eCQM QICore Content Implementation Guide
2024.0.0 - CI Build
eCQM QICore Content Implementation Guide
2024.0.0 - CI Build
eCQM QICore Content 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/ and changes regularly. See the Directory of published versions
| Draft as of 2024-07-09 |
<Measure xmlns="http://hl7.org/fhir">
<id value="AppropriateTreatmentforSTEMIFHIR"/>
<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="grid dict">
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)FHIR</td>
</tr>
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">AppropriateTreatmentforSTEMIFHIR</td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">1.2.000</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="Measure-AppropriateTreatmentforSTEMIFHIR.html">Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)FHIR</a></td>
</tr>
<tr>
<th scope="row">
<b>
short-name identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>CMS996FHIR</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
version-independent identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>urn:uuid:a48685e0-4926-4ae8-9eb3-d8e8839b1704</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
version-specific identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>urn:uuid:feb911dd-6b34-4b3f-866f-3059dd4d19d0</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
publisher (CMS) identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>996FHIR</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Effective Period: </b></th>
<td style="padding-left: 4px;">2025-01-01..2025-12-31</td>
</tr>
<tr>
<th scope="row"><b>Status: </b></th>
<td style="padding-left: 4px;">draft</td>
</tr>
<tr>
<th scope="row"><b>Publisher: </b></th>
<td style="padding-left: 4px;">Centers for Medicare & Medicaid Services (CMS)</td>
</tr>
<tr>
<th scope="row"><b>Author: </b></th>
<td style="padding-left: 4px;">Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation, The Lewin Group</td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;"><div><p>Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Purpose: </b></th>
<td style="padding-left: 4px;"><div><p>UNKNOWN</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Copyright: </b></th>
<td style="padding-left: 4px;"><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. CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. ICD-10 is copyright 2023 World Health Organization. All Rights Reserved.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Disclaimer: </b></th>
<td style="padding-left: 4px;"><div><p>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].</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Rationale: </b></th>
<td style="padding-left: 4px;"><div><p>Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (Sohlpour & Yusuf, 2014; Fibrinolytic Therapy Trialists' Collaborative Group, 1994). For patients receiving fibrinolytic therapy, the American Heart Association (AHA) estimates that 65 lives will be saved per 1,000 patients if treatment is administered within the first hour of symptom onset, and 131 lives will be saved per 1,000 patients treated if fibrinolytic therapy is delivered within the first three hours (O'Connor et al., 2010). The total ischemic time-that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy-is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O'Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O'Gara et al., 2013). Implementation of an eCQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the proposed eCQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of ED Arrival (OP-2) measure and broaden the population for which performance scores could be publicly reported.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Clinical recommendation statement: </b></th>
<td style="padding-left: 4px;"><div><p>Primary PCI in STEMI: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours' duration." - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours' duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact." Fibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact: The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) clinical practice guideline for the management of STEMI recommends that: - "In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact." Transfer to a PCI-Capable Hospital after Fibrinolytic Therapy: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe heart failure (HF), irrespective of the time delay from MI onset. - Urgent transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who demonstrate evidence of failed reperfusion or reocclusion after fibrinolytic therapy. - Transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Guidance (Usage): </b></th>
<td style="padding-left: 4px;">This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI. This FHIR-based measure has been derived from the QDM-based measure: CMS996v5. 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"><b>Population Criteria: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>6633d92a6c1d307ea36e74c0</b></th>
</tr>
<tr>
<td>Initial Population:</td>
<td>All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during an Emergency Department encounter that ends during the measurement period</td>
</tr>
<tr>
<td>Denominator:</td>
<td>Equals Initial Population</td>
</tr>
<tr>
<td>Denominator Exclusion:</td>
<td>Patients with the following conditions are excluded from measure denominator: At some point during ED encounter: - Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase Starts before the start of ED encounter and does not end before ED encounter: - Bleeding or bleeding diathesis (excluding menses) - Known malignant intracranial neoplasm (primary or metastatic) - Known structural cerebral vascular lesion (e.g., arteriovenous malformation) - Advanced dementia - Pregnancy - Diagnosis of allergy to thrombolytics At the start of ED encounter, or most recent dose within 90 days or less of ED encounter: -Active oral anticoagulant therapy Occurs 24 hours or less before start of ED encounter or during ED encounter: - Aortic dissection or ruptured aortic aneurysm - Severe neurologic impairment - Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device - Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation - Cardiopulmonary arrest, including: cardiac arrest, cardiopulmonary resuscitation (CPR), defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR Occurs 21 days or less before start of or starts during ED encounter: - Major surgery Occurs 90 days before start of or at start of ED encounter: - Ischemic stroke - Significant facial and/or closed head trauma - Peptic ulcer Occurs 90 days or less before start of ED encounter: - Intracranial or intraspinal surgery With a discharge disposition of patient expired in the ED</td>
</tr>
<tr>
<td>Numerator:</td>
<td>Emergency department encounters with a diagnosis of STEMI: - where time from ED arrival to fibrinolysis is 30 minutes or fewer; OR - where PCI is performed within 90 minutes of arrival; OR - where the patient is transferred within 45 minutes of ED arrival</td>
</tr>
<tr>
<td>Denominator Exception:</td>
<td>Emergency department encounters where the patient received fibrinolytic therapy at another facility within 24 hours.</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b> Supplemental Data Elements: </b></th>
<td style="padding-left: 4px;">
<p>SDE Ethnicity</p>
<p>SDE Payer</p>
<p>SDE Race</p>
<p>SDE Sex</p>
</td>
</tr>
<tr>
<th scope="row">
<b> Supplemental Data Guidance
: </b></th>
<td style="padding-left: 4px;"> For every patient evaluated by this measure also identify payer, race, ethnicity and sex </td>
</tr>
<tr>
<th scope="row"><b>Libraries: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td><a href="Library-AppropriateTreatmentforSTEMIFHIR.html">AppropriateTreatmentforSTEMIFHIR</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Terminology and Other Dependencies: </b></th>
<td style="padding-left: 4px;">
<li><code>Library/SupplementalDataElements|3.5.000</code></li>
<li><code>Library/FHIRHelpers|4.4.000</code></li>
<li><code>Library/CQMCommon|2.2.000</code></li>
<li><code>Library/QICoreCommon|2.1.000</code></li>
<li><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">AdministrativeGender</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-ActCode.html">ActCode</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html">Condition Clinical Status Codes</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-allergyintolerance-clinical.html">AllergyIntolerance Clinical Status Codes</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion">Emergency Department Visit</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4017/expansion">STEMI</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4020/expansion">Fibrinolytic Therapy</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion">Emergency Department Visit</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.2000.5/expansion">Percutaneous Coronary Intervention</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.87/expansion">Discharge To Acute Care Facility</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.4/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.4</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.6/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.6</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4036/expansion">Active Bleeding or Bleeding Diathesis (Excluding Menses)</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.3/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.3</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4025/expansion">Cerebral Vascular Lesion</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4043/expansion">Dementia</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4055/expansion">Pregnancy</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.5/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.5</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4045/expansion">Anticoagulant Medications, Oral</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4028/expansion">Aortic Dissection</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.114.12.1012/expansion">Neurologic impairment</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4048/expansion">Cardiopulmonary Arrest</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4056/expansion">Major Surgical Procedure</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.69/expansion">Endotracheal Intubation</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4052/expansion">Mechanical Circulatory Assist Device</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.247/expansion">Ischemic Stroke</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4026/expansion">Closed Head Trauma</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4031/expansion">Active Peptic Ulcer</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.2/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.2</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.309/expansion">Patient Expired</a></li>
</td>
</tr>
<tr>
<th scope="row"><b>Parameters:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>name</b></th>
<th><b>use</b></th>
<th><b>min</b></th>
<th><b>max</b></th>
<th><b>type</b></th>
</tr>
<tr>
<td>Measurement Period</td>
<td>In</td>
<td>0</td>
<td>1</td>
<td>Period</td>
</tr>
<tr>
<td>SDE Sex</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>Coding</td>
</tr>
<tr>
<td>Numerator</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Denominator</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>SDE Payer</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Initial Population</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>SDE Ethnicity</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>Resource</td>
</tr>
<tr>
<td>Denominator Exclusions</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>SDE Race</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>Resource</td>
</tr>
<tr>
<td>Denominator Exceptions</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>DataRequirements:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>Resource Type</b></th>
<th><b>Resource Elements</b></th>
<th><b>Valueset Name</b></th>
<th><b>Valueset</b></th>
</tr>
<tr>
<td>Patient(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a>)</td>
<td>
ethnicity
race
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
class
condition
condition.reference
condition.reference.value
location
location.type
hospitalization
hospitalization.dischargeDisposition
reasonCode
</td>
<td>
Emergency Department Evaluation and Management Visit
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion">Emergency Department Visit</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
id
id.value
code
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
clinicalStatus
</td>
<td>
STEMI
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4017/expansion">STEMI</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Active Bleeding Excluding Menses or Bleeding Diathesis
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4036/expansion">Active Bleeding or Bleeding Diathesis (Excluding Menses)</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Malignant Intracranial Neoplasm Group
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.3/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.3</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Cerebral Vascular Lesion
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4025/expansion">Cerebral Vascular Lesion</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Dementia and Related Intracranial Pathologies
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4043/expansion">Dementia</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Pregnant State
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4055/expansion">Pregnancy</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Allergy to thrombolytics
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.5/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.5</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Aortic Dissection or Ruptured Aortic Aneurysm
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4028/expansion">Aortic Dissection</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Neurologic impairment
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.114.12.1012/expansion">Neurologic impairment</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Ischemic Stroke
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.247/expansion">Ischemic Stroke</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Closed Head and Facial Trauma
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4026/expansion">Closed Head Trauma</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Active Peptic Ulcer
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4031/expansion">Active Peptic Ulcer</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Cardiopulmonary Arrest
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4048/expansion">Cardiopulmonary Arrest</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Location(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-location.html">QICoreLocation</a>)</td>
<td>
id
id.value
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>MedicationAdministration(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationadministration.html">QICoreMedicationAdministration</a>)</td>
<td>
medication
status
status.value
effective
</td>
<td>
Fibrinolytic Therapy
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4020/expansion">Fibrinolytic Therapy</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
performed
status
status.value
</td>
<td>
Percutaneous Coronary Intervention
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.2000.5/expansion">Percutaneous Coronary Intervention</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
performed
status
status.value
</td>
<td>
Major Surgical Procedure
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4056/expansion">Major Surgical Procedure</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
performed
status
status.value
</td>
<td>
Endotracheal Intubation
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.69/expansion">Endotracheal Intubation</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
performed
status
status.value
</td>
<td>
Insertion or Replacement of Mechanical Circulatory Assist Device
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4052/expansion">Mechanical Circulatory Assist Device</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
performed
status
status.value
</td>
<td>
Intracranial or Intraspinal surgery
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.2/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.2</a></td>
</tr>
<tr>
<td>Coverage(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html">QICoreCoverage</a>)</td>
<td>
type
period
</td>
<td>
Payer Type
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a></td>
</tr>
<tr>
<td>AllergyIntolerance(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-allergyintolerance.html">QICoreAllergyIntolerance</a>)</td>
<td>
code
clinicalStatus
onset
</td>
<td>
Thrombolytic medications
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.4/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.4</a></td>
</tr>
<tr>
<td>AdverseEvent(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-adverseevent.html">QICoreAdverseEvent</a>)</td>
<td>
event
recordedDate
recordedDate.value
actuality
actuality.value
</td>
<td>
Thrombolytics Adverse Event
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.6/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.6</a></td>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication.reference
status
status.value
intent
intent.value
authoredOn
authoredOn.value
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
authoredOn
authoredOn.value
</td>
<td>
Oral Anticoagulant Medications
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4045/expansion">Anticoagulant Medications, Oral</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Direct Reference Codes:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>display</b></th>
<th><b>code</b></th>
<th><b>system</b></th>
</tr>
<tr>
<td>Male</td>
<td>M</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">http://hl7.org/fhir/administrative-gender</a></td>
</tr>
<tr>
<td>Female</td>
<td>F</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">http://hl7.org/fhir/administrative-gender</a></td>
</tr>
<tr>
<td>emergency</td>
<td>EMER</td>
<td><a href="http://hl7.org/fhir/R4/v3/ActCode/cs.html">http://terminology.hl7.org/CodeSystem/v3-ActCode</a></td>
</tr>
<tr>
<td>Active</td>
<td>active</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
</tr>
<tr>
<td>Active</td>
<td>active</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-allergyintolerance-clinical.html">http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical</a></td>
</tr>
<tr>
<td>Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility</td>
<td>Z92.82</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html">http://hl7.org/fhir/sid/icd-10-cm</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Logic Definitions:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>Group</b></th>
<th><b>Scoring</b></th>
<th><b>Population Criteria</b></th>
<th><b>Expression</b></th>
</tr>
<tr>
<td> 6633d92a6c1d307ea36e74c0 </td>
<td colspan="3" style="padding-left: 4px;">
<b>Group scoring:</b>
<span> proportion </span>
<tr>
<th scope="row"><b>Type: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>Process </span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Rate Aggregation: </b></th>
<td colspan="3" style="padding-left: 4px;">None</td>
</tr>
<tr>
<th scope="row"><b>Improvement Notation: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>increase </span>
</p>
</td>
</tr>
</td>
<tr>
<td/>
<td/>
<td>Initial Population</td>
<td>
<pre><code class="language-cql">define "Initial Population":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
where AgeInYearsAt(date from start of(EDwithSTEMI.period)) >= 18</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator</td>
<td>
<pre><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exclusion</td>
<td>
<pre><code class="language-cql">define "Denominator Exclusions":
"Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"
union "Adverse Effect to Thrombolytic Medications Before End of ED Encounter"
union "Active Exclusion Diagnosis at Start of ED Encounter"
union "Active Oral Anticoagulant Medication at the Start of ED Encounter"
union "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"
union "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter"
union "Intubation or Mechanical Circulatory Assist Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"
union "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"
union "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"
union "ED Encounter with Discharge Disposition as Patient Expired"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator</td>
<td>
<pre><code class="language-cql">define "Numerator":
"Fibrinolytic Therapy within 30 Minutes of Arrival"
union "PCI within 90 Minutes of Arrival"
union "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exception</td>
<td>
<pre><code class="language-cql">define "Denominator Exceptions":
"Received tPA in Another Facility within 24 hours Prior to Admission"</code></pre>
</td>
</tr>
</tr>
</table>
<table class="grid-dict">
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Sex</td>
</tr>
<tr>
<td/>
<td>
<pre class="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><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>SDE Sex</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Sex":
SDE."SDE Sex"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>ED Encounter During MP</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "ED Encounter During MP":
["Encounter": "Emergency Department Evaluation and Management Visit"] EDEncounter
where EDEncounter.period ends during day of "Measurement Period"
and EDEncounter.status = 'finished'
and EDEncounter.class ~ "EMER"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>ED Encounter with Encounter Diagnosis of STEMI</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "ED Encounter with Encounter Diagnosis of STEMI":
"ED Encounter During MP" EDEncounter
where ( EDEncounter.reasonCode in "STEMI"
or exists ( ( EDEncounter.encounterDiagnosis ( ) ) EncDiagnosis
where EncDiagnosis.code in "STEMI"
)
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>ED Encounter with Diagnosis of STEMI</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "ED Encounter with Diagnosis of STEMI":
"ED Encounter During MP" EDEncounter
with ["Condition": "STEMI"] DxSTEMI
such that DxSTEMI.clinicalStatus ~ QICoreCommon."active"
and DxSTEMI.prevalenceInterval ( ) starts during EDEncounter.period</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>ED Encounter with STEMI Diagnosis</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "ED Encounter with STEMI Diagnosis":
"ED Encounter with Encounter Diagnosis of STEMI"
union "ED Encounter with Diagnosis of STEMI"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>Fibrinolytic Therapy within 30 Minutes of Arrival</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Fibrinolytic Therapy within 30 Minutes of Arrival":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["MedicationAdministration": "Fibrinolytic Therapy"] Fibrinolytic
such that Fibrinolytic.status = 'completed'
and start of ( Fibrinolytic.effective.toInterval ( ) ) 30 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>PCI within 90 Minutes of Arrival</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "PCI within 90 Minutes of Arrival":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["Procedure": "Percutaneous Coronary Intervention"] PCI
such that PCI.performed.toInterval ( ) starts 90 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )
and PCI.status = 'completed'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
where ( EDwithSTEMI.period ) ends 45 minutes or less after start of ( EDwithSTEMI.period )
and EDwithSTEMI.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>Numerator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Numerator":
"Fibrinolytic Therapy within 30 Minutes of Arrival"
union "PCI within 90 Minutes of Arrival"
union "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>Initial Population</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Initial Population":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
where AgeInYearsAt(date from start of(EDwithSTEMI.period)) >= 18</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>Denominator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Payer</td>
</tr>
<tr>
<td/>
<td>
<pre class="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><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>SDE Payer</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Payer":
SDE."SDE Payer"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Ethnicity</td>
</tr>
<tr>
<td/>
<td>
<pre class="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><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>SDE Ethnicity</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Ethnicity":
SDE."SDE Ethnicity"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with ["AllergyIntolerance": "Thrombolytic medications"] ThrombolyticAllergy
such that ThrombolyticAllergy.clinicalStatus ~ QICoreCommon."allergy-active"
and ThrombolyticAllergy.onset.toInterval ( ) overlaps ( EDwSTEMI.period )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>Adverse Effect to Thrombolytic Medications Before End of ED Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*define "Adverse Effect to Thrombolytic Medications Before End of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with [AdverseEvent: event in "Thrombolytic medications"] ThrombolyticAdverseEvent
such that ThrombolyticAdverseEvent.category in "Adverse reaction to thrombolytics"
and ThrombolyticAdverseEvent.recordedDate before end of ( EDwSTEMI.period )
and ThrombolyticAdverseEvent.actuality = 'actual'*/
/*KS Note - not sure we need category in the logic - it is must support, but not sure this brings value to the measure logic*/
define "Adverse Effect to Thrombolytic Medications Before End of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with [AdverseEvent: event in "Thrombolytics Adverse Event"] ThrombolyticAdverseEvent
such that ThrombolyticAdverseEvent.recordedDate before end of ( EDwSTEMI.period )
and ThrombolyticAdverseEvent.actuality = 'actual'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>Active Exclusion Diagnosis at Start of ED Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Active Exclusion Diagnosis at Start of ED Encounter":
/*KS 8-10-23: in CQLIT-389, discussed the impacts of requiring a clinical status of active but the condition could end before the end (during) the ED Visit, which would trigger an inactive status. Decided to not follow the Authoring Patterns and remove the requirement for a clinicalstatus of 'active' */
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ( ["Condition": "Active Bleeding Excluding Menses or Bleeding Diathesis"]
union ["Condition": "Malignant Intracranial Neoplasm Group"]
union ["Condition": "Cerebral Vascular Lesion"]
union ["Condition": "Dementia and Related Intracranial Pathologies"]
union ["Condition": "Pregnant State"]
union ["Condition": "Allergy to thrombolytics"] ) ActiveExclusionDx
such that /*ActiveExclusionDx.isActive ()
and */
ActiveExclusionDx.prevalenceInterval ( ) overlaps before ( EDwithSTEMI.period )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>Active Oral Anticoagulant Medication at the Start of ED Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Active Oral Anticoagulant Medication at the Start of ED Encounter":
/*this definition differs from QDM re: timing - cannot use overlaps for a single point in time*/
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["MedicationRequest": "Oral Anticoagulant Medications"] OralAnticoagulant
such that OralAnticoagulant.status = 'active'
and OralAnticoagulant.intent = 'order'
and OralAnticoagulant.authoredOn 90 days or less before or on start of EDwithSTEMI.period</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start":
/*Did not include a status of active as any diagnosis that resolves during the ED visit would not be counted*/
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ( ["Condition": "Aortic Dissection or Ruptured Aortic Aneurysm"]
union ["Condition": "Neurologic impairment"]
union ["Condition": "Cardiopulmonary Arrest"] ) ExclusionDiagnosis
such that ( ExclusionDiagnosis.prevalenceInterval ( ) starts during EDwithSTEMI.period )
or ( ExclusionDiagnosis.prevalenceInterval ( ) starts 24 hours or less before start of EDwithSTEMI.period )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["Procedure": "Major Surgical Procedure"] MajorSurgery
such that MajorSurgery.performed.toInterval ( ) starts 21 days or less before start of ( EDwithSTEMI.period )
and MajorSurgery.status = 'completed'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>Intubation or Mechanical Circulatory Assist Procedure During ED Encounter or Within 24 Hours of ED Encounter Start</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Intubation or Mechanical Circulatory Assist Procedure During ED Encounter or Within 24 Hours of ED Encounter Start":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ( ["Procedure": "Endotracheal Intubation"]
union ["Procedure": "Insertion or Replacement of Mechanical Circulatory Assist Device"] ) AirwayProcedure
such that ( ( AirwayProcedure.performed.toInterval ( ) starts during ( EDwithSTEMI.period ) )
or ( AirwayProcedure.performed.toInterval ( ) starts 24 hours or less before start of ( EDwithSTEMI.period ) )
)
and AirwayProcedure.status = 'completed'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with ( ["Condition": "Ischemic Stroke"]
union ["Condition": "Closed Head and Facial Trauma"]
union ["Condition": "Active Peptic Ulcer"]
union ["Condition": "Cardiopulmonary Arrest"] ) ExclusionCondition
such that /* ExclusionCondition.isActive ()
and */
ExclusionCondition.prevalenceInterval ( ) starts during Interval[start of ( EDwSTEMI.period ) - 90 days, start of ( EDwSTEMI.period )]</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["Procedure": "Intracranial or Intraspinal surgery"] CranialorSpinalSurgery
such that CranialorSpinalSurgery.performed.toInterval ( ) starts 90 days or less before start of ( EDwithSTEMI.period )
and CranialorSpinalSurgery.status = 'completed'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>ED Encounter with Discharge Disposition as Patient Expired</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "ED Encounter with Discharge Disposition as Patient Expired":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
where EDwithSTEMI.hospitalization.dischargeDisposition in "Patient Expired"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>Denominator Exclusions</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator Exclusions":
"Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"
union "Adverse Effect to Thrombolytic Medications Before End of ED Encounter"
union "Active Exclusion Diagnosis at Start of ED Encounter"
union "Active Oral Anticoagulant Medication at the Start of ED Encounter"
union "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"
union "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter"
union "Intubation or Mechanical Circulatory Assist Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"
union "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"
union "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"
union "ED Encounter with Discharge Disposition as Patient Expired"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Race</td>
</tr>
<tr>
<td/>
<td>
<pre class="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><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>SDE Race</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Race":
SDE."SDE Race"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>Received tPA in Another Facility within 24 hours Prior to Admission</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Received tPA in Another Facility within 24 hours Prior to Admission":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ( ["Condition": "Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility"] ) TPA
such that TPA.prevalenceInterval ( ) starts during EDwithSTEMI.period</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>Denominator Exceptions</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator Exceptions":
"Received tPA in Another Facility within 24 hours Prior to Admission"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>FHIRHelpers</td>
<td>ToConcept</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
if concept is null then
null
else
System.Concept {
codes: concept.coding C return ToCode(C),
display: concept.text.value
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CQMCommon</td>
<td>encounterDiagnosis</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns the Condition resources referenced by the diagnosis element of the Encounter
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
Encounter.diagnosis D
return singleton from ([Condition] C where C.id = D.condition.reference.getId())</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>getId</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).
@comment: This function can be used to determine the logical id of a given resource. It can be used in
a single-server environment to trace references. However, this function does not attempt to resolve
or distinguish the base of the given url, and so cannot be used safely in multi-server environments.
*/
define fluent function getId(uri String):
Last(Split(uri, '/'))</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>prevalenceInterval</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
or condition.clinicalStatus ~ "recurrence"
or condition.clinicalStatus ~ "relapse" then
Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
(end of condition.abatementInterval()) abatementDate
return if abatementDate is null then
Interval[start of condition.onset.toInterval(), abatementDate)
else
Interval[start of condition.onset.toInterval(), abatementDate]</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AppropriateTreatmentforSTEMIFHIR</td>
<td>currentemergencyDepartmentArrivalTime</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function currentemergencyDepartmentArrivalTime(EDEncounter Encounter):
/*
@description: Returns the emergency department arrival time for the encounter.
*/
start of ( singleton from ( ( ( EDEncounter.location ) ) EDLocation
where CQMCommon.GetLocation ( EDLocation.location ).type in "Emergency Department Visit"
)
).period</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CQMCommon</td>
<td>GetLocation</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns the Location resource specified by the given reference
@deprecated: This function is deprecated. Use the fluent function `getLocation()` instead.
*/
define function "GetLocation"(reference Reference ):
singleton from (
[Location] L where L.id = reference.reference.getId()
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>FHIRHelpers</td>
<td>ToString</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define function ToString(value uri): value.value</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>FHIRHelpers</td>
<td>ToCode</td>
</tr>
<tr>
<td/>
<td>
<pre class="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>
</table>
</td>
</tr>
</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-directReferenceCode">
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="EMER"/>
<display value="emergency"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="active"/>
<display value="Active"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical"/>
<code value="active"/>
<display value="Active"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/sid/icd-10-cm"/>
<code value="Z92.82"/>
<display
value="Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility"/>
</valueCoding>
</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="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Sex"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Sex":
SDE."SDE Sex""/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString value="ED Encounter During MP"/>
</extension>
<extension url="statement">
<valueString
value="define "ED Encounter During MP":
["Encounter": "Emergency Department Evaluation and Management Visit"] EDEncounter
where EDEncounter.period ends during day of "Measurement Period"
and EDEncounter.status = 'finished'
and EDEncounter.class ~ "EMER""/>
</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="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString
value="ED Encounter with Encounter Diagnosis of STEMI"/>
</extension>
<extension url="statement">
<valueString
value="define "ED Encounter with Encounter Diagnosis of STEMI":
"ED Encounter During MP" EDEncounter
where ( EDEncounter.reasonCode in "STEMI"
or exists ( ( EDEncounter.encounterDiagnosis ( ) ) EncDiagnosis
where EncDiagnosis.code in "STEMI"
)
)"/>
</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="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString value="ED Encounter with Diagnosis of STEMI"/>
</extension>
<extension url="statement">
<valueString
value="define "ED Encounter with Diagnosis of STEMI":
"ED Encounter During MP" EDEncounter
with ["Condition": "STEMI"] DxSTEMI
such that DxSTEMI.clinicalStatus ~ QICoreCommon."active"
and DxSTEMI.prevalenceInterval ( ) starts during EDEncounter.period"/>
</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="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString value="ED Encounter with STEMI Diagnosis"/>
</extension>
<extension url="statement">
<valueString
value="define "ED Encounter with STEMI Diagnosis":
"ED Encounter with Encounter Diagnosis of STEMI"
union "ED Encounter with Diagnosis of STEMI""/>
</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="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString
value="Fibrinolytic Therapy within 30 Minutes of Arrival"/>
</extension>
<extension url="statement">
<valueString
value="define "Fibrinolytic Therapy within 30 Minutes of Arrival":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["MedicationAdministration": "Fibrinolytic Therapy"] Fibrinolytic
such that Fibrinolytic.status = 'completed'
and start of ( Fibrinolytic.effective.toInterval ( ) ) 30 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )"/>
</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="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString value="PCI within 90 Minutes of Arrival"/>
</extension>
<extension url="statement">
<valueString
value="define "PCI within 90 Minutes of Arrival":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["Procedure": "Percutaneous Coronary Intervention"] PCI
such that PCI.performed.toInterval ( ) starts 90 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )
and PCI.status = 'completed'"/>
</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="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString
value="ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival"/>
</extension>
<extension url="statement">
<valueString
value="define "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
where ( EDwithSTEMI.period ) ends 45 minutes or less after start of ( EDwithSTEMI.period )
and EDwithSTEMI.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility""/>
</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="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString value="Numerator"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator":
"Fibrinolytic Therapy within 30 Minutes of Arrival"
union "PCI within 90 Minutes of Arrival"
union "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival""/>
</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="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString value="Initial Population"/>
</extension>
<extension url="statement">
<valueString
value="define "Initial Population":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
where AgeInYearsAt(date from start of(EDwithSTEMI.period)) >= 18"/>
</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="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator":
"Initial Population""/>
</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="AppropriateTreatmentforSTEMIFHIR"/>
</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="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="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AppropriateTreatmentforSTEMIFHIR"/>
</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="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString
value="Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with ["AllergyIntolerance": "Thrombolytic medications"] ThrombolyticAllergy
such that ThrombolyticAllergy.clinicalStatus ~ QICoreCommon."allergy-active"
and ThrombolyticAllergy.onset.toInterval ( ) overlaps ( EDwSTEMI.period )"/>
</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="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString
value="Adverse Effect to Thrombolytic Medications Before End of ED Encounter"/>
</extension>
<extension url="statement">
<valueString
value="/*define "Adverse Effect to Thrombolytic Medications Before End of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with [AdverseEvent: event in "Thrombolytic medications"] ThrombolyticAdverseEvent
such that ThrombolyticAdverseEvent.category in "Adverse reaction to thrombolytics"
and ThrombolyticAdverseEvent.recordedDate before end of ( EDwSTEMI.period )
and ThrombolyticAdverseEvent.actuality = 'actual'*/
/*KS Note - not sure we need category in the logic - it is must support, but not sure this brings value to the measure logic*/
define "Adverse Effect to Thrombolytic Medications Before End of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with [AdverseEvent: event in "Thrombolytics Adverse Event"] ThrombolyticAdverseEvent
such that ThrombolyticAdverseEvent.recordedDate before end of ( EDwSTEMI.period )
and ThrombolyticAdverseEvent.actuality = 'actual'"/>
</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="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString
value="Active Exclusion Diagnosis at Start of ED Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Active Exclusion Diagnosis at Start of ED Encounter":
/*KS 8-10-23: in CQLIT-389, discussed the impacts of requiring a clinical status of active but the condition could end before the end (during) the ED Visit, which would trigger an inactive status. Decided to not follow the Authoring Patterns and remove the requirement for a clinicalstatus of 'active' */
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ( ["Condition": "Active Bleeding Excluding Menses or Bleeding Diathesis"]
union ["Condition": "Malignant Intracranial Neoplasm Group"]
union ["Condition": "Cerebral Vascular Lesion"]
union ["Condition": "Dementia and Related Intracranial Pathologies"]
union ["Condition": "Pregnant State"]
union ["Condition": "Allergy to thrombolytics"] ) ActiveExclusionDx
such that /*ActiveExclusionDx.isActive ()
and */
ActiveExclusionDx.prevalenceInterval ( ) overlaps before ( EDwithSTEMI.period )"/>
</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="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString
value="Active Oral Anticoagulant Medication at the Start of ED Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Active Oral Anticoagulant Medication at the Start of ED Encounter":
/*this definition differs from QDM re: timing - cannot use overlaps for a single point in time*/
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["MedicationRequest": "Oral Anticoagulant Medications"] OralAnticoagulant
such that OralAnticoagulant.status = 'active'
and OralAnticoagulant.intent = 'order'
and OralAnticoagulant.authoredOn 90 days or less before or on start of EDwithSTEMI.period"/>
</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="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString
value="Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"/>
</extension>
<extension url="statement">
<valueString
value="define "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start":
/*Did not include a status of active as any diagnosis that resolves during the ED visit would not be counted*/
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ( ["Condition": "Aortic Dissection or Ruptured Aortic Aneurysm"]
union ["Condition": "Neurologic impairment"]
union ["Condition": "Cardiopulmonary Arrest"] ) ExclusionDiagnosis
such that ( ExclusionDiagnosis.prevalenceInterval ( ) starts during EDwithSTEMI.period )
or ( ExclusionDiagnosis.prevalenceInterval ( ) starts 24 hours or less before start of EDwithSTEMI.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="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString
value="Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["Procedure": "Major Surgical Procedure"] MajorSurgery
such that MajorSurgery.performed.toInterval ( ) starts 21 days or less before start of ( EDwithSTEMI.period )
and MajorSurgery.status = 'completed'"/>
</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="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString
value="Intubation or Mechanical Circulatory Assist Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"/>
</extension>
<extension url="statement">
<valueString
value="define "Intubation or Mechanical Circulatory Assist Procedure During ED Encounter or Within 24 Hours of ED Encounter Start":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ( ["Procedure": "Endotracheal Intubation"]
union ["Procedure": "Insertion or Replacement of Mechanical Circulatory Assist Device"] ) AirwayProcedure
such that ( ( AirwayProcedure.performed.toInterval ( ) starts during ( EDwithSTEMI.period ) )
or ( AirwayProcedure.performed.toInterval ( ) starts 24 hours or less before start of ( EDwithSTEMI.period ) )
)
and AirwayProcedure.status = 'completed'"/>
</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="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString
value="Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with ( ["Condition": "Ischemic Stroke"]
union ["Condition": "Closed Head and Facial Trauma"]
union ["Condition": "Active Peptic Ulcer"]
union ["Condition": "Cardiopulmonary Arrest"] ) ExclusionCondition
such that /* ExclusionCondition.isActive ()
and */
ExclusionCondition.prevalenceInterval ( ) starts during Interval[start of ( EDwSTEMI.period ) - 90 days, start of ( EDwSTEMI.period )]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="23"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString
value="Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["Procedure": "Intracranial or Intraspinal surgery"] CranialorSpinalSurgery
such that CranialorSpinalSurgery.performed.toInterval ( ) starts 90 days or less before start of ( EDwithSTEMI.period )
and CranialorSpinalSurgery.status = 'completed'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="24"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString
value="ED Encounter with Discharge Disposition as Patient Expired"/>
</extension>
<extension url="statement">
<valueString
value="define "ED Encounter with Discharge Disposition as Patient Expired":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
where EDwithSTEMI.hospitalization.dischargeDisposition in "Patient Expired""/>
</extension>
<extension url="displaySequence">
<valueInteger value="25"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator Exclusions"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator Exclusions":
"Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"
union "Adverse Effect to Thrombolytic Medications Before End of ED Encounter"
union "Active Exclusion Diagnosis at Start of ED Encounter"
union "Active Oral Anticoagulant Medication at the Start of ED Encounter"
union "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"
union "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter"
union "Intubation or Mechanical Circulatory Assist Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"
union "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"
union "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"
union "ED Encounter with Discharge Disposition as Patient Expired""/>
</extension>
<extension url="displaySequence">
<valueInteger value="26"/>
</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="27"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AppropriateTreatmentforSTEMIFHIR"/>
</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="28"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString
value="Received tPA in Another Facility within 24 hours Prior to Admission"/>
</extension>
<extension url="statement">
<valueString
value="define "Received tPA in Another Facility within 24 hours Prior to Admission":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ( ["Condition": "Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility"] ) TPA
such that TPA.prevalenceInterval ( ) starts during EDwithSTEMI.period"/>
</extension>
<extension url="displaySequence">
<valueInteger value="29"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator Exceptions"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator Exceptions":
"Received tPA in Another Facility within 24 hours Prior to Admission""/>
</extension>
<extension url="displaySequence">
<valueInteger value="30"/>
</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="ToConcept"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
if concept is null then
null
else
System.Concept {
codes: concept.coding C return ToCode(C),
display: concept.text.value
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="31"/>
</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="encounterDiagnosis"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the Condition resources referenced by the diagnosis element of the Encounter
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
Encounter.diagnosis D
return singleton from ([Condition] C where C.id = D.condition.reference.getId())"/>
</extension>
<extension url="displaySequence">
<valueInteger value="32"/>
</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="getId"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).
@comment: This function can be used to determine the logical id of a given resource. It can be used in
a single-server environment to trace references. However, this function does not attempt to resolve
or distinguish the base of the given url, and so cannot be used safely in multi-server environments.
*/
define fluent function getId(uri String):
Last(Split(uri, '/'))"/>
</extension>
<extension url="displaySequence">
<valueInteger value="33"/>
</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="prevalenceInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
or condition.clinicalStatus ~ "recurrence"
or condition.clinicalStatus ~ "relapse" then
Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
(end of condition.abatementInterval()) abatementDate
return if abatementDate is null then
Interval[start of condition.onset.toInterval(), abatementDate)
else
Interval[start of condition.onset.toInterval(), abatementDate]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="34"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AppropriateTreatmentforSTEMIFHIR"/>
</extension>
<extension url="name">
<valueString value="currentemergencyDepartmentArrivalTime"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function currentemergencyDepartmentArrivalTime(EDEncounter Encounter):
/*
@description: Returns the emergency department arrival time for the encounter.
*/
start of ( singleton from ( ( ( EDEncounter.location ) ) EDLocation
where CQMCommon.GetLocation ( EDLocation.location ).type in "Emergency Department Visit"
)
).period"/>
</extension>
<extension url="displaySequence">
<valueInteger value="35"/>
</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="GetLocation"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the Location resource specified by the given reference
@deprecated: This function is deprecated. Use the fluent function `getLocation()` instead.
*/
define function "GetLocation"(reference Reference ):
singleton from (
[Location] L where L.id = reference.reference.getId()
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="36"/>
</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="37"/>
</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="38"/>
</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 SDE"/>
<resource value="Library/SupplementalDataElements|3.5.000"/>
</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 CQMCommon"/>
<resource value="Library/CQMCommon|2.2.000"/>
</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="Code system AdministrativeGender"/>
<resource value="http://hl7.org/fhir/administrative-gender"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ActCode"/>
<resource value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ConditionClinicalStatusCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system AllergyIntoleranceClinicalStatusCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ICD10CM"/>
<resource value="http://hl7.org/fhir/sid/icd-10-cm"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Emergency Department Evaluation and Management Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set STEMI"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4017"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Fibrinolytic Therapy"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4020"/>
</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 Percutaneous Coronary Intervention"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.2000.5"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Discharge To Acute Care Facility"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87"/>
</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>
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<purpose value="UNKNOWN"/>
<usage
value="This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI. This FHIR-based measure has been derived from the QDM-based measure: CMS996v5. 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. CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. ICD-10 is copyright 2023 World Health Organization. All Rights Reserved."/>
<effectivePeriod>
<start value="2025-01-01"/>
<end value="2025-12-31"/>
</effectivePeriod>
<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>
<author>
<name value="The Lewin Group"/>
<telecom>
<system value="url"/>
<value value="https://www.lewin.com/"/>
</telecom>
</author>
<library
value="https://madie.cms.gov/Library/AppropriateTreatmentforSTEMIFHIR"/>
<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]."/>
<rationale
value="Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (Sohlpour & Yusuf, 2014; Fibrinolytic Therapy Trialists' Collaborative Group, 1994). For patients receiving fibrinolytic therapy, the American Heart Association (AHA) estimates that 65 lives will be saved per 1,000 patients if treatment is administered within the first hour of symptom onset, and 131 lives will be saved per 1,000 patients treated if fibrinolytic therapy is delivered within the first three hours (O'Connor et al., 2010). The total ischemic time-that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy-is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O'Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O'Gara et al., 2013). Implementation of an eCQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the proposed eCQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of ED Arrival (OP-2) measure and broaden the population for which performance scores could be publicly reported."/>
<clinicalRecommendationStatement
value="Primary PCI in STEMI: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours' duration." - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours' duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact." Fibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact: The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) clinical practice guideline for the management of STEMI recommends that: - "In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact." Transfer to a PCI-Capable Hospital after Fibrinolytic Therapy: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe heart failure (HF), irrespective of the time delay from MI onset. - Urgent transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who demonstrate evidence of failed reperfusion or reocclusion after fibrinolytic therapy. - Transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy."/>
<group id="6633d92a6c1d307ea36e74c0">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
<valueCode value="Encounter"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="process"/>
<display value="Process"/>
</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="increase"/>
</coding>
</valueCodeableConcept>
</extension>
<population id="9368D43C-EC53-489B-BFAB-E61F16298E63">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</code>
<description
value="All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during an Emergency Department encounter that ends during the measurement period"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
</criteria>
</population>
<population id="EBF05C28-BF39-423D-A055-FCD964FE0333">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator"/>
<display value="Denominator"/>
</coding>
</code>
<description value="Equals Initial Population"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator"/>
</criteria>
</population>
<population id="9BDC7445-0BF6-4941-8732-893B185A378E">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exclusion"/>
<display value="Denominator Exclusion"/>
</coding>
</code>
<description
value="Patients with the following conditions are excluded from measure denominator: At some point during ED encounter: - Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase Starts before the start of ED encounter and does not end before ED encounter: - Bleeding or bleeding diathesis (excluding menses) - Known malignant intracranial neoplasm (primary or metastatic) - Known structural cerebral vascular lesion (e.g., arteriovenous malformation) - Advanced dementia - Pregnancy - Diagnosis of allergy to thrombolytics At the start of ED encounter, or most recent dose within 90 days or less of ED encounter: -Active oral anticoagulant therapy Occurs 24 hours or less before start of ED encounter or during ED encounter: - Aortic dissection or ruptured aortic aneurysm - Severe neurologic impairment - Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device - Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation - Cardiopulmonary arrest, including: cardiac arrest, cardiopulmonary resuscitation (CPR), defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR Occurs 21 days or less before start of or starts during ED encounter: - Major surgery Occurs 90 days before start of or at start of ED encounter: - Ischemic stroke - Significant facial and/or closed head trauma - Peptic ulcer Occurs 90 days or less before start of ED encounter: - Intracranial or intraspinal surgery With a discharge disposition of patient expired in the ED"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exclusions"/>
</criteria>
</population>
<population id="D66FC17B-ABED-4476-A524-B092500128D9">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator"/>
<display value="Numerator"/>
</coding>
</code>
<description
value="Emergency department encounters with a diagnosis of STEMI: - where time from ED arrival to fibrinolysis is 30 minutes or fewer; OR - where PCI is performed within 90 minutes of arrival; OR - where the patient is transferred within 45 minutes of ED arrival"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator"/>
</criteria>
</population>
<population id="752e3422-6975-4e47-8557-a2cb68f6adad">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exception"/>
<display value="Denominator Exception"/>
</coding>
</code>
<description
value="Emergency department encounters where the patient received fibrinolytic therapy at another facility within 24 hours."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exceptions"/>
</criteria>
</population>
</group>
<supplementalData id="sde-ethnicity">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Ethnicity"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Ethnicity"/>
</criteria>
</supplementalData>
<supplementalData id="sde-payer">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Payer"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Payer"/>
</criteria>
</supplementalData>
<supplementalData id="sde-race">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Race"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Race"/>
</criteria>
</supplementalData>
<supplementalData id="sde-sex">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Sex"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Sex"/>
</criteria>
</supplementalData>
</Measure>
IG © 2023+ cqframework. Package gov.healthit.ecqi.ecqms#2024.0.0 based on FHIR 4.0.1. Generated 2024-11-07
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