for adult patients. It is not intended to require that clinical staff perform additional measurements or tests that are not needed for diagnostic assessment or treatment of patients.</p>
</div></td>
</tr>
<tr>
<th scope="row" class="row-header">Guidance</th>
<td class="content-container"><div><p>These specifications are for use for data with discharges that occur between July 1, 2025 and June 30, 2026. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2027. This logic guides the user to extract the FIRST resulted HWM-specific CCDEs for all Medicare FFS and MA hospitalizations for patients aged 65 through 94 years (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area, such as the emergency department or hospital outpatient location. The logic supports extraction of the FIRST set of HWM-specific CCDEs in two different ways, depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility: 1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs (physical exams) within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission. 2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for core clinical data element values related to a patient who is subsequently admitted. Value sets for the laboratory tests are represented using Logical Observation Identifiers Names and Codes (LOINC) currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements. NOTE: It is recommended hospitals only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. Hospitals may also choose to report ALL values on an encounter during their entire admission; however, only the first resulted values are utilized in the logic for measure calculation. For each CCDE, it is recommended that hospitals report the below Unified Code for Units of Measure (UCUM) units, however, any unit may be submitted. Where the reported unit is not easily converted to the requested UCUM units, the value will be set to missing and multiple imputation will be used to impute a value based on the characteristics of the CCDE reported. CCDE UCUM Unit: Bicarbonate--------------------------------------meq/L mmol/L Creatinine-----------------------------------------mg/dL Heart rate-----------------------------------------{Beats}/min Hematocrit ---------------------------------------% Oxygen saturation (by pulse oximetry)----% Platelet--------------------------------------------10<em>3/uL Sodium--------------------------------------------meq/L mmol/L Systolic blood pressure-----------------------mm[Hg] Temperature-------------------------------------Cel [degF] White blood cell count -----------------------{Cells}/uL 10</em>3/uL 10*9/L For each hospitalization please also submit the following Linking Variables: CMS Certification Number (CCN); National Provider Identifier (NPI) for MA patients; Medicare Beneficiary Identifier (MBI); Inpatient Admission Date; and Discharge Date. The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This FHIR-based measure has been derived from the QDM-based measure: CMS844v5. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).</p>
</div></td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Guidance</th>
<td class="content-container">For hospitalizations in the Initial Population, report the FIRST value for vital signs (physical exams) resulted within the 24 hours prior to the inpatient admission. If no values were resulted in the 24 hours prior to the admission (for example, for patients directly admitted to the hospital) report the first value resulted within 2 hours after the start of the inpatient admission. The physical exam CCDEs are as follows:: Body Temperature Heart rate Oxygen saturation (by pulse oximetry) Systolic blood pressure For laboratory test results, report the FIRST value resulted within the 24 hours prior to admission. If there are no values in the 24 hours prior to admission, report the first value resulted within 24 hours after the start of the inpatient admission. The laboratory tests CCDEs are as follows: Bicarbonate (or carbon dioxide, see Bicarbonate Lab Test value set) Creatinine Hematocrit Platelet Sodium White blood cell count First values for the CCDEs may be resulted in the emergency department or other hospital outpatient locations within the hospital facility before a patient is subsequently admitted to the same hospital. First values for these data elements may also be resulted in an inpatient location for directly admitted patients who do not receive care in the emergency department or other hospital outpatient/same day surgery locations before admission. NOTE: Do not report ALL values on a hospitalization during the entire admission. Only report the FIRST resulted value for EACH CCDE collected in the appropriate timeframe, if available. For every patient in the Initial Population, also identify payer, race, ethnicity and sex.</td>
</tr>
<tr>
<th colspan="2" scope="row" class="row-header">Measure Population Criteria (ID: 6385011c4ba3d47c885c02aa)</th>
</tr>
<tr>
<th scope="row" class="row-header">Summary</th>
<td class="content-container">This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from hospitalizations for adult Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) patients admitted to acute care hospitals.</td>
</tr>
<tr>
<th scope="row" class="row-header">Initial Population</th>
<td class="content-container">
<em>ID</em>: 24BB5BA9-820F-4958-B8AA-AA8962E9E398
<br/>
<em>Description</em>:
<p style="white-space: pre-line" class="tab-one">All Medicare FFS and MA hospitalizations for patients aged 65 through 94 years at the start of an inpatient admission, where the length of stay is less than 365 days, and the hospitalization ends during the measurement period. NOTE: All Medicare FFS and MA hospitalizations meeting the above criteria should be included, regardless of whether Medicare FFS/MA is the primary, secondary, or tertiary payer.</p>
<em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhir-initial-population">Initial Population</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Population Basis</th>
<td class="content-container">Encounter</td>
</tr>
<tr>
<th scope="row" class="row-header">Scoring</th>
<td class="content-container"><span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-scoring cohort}">Cohort</span></td>
</tr>
<tr>
<th scope="row" class="row-header">Type</th>
<td class="content-container"><span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-type outcome}">Outcome</span></td>
</tr>
<tr>
<th scope="row" class="row-header">Rate Aggregation</th>
<td class="content-container">None</td>
</tr>
<tr>
<th scope="row" class="row-header">Improvement Notation</th>
<td class="content-container"><span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-improvement-notation decrease}">decrease</span></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>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>
<br/>
<em>Description</em>: SDE Ethnicity
<br/>
<em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhir-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>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>
<br/>
<em>Description</em>: SDE Payer
<br/>
<em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhir-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>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>
<br/>
<em>Description</em>: SDE Race
<br/>
<em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhir-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>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>
<br/>
<em>Description</em>: SDE Sex
<br/>
<em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhir-sde-sex">SDE Sex</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Element</th>
<td class="content-container">
<em>ID</em>: encounter-with-first-bicarbonate-lab-test
<br/>
<em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>
<br/>
<em>Description</em>: Encounter with First Bicarbonate Lab Test
<br/>
<em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhir-encounter-with-first-bicarbonate-lab-test">Encounter with First Bicarbonate Lab Test</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Element</th>
<td class="content-container">
<em>ID</em>: encounter-with-first-body-temperature
<br/>
<em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>
<br/>
<em>Description</em>: Encounter with First Body Temperature
<br/>
<em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhir-encounter-with-first-body-temperature">Encounter with First Body Temperature</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Element</th>
<td class="content-container">
<em>ID</em>: encounter-with-first-creatinine-lab-test
<br/>
<em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>
<br/>
<em>Description</em>: Encounter with First Creatinine Lab Test
<br/>
<em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhir-encounter-with-first-creatinine-lab-test">Encounter with First Creatinine Lab Test</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Element</th>
<td class="content-container">
<em>ID</em>: encounter-with-first-heart-rate
<br/>
<em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>
<br/>
<em>Description</em>: Encounter with First Heart Rate
<br/>
<em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhir-encounter-with-first-heart-rate">Encounter with First Heart Rate</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Element</th>
<td class="content-container">
<em>ID</em>: encounter-with-first-hematocrit-lab-test
<br/>
<em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>
<br/>
<em>Description</em>: Encounter with First Hematocrit Lab Test
<br/>
<em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhir-encounter-with-first-hematocrit-lab-test">Encounter with First Hematocrit Lab Test</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Element</th>
<td class="content-container">
<em>ID</em>: encounter-with-first-oxygen-saturation
<br/>
<em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>
<br/>
<em>Description</em>: Encounter with First Oxygen Saturation
<br/>
<em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhir-encounter-with-first-oxygen-saturation">Encounter with First Oxygen Saturation</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Element</th>
<td class="content-container">
<em>ID</em>: encounter-with-first-platelet-lab-test
<br/>
<em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>
<br/>
<em>Description</em>: Encounter with First Platelet Lab Test
<br/>
<em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhir-encounter-with-first-platelet-lab-test">Encounter with First Platelet Lab Test</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Element</th>
<td class="content-container">
<em>ID</em>: encounter-with-first-sodium-lab-test
<br/>
<em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>
<br/>
<em>Description</em>: Encounter with First Sodium Lab Test
<br/>
<em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhir-encounter-with-first-sodium-lab-test">Encounter with First Sodium Lab Test</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Element</th>
<td class="content-container">
<em>ID</em>: encounter-with-first-white-blood-cells-lab-test
<br/>
<em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>
<br/>
<em>Description</em>: Encounter with First White Blood Cells Lab Test
<br/>
<em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhir-encounter-with-first-white-blood-cells-lab-test">Encounter with First White Blood Cells Lab Test</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Element</th>
<td class="content-container">
<em>ID</em>: qualifying-blood-pressure-reading
<br/>
<em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>
<br/>
<em>Description</em>: Qualifying Blood Pressure Reading
<br/>
<em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhir-qualifying-blood-pressure-reading">Qualifying Blood Pressure Reading</a>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Supplemental Data Element</th>
<td class="content-container">
<em>ID</em>: test2
<br/>
<em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>
<br/>
<em>Description</em>: Test2
<br/>
<em>Logic Definition</em>: <a href="#hybridhospitalwidemortalityfhir-test2">Test2</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"><a href="Library-HybridHospitalWideMortalityFHIR.html">HybridHospitalWideMortalityFHIR</a></td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Library CQMCommon
<br/>
<em>Resource</em>: <code>Library/CQMCommon|2.2.000</code>
<br/>
<em>Canonical URL</em>: <tt>Library/CQMCommon|2.2.000</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>: <code>Library/FHIRHelpers|4.4.000</code>
<br/>
<em>Canonical URL</em>: <tt>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>: <code>Library/QICoreCommon|2.1.000</code>
<br/>
<em>Canonical URL</em>: <tt>Library/QICoreCommon|2.1.000</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>: <code>Library/SupplementalDataElements|3.5.000</code>
<br/>
<em>Canonical URL</em>: <tt>Library/SupplementalDataElements|3.5.000</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Code system AdministrativeGender
<br/>
<em>Resource</em>: <a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">AdministrativeGender</a>
<br/>
<em>Canonical URL</em>: <tt>http://hl7.org/fhir/administrative-gender</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Value set Encounter Inpatient
<br/>
<em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a>
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Value set Medicare FFS payer
<br/>
<em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1104.10/expansion">Medicare payer</a>
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.10</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Value set Medicare Advantage payer
<br/>
<em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1104.12/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.12</a>
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.12</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Value set Observation Services
<br/>
<em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion">Observation Services</a>
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Value set Emergency Department Visit
<br/>
<em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion">Emergency Department Visit</a>
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Value set Outpatient Surgery Service
<br/>
<em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.38/expansion">Outpatient Surgery Service</a>
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.38</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Value set Bicarbonate lab test
<br/>
<em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.139/expansion">Bicarbonate lab test</a>
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.139</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Value set White blood cells count lab test
<br/>
<em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.129/expansion">White blood cells count lab test</a>
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.129</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Value set Hematocrit lab test
<br/>
<em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.114/expansion">Hematocrit lab test</a>
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.114</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Value set Platelet count lab test
<br/>
<em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.127/expansion">Platelet count lab test</a>
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.127</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Value set Creatinine lab test
<br/>
<em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.2363/expansion">Creatinine lab test</a>
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.2363</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Value set Payer Type
<br/>
<em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a>
<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">Dependency</th>
<td class="content-container">
<em>Description</em>: Value set Oxygen Saturation by Pulse Oximetry
<br/>
<em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.151/expansion">Oxygen Saturation in Arterial Blood by Pulse Oximetry</a>
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.151</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Dependency</th>
<td class="content-container">
<em>Description</em>: Value set Sodium lab test
<br/>
<em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.119/expansion">Sodium lab test</a>
<br/>
<em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.119</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Direct Reference Code</th>
<td class="content-container">
<em>Display</em>: Male
<br/>
<em>Code</em>: M
<br/>
<em>System</em>: <tt>http://hl7.org/fhir/administrative-gender</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Direct Reference Code</th>
<td class="content-container">
<em>Display</em>: Female
<br/>
<em>Code</em>: F
<br/>
<em>System</em>: <tt>http://hl7.org/fhir/administrative-gender</tt>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Parameter</th>
<td class="content-container">
<em>Name</em>: Measurement Period
<br/>
<em>Use</em>: In
<br/>
<em>Min Cardinality</em>: 0
<br/>
<em>Max Cardinality</em>: 1
<br/>
<em>Type</em>: Period
</td>
</tr>
<tr>
<th scope="row" class="row-header">Parameter</th>
<td class="content-container">
<em>Name</em>: Encounter with First Bicarbonate Lab Test
<br/>
<em>Use</em>: Out
<br/>
<em>Min Cardinality</em>: 0
<br/>
<em>Max Cardinality</em>: *
<br/>
<em>Type</em>: Resource
</td>
</tr>
<tr>
<th scope="row" class="row-header">Parameter</th>
<td class="content-container">
<em>Name</em>: Encounter with First Heart Rate
<br/>
<em>Use</em>: Out
<br/>
<em>Min Cardinality</em>: 0
<br/>
<em>Max Cardinality</em>: *
<br/>
<em>Type</em>: Resource
</td>
</tr>
<tr>
<th scope="row" class="row-header">Parameter</th>
<td class="content-container">
<em>Name</em>: Encounter with First White Blood Cells Lab Test
<br/>
<em>Use</em>: Out
<br/>
<em>Min Cardinality</em>: 0
<br/>
<em>Max Cardinality</em>: *
<br/>
<em>Type</em>: Resource
</td>
</tr>
<tr>
<th scope="row" class="row-header">Parameter</th>
<td class="content-container">
<em>Name</em>: Encounter with First Hematocrit Lab Test
<br/>
<em>Use</em>: Out
<br/>
<em>Min Cardinality</em>: 0
<br/>
<em>Max Cardinality</em>: *
<br/>
<em>Type</em>: Resource
</td>
</tr>
<tr>
<th scope="row" class="row-header">Parameter</th>
<td class="content-container">
<em>Name</em>: Encounter with First Platelet Lab Test
<br/>
<em>Use</em>: Out
<br/>
<em>Min Cardinality</em>: 0
<br/>
<em>Max Cardinality</em>: *
<br/>
<em>Type</em>: Resource
</td>
</tr>
<tr>
<th scope="row" class="row-header">Parameter</th>
<td class="content-container">
<em>Name</em>: SDE Race
<br/>
<em>Use</em>: Out
<br/>
<em>Min Cardinality</em>: 0
<br/>
<em>Max Cardinality</em>: 1
<br/>
<em>Type</em>: Resource
</td>
</tr>
<tr>
<th scope="row" class="row-header">Parameter</th>
<td class="content-container">
<em>Name</em>: SDE Sex
<br/>
<em>Use</em>: Out
<br/>
<em>Min Cardinality</em>: 0
<br/>
<em>Max Cardinality</em>: 1
<br/>
<em>Type</em>: Coding
</td>
</tr>
<tr>
<th scope="row" class="row-header">Parameter</th>
<td class="content-container">
<em>Name</em>: Encounter with First Creatinine Lab Test
<br/>
<em>Use</em>: Out
<br/>
<em>Min Cardinality</em>: 0
<br/>
<em>Max Cardinality</em>: *
<br/>
<em>Type</em>: Resource
</td>
</tr>
<tr>
<th scope="row" class="row-header">Parameter</th>
<td class="content-container">
<em>Name</em>: Encounter with First Body Temperature
<br/>
<em>Use</em>: Out
<br/>
<em>Min Cardinality</em>: 0
<br/>
<em>Max Cardinality</em>: *
<br/>
<em>Type</em>: Resource
</td>
</tr>
<tr>
<th scope="row" class="row-header">Parameter</th>
<td class="content-container">
<em>Name</em>: SDE Payer
<br/>
<em>Use</em>: Out
<br/>
<em>Min Cardinality</em>: 0
<br/>
<em>Max Cardinality</em>: *
<br/>
<em>Type</em>: Resource
</td>
</tr>
<tr>
<th scope="row" class="row-header">Parameter</th>
<td class="content-container">
<em>Name</em>: Initial Population
<br/>
<em>Use</em>: Out
<br/>
<em>Min Cardinality</em>: 0
<br/>
<em>Max Cardinality</em>: *
<br/>
<em>Type</em>: Resource
</td>
</tr>
<tr>
<th scope="row" class="row-header">Parameter</th>
<td class="content-container">
<em>Name</em>: SDE Ethnicity
<br/>
<em>Use</em>: Out
<br/>
<em>Min Cardinality</em>: 0
<br/>
<em>Max Cardinality</em>: 1
<br/>
<em>Type</em>: Resource
</td>
</tr>
<tr>
<th scope="row" class="row-header">Parameter</th>
<td class="content-container">
<em>Name</em>: Encounter with First Oxygen Saturation
<br/>
<em>Use</em>: Out
<br/>
<em>Min Cardinality</em>: 0
<br/>
<em>Max Cardinality</em>: *
<br/>
<em>Type</em>: Resource
</td>
</tr>
<tr>
<th scope="row" class="row-header">Parameter</th>
<td class="content-container">
<em>Name</em>: Encounter with First Sodium Lab Test
<br/>
<em>Use</em>: Out
<br/>
<em>Min Cardinality</em>: 0
<br/>
<em>Max Cardinality</em>: *
<br/>
<em>Type</em>: Resource
</td>
</tr>
<tr>
<th colspan="2" scope="row" class="section-header"><a name="effective-data-requirements"> </a>Measure Logic Data Requirements</th>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Encounter
<br/>
<em>Profile(s)</em>:
<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>
<br/>
<em>Must Support Elements</em>: type, status, status.value, period, id, id.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> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion">Observation Services</a>
<br/>
<span class="tab-one"><em>Path</em>: status.value</span>
<br/>
<span class="tab-one"><em>Code</em>: </span>
<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>:
<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>
<br/>
<em>Must Support Elements</em>: type, status, status.value, period, id, id.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> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion">Emergency Department Visit</a>
<br/>
<span class="tab-one"><em>Path</em>: status.value</span>
<br/>
<span class="tab-one"><em>Code</em>: </span>
<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>:
<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>
<br/>
<em>Must Support Elements</em>: type, period, id, id.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> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.38/expansion">Outpatient Surgery Service</a>
<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>:
<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>
<br/>
<em>Must Support Elements</em>: type, status, status.value, period, id, id.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> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a>
<br/>
<span class="tab-one"><em>Path</em>: status.value</span>
<br/>
<span class="tab-one"><em>Code</em>: </span>
<br/>
</td>
</tr>
<tr>
<th scope="row" class="row-header">Data Requirement</th>
<td class="content-container">
<em>Type</em>: Patient
<br/>
<em>Profile(s)</em>:
<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a>
<br/>
<em>Must Support Elements</em>: race, ethnicity
<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>:
<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html">QICoreCoverage</a>
<br/>
<em>Must Support Elements</em>: type
<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> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1104.10/expansion">Medicare payer</a>
<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>:
<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html">QICoreCoverage</a>
<br/>
<em>Must Support Elements</em>: type
<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> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1104.12/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.12</a>
<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>:
<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html">QICoreCoverage</a>
<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> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a>
<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>:
<a href="http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html">US Core Laboratory Result Observation Profile</a>
<br/>
<em>Must Support Elements</em>: code, issued, issued.value, status, status.value, 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> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.139/expansion">Bicarbonate lab test</a>
<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>:
<a href="http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html">US Core Laboratory Result Observation Profile</a>
<br/>
<em>Must Support Elements</em>: code, issued, issued.value, status, status.value, 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> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.129/expansion">White blood cells count lab test</a>
<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>:
<a href="http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html">US Core Laboratory Result Observation Profile</a>
<br/>
<em>Must Support Elements</em>: code, issued, issued.value, status, status.value, 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> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.114/expansion">Hematocrit lab test</a>
<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>:
<a href="http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html">US Core Laboratory Result Observation Profile</a>
<br/>
<em>Must Support Elements</em>: code, issued, issued.value, status, status.value, 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> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.127/expansion">Platelet count lab test</a>
<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>:
<a href="http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html">US Core Laboratory Result Observation Profile</a>
<br/>
<em>Must Support Elements</em>: code, issued, issued.value, status, status.value, 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> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.2363/expansion">Creatinine lab test</a>
<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>:
<a href="http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html">US Core Laboratory Result Observation Profile</a>
<br/>
<em>Must Support Elements</em>: code, issued, issued.value, status, status.value, 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> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.119/expansion">Sodium lab test</a>
<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>:
<a href="http://hl7.org/fhir/R4/heartrate.html">Observation Heart Rate Profile</a>
<br/>
<em>Must Support Elements</em>: effective, status, status.value, value
<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>:
<a href="http://hl7.org/fhir/R4/bodytemp.html">Observation Body Temperature Profile</a>
<br/>
<em>Must Support Elements</em>: effective, status, status.value, value
<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>:
<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>
<br/>
<em>Must Support Elements</em>: code, effective, status, status.value, 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> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.151/expansion">Oxygen Saturation in Arterial Blood by Pulse Oximetry</a>
<br/>
</td>
</tr>
<tr>
<th colspan="2" scope="row" class="row-header">Measure Logic Definitions</th>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="hybridhospitalwidemortalityfhir-inpatient-encounters"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIR</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Inpatient Encounters":
[Encounter: "Encounter Inpatient"] EncounterInpatient
with ( [Coverage: "Medicare FFS payer"]
union [Coverage: "Medicare Advantage payer"] ) MedicarePayer
such that ( EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService ( ).lengthInDays ( ) ) < 365
and EncounterInpatient.status = 'finished'
and AgeInYearsAt(date from start of EncounterInpatient.period) in Interval[65, 94]
and EncounterInpatient.period ends during day of "Measurement Period"</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="hybridhospitalwidemortalityfhir-encounter-with-first-bicarbonate-lab-test"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIR</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Encounter with First Bicarbonate Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstBicarbonateLab: First(["USCoreLaboratoryResultObservationProfile": "Bicarbonate lab test"] BicarbonateLab
where BicarbonateLab.issued.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
and BicarbonateLab.status in { 'final', 'amended', 'corrected' }
and BicarbonateLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstBicarbonateResult: FirstBicarbonateLab.value as Quantity,
Timing: FirstBicarbonateLab.issued
}</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="hybridhospitalwidemortalityfhir-encounter-with-first-heart-rate"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIR</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Encounter with First Heart Rate":
"Inpatient Encounters" EncounterInpatient
let FirstHeartRate: First(["observation-heartrate"] HeartRate
where HeartRate.effective.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 120 minutes]
and HeartRate.status in { 'final', 'amended', 'corrected' }
and HeartRate.value is not null
sort by effective.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstHeartRateResult: FirstHeartRate.value as Quantity,
Timing: FirstHeartRate.effective.earliest ( )
}</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="hybridhospitalwidemortalityfhir-encounter-with-first-white-blood-cells-lab-test"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIR</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Encounter with First White Blood Cells Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstWhiteBloodCellLab: First(["USCoreLaboratoryResultObservationProfile": "White blood cells count lab test"] WhiteBloodCellLab
where WhiteBloodCellLab.issued.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
and WhiteBloodCellLab.status in { 'final', 'amended', 'corrected' }
and WhiteBloodCellLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstWhiteBloodCellResult: FirstWhiteBloodCellLab.value as Quantity,
Timing: FirstWhiteBloodCellLab.issued
}</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="hybridhospitalwidemortalityfhir-encounter-with-first-hematocrit-lab-test"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIR</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Encounter with First Hematocrit Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstHematocritLab: First(["USCoreLaboratoryResultObservationProfile": "Hematocrit lab test"] HematocritLab
where HematocritLab.issued.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
and HematocritLab.status in { 'final', 'amended', 'corrected' }
and HematocritLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstHematocritResult: FirstHematocritLab.value as Quantity,
Timing: FirstHematocritLab.issued
}</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="hybridhospitalwidemortalityfhir-encounter-with-first-platelet-lab-test"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIR</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Encounter with First Platelet Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstPlateletLab: First(["USCoreLaboratoryResultObservationProfile": "Platelet count lab test"] PlateletLab
where PlateletLab.issued.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
and PlateletLab.status in { 'final', 'amended', 'corrected' }
and PlateletLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstPlateletResult: FirstPlateletLab.value as Quantity,
Timing: FirstPlateletLab.issued
}</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="hybridhospitalwidemortalityfhir-sde-race"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIR</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="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.gender = 'male' then "M"
when Patient.gender = 'female' then "F"
else null
end</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="hybridhospitalwidemortalityfhir-sde-sex"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIR</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="hybridhospitalwidemortalityfhir-encounter-with-first-creatinine-lab-test"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIR</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Encounter with First Creatinine Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstCreatinineLab: First(["USCoreLaboratoryResultObservationProfile": "Creatinine lab test"] CreatinineLab
where CreatinineLab.issued.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
and CreatinineLab.status in { 'final', 'amended', 'corrected' }
and CreatinineLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstCreatinineResult: FirstCreatinineLab.value as Quantity,
Timing: FirstCreatinineLab.issued
}</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="hybridhospitalwidemortalityfhir-encounter-with-first-body-temperature"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIR</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Encounter with First Body Temperature":
"Inpatient Encounters" EncounterInpatient
let FirstTemperature: First(["observation-bodytemp"] temperature
where temperature.effective.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 120 minutes]
and temperature.status in { 'final', 'amended', 'corrected' }
and temperature.value is not null
sort by effective.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstTemperatureResult: FirstTemperature.value as Quantity,
Timing: FirstTemperature.effective.earliest ( )
}</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="hybridhospitalwidemortalityfhir-sde-payer"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIR</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="hybridhospitalwidemortalityfhir-initial-population"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIR</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Initial Population":
"Inpatient Encounters"</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="hybridhospitalwidemortalityfhir-sde-ethnicity"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIR</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="hybridhospitalwidemortalityfhir-encounter-with-first-oxygen-saturation"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIR</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Encounter with First Oxygen Saturation":
"Inpatient Encounters" EncounterInpatient
let FirstOxygenSat: First([Observation: "Oxygen Saturation by Pulse Oximetry"] O2Saturation
where O2Saturation.effective.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 120 minutes]
and O2Saturation.status in { 'final', 'amended', 'corrected' }
and O2Saturation.value is not null
sort by effective.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstOxygenSatResult: FirstOxygenSat.value as Quantity,
Timing: FirstOxygenSat.effective.earliest ( )
}</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="hybridhospitalwidemortalityfhir-encounter-with-first-sodium-lab-test"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> HybridHospitalWideMortalityFHIR</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define "Encounter with First Sodium Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstSodiumLab: First(["USCoreLaboratoryResultObservationProfile": "Sodium lab test"] SodiumLab
where SodiumLab.issued.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
and SodiumLab.status in { 'final', 'amended', 'corrected' }
and SodiumLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstSodiumResult: FirstSodiumLab.value as Quantity,
Timing: FirstSodiumLab.issued
}</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cqmcommon-lengthindays"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CQMCommon</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Calculates the difference in calendar days between the start and end of the given interval.
*/
define fluent function lengthInDays(Value Interval<DateTime> ):
difference in days between start of Value and end of Value</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="cqmcommon-hospitalizationwithobservationandoutpatientsurgeryservice"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> CQMCommon</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Hospitalization with Observation and Outpatient Surgery Service returns the total interval from the start of any immediately prior emergency department visit, outpatient surgery visit or observation visit to the discharge of the given encounter.
*/
define fluent function hospitalizationWithObservationAndOutpatientSurgeryService(TheEncounter "Encounter" ):
TheEncounter Visit
let ObsVisit: Last([Encounter: "Observation Services"] LastObs
where LastObs.status = 'finished'
and LastObs.period ends 1 hour or less on or before start of Visit.period
sort by end of period
),
VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
where LastED.status = 'finished'
and LastED.period ends 1 hour or less on or before VisitStart
sort by end of period
),
VisitStartWithED: Coalesce(start of EDVisit.period, VisitStart),
OutpatientSurgeryVisit: Last([Encounter: "Outpatient Surgery Service"] LastSurgeryOP
where LastSurgeryOP.period ends 1 hour or less on or before VisitStartWithED
sort by end of period
)
return Interval[Coalesce(start of OutpatientSurgeryVisit.period, VisitStartWithED), end of Visit.period]</code></pre>
</td>
</tr>
<tr>
<th scope="row" rowspan="2" class="row-header">
<a name="qicorecommon-earliest"> </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: Given an interval, return the starting point if the interval has a starting boundary specified,
otherwise, return the ending point
*/
define fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
(choice.toInterval()) period
return
if (period."hasStart"()) then start of period
else end of period</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-tocode"> </a>
Logic Definition
</th>
<td class="content-container"><em>Library Name:</em> FHIRHelpers</td>
</tr>
<tr>
<td>
<pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
if coding is null then
null
else
System.Code {
code: coding.code.value,
system: coding.system.value,
version: coding.version.value,
display: coding.display.value
}</code></pre>
</td>
</tr>
<tr>
<th colspan="2" scope="row" class="row-header">Generated using version 0.4.6 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/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/administrative-gender"/>
<code value="M"/>
<display value="Male"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/administrative-gender"/>
<code value="F"/>
<display value="Female"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HybridHospitalWideMortalityFHIR"/>
</extension>
<extension url="name">
<valueString value="Inpatient Encounters"/>
</extension>
<extension url="statement">
<valueString
value="define "Inpatient Encounters":
[Encounter: "Encounter Inpatient"] EncounterInpatient
with ( [Coverage: "Medicare FFS payer"]
union [Coverage: "Medicare Advantage payer"] ) MedicarePayer
such that ( EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService ( ).lengthInDays ( ) ) < 365
and EncounterInpatient.status = 'finished'
and AgeInYearsAt(date from start of EncounterInpatient.period) in Interval[65, 94]
and EncounterInpatient.period ends during day of "Measurement Period""/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HybridHospitalWideMortalityFHIR"/>
</extension>
<extension url="name">
<valueString value="Encounter with First Bicarbonate Lab Test"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First Bicarbonate Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstBicarbonateLab: First(["USCoreLaboratoryResultObservationProfile": "Bicarbonate lab test"] BicarbonateLab
where BicarbonateLab.issued.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
and BicarbonateLab.status in { 'final', 'amended', 'corrected' }
and BicarbonateLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstBicarbonateResult: FirstBicarbonateLab.value as Quantity,
Timing: FirstBicarbonateLab.issued
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HybridHospitalWideMortalityFHIR"/>
</extension>
<extension url="name">
<valueString value="Encounter with First Heart Rate"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First Heart Rate":
"Inpatient Encounters" EncounterInpatient
let FirstHeartRate: First(["observation-heartrate"] HeartRate
where HeartRate.effective.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 120 minutes]
and HeartRate.status in { 'final', 'amended', 'corrected' }
and HeartRate.value is not null
sort by effective.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstHeartRateResult: FirstHeartRate.value as Quantity,
Timing: FirstHeartRate.effective.earliest ( )
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HybridHospitalWideMortalityFHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter with First White Blood Cells Lab Test"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First White Blood Cells Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstWhiteBloodCellLab: First(["USCoreLaboratoryResultObservationProfile": "White blood cells count lab test"] WhiteBloodCellLab
where WhiteBloodCellLab.issued.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
and WhiteBloodCellLab.status in { 'final', 'amended', 'corrected' }
and WhiteBloodCellLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstWhiteBloodCellResult: FirstWhiteBloodCellLab.value as Quantity,
Timing: FirstWhiteBloodCellLab.issued
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HybridHospitalWideMortalityFHIR"/>
</extension>
<extension url="name">
<valueString value="Encounter with First Hematocrit Lab Test"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First Hematocrit Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstHematocritLab: First(["USCoreLaboratoryResultObservationProfile": "Hematocrit lab test"] HematocritLab
where HematocritLab.issued.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
and HematocritLab.status in { 'final', 'amended', 'corrected' }
and HematocritLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstHematocritResult: FirstHematocritLab.value as Quantity,
Timing: FirstHematocritLab.issued
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HybridHospitalWideMortalityFHIR"/>
</extension>
<extension url="name">
<valueString value="Encounter with First Platelet Lab Test"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First Platelet Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstPlateletLab: First(["USCoreLaboratoryResultObservationProfile": "Platelet count lab test"] PlateletLab
where PlateletLab.issued.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
and PlateletLab.status in { 'final', 'amended', 'corrected' }
and PlateletLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstPlateletResult: FirstPlateletLab.value as Quantity,
Timing: FirstPlateletLab.issued
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HybridHospitalWideMortalityFHIR"/>
</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="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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.gender = 'male' then "M"
when Patient.gender = 'female' then "F"
else null
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HybridHospitalWideMortalityFHIR"/>
</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="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HybridHospitalWideMortalityFHIR"/>
</extension>
<extension url="name">
<valueString value="Encounter with First Creatinine Lab Test"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First Creatinine Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstCreatinineLab: First(["USCoreLaboratoryResultObservationProfile": "Creatinine lab test"] CreatinineLab
where CreatinineLab.issued.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
and CreatinineLab.status in { 'final', 'amended', 'corrected' }
and CreatinineLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstCreatinineResult: FirstCreatinineLab.value as Quantity,
Timing: FirstCreatinineLab.issued
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HybridHospitalWideMortalityFHIR"/>
</extension>
<extension url="name">
<valueString value="Encounter with First Body Temperature"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First Body Temperature":
"Inpatient Encounters" EncounterInpatient
let FirstTemperature: First(["observation-bodytemp"] temperature
where temperature.effective.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 120 minutes]
and temperature.status in { 'final', 'amended', 'corrected' }
and temperature.value is not null
sort by effective.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstTemperatureResult: FirstTemperature.value as Quantity,
Timing: FirstTemperature.effective.earliest ( )
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="11"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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="12"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HybridHospitalWideMortalityFHIR"/>
</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="13"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HybridHospitalWideMortalityFHIR"/>
</extension>
<extension url="name">
<valueString value="Initial Population"/>
</extension>
<extension url="statement">
<valueString
value="define "Initial Population":
"Inpatient Encounters""/>
</extension>
<extension url="displaySequence">
<valueInteger value="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HybridHospitalWideMortalityFHIR"/>
</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="16"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HybridHospitalWideMortalityFHIR"/>
</extension>
<extension url="name">
<valueString value="Encounter with First Oxygen Saturation"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First Oxygen Saturation":
"Inpatient Encounters" EncounterInpatient
let FirstOxygenSat: First([Observation: "Oxygen Saturation by Pulse Oximetry"] O2Saturation
where O2Saturation.effective.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 120 minutes]
and O2Saturation.status in { 'final', 'amended', 'corrected' }
and O2Saturation.value is not null
sort by effective.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstOxygenSatResult: FirstOxygenSat.value as Quantity,
Timing: FirstOxygenSat.effective.earliest ( )
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="HybridHospitalWideMortalityFHIR"/>
</extension>
<extension url="name">
<valueString value="Encounter with First Sodium Lab Test"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First Sodium Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstSodiumLab: First(["USCoreLaboratoryResultObservationProfile": "Sodium lab test"] SodiumLab
where SodiumLab.issued.earliest() during Interval[start of EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService() - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
and SodiumLab.status in { 'final', 'amended', 'corrected' }
and SodiumLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstSodiumResult: FirstSodiumLab.value as Quantity,
Timing: FirstSodiumLab.issued
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="18"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CQMCommon"/>
</extension>
<extension url="name">
<valueString value="lengthInDays"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Calculates the difference in calendar days between the start and end of the given interval.
*/
define fluent function lengthInDays(Value Interval<DateTime> ):
difference in days between start of Value and end of Value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="19"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CQMCommon"/>
</extension>
<extension url="name">
<valueString
value="hospitalizationWithObservationAndOutpatientSurgeryService"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Hospitalization with Observation and Outpatient Surgery Service returns the total interval from the start of any immediately prior emergency department visit, outpatient surgery visit or observation visit to the discharge of the given encounter.
*/
define fluent function hospitalizationWithObservationAndOutpatientSurgeryService(TheEncounter "Encounter" ):
TheEncounter Visit
let ObsVisit: Last([Encounter: "Observation Services"] LastObs
where LastObs.status = 'finished'
and LastObs.period ends 1 hour or less on or before start of Visit.period
sort by end of period
),
VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
where LastED.status = 'finished'
and LastED.period ends 1 hour or less on or before VisitStart
sort by end of period
),
VisitStartWithED: Coalesce(start of EDVisit.period, VisitStart),
OutpatientSurgeryVisit: Last([Encounter: "Outpatient Surgery Service"] LastSurgeryOP
where LastSurgeryOP.period ends 1 hour or less on or before VisitStartWithED
sort by end of period
)
return Interval[Coalesce(start of OutpatientSurgeryVisit.period, VisitStartWithED), end of Visit.period]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="20"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="earliest"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Given an interval, return the starting point if the interval has a starting boundary specified,
otherwise, return the ending point
*/
define fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
(choice.toInterval()) period
return
if (period."hasStart"()) then start of period
else end of period"/>
</extension>
<extension url="displaySequence">
<valueInteger value="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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="22"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToCode"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
if coding is null then
null
else
System.Code {
code: coding.code.value,
system: coding.system.value,
version: coding.version.value,
display: coding.display.value
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="23"/>
</extension>
</extension>
<name value="EffectiveDataRequirements"/>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library CQMCommon"/>
<resource value="Library/CQMCommon|2.2.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource value="Library/FHIRHelpers|4.4.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library QICoreCommon"/>
<resource value="Library/QICoreCommon|2.1.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library SDE"/>
<resource value="Library/SupplementalDataElements|3.5.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system AdministrativeGender"/>
<resource value="http://hl7.org/fhir/administrative-gender"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Encounter Inpatient"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Medicare FFS payer"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.10"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Medicare Advantage payer"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.12"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Observation Services"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Emergency Department Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Outpatient Surgery Service"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.38"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Bicarbonate lab test"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.139"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set White blood cells count lab test"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.129"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Hematocrit lab test"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.114"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Platelet count lab test"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.127"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Creatinine lab test"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.2363"/>
</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 Oxygen Saturation by Pulse Oximetry"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.151"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Sodium lab test"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.119"/>
</relatedArtifact>
<parameter>
<name value="Measurement Period"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="Period"/>
</parameter>
<parameter>
<name value="Encounter with First Bicarbonate Lab Test"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Encounter with First Heart Rate"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Encounter with First White Blood Cells Lab Test"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Encounter with First Hematocrit Lab Test"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Encounter with First Platelet Lab Test"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="SDE Race"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="SDE Sex"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Coding"/>
</parameter>
<parameter>
<name value="Encounter with First Creatinine Lab Test"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Encounter with First Body Temperature"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="SDE Payer"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Initial Population"/>
<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="Encounter with First Oxygen Saturation"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Encounter with First Sodium Lab Test"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"/>
</codeFilter>
<codeFilter>
<path value="status.value"/>
<code>
<code value="finished"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"/>
</codeFilter>
<codeFilter>
<path value="status.value"/>
<code>
<code value="finished"/>
</code>
</codeFilter>
<dateFilter>
<path value="period"/>
<valuePeriod>
<extension url="http://hl7.org/fhir/uv/crmi-analysisException">
<valueString
value="Error attempting to determine filter value: toFhirValue not implemented for Subtract"/>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.38"/>
</codeFilter>
<dateFilter>
<path value="period"/>
<valuePeriod>
<extension url="http://hl7.org/fhir/uv/crmi-analysisException">
<valueString
value="Error attempting to determine filter value: toFhirValue not implemented for Subtract"/>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
</codeFilter>
<codeFilter>
<path value="status.value"/>
<code>
<code value="finished"/>
</code>
</codeFilter>
<dateFilter>
<path value="period"/>
<valuePeriod>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
<valueExpression>
<language value="text/cql-identifier"/>
<expression value="Measurement Period"/>
</valueExpression>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Patient"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
<mustSupport value="race"/>
<mustSupport value="ethnicity"/>
</dataRequirement>
<dataRequirement>
<type value="Coverage"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
<mustSupport value="type"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.10"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Coverage"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
<mustSupport value="type"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.12"/>
</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="Observation"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab"/>
<mustSupport value="code"/>
<mustSupport value="issued"/>
<mustSupport value="issued.value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.139"/>
</codeFilter>
<dateFilter>
<path value="issued.value"/>
<valuePeriod>
<extension url="http://hl7.org/fhir/uv/crmi-analysisException">
<valueString
value="Error attempting to determine filter value: toFhirValue not implemented for Subtract"/>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab"/>
<mustSupport value="code"/>
<mustSupport value="issued"/>
<mustSupport value="issued.value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.129"/>
</codeFilter>
<dateFilter>
<path value="issued.value"/>
<valuePeriod>
<extension url="http://hl7.org/fhir/uv/crmi-analysisException">
<valueString
value="Error attempting to determine filter value: toFhirValue not implemented for Subtract"/>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab"/>
<mustSupport value="code"/>
<mustSupport value="issued"/>
<mustSupport value="issued.value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.114"/>
</codeFilter>
<dateFilter>
<path value="issued.value"/>
<valuePeriod>
<extension url="http://hl7.org/fhir/uv/crmi-analysisException">
<valueString
value="Error attempting to determine filter value: toFhirValue not implemented for Subtract"/>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab"/>
<mustSupport value="code"/>
<mustSupport value="issued"/>
<mustSupport value="issued.value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.127"/>
</codeFilter>
<dateFilter>
<path value="issued.value"/>
<valuePeriod>
<extension url="http://hl7.org/fhir/uv/crmi-analysisException">
<valueString
value="Error attempting to determine filter value: toFhirValue not implemented for Subtract"/>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab"/>
<mustSupport value="code"/>
<mustSupport value="issued"/>
<mustSupport value="issued.value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.2363"/>
</codeFilter>
<dateFilter>
<path value="issued.value"/>
<valuePeriod>
<extension url="http://hl7.org/fhir/uv/crmi-analysisException">
<valueString
value="Error attempting to determine filter value: toFhirValue not implemented for Subtract"/>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab"/>
<mustSupport value="code"/>
<mustSupport value="issued"/>
<mustSupport value="issued.value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.119"/>
</codeFilter>
<dateFilter>
<path value="issued.value"/>
<valuePeriod>
<extension url="http://hl7.org/fhir/uv/crmi-analysisException">
<valueString
value="Error attempting to determine filter value: toFhirValue not implemented for Subtract"/>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/heartrate"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<dateFilter>
<path value="effective"/>
<valuePeriod>
<extension url="http://hl7.org/fhir/uv/crmi-analysisException">
<valueString
value="Error attempting to determine filter value: toFhirValue not implemented for Subtract"/>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/bodytemp"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<dateFilter>
<path value="effective"/>
<valuePeriod>
<extension url="http://hl7.org/fhir/uv/crmi-analysisException">
<valueString
value="Error attempting to determine filter value: toFhirValue not implemented for Subtract"/>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
<mustSupport value="code"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.151"/>
</codeFilter>
</dataRequirement>
</Library>
</contained>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" id="supplementalDataGuidance">
<extension url="guidance">
<valueString
value="For hospitalizations in the Initial Population, report the FIRST value for vital signs (physical exams) resulted within the 24 hours prior to the inpatient admission. If no values were resulted in the 24 hours prior to the admission (for example, for patients directly admitted to the hospital) report the first value resulted within 2 hours after the start of the inpatient admission. The physical exam CCDEs are as follows:: Body Temperature Heart rate Oxygen saturation (by pulse oximetry) Systolic blood pressure For laboratory test results, report the FIRST value resulted within the 24 hours prior to admission. If there are no values in the 24 hours prior to admission, report the first value resulted within 24 hours after the start of the inpatient admission. The laboratory tests CCDEs are as follows: Bicarbonate (or carbon dioxide, see Bicarbonate Lab Test value set) Creatinine Hematocrit Platelet Sodium White blood cell count First values for the CCDEs may be resulted in the emergency department or other hospital outpatient locations within the hospital facility before a patient is subsequently admitted to the same hospital. First values for these data elements may also be resulted in an inpatient location for directly admitted patients who do not receive care in the emergency department or other hospital outpatient/same day surgery locations before admission. NOTE: Do not report ALL values on a hospitalization during the entire admission. Only report the FIRST resulted value for EACH CCDE collected in the appropriate timeframe, if available. For every patient in the Initial Population, also identify payer, race, ethnicity and sex."/>
</extension>
<extension url="usage">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
<display value="Supplemental Data"/>
</coding>
<text value="Supplemental Data Guidance"/>
</valueCodeableConcept>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem">
<valueReference>
<reference value="Device/cqf-tooling"/>
</valueReference>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements" id="effective-data-requirements">
<valueReference>
<reference value="#effective-data-requirements"/>
</valueReference>
</extension>
<url value="https://madie.cms.gov/Measure/HybridHospitalWideMortalityFHIR"/>
<identifier>
<use value="usual"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="short-name"/>
<display value="Short Name"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/shortName"/>
<value value="CMS844FHIR"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="version-independent"/>
<display value="Version Independent"/>
</coding>
</type>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:965255e9-dfeb-42d0-8416-2c4b7ecc5109"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="version-specific"/>
<display value="Version Specific"/>
</coding>
</type>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:9a5510d6-6e1b-48a6-8aa3-7540ce826466"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="endorser"/>
<display value="Endorser"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/cbeId"/>
<value value="3502"/>
<assigner>
<display value="CMS Consensus Based Entity"/>
</assigner>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="publisher"/>
<display value="Publisher"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/cmsId"/>
<value value="844FHIR"/>
<assigner>
<display value="CMS"/>
</assigner>
</identifier>
<version value="0.0.001"/>
<name value="HybridHospitalWideMortalityFHIR"/>
<title
value="Core Clinical Data Elements for the Hybrid Hospital Wide All Condition All Procedure Risk Standardized Mortality Measure HWMFHIR"/>
<status value="active"/>
<experimental value="true"/>
<date value="2024-09-09T19:21:02+00:00"/>
<publisher value="Centers for Medicare & Medicaid Services (CMS)"/>
<contact>
<telecom>
<system value="url"/>
<value value="https://www.cms.gov/"/>
</telecom>
</contact>
<description
value="This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from hospitalizations for adult Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) patients admitted to acute care hospitals."/>
<useContext>
<code>
<system
value="http://terminology.hl7.org/CodeSystem/extended-usage-context-type-codes"/>
<code value="setting"/>
<display value="Setting"/>
</code>
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/intended-care-setting-codes"/>
<code value="hospital"/>
<display value="Hospital"/>
</coding>
</valueCodeableConcept>
</useContext>
<purpose value="UNKNOWN"/>
<usage
value="These specifications are for use for data with discharges that occur between July 1, 2025 and June 30, 2026. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2027. This logic guides the user to extract the FIRST resulted HWM-specific CCDEs for all Medicare FFS and MA hospitalizations for patients aged 65 through 94 years (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area, such as the emergency department or hospital outpatient location. The logic supports extraction of the FIRST set of HWM-specific CCDEs in two different ways, depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility: 1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs (physical exams) within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission. 2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for core clinical data element values related to a patient who is subsequently admitted. Value sets for the laboratory tests are represented using Logical Observation Identifiers Names and Codes (LOINC) currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements. NOTE: It is recommended hospitals only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. Hospitals may also choose to report ALL values on an encounter during their entire admission; however, only the first resulted values are utilized in the logic for measure calculation. For each CCDE, it is recommended that hospitals report the below Unified Code for Units of Measure (UCUM) units, however, any unit may be submitted. Where the reported unit is not easily converted to the requested UCUM units, the value will be set to missing and multiple imputation will be used to impute a value based on the characteristics of the CCDE reported. CCDE UCUM Unit: Bicarbonate--------------------------------------meq/L mmol/L Creatinine-----------------------------------------mg/dL Heart rate-----------------------------------------{Beats}/min Hematocrit ---------------------------------------% Oxygen saturation (by pulse oximetry)----% Platelet--------------------------------------------10*3/uL Sodium--------------------------------------------meq/L mmol/L Systolic blood pressure-----------------------mm[Hg] Temperature-------------------------------------Cel [degF] White blood cell count -----------------------{Cells}/uL 10*3/uL 10*9/L For each hospitalization please also submit the following Linking Variables: CMS Certification Number (CCN); National Provider Identifier (NPI) for MA patients; Medicare Beneficiary Identifier (MBI); Inpatient Admission Date; and Discharge Date. The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This FHIR-based measure has been derived from the QDM-based measure: CMS844v5. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html)."/>
<copyright
value="Limited proprietary coding is contained in these specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. All rights reserved. LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc."/>
<effectivePeriod>
<start value="2025-07-01"/>
<end value="2026-06-30"/>
</effectivePeriod>
<author>
<name value="Lantana Consulting Group"/>
<telecom>
<system value="url"/>
<value value="https://www.lantanagroup.com/"/>
</telecom>
</author>
<author>
<name
value="Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation"/>
<telecom>
<system value="url"/>
<value value="https://medicine.yale.edu/core/"/>
</telecom>
</author>
<library
value="https://madie.cms.gov/Library/HybridHospitalWideMortalityFHIR"/>
<disclaimer
value="These performance specifications are not clinical guidelines and do not establish a standard of medical care, and have 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]."/>
<scoring>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="cohort"/>
<display value="Cohort"/>
</coding>
<text value="Cohort"/>
</scoring>
<rationale
value="The intent of this logic is to extract the FIRST set of clinical data elements from hospital electronic health records (EHRs) for all qualifying hospitalizations. The data will be linked with administrative claims to risk adjust the Hybrid HWM outcome measure. This work addresses stakeholder concerns that clinical data garnered from patients and used by clinicians to guide diagnostic decisions and treatment, are preferable to administrative claims data when profiling hospitals’ case mix. We are calling the list of data elements for extraction the "HWM-specific core clinical data elements" (CCDE). The CCDEs are the first set of vital signs and basic laboratory tests resulted from hospitalizations for adult Medicare FFS and MA patients, age 65 through 94 years (Initial Population), after they arrive at the hospital to which they are subsequently admitted. For example, this first set of data values are often captured in the emergency department or in the pre-operative area, sometimes hours before a patient is admitted to that same facility. Hospitalizations over the age of 94 years are not included to avoid holding hospitals responsible for the survival of the oldest elderly patients, who may be less likely to have survival as a primary goal. While we acknowledge that many elderly patients do have survival beyond 30 days as a primary goal for their hospitalization, with input from our Technical Expert Panel and work groups, we decided to only include hospitalizations between 65 and 94 years of age. These CCDEs were selected because they: 1. reflect patients' clinical status when they first present to the hospital; 2. are clinically and statistically relevant to patient outcomes; 3. are consistently obtained during adult inpatient hospitalizations based on current clinical practice; 4. are captured with a standard definition and recorded in a standard format across providers; and 5. are entered in structured fields that are feasibly retrieved from current EHR systems (YNHHSC/CORE, 2015). Additional data called Linking Variables are used to link EHR data files with administrative claims data for CMS to calculate results for the Hybrid HWM measure, which are: CMS Certification Number (CCN); National Provider Identifier (NPI) for MA patients; Medicare Beneficiary Identifier (MBI); Date of Birth; Sex; Inpatient Admission Date; and Discharge Date."/>
<clinicalRecommendationStatement
value="The logic is not meant to guide or alter the care patients receive. The purpose of this CCDE logic is to extract clinical data that are already routinely captured in EHRs from hospitalizations for adult patients. It is not intended to require that clinical staff perform additional measurements or tests that are not needed for diagnostic assessment or treatment of patients."/>
<guidance
value="These specifications are for use for data with discharges that occur between July 1, 2025 and June 30, 2026. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2027. This logic guides the user to extract the FIRST resulted HWM-specific CCDEs for all Medicare FFS and MA hospitalizations for patients aged 65 through 94 years (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area, such as the emergency department or hospital outpatient location. The logic supports extraction of the FIRST set of HWM-specific CCDEs in two different ways, depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility: 1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs (physical exams) within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission. 2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for core clinical data element values related to a patient who is subsequently admitted. Value sets for the laboratory tests are represented using Logical Observation Identifiers Names and Codes (LOINC) currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements. NOTE: It is recommended hospitals only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. Hospitals may also choose to report ALL values on an encounter during their entire admission; however, only the first resulted values are utilized in the logic for measure calculation. For each CCDE, it is recommended that hospitals report the below Unified Code for Units of Measure (UCUM) units, however, any unit may be submitted. Where the reported unit is not easily converted to the requested UCUM units, the value will be set to missing and multiple imputation will be used to impute a value based on the characteristics of the CCDE reported. CCDE UCUM Unit: Bicarbonate--------------------------------------meq/L mmol/L Creatinine-----------------------------------------mg/dL Heart rate-----------------------------------------{Beats}/min Hematocrit ---------------------------------------% Oxygen saturation (by pulse oximetry)----% Platelet--------------------------------------------10*3/uL Sodium--------------------------------------------meq/L mmol/L Systolic blood pressure-----------------------mm[Hg] Temperature-------------------------------------Cel [degF] White blood cell count -----------------------{Cells}/uL 10*3/uL 10*9/L For each hospitalization please also submit the following Linking Variables: CMS Certification Number (CCN); National Provider Identifier (NPI) for MA patients; Medicare Beneficiary Identifier (MBI); Inpatient Admission Date; and Discharge Date. The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This FHIR-based measure has been derived from the QDM-based measure: CMS844v5. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html)."/>
<group id="6385011c4ba3d47c885c02aa">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="cohort"/>
<display value="Cohort"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
<valueCode value="Encounter"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="outcome"/>
<display value="Outcome"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation">
<valueCode value="None"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
<code value="decrease"/>
<display value="decrease"/>
</coding>
</valueCodeableConcept>
</extension>
<description
value="This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from hospitalizations for adult Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) patients admitted to acute care hospitals."/>
<population id="24BB5BA9-820F-4958-B8AA-AA8962E9E398">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</code>
<description
value="All Medicare FFS and MA hospitalizations for patients aged 65 through 94 years at the start of an inpatient admission, where the length of stay is less than 365 days, and the hospitalization ends during the measurement period. NOTE: All Medicare FFS and MA hospitalizations meeting the above criteria should be included, regardless of whether Medicare FFS/MA is the primary, secondary, or tertiary payer."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
</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>
<supplementalData id="encounter-with-first-bicarbonate-lab-test">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First Bicarbonate Lab Test"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First Bicarbonate Lab Test"/>
</criteria>
</supplementalData>
<supplementalData id="encounter-with-first-body-temperature">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First Body Temperature"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First Body Temperature"/>
</criteria>
</supplementalData>
<supplementalData id="encounter-with-first-creatinine-lab-test">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First Creatinine Lab Test"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First Creatinine Lab Test"/>
</criteria>
</supplementalData>
<supplementalData id="encounter-with-first-heart-rate">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First Heart Rate"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First Heart Rate"/>
</criteria>
</supplementalData>
<supplementalData id="encounter-with-first-hematocrit-lab-test">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First Hematocrit Lab Test"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First Hematocrit Lab Test"/>
</criteria>
</supplementalData>
<supplementalData id="encounter-with-first-oxygen-saturation">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First Oxygen Saturation"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First Oxygen Saturation"/>
</criteria>
</supplementalData>
<supplementalData id="encounter-with-first-platelet-lab-test">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First Platelet Lab Test"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First Platelet Lab Test"/>
</criteria>
</supplementalData>
<supplementalData id="encounter-with-first-sodium-lab-test">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First Sodium Lab Test"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First Sodium Lab Test"/>
</criteria>
</supplementalData>
<supplementalData id="encounter-with-first-white-blood-cells-lab-test">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First White Blood Cells Lab Test"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First White Blood Cells Lab Test"/>
</criteria>
</supplementalData>
<supplementalData id="qualifying-blood-pressure-reading">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Qualifying Blood Pressure Reading"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Qualifying Blood Pressure Reading"/>
</criteria>
</supplementalData>
<supplementalData id="test2">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Test2"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Test2"/>
</criteria>
</supplementalData>
</Measure>