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

: Appropriate Treatment for Upper Respiratory Infection (URI)FHIR - XML Representation

Draft as of 2024-12-18

Raw xml | Download


<Measure xmlns="http://hl7.org/fhir">
  <id value="AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR"/>
  <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 Upper Respiratory Infection (URI)FHIR</td>
            </tr>
        

        

        
            <tr>
                <th scope="row"><b>Id: </b></th>
                <td style="padding-left: 4px;">AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR</td>
            </tr>
        

        
            <tr>
                <th scope="row"><b>Version: </b></th>
                <td style="padding-left: 4px;">0.1.001</td>
            </tr>
        

        
            <tr>
                <th scope="row"><b>Url: </b></th>
                <td style="padding-left: 4px;"><a href="Measure-AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR.html">Appropriate Treatment for Upper Respiratory Infection (URI)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>CMS154FHIR</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:25892635-c2b4-4c29-a351-ef60797c3bd5</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:d8161a82-9300-40d3-aeb0-c3aee7a48457</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>154FHIR</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;">National Committee for Quality Assurance</td>
            </tr>
        

        
        <tr>
            <th scope="row"><b>Author: </b></th>
            <td style="padding-left: 4px;">National Committee for Quality Assurance</td>
        </tr>
        

        

        
            <tr>
                <th scope="row"><b>Description: </b></th>
                <td style="padding-left: 4px;"><div><p>Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic order</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>This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2024 National Committee for Quality Assurance. All Rights Reserved.</p>
<p>Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications.</p>
<p>CPT(R) codes, descriptions and other data are copyright 2024. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use.</p>
<p>Some measure specifications contain coding from LOINC(R) (http://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use.</p>
<p>This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation.</p>
<p>ICD-10 copyright 2024 World Health Organization. All Rights Reserved.</p>
<p>Some measures use RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the measures and does not endorse or recommend this or any other product.</p>
<p>“HL7” is the registered trademark of Health Level Seven International.</p>
</div></td>
            </tr>
        

        
            <tr>
                <th scope="row"><b>Disclaimer: </b></th>
                <td style="padding-left: 4px;"><div><p>The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.</p>
<p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>
</div></td>
            </tr>
        

        

        

        
            <tr>
                <th scope="row"><b>Scoring: </b></th>
                <td style="padding-left: 4px;">
                    
                        
                            <p style="margin-bottom: 5px;">
                                <span>Proportion </span>
                            </p>
                        
                    
                    
                </td>
            </tr>
        

        

        

        

        

        
        <tr>
            <th scope="row"><b>Rationale: </b></th>
            <td style="padding-left: 4px;"><div><p>Most URI, also known as the common cold, are caused by viruses that require no antibiotic treatment. Too often, antibiotics are prescribed inappropriately, which can lead to antibiotic resistance (when antibiotics can no longer cure bacterial infections). In the United States, at least 2.8 million antibiotic-resistant illnesses and 35,000 deaths occur each year (Centers for Disease Control and Prevention [CDC], 2020).</p>
</div></td>
        </tr>
        

        
        <tr>
            <th scope="row"><b>Clinical recommendation statement: </b></th>
            <td style="padding-left: 4px;"><div><p>American Family Physician (Fashner, Ericson, &amp; Werner, 2012)</p>
<ul>
<li>
<p>Antibiotics should not be used for the treatment of cold symptoms in children or adults. (A)</p>
</li>
<li>
<p>Nonsteroidal anti-inflammatory drugs reduce pain secondary to upper respiratory tract infection in adults. (A)</p>
</li>
<li>
<p>Decongestants, antihistamine/decongestant combinations, and intranasal ipratropium (Atrovent) may improve cold symptoms in adults. (B)</p>
</li>
</ul>
<p>Institute for Clinical Systems Improvement (ICSI) (Short et al., 2017)
The ICSI work group does not recommend antibiotics for treatment of common cold symptoms in children and adults.</p>
</div></td>
        </tr>
        

        

        
            <tr>
                <th scope="row"><b>Guidance (Usage): </b></th>
                <td style="padding-left: 4px;">This is an episode of care measure that examines all eligible episodes for the patient.

This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 months of age and older with a diagnosis of upper respiratory infection from January 1 to December 28 of the measurement period.

This FHIR-based measure has been derived from the QDM-based measure: CMS154v13. 

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>661d86660f0a9077c1d5a582</b></th>
                                    </tr>
                                
                                
                                    <tr>
                                        <td>Initial Population:</td>

                                        
                                            
                                                <td>Outpatient visits, telephone visits, virtual encounter (i.e., e-visit or virtual check-in), or emergency department visits with a diagnosis of URI from January 1 to December 28 of the measurement period for patients 3 months of age and older</td>
                                            
                                        

                                    </tr>
                                
                                    <tr>
                                        <td>Denominator:</td>

                                        
                                            
                                                <td>Equals Initial Population</td>
                                            
                                        

                                    </tr>
                                
                                    <tr>
                                        <td>Denominator Exclusion:</td>

                                        
                                            
                                                <td>Exclude URI episodes when the patient had hospice care for any part of the measurement period.

Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. 

Exclude URI episodes where the patient is taking antibiotics in the 30 days prior to the episode date.

Exclude URI episodes where the patient had competing diagnosis on or three days after the episode date.</td>
                                            
                                        

                                    </tr>
                                
                                    <tr>
                                        <td>Numerator:</td>

                                        
                                            
                                                <td>URI episodes without a prescription for antibiotic medication on or three days after the outpatient visit, telephone visit, virtual encounter, or emergency department visit for an upper respiratory infection</td>
                                            
                                        

                                    </tr>
                                
                                
                                  <tr><b>Stratifier Criteria: </b></tr>
                                    
                                        <tr>
                                            
                                                <td>Stratum:</td>
                                            

                                            
                                                <td>3 months-17 years</td>
                                            
                                        </tr>
                                    
                                        <tr>
                                            
                                                <td>Stratum:</td>
                                            

                                            
                                                <td>18-64 years</td>
                                            
                                        </tr>
                                    
                                        <tr>
                                            
                                                <td>Stratum:</td>
                                            

                                            
                                                <td>65 years and older</td>
                                            
                                        </tr>
                                    
                                
                            </table>
                        
                    </td>
                </tr>
            
        

        

        

        

        
            <tr>
                <th scope="row"><b>Libraries: </b></th>
                <td style="padding-left: 4px;">
                    <table class="grid-dict">
                        
                            <tr>
                                <td><a href="Library-AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR.html">AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR</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/Status|1.8.000</code></li>
                        
                            <li><code>Library/FHIRHelpers|4.4.000</code></li>
                        
                            <li><code>Library/QICoreCommon|2.1.000</code></li>
                        
                            <li><code>Library/Hospice|6.12.000</code></li>
                        
                            <li><code>Library/Antibiotic|1.7.000</code></li>
                        
                            <li><code>Library/CumulativeMedicationDuration|4.1.000</code></li>
                        
                            <li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-CPT.html">Current Procedural Terminology (CPT®)</a></li>
                        
                            <li><a href="http://hl7.org/fhir/R4/codesystem-snomedct.html">SNOMED CT (all versions)</a></li>
                        
                            <li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-observation-category.html">Observation Category Codes</a></li>
                        
                            <li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html">Logical Observation Identifiers, Names and Codes (LOINC)</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/2.16.840.1.113883.3.464.1003.101.12.1016/expansion">Home Healthcare Services</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1073/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1073</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion">Office Visit</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1008/expansion">Outpatient Consultation</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1027/expansion">Preventive Care Services - Group Counseling</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1026/expansion">Preventive Care Services-Individual Counseling</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1022/expansion">Preventive Care Services, Initial Office Visit, 0 to 17</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1024/expansion">Preventive Care, Established Office Visit, 0 to 17</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion">Preventive Care Services - Established Office Visit, 18 and Up</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion">Preventive Care Services-Initial Office Visit, 18 and Up</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion">Telephone Visits</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1089/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.102.12.1022/expansion">Upper Respiratory Infection</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1001/expansion">Antibiotic Medications for Pharyngitis</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.102.12.1025/expansion">Comorbid Conditions for Respiratory Conditions</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.102.12.1017/expansion">Competing Conditions for Respiratory Conditions</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.102.12.1011/expansion">Acute Pharyngitis</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.102.12.1012/expansion">Acute Tonsillitis</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>ErrorLevel</td>
                                    <td>In</td>
                                    <td>0</td>
                                    <td>1</td>
                                    <td>string</td>
                                </tr>
                            
                                <tr>
                                    <td>Numerator</td>
                                    <td>Out</td>
                                    <td>0</td>
                                    <td>*</td>
                                    <td>Resource</td>
                                </tr>
                            
                                <tr>
                                    <td>Stratification 3</td>
                                    <td>Out</td>
                                    <td>0</td>
                                    <td>*</td>
                                    <td>Resource</td>
                                </tr>
                            
                                <tr>
                                    <td>Stratification 2</td>
                                    <td>Out</td>
                                    <td>0</td>
                                    <td>*</td>
                                    <td>Resource</td>
                                </tr>
                            
                                <tr>
                                    <td>Stratification 1</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>Initial Population</td>
                                    <td>Out</td>
                                    <td>0</td>
                                    <td>*</td>
                                    <td>Resource</td>
                                </tr>
                            
                                <tr>
                                    <td>Denominator Exclusions</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>
                                        
                                    </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
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </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
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </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>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Home Healthcare Services
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion">Home Healthcare Services</a></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
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Medical Disability Exam
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1073/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1073</a></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
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Office Visit
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion">Office Visit</a></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
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Outpatient Consultation
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1008/expansion">Outpatient Consultation</a></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
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Preventive Care Services Group Counseling
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1027/expansion">Preventive Care Services - Group Counseling</a></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
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Preventive Care Services Individual Counseling
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1026/expansion">Preventive Care Services-Individual Counseling</a></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
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Preventive Care Services, Initial Office Visit, 0 to 17
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1022/expansion">Preventive Care Services, Initial Office Visit, 0 to 17</a></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
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Preventive Care, Established Office Visit, 0 to 17
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1024/expansion">Preventive Care, Established Office Visit, 0 to 17</a></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
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Preventive Care Services Established Office Visit, 18 and Up
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion">Preventive Care Services - Established Office Visit, 18 and Up</a></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
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Preventive Care Services Initial Office Visit, 18 and Up
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion">Preventive Care Services-Initial Office Visit, 18 and Up</a></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
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Telephone Visits
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion">Telephone Visits</a></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
                                        
                                            status
                                        
                                            status.value
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Virtual Encounter
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1089/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089</a></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
                                        
                                            hospitalization
                                        
                                            hospitalization.dischargeDisposition
                                        
                                            period
                                        
                                            status
                                        
                                            status.value
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Encounter Inpatient
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a></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
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Hospice Encounter
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003</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>
                                        
                                            
                                                 Upper Respiratory Infection
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.102.12.1022/expansion">Upper Respiratory Infection</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>
                                        
                                            
                                                 Hospice Diagnosis
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165</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>
                                        
                                            
                                                 Comorbid Conditions for Respiratory Conditions
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.102.12.1025/expansion">Comorbid Conditions for Respiratory Conditions</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>
                                        
                                            
                                                 Competing Conditions for Respiratory Conditions
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.102.12.1017/expansion">Competing Conditions for Respiratory Conditions</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>
                                        
                                            
                                                 Acute Pharyngitis
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.102.12.1011/expansion">Acute Pharyngitis</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>
                                        
                                            
                                                 Acute Tonsillitis
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.102.12.1012/expansion">Acute Tonsillitis</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>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
                                        
                                            status
                                        
                                            status.value
                                        
                                            intent
                                        
                                            intent.value
                                        
                                            authoredOn
                                        
                                            authoredOn.value
                                        
                                            dosageInstruction
                                        
                                            dispenseRequest
                                        
                                            dispenseRequest.expectedSupplyDuration
                                        
                                            dispenseRequest.quantity
                                        
                                            dispenseRequest.numberOfRepeatsAllowed
                                        
                                            dispenseRequest.numberOfRepeatsAllowed.value
                                        
                                            dispenseRequest.validityPeriod
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Antibiotic Medications for Upper Respiratory Infection
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1001/expansion">Antibiotic Medications for Pharyngitis</a></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
                                        
                                            dosageInstruction
                                        
                                            dispenseRequest
                                        
                                            dispenseRequest.expectedSupplyDuration
                                        
                                            dispenseRequest.quantity
                                        
                                            dispenseRequest.numberOfRepeatsAllowed
                                        
                                            dispenseRequest.numberOfRepeatsAllowed.value
                                        
                                            dispenseRequest.validityPeriod
                                        
                                    </td>
                                    <td>
                                        
                                    </td>
                                    <td/>
                                </tr>
                            
                                <tr>
                                    <td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                            value
                                        
                                            effective
                                        
                                            status
                                        
                                            status.value
                                        
                                            category
                                        
                                    </td>
                                    <td>
                                        
                                    </td>
                                    <td/>
                                </tr>
                            
                                <tr>
                                    <td>ServiceRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html">QICoreServiceRequest</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                            authoredOn
                                        
                                            authoredOn.value
                                        
                                            status
                                        
                                            status.value
                                        
                                            intent
                                        
                                            intent.value
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Hospice Care Ambulatory
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</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>
                                        
                                            
                                                 Hospice Care Ambulatory
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</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>Unlisted preventive medicine service</td>
                                        <td>99429</td>
                                        <td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-CPT.html">http://www.ama-assn.org/go/cpt</a></td>
                                    </tr>
                                
                                    <tr>
                                        <td>Discharge to home for hospice care (procedure)</td>
                                        <td>428361000124107</td>
                                        <td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
                                    </tr>
                                
                                    <tr>
                                        <td>Discharge to healthcare facility for hospice care (procedure)</td>
                                        <td>428371000124100</td>
                                        <td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
                                    </tr>
                                
                                    <tr>
                                        <td>survey</td>
                                        <td>survey</td>
                                        <td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-observation-category.html">http://terminology.hl7.org/CodeSystem/observation-category</a></td>
                                    </tr>
                                
                                    <tr>
                                        <td>Yes (qualifier value)</td>
                                        <td>373066001</td>
                                        <td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
                                    </tr>
                                
                                    <tr>
                                        <td>Hospice care [Minimum Data Set]</td>
                                        <td>45755-6</td>
                                        <td><a href="https://loinc.org/">http://loinc.org</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> 661d86660f0a9077c1d5a582 </td>
                                <td colspan="3" style="padding-left: 4px;">
                                    
                                        <b>Group scoring:</b>
                                        
                                            <span>  proportion </span>
                                        
                                    

                                    

                                    
                                        <b>Measure scoring:</b>
                                        
                                            <p style="margin-bottom: 5px;">
                                                <span>Proportion</span>
                                            </p>
                                        
                                    

                                    

                                    
                                        <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 &quot;Initial Population&quot;:
  &quot;Encounter with Upper Respiratory Infection&quot; EncounterWithURI
    where AgeInMonthsAt(date from start of &quot;Measurement Period&quot;) &gt;= 3
    return EncounterWithURI</code></pre>
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td/>
                                    <td/>
                                    <td>Denominator</td>
                                    <td>
                                        
                                            <pre><code class="language-cql">define &quot;Denominator&quot;:
  &quot;Initial Population&quot;</code></pre>
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td/>
                                    <td/>
                                    <td>Denominator Exclusion</td>
                                    <td>
                                        
                                            <pre><code class="language-cql">define &quot;Denominator Exclusions&quot;:
  &quot;Encounters and Assessments with Hospice Patient&quot;
    union Antibiotic.&quot;Has Comorbid Condition History&quot; ( &quot;Encounter with Upper Respiratory Infection&quot;, ( [Condition: &quot;Comorbid Conditions for Respiratory Conditions&quot;] ) )
    union Antibiotic.&quot;Has Antibiotic Medication History&quot; ( &quot;Encounter with Upper Respiratory Infection&quot;, ( [MedicationRequest: &quot;Antibiotic Medications for Upper Respiratory Infection&quot;] ) )
    union Antibiotic.&quot;Has Competing Diagnosis History&quot; ( &quot;Encounter with Upper Respiratory Infection&quot;, ( [Condition: &quot;Competing Conditions for Respiratory Conditions&quot;]
        union [Condition: &quot;Acute Pharyngitis&quot;]
        union [Condition: &quot;Acute Tonsillitis&quot;]
    ) )</code></pre>
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td/>
                                    <td/>
                                    <td>Numerator</td>
                                    <td>
                                        
                                            <pre><code class="language-cql">define &quot;Numerator&quot;:
  &quot;Encounter with Upper Respiratory Infection&quot; EncounterWithURI
    without ( ( [MedicationRequest: &quot;Antibiotic Medications for Upper Respiratory Infection&quot;] ).isMedicationOrder ( ) ) OrderedAntibiotic
      such that OrderedAntibiotic.authoredOn 3 days or less on or after start of EncounterWithURI.period.toInterval ( )
    return EncounterWithURI</code></pre>
                                        
                                    </td>
                                </tr>
                                
                                
                                <tr>
                                    <td/>
                                    <td/>
                                    <td/>
                                    <td>
                                        
                                            <pre><code class="language-cql"/></pre>
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td/>
                                    <td/>
                                    <td/>
                                    <td>
                                        
                                            <pre><code class="language-cql"/></pre>
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td/>
                                    <td/>
                                    <td/>
                                    <td>
                                        
                                            <pre><code class="language-cql"/></pre>
                                        
                                    </td>
                                </tr>
                                
                            
                            </tr>
                        </table>
                

                <table class="grid-dict">
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR</td>
                            
                            
                                <td>Qualifying Encounters</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Qualifying Encounters&quot;:
  ( ( [Encounter: &quot;Emergency Department Evaluation and Management Visit&quot;]
      union [Encounter: &quot;Home Healthcare Services&quot;]
      union [Encounter: &quot;Medical Disability Exam&quot;]
      union [Encounter: &quot;Office Visit&quot;]
      union [Encounter: &quot;Outpatient Consultation&quot;]
      union [Encounter: &quot;Preventive Care Services Group Counseling&quot;]
      union [Encounter: &quot;Preventive Care Services Individual Counseling&quot;]
      union [Encounter: &quot;Preventive Care Services, Initial Office Visit, 0 to 17&quot;]
      union [Encounter: &quot;Preventive Care, Established Office Visit, 0 to 17&quot;]
      union [Encounter: &quot;Preventive Care Services Established Office Visit, 18 and Up&quot;]
      union [Encounter: &quot;Preventive Care Services Initial Office Visit, 18 and Up&quot;]
      union [Encounter: &quot;Telephone Visits&quot;]
      union [Encounter: &quot;Virtual Encounter&quot;]
      union ( [Encounter] E
          where exists ( ( E.type ) T
              where T ~ &quot;Unlisted preventive medicine service&quot;
          )
      )
  ).isEncounterPerformed ( ) ) ValidEncounter
    where ValidEncounter.period.toInterval ( ) ends during day of Interval[( start of &quot;Measurement Period&quot; ), ( end of &quot;Measurement Period&quot; ) - 3 days]</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR</td>
                            
                            
                                <td>Encounter with Upper Respiratory Infection</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Encounter with Upper Respiratory Infection&quot;:
  from
    &quot;Qualifying Encounters&quot; QualifyingEncounters,
    [Condition: &quot;Upper Respiratory Infection&quot;] URI
    where URI.prevalenceInterval ( ) starts during day of QualifyingEncounters.period.toInterval ( )
      or URI.prevalenceInterval ( ) overlaps before QualifyingEncounters.period.toInterval ( )
    return QualifyingEncounters</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR</td>
                            
                            
                                <td>Numerator</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Numerator&quot;:
  &quot;Encounter with Upper Respiratory Infection&quot; EncounterWithURI
    without ( ( [MedicationRequest: &quot;Antibiotic Medications for Upper Respiratory Infection&quot;] ).isMedicationOrder ( ) ) OrderedAntibiotic
      such that OrderedAntibiotic.authoredOn 3 days or less on or after start of EncounterWithURI.period.toInterval ( )
    return EncounterWithURI</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR</td>
                            
                            
                                <td>Stratification 3</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Stratification 3&quot;:
  &quot;Encounter with Upper Respiratory Infection&quot; EncounterWithURI
    where AgeInYearsAt(date from start of &quot;Measurement Period&quot;) &gt;= 65
    return EncounterWithURI</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR</td>
                            
                            
                                <td>Stratification 2</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Stratification 2&quot;:
  &quot;Encounter with Upper Respiratory Infection&quot; EncounterWithURI
    where AgeInYearsAt(date from start of &quot;Measurement Period&quot;) in Interval[18, 64]
    return EncounterWithURI</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR</td>
                            
                            
                                <td>Stratification 1</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Stratification 1&quot;:
  &quot;Encounter with Upper Respiratory Infection&quot; EncounterWithURI
    where AgeInMonthsAt(date from start of &quot;Measurement Period&quot;) &gt;= 3
      and AgeInYearsAt(date from start of &quot;Measurement Period&quot;) &lt;= 17
    return EncounterWithURI</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR</td>
                            
                            
                                <td>Initial Population</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Initial Population&quot;:
  &quot;Encounter with Upper Respiratory Infection&quot; EncounterWithURI
    where AgeInMonthsAt(date from start of &quot;Measurement Period&quot;) &gt;= 3
    return EncounterWithURI</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR</td>
                            
                            
                                <td>Denominator</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Denominator&quot;:
  &quot;Initial Population&quot;</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Hospice</td>
                            
                            
                                <td>Has Hospice Services</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Hospice Services&quot;:
  exists ((([Encounter: &quot;Encounter Inpatient&quot;]).isEncounterPerformed()) InpatientEncounter
      where (InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to home for hospice care (procedure)&quot;
          or InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to healthcare facility for hospice care (procedure)&quot;
      )
        and InpatientEncounter.period.toInterval() ends during day of &quot;Measurement Period&quot;
  )
    or exists ((([Encounter: &quot;Hospice Encounter&quot;]).isEncounterPerformed()) HospiceEncounter
        where HospiceEncounter.period.toInterval() overlaps day of &quot;Measurement Period&quot;
    )
    or exists ((([Observation: &quot;Hospice care [Minimum Data Set]&quot;]).isAssessmentPerformed()) HospiceAssessment
        where HospiceAssessment.value ~ &quot;Yes (qualifier value)&quot;
          and HospiceAssessment.effective.toInterval() overlaps day of &quot;Measurement Period&quot;
    )
    or exists ((([ServiceRequest: &quot;Hospice Care Ambulatory&quot;]).isInterventionOrder()) HospiceOrder
        where HospiceOrder.authoredOn.toInterval() during day of &quot;Measurement Period&quot;
        // and HospiceOrder.doNotPerform is not true
        // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447
    )
    or exists ((([Procedure: &quot;Hospice Care Ambulatory&quot;]).isInterventionPerformed()) HospicePerformed
        where HospicePerformed.performed.toInterval() overlaps day of &quot;Measurement Period&quot;
    )
    or exists (([Condition: &quot;Hospice Diagnosis&quot;]) HospiceCareDiagnosis
        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of &quot;Measurement Period&quot;
    )</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR</td>
                            
                            
                                <td>Encounters and Assessments with Hospice Patient</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Encounters and Assessments with Hospice Patient&quot;:
  &quot;Initial Population&quot; EligibleEncounters
    where Hospice.&quot;Has Hospice Services&quot;</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR</td>
                            
                            
                                <td>Denominator Exclusions</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Denominator Exclusions&quot;:
  &quot;Encounters and Assessments with Hospice Patient&quot;
    union Antibiotic.&quot;Has Comorbid Condition History&quot; ( &quot;Encounter with Upper Respiratory Infection&quot;, ( [Condition: &quot;Comorbid Conditions for Respiratory Conditions&quot;] ) )
    union Antibiotic.&quot;Has Antibiotic Medication History&quot; ( &quot;Encounter with Upper Respiratory Infection&quot;, ( [MedicationRequest: &quot;Antibiotic Medications for Upper Respiratory Infection&quot;] ) )
    union Antibiotic.&quot;Has Competing Diagnosis History&quot; ( &quot;Encounter with Upper Respiratory Infection&quot;, ( [Condition: &quot;Competing Conditions for Respiratory Conditions&quot;]
        union [Condition: &quot;Acute Pharyngitis&quot;]
        union [Condition: &quot;Acute Tonsillitis&quot;]
    ) )</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Status</td>
                            
                            
                                <td>isEncounterPerformed</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">//Encounter, Performed
//General usage unless required otherwise by measure intent (e.g., follow-up encounters)
define fluent function isEncounterPerformed(Enc List&lt;Encounter&gt;):
  Enc E
    where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}</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>QICoreCommon</td>
                            
                            
                                <td>toInterval</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval&lt;DateTime&gt;, or Interval&lt;Quantity&gt; types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval&lt;DateTime&gt; or Interval&lt;Quantity&gt;.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice&lt;DateTime, Quantity, Interval&lt;DateTime&gt;, Interval&lt;Quantity&gt;, Timing&gt;):
  case
	  when choice is DateTime then
    	Interval[choice as DateTime, choice as DateTime]
		when choice is Interval&lt;DateTime&gt; then
  		choice as Interval&lt;DateTime&gt;
		when choice is Quantity then
		  Interval[Patient.birthDate + (choice as Quantity),
			  Patient.birthDate + (choice as Quantity) + 1 year)
		when choice is Interval&lt;Quantity&gt; then
		  Interval[Patient.birthDate + (choice.low as Quantity),
			  Patient.birthDate + (choice.high as Quantity) + 1 year)
		when choice is Timing then
      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval&lt;DateTime&gt;
		else
			null as Interval&lt;DateTime&gt;
	end</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 ~ &quot;active&quot;
  or condition.clinicalStatus ~ &quot;recurrence&quot;
  or condition.clinicalStatus ~ &quot;relapse&quot; 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>Status</td>
                            
                            
                                <td>isMedicationOrder</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">//Medication, Order: active and completed only
define fluent function isMedicationOrder(MedicationRequest List&lt;MedicationRequest&gt;):
  MedicationRequest M
    where M.status in { 'active', 'completed' }
      and M.intent = 'order'</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Status</td>
                            
                            
                                <td>isAssessmentPerformed</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">//This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA.

//Assessment, Performed
define fluent function isAssessmentPerformed(Obs List&lt;Observation&gt;):
  Obs O
    where O.status in { 'final', 'amended', 'corrected' }
          and exists ( O.category ObservationCategory
          where ( ObservationCategory ) ~ &quot;survey&quot;
      )</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Status</td>
                            
                            
                                <td>isInterventionOrder</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">//Intervention, Order: active and completed only    
define fluent function isInterventionOrder(ServiceRequest List&lt;ServiceRequest&gt;):
  ServiceRequest S
    where S.status in { 'active', 'completed' }
      and S.intent = 'order'</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Status</td>
                            
                            
                                <td>isInterventionPerformed</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">//Intervention, Performed
define fluent function isInterventionPerformed(Proc List&lt;Procedure&gt;):
  Proc P
    where P.status ~ 'completed'</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Antibiotic</td>
                            
                            
                                <td>Has Comorbid Condition History</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define function &quot;Has Comorbid Condition History&quot;(episodeDate List&lt;Encounter&gt;, comorbidConditions List&lt;Condition&gt;):
  episodeDate eDate
      with comorbidConditions comcondition
        such that date from start of comcondition.prevalenceInterval() during Interval[date from start of eDate.period.toInterval() - 1 year, date from start of eDate.period.toInterval()]
      return eDate</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Antibiotic</td>
                            
                            
                                <td>Has Antibiotic Medication History</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define function &quot;Has Antibiotic Medication History&quot;(episodeDate List&lt;Encounter&gt;, antibioticMedications List&lt;MedicationRequest&gt;):
   episodeDate DateOfEpisode
    with antibioticMedications ActiveMedication
      such that ActiveMedication.medicationRequestPeriod() overlaps day of Interval[date from start of DateOfEpisode.period.toInterval()  - 30 days, date from start of DateOfEpisode.period.toInterval() - 1 day]</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>CumulativeMedicationDuration</td>
                            
                            
                                <td>medicationRequestPeriod</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define fluent function medicationRequestPeriod(Request &quot;MedicationRequest&quot;):
  Request R
    let
      dosage: singleton from R.dosageInstruction,
      doseAndRate: singleton from dosage.doseAndRate,
      timing: dosage.timing,
      frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),
      period: Quantity(timing.repeat.period, timing.repeat.periodUnit),
      doseRange: doseAndRate.dose,
      doseQuantity: doseAndRate.dose,
      dose: Coalesce(end of doseRange, doseQuantity),
      dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),
      boundsPeriod: timing.repeat.bounds as Interval&lt;DateTime&gt;,
      daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value,
      quantity: R.dispenseRequest.quantity,
      refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),
      startDate:
        Coalesce(
          date from start of boundsPeriod,
          date from R.authoredOn,
          date from start of R.dispenseRequest.validityPeriod
        ),
      totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills)
    return
      if startDate is not null and totalDaysSupplied is not null then
        Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ]
      else if startDate is not null and boundsPeriod.&quot;high&quot; is not null then
        Interval[startDate, date from end of boundsPeriod]
      else
        null</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>CumulativeMedicationDuration</td>
                            
                            
                                <td>Quantity</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">/**********************************************************************/
/* Functions in this region are copied from opioid-mme-r4             */
/**********************************************************************/

define function Quantity(value Decimal, unit String):
  if value is not null then
    System.Quantity { value: value, unit: unit }
  else
    null</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>CumulativeMedicationDuration</td>
                            
                            
                                <td>ToDaily</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">/*
 Goal is to get to number of days
 Two broad approaches to the calculation:
  1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered
  2) Based on relevant period, determine a covered interval and calculate the length of that interval in days
This topic covers several use cases and illustrates how to calculate Cumulative
Medication Duration for each type of medication resource using the supply and
frequency approach.
*/

/*
  For the first approach, we need to get from frequency to a frequency/day
  So we define ToDaily
*/

/*
  Calculates daily frequency given frequency within a period
*/
define function ToDaily(frequency System.Integer, period System.Quantity):
  case period.unit
    when 'h' then frequency * (24.0 / period.value)
    when 'min' then frequency * (24.0 / period.value) * 60
    when 's' then frequency * (24.0 / period.value) * 60 * 60
    when 'd' then frequency * (24.0 / period.value) / 24
    when 'wk' then frequency * (24.0 / period.value) / (24 * 7)
    when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
    when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
    when 'hour' then frequency * (24.0 / period.value)
    when 'minute' then frequency * (24.0 / period.value) * 60
    when 'second' then frequency * (24.0 / period.value) * 60 * 60
    when 'day' then frequency * (24.0 / period.value) / 24
    when 'week' then frequency * (24.0 / period.value) / (24 * 7)
    when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
    when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
    when 'hours' then frequency * (24.0 / period.value)
    when 'minutes' then frequency * (24.0 / period.value) * 60
    when 'seconds' then frequency * (24.0 / period.value) * 60 * 60
    when 'days' then frequency * (24.0 / period.value) / 24
    when 'weeks' then frequency * (24.0 / period.value) / (24 * 7)
    when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
    when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
    else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' &amp; period.unit)
  end</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>Antibiotic</td>
                            
                            
                                <td>Has Competing Diagnosis History</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define function &quot;Has Competing Diagnosis History&quot;(episodeDate List&lt;Encounter&gt;, competingConditions List&lt;Condition&gt;):
  episodeDate eDate
      with competingConditions competcondition
        such that competcondition.prevalenceInterval() starts 3 days or less on or after day of start of eDate.period
      return eDate</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://www.ama-assn.org/go/cpt"/>
          <code value="99429"/>
          <display value="Unlisted preventive medicine service"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="428361000124107"/>
          <display value="Discharge to home for hospice care (procedure)"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="428371000124100"/>
          <display
                   value="Discharge to healthcare facility for hospice care (procedure)"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/observation-category"/>
          <code value="survey"/>
          <display value="survey"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="373066001"/>
          <display value="Yes (qualifier value)"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="45755-6"/>
          <display value="Hospice care [Minimum Data Set]"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString
                       value="AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Qualifying Encounters"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Qualifying Encounters&quot;:
  ( ( [Encounter: &quot;Emergency Department Evaluation and Management Visit&quot;]
      union [Encounter: &quot;Home Healthcare Services&quot;]
      union [Encounter: &quot;Medical Disability Exam&quot;]
      union [Encounter: &quot;Office Visit&quot;]
      union [Encounter: &quot;Outpatient Consultation&quot;]
      union [Encounter: &quot;Preventive Care Services Group Counseling&quot;]
      union [Encounter: &quot;Preventive Care Services Individual Counseling&quot;]
      union [Encounter: &quot;Preventive Care Services, Initial Office Visit, 0 to 17&quot;]
      union [Encounter: &quot;Preventive Care, Established Office Visit, 0 to 17&quot;]
      union [Encounter: &quot;Preventive Care Services Established Office Visit, 18 and Up&quot;]
      union [Encounter: &quot;Preventive Care Services Initial Office Visit, 18 and Up&quot;]
      union [Encounter: &quot;Telephone Visits&quot;]
      union [Encounter: &quot;Virtual Encounter&quot;]
      union ( [Encounter] E
          where exists ( ( E.type ) T
              where T ~ &quot;Unlisted preventive medicine service&quot;
          )
      )
  ).isEncounterPerformed ( ) ) ValidEncounter
    where ValidEncounter.period.toInterval ( ) ends during day of Interval[( start of &quot;Measurement Period&quot; ), ( end of &quot;Measurement Period&quot; ) - 3 days]"/>
        </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="AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Encounter with Upper Respiratory Infection"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Encounter with Upper Respiratory Infection&quot;:
  from
    &quot;Qualifying Encounters&quot; QualifyingEncounters,
    [Condition: &quot;Upper Respiratory Infection&quot;] URI
    where URI.prevalenceInterval ( ) starts during day of QualifyingEncounters.period.toInterval ( )
      or URI.prevalenceInterval ( ) overlaps before QualifyingEncounters.period.toInterval ( )
    return QualifyingEncounters"/>
        </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="AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Numerator"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Numerator&quot;:
  &quot;Encounter with Upper Respiratory Infection&quot; EncounterWithURI
    without ( ( [MedicationRequest: &quot;Antibiotic Medications for Upper Respiratory Infection&quot;] ).isMedicationOrder ( ) ) OrderedAntibiotic
      such that OrderedAntibiotic.authoredOn 3 days or less on or after start of EncounterWithURI.period.toInterval ( )
    return EncounterWithURI"/>
        </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="AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Stratification 3"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Stratification 3&quot;:
  &quot;Encounter with Upper Respiratory Infection&quot; EncounterWithURI
    where AgeInYearsAt(date from start of &quot;Measurement Period&quot;) &gt;= 65
    return EncounterWithURI"/>
        </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="AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Stratification 2"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Stratification 2&quot;:
  &quot;Encounter with Upper Respiratory Infection&quot; EncounterWithURI
    where AgeInYearsAt(date from start of &quot;Measurement Period&quot;) in Interval[18, 64]
    return EncounterWithURI"/>
        </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="AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Stratification 1"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Stratification 1&quot;:
  &quot;Encounter with Upper Respiratory Infection&quot; EncounterWithURI
    where AgeInMonthsAt(date from start of &quot;Measurement Period&quot;) &gt;= 3
      and AgeInYearsAt(date from start of &quot;Measurement Period&quot;) &lt;= 17
    return EncounterWithURI"/>
        </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="AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Initial Population"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Initial Population&quot;:
  &quot;Encounter with Upper Respiratory Infection&quot; EncounterWithURI
    where AgeInMonthsAt(date from start of &quot;Measurement Period&quot;) &gt;= 3
    return EncounterWithURI"/>
        </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="AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Denominator"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Denominator&quot;:
  &quot;Initial Population&quot;"/>
        </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="Hospice"/>
        </extension>
        <extension url="name">
          <valueString value="Has Hospice Services"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Has Hospice Services&quot;:
  exists ((([Encounter: &quot;Encounter Inpatient&quot;]).isEncounterPerformed()) InpatientEncounter
      where (InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to home for hospice care (procedure)&quot;
          or InpatientEncounter.hospitalization.dischargeDisposition ~ &quot;Discharge to healthcare facility for hospice care (procedure)&quot;
      )
        and InpatientEncounter.period.toInterval() ends during day of &quot;Measurement Period&quot;
  )
    or exists ((([Encounter: &quot;Hospice Encounter&quot;]).isEncounterPerformed()) HospiceEncounter
        where HospiceEncounter.period.toInterval() overlaps day of &quot;Measurement Period&quot;
    )
    or exists ((([Observation: &quot;Hospice care [Minimum Data Set]&quot;]).isAssessmentPerformed()) HospiceAssessment
        where HospiceAssessment.value ~ &quot;Yes (qualifier value)&quot;
          and HospiceAssessment.effective.toInterval() overlaps day of &quot;Measurement Period&quot;
    )
    or exists ((([ServiceRequest: &quot;Hospice Care Ambulatory&quot;]).isInterventionOrder()) HospiceOrder
        where HospiceOrder.authoredOn.toInterval() during day of &quot;Measurement Period&quot;
        // and HospiceOrder.doNotPerform is not true
        // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447
    )
    or exists ((([Procedure: &quot;Hospice Care Ambulatory&quot;]).isInterventionPerformed()) HospicePerformed
        where HospicePerformed.performed.toInterval() overlaps day of &quot;Measurement Period&quot;
    )
    or exists (([Condition: &quot;Hospice Diagnosis&quot;]) HospiceCareDiagnosis
        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of &quot;Measurement Period&quot;
    )"/>
        </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="AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR"/>
        </extension>
        <extension url="name">
          <valueString
                       value="Encounters and Assessments with Hospice Patient"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Encounters and Assessments with Hospice Patient&quot;:
  &quot;Initial Population&quot; EligibleEncounters
    where Hospice.&quot;Has Hospice Services&quot;"/>
        </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="AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Denominator Exclusions"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Denominator Exclusions&quot;:
  &quot;Encounters and Assessments with Hospice Patient&quot;
    union Antibiotic.&quot;Has Comorbid Condition History&quot; ( &quot;Encounter with Upper Respiratory Infection&quot;, ( [Condition: &quot;Comorbid Conditions for Respiratory Conditions&quot;] ) )
    union Antibiotic.&quot;Has Antibiotic Medication History&quot; ( &quot;Encounter with Upper Respiratory Infection&quot;, ( [MedicationRequest: &quot;Antibiotic Medications for Upper Respiratory Infection&quot;] ) )
    union Antibiotic.&quot;Has Competing Diagnosis History&quot; ( &quot;Encounter with Upper Respiratory Infection&quot;, ( [Condition: &quot;Competing Conditions for Respiratory Conditions&quot;]
        union [Condition: &quot;Acute Pharyngitis&quot;]
        union [Condition: &quot;Acute Tonsillitis&quot;]
    ) )"/>
        </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="Status"/>
        </extension>
        <extension url="name">
          <valueString value="isEncounterPerformed"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//Encounter, Performed
//General usage unless required otherwise by measure intent (e.g., follow-up encounters)
define fluent function isEncounterPerformed(Enc List&lt;Encounter&gt;):
  Enc E
    where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}"/>
        </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="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="12"/>
        </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="toInterval"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval&lt;DateTime&gt;, or Interval&lt;Quantity&gt; types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval&lt;DateTime&gt; or Interval&lt;Quantity&gt;.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice&lt;DateTime, Quantity, Interval&lt;DateTime&gt;, Interval&lt;Quantity&gt;, Timing&gt;):
  case
	  when choice is DateTime then
    	Interval[choice as DateTime, choice as DateTime]
		when choice is Interval&lt;DateTime&gt; then
  		choice as Interval&lt;DateTime&gt;
		when choice is Quantity then
		  Interval[Patient.birthDate + (choice as Quantity),
			  Patient.birthDate + (choice as Quantity) + 1 year)
		when choice is Interval&lt;Quantity&gt; then
		  Interval[Patient.birthDate + (choice.low as Quantity),
			  Patient.birthDate + (choice.high as Quantity) + 1 year)
		when choice is Timing then
      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval&lt;DateTime&gt;
		else
			null as Interval&lt;DateTime&gt;
	end"/>
        </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="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 ~ &quot;active&quot;
  or condition.clinicalStatus ~ &quot;recurrence&quot;
  or condition.clinicalStatus ~ &quot;relapse&quot; 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="14"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="Status"/>
        </extension>
        <extension url="name">
          <valueString value="isMedicationOrder"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//Medication, Order: active and completed only
define fluent function isMedicationOrder(MedicationRequest List&lt;MedicationRequest&gt;):
  MedicationRequest M
    where M.status in { 'active', 'completed' }
      and M.intent = 'order'"/>
        </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="Status"/>
        </extension>
        <extension url="name">
          <valueString value="isAssessmentPerformed"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA.

//Assessment, Performed
define fluent function isAssessmentPerformed(Obs List&lt;Observation&gt;):
  Obs O
    where O.status in { 'final', 'amended', 'corrected' }
          and exists ( O.category ObservationCategory
          where ( ObservationCategory ) ~ &quot;survey&quot;
      )"/>
        </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="Status"/>
        </extension>
        <extension url="name">
          <valueString value="isInterventionOrder"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//Intervention, Order: active and completed only    
define fluent function isInterventionOrder(ServiceRequest List&lt;ServiceRequest&gt;):
  ServiceRequest S
    where S.status in { 'active', 'completed' }
      and S.intent = 'order'"/>
        </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="Status"/>
        </extension>
        <extension url="name">
          <valueString value="isInterventionPerformed"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="//Intervention, Performed
define fluent function isInterventionPerformed(Proc List&lt;Procedure&gt;):
  Proc P
    where P.status ~ 'completed'"/>
        </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="Antibiotic"/>
        </extension>
        <extension url="name">
          <valueString value="Has Comorbid Condition History"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define function &quot;Has Comorbid Condition History&quot;(episodeDate List&lt;Encounter&gt;, comorbidConditions List&lt;Condition&gt;):
  episodeDate eDate
      with comorbidConditions comcondition
        such that date from start of comcondition.prevalenceInterval() during Interval[date from start of eDate.period.toInterval() - 1 year, date from start of eDate.period.toInterval()]
      return eDate"/>
        </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="Antibiotic"/>
        </extension>
        <extension url="name">
          <valueString value="Has Antibiotic Medication History"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define function &quot;Has Antibiotic Medication History&quot;(episodeDate List&lt;Encounter&gt;, antibioticMedications List&lt;MedicationRequest&gt;):
   episodeDate DateOfEpisode
    with antibioticMedications ActiveMedication
      such that ActiveMedication.medicationRequestPeriod() overlaps day of Interval[date from start of DateOfEpisode.period.toInterval()  - 30 days, date from start of DateOfEpisode.period.toInterval() - 1 day]"/>
        </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="CumulativeMedicationDuration"/>
        </extension>
        <extension url="name">
          <valueString value="medicationRequestPeriod"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define fluent function medicationRequestPeriod(Request &quot;MedicationRequest&quot;):
  Request R
    let
      dosage: singleton from R.dosageInstruction,
      doseAndRate: singleton from dosage.doseAndRate,
      timing: dosage.timing,
      frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),
      period: Quantity(timing.repeat.period, timing.repeat.periodUnit),
      doseRange: doseAndRate.dose,
      doseQuantity: doseAndRate.dose,
      dose: Coalesce(end of doseRange, doseQuantity),
      dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),
      boundsPeriod: timing.repeat.bounds as Interval&lt;DateTime&gt;,
      daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value,
      quantity: R.dispenseRequest.quantity,
      refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),
      startDate:
        Coalesce(
          date from start of boundsPeriod,
          date from R.authoredOn,
          date from start of R.dispenseRequest.validityPeriod
        ),
      totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills)
    return
      if startDate is not null and totalDaysSupplied is not null then
        Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ]
      else if startDate is not null and boundsPeriod.&quot;high&quot; is not null then
        Interval[startDate, date from end of boundsPeriod]
      else
        null"/>
        </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="CumulativeMedicationDuration"/>
        </extension>
        <extension url="name">
          <valueString value="Quantity"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/**********************************************************************/
/* Functions in this region are copied from opioid-mme-r4             */
/**********************************************************************/

define function Quantity(value Decimal, unit String):
  if value is not null then
    System.Quantity { value: value, unit: unit }
  else
    null"/>
        </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="CumulativeMedicationDuration"/>
        </extension>
        <extension url="name">
          <valueString value="ToDaily"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
 Goal is to get to number of days
 Two broad approaches to the calculation:
  1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered
  2) Based on relevant period, determine a covered interval and calculate the length of that interval in days
This topic covers several use cases and illustrates how to calculate Cumulative
Medication Duration for each type of medication resource using the supply and
frequency approach.
*/

/*
  For the first approach, we need to get from frequency to a frequency/day
  So we define ToDaily
*/

/*
  Calculates daily frequency given frequency within a period
*/
define function ToDaily(frequency System.Integer, period System.Quantity):
  case period.unit
    when 'h' then frequency * (24.0 / period.value)
    when 'min' then frequency * (24.0 / period.value) * 60
    when 's' then frequency * (24.0 / period.value) * 60 * 60
    when 'd' then frequency * (24.0 / period.value) / 24
    when 'wk' then frequency * (24.0 / period.value) / (24 * 7)
    when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
    when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
    when 'hour' then frequency * (24.0 / period.value)
    when 'minute' then frequency * (24.0 / period.value) * 60
    when 'second' then frequency * (24.0 / period.value) * 60 * 60
    when 'day' then frequency * (24.0 / period.value) / 24
    when 'week' then frequency * (24.0 / period.value) / (24 * 7)
    when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
    when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
    when 'hours' then frequency * (24.0 / period.value)
    when 'minutes' then frequency * (24.0 / period.value) * 60
    when 'seconds' then frequency * (24.0 / period.value) * 60 * 60
    when 'days' then frequency * (24.0 / period.value) / 24
    when 'weeks' then frequency * (24.0 / period.value) / (24 * 7)
    when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
    when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
    else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' &amp; period.unit)
  end"/>
        </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="Antibiotic"/>
        </extension>
        <extension url="name">
          <valueString value="Has Competing Diagnosis History"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define function &quot;Has Competing Diagnosis History&quot;(episodeDate List&lt;Encounter&gt;, competingConditions List&lt;Condition&gt;):
  episodeDate eDate
      with competingConditions competcondition
        such that competcondition.prevalenceInterval() starts 3 days or less on or after day of start of eDate.period
      return eDate"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="24"/>
        </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 Status"/>
        <resource value="Library/Status|1.8.000"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library FHIRHelpers"/>
        <resource value="Library/FHIRHelpers|4.4.000"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library QICoreCommon"/>
        <resource value="Library/QICoreCommon|2.1.000"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library Hospice"/>
        <resource value="Library/Hospice|6.12.000"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library Antibiotic"/>
        <resource value="Library/Antibiotic|1.7.000"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library CMD"/>
        <resource value="Library/CumulativeMedicationDuration|4.1.000"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Code system CPT"/>
        <resource value="http://www.ama-assn.org/go/cpt"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Code system SNOMEDCT"/>
        <resource value="http://snomed.info/sct"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Code system ObservationCategoryCodes"/>
        <resource
                  value="http://terminology.hl7.org/CodeSystem/observation-category"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Code system LOINC"/>
        <resource value="http://loinc.org"/>
      </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 Home Healthcare Services"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Medical Disability Exam"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1073"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Office Visit"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Outpatient Consultation"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Preventive Care Services Group Counseling"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1027"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Preventive Care Services Individual Counseling"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1026"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Preventive Care Services, Initial Office Visit, 0 to 17"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Preventive Care, Established Office Visit, 0 to 17"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Preventive Care Services Established Office Visit, 18 and Up"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Preventive Care Services Initial Office Visit, 18 and Up"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Telephone Visits"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Virtual Encounter"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Upper Respiratory Infection"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1022"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Antibiotic Medications for Upper Respiratory Infection"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Encounter Inpatient"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Hospice Encounter"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Hospice Care Ambulatory"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Hospice Diagnosis"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Comorbid Conditions for Respiratory Conditions"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1025"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Competing Conditions for Respiratory Conditions"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1017"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Acute Pharyngitis"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Acute Tonsillitis"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012"/>
      </relatedArtifact>
      <parameter>
        <name value="Measurement Period"/>
        <use value="in"/>
        <min value="0"/>
        <max value="1"/>
        <type value="Period"/>
      </parameter>
      <parameter>
        <name value="ErrorLevel"/>
        <use value="in"/>
        <min value="0"/>
        <max value="1"/>
        <type value="string"/>
      </parameter>
      <parameter>
        <name value="Numerator"/>
        <use value="out"/>
        <min value="0"/>
        <max value="*"/>
        <type value="Resource"/>
      </parameter>
      <parameter>
        <name value="Stratification 3"/>
        <use value="out"/>
        <min value="0"/>
        <max value="*"/>
        <type value="Resource"/>
      </parameter>
      <parameter>
        <name value="Stratification 2"/>
        <use value="out"/>
        <min value="0"/>
        <max value="*"/>
        <type value="Resource"/>
      </parameter>
      <parameter>
        <name value="Stratification 1"/>
        <use value="out"/>
        <min value="0"/>
        <max value="*"/>
        <type value="Resource"/>
      </parameter>
      <parameter>
        <name value="Denominator"/>
        <use value="out"/>
        <min value="0"/>
        <max value="*"/>
        <type value="Resource"/>
      </parameter>
      <parameter>
        <name value="Initial Population"/>
        <use value="out"/>
        <min value="0"/>
        <max value="*"/>
        <type value="Resource"/>
      </parameter>
      <parameter>
        <name value="Denominator Exclusions"/>
        <use value="out"/>
        <min value="0"/>
        <max value="*"/>
        <type value="Resource"/>
      </parameter>
      <dataRequirement>
        <type value="Patient"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="period"/>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1073"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1027"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1026"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="hospitalization"/>
        <mustSupport value="hospitalization.dischargeDisposition"/>
        <mustSupport value="period"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Condition"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
        <mustSupport value="code"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1022"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Condition"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
        <mustSupport value="code"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Condition"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
        <mustSupport value="code"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1025"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Condition"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
        <mustSupport value="code"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1017"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Condition"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
        <mustSupport value="code"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Condition"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
        <mustSupport value="code"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Medication"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
        <mustSupport value="id"/>
      </dataRequirement>
      <dataRequirement>
        <type value="Medication"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
        <mustSupport value="id"/>
      </dataRequirement>
      <dataRequirement>
        <type value="MedicationRequest"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"/>
        <mustSupport value="medication"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="intent"/>
        <mustSupport value="intent.value"/>
        <mustSupport value="authoredOn"/>
        <mustSupport value="authoredOn.value"/>
        <mustSupport value="dosageInstruction"/>
        <mustSupport value="dispenseRequest"/>
        <mustSupport value="dispenseRequest.expectedSupplyDuration"/>
        <mustSupport value="dispenseRequest.quantity"/>
        <mustSupport value="dispenseRequest.numberOfRepeatsAllowed"/>
        <mustSupport value="dispenseRequest.numberOfRepeatsAllowed.value"/>
        <mustSupport value="dispenseRequest.validityPeriod"/>
        <codeFilter>
          <path value="medication"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="MedicationRequest"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"/>
        <mustSupport value="medication.reference"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="intent"/>
        <mustSupport value="intent.value"/>
        <mustSupport value="authoredOn"/>
        <mustSupport value="authoredOn.value"/>
        <mustSupport value="dosageInstruction"/>
        <mustSupport value="dispenseRequest"/>
        <mustSupport value="dispenseRequest.expectedSupplyDuration"/>
        <mustSupport value="dispenseRequest.quantity"/>
        <mustSupport value="dispenseRequest.numberOfRepeatsAllowed"/>
        <mustSupport value="dispenseRequest.numberOfRepeatsAllowed.value"/>
        <mustSupport value="dispenseRequest.validityPeriod"/>
      </dataRequirement>
      <dataRequirement>
        <type value="Observation"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
        <mustSupport value="code"/>
        <mustSupport value="value"/>
        <mustSupport value="effective"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="category"/>
        <codeFilter>
          <path value="code"/>
          <code>
            <system value="http://loinc.org"/>
            <code value="45755-6"/>
            <display value="Hospice care [Minimum Data Set]"/>
          </code>
        </codeFilter>
        <codeFilter>
          <path value="value"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="ServiceRequest"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"/>
        <mustSupport value="code"/>
        <mustSupport value="authoredOn"/>
        <mustSupport value="authoredOn.value"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <mustSupport value="intent"/>
        <mustSupport value="intent.value"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Procedure"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
        <mustSupport value="code"/>
        <mustSupport value="performed"/>
        <mustSupport value="status"/>
        <mustSupport value="status.value"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"/>
        </codeFilter>
      </dataRequirement>
    </Library>
  </contained>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem">
    <valueReference>
      <reference value="Device/cqf-tooling"/>
    </valueReference>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements" id="effective-data-requirements">
    <valueReference>
      <reference value="#effective-data-requirements"/>
    </valueReference>
  </extension>
  <url
       value="https://madie.cms.gov/Measure/AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR"/>
  <identifier>
    <use value="usual"/>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
        <code value="short-name"/>
      </coding>
    </type>
    <system value="https://madie.cms.gov/measure/shortName"/>
    <value value="CMS154FHIR"/>
  </identifier>
  <identifier>
    <use value="official"/>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
        <code value="version-independent"/>
      </coding>
    </type>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:uuid:25892635-c2b4-4c29-a351-ef60797c3bd5"/>
  </identifier>
  <identifier>
    <use value="official"/>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
        <code value="version-specific"/>
      </coding>
    </type>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:uuid:d8161a82-9300-40d3-aeb0-c3aee7a48457"/>
  </identifier>
  <identifier>
    <use value="official"/>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
        <code value="publisher"/>
      </coding>
    </type>
    <system value="https://madie.cms.gov/measure/cmsId"/>
    <value value="154FHIR"/>
    <assigner>
      <display value="CMS"/>
    </assigner>
  </identifier>
  <version value="0.1.001"/>
  <name value="AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR"/>
  <title
         value="Appropriate Treatment for Upper Respiratory Infection (URI)FHIR"/>
  <status value="draft"/>
  <experimental value="false"/>
  <date value="2024-12-18T21:25:48+00:00"/>
  <publisher value="National Committee for Quality Assurance"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="https://www.ncqa.org/"/>
    </telecom>
  </contact>
  <description
               value="Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic order"/>
  <purpose value="UNKNOWN"/>
  <usage
         value="This is an episode of care measure that examines all eligible episodes for the patient.

This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 months of age and older with a diagnosis of upper respiratory infection from January 1 to December 28 of the measurement period.

This FHIR-based measure has been derived from the QDM-based measure: CMS154v13. 

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="This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2024 National Committee for Quality Assurance. All Rights Reserved.

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications.

CPT(R) codes, descriptions and other data are copyright 2024. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use.

Some measure specifications contain coding from LOINC(R) (http://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use.

This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. 

ICD-10 copyright 2024 World Health Organization. All Rights Reserved.

Some measures use RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the measures and does not endorse or recommend this or any other product.

“HL7” is the registered trademark of Health Level Seven International."/>
  <effectivePeriod>
    <start value="2025-01-01"/>
    <end value="2025-12-31"/>
  </effectivePeriod>
  <author>
    <name value="National Committee for Quality Assurance"/>
    <telecom>
      <system value="url"/>
      <value value="https://www.ncqa.org/"/>
    </telecom>
  </author>
  <library
           value="https://madie.cms.gov/Library/AppropriateTreatmentforUpperRespiratoryInfectionURIFHIR"/>
  <disclaimer
              value="The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.
 
Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]."/>
  <scoring>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
      <code value="proportion"/>
      <display value="Proportion"/>
    </coding>
  </scoring>
  <rationale
             value="Most URI, also known as the common cold, are caused by viruses that require no antibiotic treatment. Too often, antibiotics are prescribed inappropriately, which can lead to antibiotic resistance (when antibiotics can no longer cure bacterial infections). In the United States, at least 2.8 million antibiotic-resistant illnesses and 35,000 deaths occur each year (Centers for Disease Control and Prevention [CDC], 2020)."/>
  <clinicalRecommendationStatement
                                   value="American Family Physician (Fashner, Ericson, &amp; Werner, 2012) 

- Antibiotics should not be used for the treatment of cold symptoms in children or adults. (A) 

- Nonsteroidal anti-inflammatory drugs reduce pain secondary to upper respiratory tract infection in adults. (A) 

- Decongestants, antihistamine/decongestant combinations, and intranasal ipratropium (Atrovent) may improve cold symptoms in adults. (B)

Institute for Clinical Systems Improvement (ICSI) (Short et al., 2017)
The ICSI work group does not recommend antibiotics for treatment of common cold symptoms in children and adults."/>
  <group id="661d86660f0a9077c1d5a582">
    <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="6DBE917A-E110-4517-82A0-29C307A751A0">
      <code>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="initial-population"/>
          <display value="Initial Population"/>
        </coding>
      </code>
      <description
                   value="Outpatient visits, telephone visits, virtual encounter (i.e., e-visit or virtual check-in), or emergency department visits with a diagnosis of URI from January 1 to December 28 of the measurement period for patients 3 months of age and older"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Initial Population"/>
      </criteria>
    </population>
    <population id="AC6DDEB9-AD25-459F-B145-66B89BF57BE8">
      <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="0B689432-9ECE-4091-B1F8-2D6E134D5110">
      <code>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="denominator-exclusion"/>
          <display value="Denominator Exclusion"/>
        </coding>
      </code>
      <description
                   value="Exclude URI episodes when the patient had hospice care for any part of the measurement period.

Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. 

Exclude URI episodes where the patient is taking antibiotics in the 30 days prior to the episode date.

Exclude URI episodes where the patient had competing diagnosis on or three days after the episode date."/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Denominator Exclusions"/>
      </criteria>
    </population>
    <population id="D321AC3A-81D1-43FE-8787-87AA0D0EB6B4">
      <code>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="numerator"/>
          <display value="Numerator"/>
        </coding>
      </code>
      <description
                   value="URI episodes without a prescription for antibiotic medication on or three days after the outpatient visit, telephone visit, virtual encounter, or emergency department visit for an upper respiratory infection"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Numerator"/>
      </criteria>
    </population>
    <stratifier id="6fddfab7-ee36-4e97-9859-09f0abfabfeb">
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-population"/>
            <code value="initial-population"/>
            <display value="Initial Population"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <description value="3 months-17 years"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Stratification 1"/>
      </criteria>
    </stratifier>
    <stratifier id="863976f9-0817-4734-bda3-19e3fadf951d">
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-population"/>
            <code value="initial-population"/>
            <display value="Initial Population"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <description value="18-64 years"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Stratification 2"/>
      </criteria>
    </stratifier>
    <stratifier id="7c5d99f3-6bb1-4528-a575-fa77e1113c0d">
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/measure-population"/>
            <code value="initial-population"/>
            <display value="Initial Population"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <description value="65 years and older"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Stratification 3"/>
      </criteria>
    </stratifier>
  </group>
</Measure>