eCQM QICore Content Implementation Guide
2024.0.0 - CI Build
eCQM QICore Content Implementation Guide
2024.0.0 - CI Build
eCQM QICore Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2024.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/ecqm-content-qicore-2024/ and changes regularly. See the Directory of published versions
| Draft as of 2024-12-18 |
<Measure xmlns="http://hl7.org/fhir">
<id value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
<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;">Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF less than or equal to 40%)FHIR</td>
</tr>
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">0.2.000</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="Measure-CADBetaBlockerTherapyPriorMIorLVSDFHIR.html">Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF less than or equal to 40%)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>CMS145FHIR</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:466e5d36-1e01-478b-9dcb-edac33594dd5</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:b4533eba-331a-4cb7-88b3-6f2d07e225e9</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
endorser (CMS Consensus Based Entity) identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>0070e</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>145FHIR</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;">American Heart Association</td>
</tr>
<tr>
<th scope="row"><b>Author: </b></th>
<td style="padding-left: 4px;">American Heart Association, American Medical Association (AMA), American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)</td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;"><div><p>Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior left ventricular ejection fraction (LVEF) <=40% who were prescribed beta-blocker therapy</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>Copyright 2024 American College of Cardiology and American Heart Association. All Rights Reserved.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Disclaimer: </b></th>
<td style="padding-left: 4px;"><div><p>The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.</p>
<p>The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, 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.</p>
<p>Commercial uses of the Measure require a license agreement between the user and the American College of Cardiology (ACC) or the American Heart Association (AHA). Neither the ACC, nor AHA, nor their members shall be responsible for any use of the Measure.</p>
<p>ACC and AHA encourage use of the Measure by other health care professionals, where appropriate.</p>
<p>THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.</p>
<p>Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The ACC and AHA and their members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications.</p>
<p>CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) is copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2023 World Health Organization. All Rights Reserved.</p>
<p>The American Medical Association’s and the PCPI(R) Foundation’s significant past efforts and contributions to the performance measure are gratefully acknowledged.</p>
<p>Due to technical limitations, registered trademarks are indicated by (R) or [R].</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>For patients with coronary artery disease (CAD), beta-blockers are recommended for 3 years after myocardial infarction or acute coronary syndrome. Beta-blockers, particularly carvedilol, metoprolol succinate, or bisoprolol which have been shown to reduce risk of death, are recommended indefinitely for patients with CAD and LV systolic dysfunction. These agents have proven efficacy in reducing angina onset and improving the ischemic threshold during exercise. In patients who have suffered an MI, beta-blockers significantly reduce deaths and recurrent MIs (Fihn et al., 2012).</p>
<p>Nonadherence to cardioprotective medications is prevalent among outpatients with CAD and can be associated with a broad range of adverse outcomes, including all-cause and cardiovascular mortality, cardiovascular hospitalizations, and the need for revascularization procedures (Gibbons et al., 2002).</p>
<p>This measure is intended to promote beta-blocker usage in select patients with CAD.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Clinical recommendation statement: </b></th>
<td style="padding-left: 4px;"><div><p>Beta-blocker therapy should be started and continued for 3 years in all patients with normal LV function after MI or acute coronary syndrome (ACS) (Class I, Level of Evidence: B) (Fihn et al., 2012).</p>
<p>Beta-blocker therapy should be used in all patients with LV systolic dysfunction (EF <= 40%) with heart failure or prior MI, unless contraindicated. (Use should be limited to carvedilol, metoprolol succinate, or bisoprolol, which have been shown to reduce risk of death.) (Class I, Level of Evidence: A) (Fihn et al., 2012).</p>
<p>In patients with chronic coronary disease (CCD) and LVEF ≤40% with or without previous MI, the use of beta-blocker therapy is recommended to reduce the risk of future Major Adverse Cardiac Events (MACE), including cardiovascular death. (Class 1, Level of Evidence: A) (Virani et al., 2023)</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Guidance (Usage): </b></th>
<td style="padding-left: 4px;">Beta-blocker therapy:
- For patients with prior MI, beta-blocker therapy includes any agent within the beta-blocker drug class. As of 2015, no recommendations or evidence are cited in current stable ischemic heart disease guidelines for preferential use of specific agents.
- For patients with prior LVEF <=40%, beta-blocker therapy includes the following: bisoprolol, carvedilol, or sustained release metoprolol succinate.
The requirement of two or more visits is to establish that the eligible clinician has an existing relationship with the patient.
A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than or equal to 40% threshold noted in the denominator logic. A range that is greater than 40% would not meet the measure requirement.
In order for the Ejection Fraction result pathway to be recognized as below 40%, the result must be reported as a number with unit of %. A text string of "below 40%" or "ejection fraction between 35 and 40%" will not be recognized through electronic data capture. Although, this criteria can also be met using the Diagnosis pathway if specified as "Moderate or Severe."
If a patient has had a myocardial infarction (MI) within the past 3 years and a current or prior LVEF <=40% (or moderate or severe LVSD), the patient should only be counted in Population Criteria 1.
This eCQM is a patient-based measure.
This FHIR-based measure has been derived from the QDM-based measure: CMS145v13.
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>6643a4bda7a1805d3b73744c</b></th>
</tr>
<tr>
<td>Initial Population:</td>
<td>All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of coronary artery disease</td>
</tr>
<tr>
<td>Denominator:</td>
<td>Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <=40%</td>
</tr>
<tr>
<td>Numerator:</td>
<td>Patients who were prescribed beta-blocker therapy</td>
</tr>
<tr>
<td>Denominator Exception:</td>
<td>Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., arrhythmia, asthma, bradycardia, hypotension, patients with atrioventricular block without cardiac pacer, observation of consecutive heart rates <50, allergy, intolerance, other medical reasons).
Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons).</td>
</tr>
</table>
<table class="grid-dict">
<tr>
<th><b>6643a4bda7a1805d3b73744d</b></th>
</tr>
<tr>
<td>Initial Population:</td>
<td>All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of coronary artery disease</td>
</tr>
<tr>
<td>Denominator:</td>
<td>Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <=40%</td>
</tr>
<tr>
<td>Numerator:</td>
<td>Patients who were prescribed beta-blocker therapy</td>
</tr>
<tr>
<td>Denominator Exception:</td>
<td>Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., arrhythmia, asthma, bradycardia, hypotension, patients with atrioventricular block without cardiac pacer, observation of consecutive heart rates <50, allergy, intolerance, other medical reasons).
Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons).</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b> Supplemental Data Elements: </b></th>
<td style="padding-left: 4px;">
<p>SDE Sex</p>
<p>SDE Race</p>
<p>SDE Payer</p>
<p>SDE Ethnicity</p>
</td>
</tr>
<tr>
<th scope="row">
<b> Supplemental Data Guidance
: </b></th>
<td style="padding-left: 4px;"> For every patient evaluated by this measure also identify payer, race, ethnicity and sex </td>
</tr>
<tr>
<th scope="row"><b>Libraries: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td><a href="Library-CADBetaBlockerTherapyPriorMIorLVSDFHIR.html">CADBetaBlockerTherapyPriorMIorLVSDFHIR</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Terminology and Other Dependencies: </b></th>
<td style="padding-left: 4px;">
<li><code>Library/SupplementalDataElements|3.5.000</code></li>
<li><code>Library/FHIRHelpers|4.4.000</code></li>
<li><code>Library/AHAOverall|2.8.000</code></li>
<li><code>Library/QICoreCommon|2.1.000</code></li>
<li><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">AdministrativeGender</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html">Condition Clinical Status Codes</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-condition-ver-status.html">ConditionVerificationStatus</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-allergyintolerance-clinical.html">AllergyIntolerance Clinical Status Codes</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/2.16.840.1.113883.3.464.1003.101.12.1012/expansion">Nursing Facility Visit</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1014/expansion">Care Services in Long-Term Residential Facility</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/2.16.840.1.113883.3.526.3.1012/expansion">Patient Provider Interaction</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.369/expansion">Coronary Artery Disease No MI</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.371/expansion">Cardiac Surgery</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.403/expansion">Myocardial Infarction</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1134/expansion">Ejection Fraction</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1090/expansion">Moderate or Severe LVSD</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1092/expansion">Moderate or Severe</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.366/expansion">Arrhythmia</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.362/expansion">Asthma</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.412/expansion">Bradycardia</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.370/expansion">Hypotension</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1493/expansion">Beta Blocker Therapy Ingredient</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1177/expansion">Allergy to Beta Blocker Therapy</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1178/expansion">Intolerance to Beta Blocker Therapy</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.367/expansion">Atrioventricular Block</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.368/expansion">Cardiac Pacer in Situ</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1178.53/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.53</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1184/expansion">Beta Blocker Therapy for LVSD</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1174/expansion">Beta Blocker Therapy</a></li>
</td>
</tr>
<tr>
<th scope="row"><b>Parameters:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>name</b></th>
<th><b>use</b></th>
<th><b>min</b></th>
<th><b>max</b></th>
<th><b>type</b></th>
</tr>
<tr>
<td>Measurement Period</td>
<td>In</td>
<td>0</td>
<td>1</td>
<td>Period</td>
</tr>
<tr>
<td>SDE Sex</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>Coding</td>
</tr>
<tr>
<td>Denominator 2</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
<tr>
<td>Denominator Exceptions 1</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
<tr>
<td>Numerator 1</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
<tr>
<td>SDE Payer</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Numerator 2</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
<tr>
<td>Initial Population</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
<tr>
<td>SDE Ethnicity</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>Resource</td>
</tr>
<tr>
<td>Denominator Exceptions 2</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
<tr>
<td>SDE Race</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>Resource</td>
</tr>
<tr>
<td>Denominator 1</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>DataRequirements:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>Resource Type</b></th>
<th><b>Resource Elements</b></th>
<th><b>Valueset Name</b></th>
<th><b>Valueset</b></th>
</tr>
<tr>
<td>Patient(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a>)</td>
<td>
ethnicity
race
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
id
id.value
</td>
<td>
Patient Provider Interaction
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1012/expansion">Patient Provider Interaction</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
id
id.value
</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
period
status
status.value
id
id.value
</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
period
status
status.value
id
id.value
</td>
<td>
Care Services in Long Term Residential Facility
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1014/expansion">Care Services in Long-Term Residential Facility</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
id
id.value
</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
period
status
status.value
id
id.value
</td>
<td>
Nursing Facility Visit
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1012/expansion">Nursing Facility Visit</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Coronary Artery Disease No MI
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.369/expansion">Coronary Artery Disease No MI</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
severity
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Moderate or Severe LVSD
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1090/expansion">Moderate or Severe LVSD</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>
Myocardial Infarction
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.403/expansion">Myocardial Infarction</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>
Arrhythmia
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.366/expansion">Arrhythmia</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>
Asthma
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.362/expansion">Asthma</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>
Bradycardia
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.412/expansion">Bradycardia</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>
Hypotension
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.370/expansion">Hypotension</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Allergy to Beta Blocker Therapy
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1177/expansion">Allergy to Beta Blocker Therapy</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>
Intolerance to Beta Blocker Therapy
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1178/expansion">Intolerance to Beta Blocker Therapy</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>
Atrioventricular Block
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.367/expansion">Atrioventricular Block</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>
Cardiac Pacer in Situ
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.368/expansion">Cardiac Pacer in Situ</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>
Cardiac Surgery
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.371/expansion">Cardiac Surgery</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
</td>
<td>
Cardiac Pacer
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1178.53/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.53</a></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
status
status.value
</td>
<td>
Ejection Fraction
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1134/expansion">Ejection Fraction</a></td>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/R4/heartrate.html">Observation Heart Rate Profile</a>)</td>
<td>
effective
value
status
status.value
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>AllergyIntolerance(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-allergyintolerance.html">QICoreAllergyIntolerance</a>)</td>
<td>
code
</td>
<td>
Beta Blocker Therapy Ingredient
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1493/expansion">Beta Blocker Therapy Ingredient</a></td>
</tr>
<tr>
<td>AllergyIntolerance(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-allergyintolerance.html">QICoreAllergyIntolerance</a>)</td>
<td>
code
</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
dosageInstruction
status
status.value
intent
intent.value
</td>
<td>
Beta Blocker Therapy for LVSD
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1184/expansion">Beta Blocker Therapy for LVSD</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
dosageInstruction
status
status.value
intent
intent.value
</td>
<td>
Beta Blocker Therapy
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1174/expansion">Beta Blocker Therapy</a></td>
</tr>
<tr>
<td>Coverage(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html">QICoreCoverage</a>)</td>
<td>
type
period
</td>
<td>
Payer Type
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Direct Reference Codes:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>display</b></th>
<th><b>code</b></th>
<th><b>system</b></th>
</tr>
<tr>
<td>Male</td>
<td>M</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">http://hl7.org/fhir/administrative-gender</a></td>
</tr>
<tr>
<td>Female</td>
<td>F</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">http://hl7.org/fhir/administrative-gender</a></td>
</tr>
<tr>
<td>Active</td>
<td>active</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
</tr>
<tr>
<td>Recurrence</td>
<td>recurrence</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
</tr>
<tr>
<td>Relapse</td>
<td>relapse</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
</tr>
<tr>
<td>Confirmed</td>
<td>confirmed</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-condition-ver-status.html">http://terminology.hl7.org/CodeSystem/condition-ver-status</a></td>
</tr>
<tr>
<td>Left ventricular systolic dysfunction (disorder)</td>
<td>134401001</td>
<td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
</tr>
<tr>
<td>Substance with beta adrenergic receptor antagonist mechanism of action (substance)</td>
<td>373254001</td>
<td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
</tr>
<tr>
<td>Active</td>
<td>active</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-allergyintolerance-clinical.html">http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical</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> 6643a4bda7a1805d3b73744c </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;">This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes:
- Population 1: Patients with left ventricular systolic dysfunction (LVEF <=40%)
- Population 2: Patients with a prior (within the past 3 years) myocardial infarction
For the purposes of this measure, a single performance rate can be calculated as follows:
Performance Rate = (Numerator 1 + Numerator 2)/ [(Denominator 1 - Denominator Exceptions 1) + (Denominator 2 - Denominator Exceptions 2)]</td>
</tr>
<tr>
<th scope="row"><b>Improvement Notation: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>Increased score indicates improvement </span>
</p>
</td>
</tr>
</td>
<tr>
<td/>
<td/>
<td>Initial Population</td>
<td>
<pre><code class="language-cql">define "Initial Population":
AgeInYearsAt(date from start of "Measurement Period") >= 18
and exists ( "Qualifying Encounter During Measurement Period" Encounter1
with "Qualifying Encounter During Measurement Period" Encounter2
such that Encounter2.id !~ Encounter1.id
)
and exists "Qualifying CAD Encounter"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator</td>
<td>
<pre><code class="language-cql">define "Denominator 1":
"Initial Population"
and exists "Qualifying CAD Encounter and History of Moderate or Severe LVSD"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator</td>
<td>
<pre><code class="language-cql">define "Numerator 1":
"Has Beta Blocker Therapy for LVSD Ordered"
or "Is Currently Taking Beta Blocker Therapy for LVSD"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exception</td>
<td>
<pre><code class="language-cql">/*
@commentedOut: "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
@commentedOutReason: Negation issue noted in https://github.com/cqframework/cql-execution/issues/296, which is tied to https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1455
*/
define "Denominator Exceptions 1":
"Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
//or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
or "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer"</code></pre>
</td>
</tr>
<td> 6643a4bda7a1805d3b73744d </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;">This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes:
- Population 1: Patients with left ventricular systolic dysfunction (LVEF <=40%)
- Population 2: Patients with a prior (within the past 3 years) myocardial infarction
For the purposes of this measure, a single performance rate can be calculated as follows:
Performance Rate = (Numerator 1 + Numerator 2)/ [(Denominator 1 - Denominator Exceptions 1) + (Denominator 2 - Denominator Exceptions 2)]</td>
</tr>
<tr>
<th scope="row"><b>Improvement Notation: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>Increased score indicates improvement </span>
</p>
</td>
</tr>
</td>
<tr>
<td/>
<td/>
<td>Initial Population</td>
<td>
<pre><code class="language-cql">define "Initial Population":
AgeInYearsAt(date from start of "Measurement Period") >= 18
and exists ( "Qualifying Encounter During Measurement Period" Encounter1
with "Qualifying Encounter During Measurement Period" Encounter2
such that Encounter2.id !~ Encounter1.id
)
and exists "Qualifying CAD Encounter"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator</td>
<td>
<pre><code class="language-cql">define "Denominator 2":
"Initial Population"
and exists "Qualifying CAD Encounter and Prior MI"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator</td>
<td>
<pre><code class="language-cql">define "Numerator 2":
"Has Beta Blocker Therapy Ordered"
or "Is Currently Taking Beta Blocker Therapy"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exception</td>
<td>
<pre><code class="language-cql">/*
@commentedOut: "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
@commentedOutReason: Negation issue noted in https://github.com/cqframework/cql-execution/issues/296, which is tied to https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1455
*/
define "Denominator Exceptions 2":
"Has Arrhythmia with Qualifying CAD Encounter and Prior MI"
or "Has Asthma with Qualifying CAD Encounter and Prior MI"
or "Has Bradycardia with Qualifying CAD Encounter and Prior MI"
or "Has Hypotension with Qualifying CAD Encounter and Prior MI"
or "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI"
or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI"
or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI"
//or "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
or "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer"</code></pre>
</td>
</tr>
</tr>
</table>
<table class="grid-dict">
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Sex</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Sex":
case
when Patient.gender = 'male' then "M"
when Patient.gender = 'female' then "F"
else null
end</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>SDE Sex</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Sex":
SDE."SDE Sex"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Qualifying Encounter During Measurement Period</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Qualifying Encounter During Measurement Period":
( [Encounter: "Office Visit"]
union [Encounter: "Outpatient Consultation"]
union [Encounter: "Nursing Facility Visit"]
union [Encounter: "Care Services in Long Term Residential Facility"]
union [Encounter: "Home Healthcare Services"]
union [Encounter: "Patient Provider Interaction"] ) ValidEncounter
where ValidEncounter.period during day of "Measurement Period"
and ValidEncounter.status = 'finished'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Outpatient Encounter During Measurement Period</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Outpatient Encounter During Measurement Period":
( [Encounter: "Office Visit"]
union [Encounter: "Outpatient Consultation"]
union [Encounter: "Care Services in Long Term Residential Facility"]
union [Encounter: "Home Healthcare Services"]
union [Encounter: "Nursing Facility Visit"] ) QualifyingEncounter
where QualifyingEncounter.period during day of "Measurement Period"
and QualifyingEncounter.status = 'finished'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Coronary Artery Disease Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Coronary Artery Disease Encounter":
"Outpatient Encounter During Measurement Period" ValidQualifyingEncounter
with [Condition: "Coronary Artery Disease No MI"] CoronaryArteryDisease
such that CoronaryArteryDisease.overlapsDayOfEncounter ( ValidQualifyingEncounter )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>History of Cardiac Surgery Prior to Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "History of Cardiac Surgery Prior to Encounter":
"Outpatient Encounter During Measurement Period" ValidQualifyingEncounter
with [Procedure: "Cardiac Surgery"] CardiacSurgery
such that CardiacSurgery.performed.toInterval ( ) starts before end of ValidQualifyingEncounter.period
and CardiacSurgery.status = 'completed'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Qualifying CAD Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Qualifying CAD Encounter":
"Coronary Artery Disease Encounter"
union "History of Cardiac Surgery Prior to Encounter"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Initial Population</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Initial Population":
AgeInYearsAt(date from start of "Measurement Period") >= 18
and exists ( "Qualifying Encounter During Measurement Period" Encounter1
with "Qualifying Encounter During Measurement Period" Encounter2
such that Encounter2.id !~ Encounter1.id
)
and exists "Qualifying CAD Encounter"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AHAOverall</td>
<td>Moderate or Severe LVSD Findings</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns a union of the following:
* Observations where the final, amended or correction ejection fraction result is <= 40
* Moderate or Severe LVSD conditions where the diagnosis has been confirmed as active
*/
define "Moderate or Severe LVSD Findings":
( [Observation: "Ejection Fraction"] EjectionFraction
where EjectionFraction.value as Quantity <= 40 '%'
and EjectionFraction.status in {'final', 'amended', 'corrected'}
)
union (
( [Condition: "Moderate or Severe LVSD"]
union ( [Condition: "Left ventricular systolic dysfunction (disorder)"] LVSDDiagnosis
where LVSDDiagnosis.severity in "Moderate or Severe" )
) ModerateOrSevereLVSD
where ModerateOrSevereLVSD.isConfirmedActiveDiagnosis()
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Qualifying CAD Encounter and Prior MI</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Qualifying CAD Encounter and Prior MI":
"Qualifying CAD Encounter" EncounterWithCADProxy
with [Condition: "Myocardial Infarction"] MyocardialInfarction
such that MyocardialInfarction.prevalenceInterval ( ) starts 3 years or less before day of start of EncounterWithCADProxy.period
and not exists AHA."Moderate or Severe LVSD Findings"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Denominator 2</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator 2":
"Initial Population"
and exists "Qualifying CAD Encounter and Prior MI"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Qualifying CAD Encounter and History of Moderate or Severe LVSD</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Qualifying CAD Encounter and History of Moderate or Severe LVSD":
"Qualifying CAD Encounter" EncounterWithCADProxy
with AHA."Moderate or Severe LVSD Findings" LVSDFindings
such that Coalesce(LVSDFindings.prevalenceInterval(), LVSDFindings.effective.toInterval()) starts before end of EncounterWithCADProxy.period</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [Condition: "Arrhythmia"] ArrhythmiaDiagnosis
where ArrhythmiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [Condition: "Asthma"] AsthmaDiagnosis
where AsthmaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [Condition: "Bradycardia"] BradycardiaDiagnosis
where BradycardiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [Condition: "Hypotension"] HypotensionDiagnosis
where HypotensionDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
* @code: Heart rate - 8867-4
* @profile: http://hl7.org/fhir/StructureDefinition/heartrate
*/
define "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( from
["observation-heartrate"] HeartRate,
"Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
let PriorHeartRate: Last(["observation-heartrate"] MostRecentPriorHeartRate
where MostRecentPriorHeartRate.effective.toInterval() during CADEncounterModerateOrSevereLVSD.period
and MostRecentPriorHeartRate.effective.toInterval() before HeartRate.effective.toInterval()
sort by start of effective.toInterval()
)
where HeartRate.effective.toInterval ( ) during CADEncounterModerateOrSevereLVSD.period
and HeartRate.value < 50 '/min'
and PriorHeartRate.value < 50 '/min'
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( ( [AllergyIntolerance: "Beta Blocker Therapy Ingredient"]
union [AllergyIntolerance: "Substance with beta adrenergic receptor antagonist mechanism of action (substance)"] ) BetaBlockerAllergyIntolerance
where BetaBlockerAllergyIntolerance.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( ( [Condition: "Allergy to Beta Blocker Therapy"]
union [Condition: "Intolerance to Beta Blocker Therapy"] ) BetaBlockerAllergyOrIntoleranceDiagnosis
where BetaBlockerAllergyOrIntoleranceDiagnosis.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [Condition: "Atrioventricular Block"] AtrioventricularBlock
where AtrioventricularBlock.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and History of Moderate or Severe LVSD</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [Condition: "Cardiac Pacer in Situ"] CardiacPacerDiagnosis
where CardiacPacerDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and History of Moderate or Severe LVSD</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [Procedure: "Cardiac Pacer"] ImplantedCardiacPacer
with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
such that ImplantedCardiacPacer.performed.toInterval ( ) starts before end of CADEncounterModerateOrSevereLVSD.period
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer":
"Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
and not "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
and not "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and History of Moderate or Severe LVSD"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Denominator Exceptions 1</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@commentedOut: "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
@commentedOutReason: Negation issue noted in https://github.com/cqframework/cql-execution/issues/296, which is tied to https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1455
*/
define "Denominator Exceptions 1":
"Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
//or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
or "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Beta Blocker Therapy for LVSD Ordered</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Beta Blocker Therapy for LVSD Ordered":
exists ( [MedicationRequest: medication in "Beta Blocker Therapy for LVSD"] BetaBlockerForLVSDOrdered
where BetaBlockerForLVSDOrdered.authoredDuringDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Is Currently Taking Beta Blocker Therapy for LVSD</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Is Currently Taking Beta Blocker Therapy for LVSD":
exists ( [MedicationRequest: medication in "Beta Blocker Therapy for LVSD"] ActiveBetaBlockerForLVSD
with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
such that First((collapse(ActiveBetaBlockerForLVSD.dosageInstruction.timing.repeat.bounds DoseTime
return DoseTime.toInterval()
)) DrugPeriod
sort by start of $this
) overlaps after day of CADEncounterModerateOrSevereLVSD.period
where ActiveBetaBlockerForLVSD.status in { 'active', 'completed' }
and ActiveBetaBlockerForLVSD.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Numerator 1</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Numerator 1":
"Has Beta Blocker Therapy for LVSD Ordered"
or "Is Currently Taking Beta Blocker Therapy for LVSD"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Payer</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Payer":
[Coverage: type in "Payer Type"] Payer
return {
code: Payer.type,
period: Payer.period
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>SDE Payer</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Payer":
SDE."SDE Payer"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Beta Blocker Therapy Ordered</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Beta Blocker Therapy Ordered":
exists ( [MedicationRequest: medication in "Beta Blocker Therapy"] BetaBlockerOrdered
where BetaBlockerOrdered.authoredDuringDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Is Currently Taking Beta Blocker Therapy</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Is Currently Taking Beta Blocker Therapy":
exists ( [MedicationRequest: medication in "Beta Blocker Therapy"] ActiveBetaBlocker
with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
such that First((collapse(ActiveBetaBlocker.dosageInstruction.timing.repeat.bounds DoseTime
return DoseTime.toInterval()
)) DrugPeriod
sort by start of $this
) overlaps after day of CADEncounterMI.period
where ActiveBetaBlocker.status in { 'active', 'completed' }
and ActiveBetaBlocker.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Numerator 2</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Numerator 2":
"Has Beta Blocker Therapy Ordered"
or "Is Currently Taking Beta Blocker Therapy"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Ethnicity</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Ethnicity":
Patient.ethnicity E
return Tuple {
codes: { E.ombCategory } union E.detailed,
display: E.text
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>SDE Ethnicity</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Ethnicity":
SDE."SDE Ethnicity"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Arrhythmia with Qualifying CAD Encounter and Prior MI</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Arrhythmia with Qualifying CAD Encounter and Prior MI":
exists ( [Condition: "Arrhythmia"] ArrhythmiaDiagnosis
where ArrhythmiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Asthma with Qualifying CAD Encounter and Prior MI</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Asthma with Qualifying CAD Encounter and Prior MI":
exists ( [Condition: "Asthma"] AsthmaDiagnosis
where AsthmaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Bradycardia with Qualifying CAD Encounter and Prior MI</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Bradycardia with Qualifying CAD Encounter and Prior MI":
exists ( [Condition: "Bradycardia"] BradycardiaDiagnosis
where BradycardiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Hypotension with Qualifying CAD Encounter and Prior MI</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Hypotension with Qualifying CAD Encounter and Prior MI":
exists ( [Condition: "Hypotension"] HypotensionDiagnosis
where HypotensionDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
* @code: Heart rate - 8867-4
* @profile: http://hl7.org/fhir/StructureDefinition/heartrate
*/
define "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI":
exists ( from
["observation-heartrate"] HeartRate,
"Qualifying CAD Encounter and Prior MI" CADEncounterMI
let PriorHeartRate: Last(["observation-heartrate"] MostRecentPriorHeartRate
where MostRecentPriorHeartRate.effective.toInterval() during CADEncounterMI.period
and MostRecentPriorHeartRate.status in { 'final', 'amended', 'corrected' }
and MostRecentPriorHeartRate.effective.toInterval() before HeartRate.effective.toInterval()
sort by start of effective.toInterval()
)
where HeartRate.effective.toInterval ( ) during CADEncounterMI.period
and HeartRate.status in { 'final', 'amended', 'corrected' }
and HeartRate.value < 50 '/min'
and PriorHeartRate.value < 50 '/min'
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI":
exists ( ( [AllergyIntolerance: "Beta Blocker Therapy Ingredient"]
union [AllergyIntolerance: "Substance with beta adrenergic receptor antagonist mechanism of action (substance)"] ) BetaBlockerAllergyIntolerance
where BetaBlockerAllergyIntolerance.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI":
exists ( ( [Condition: "Allergy to Beta Blocker Therapy"]
union [Condition: "Intolerance to Beta Blocker Therapy"] ) BetaBlockerAllergyOrIntoleranceDiagnosis
where BetaBlockerAllergyOrIntoleranceDiagnosis.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI":
exists ( [Condition: "Atrioventricular Block"] AtrioventricularBlock
where AtrioventricularBlock.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and Prior MI</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and Prior MI":
exists ( [Condition: "Cardiac Pacer in Situ"] CardiacPacerDiagnosis
where CardiacPacerDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI":
exists ( [Procedure: "Cardiac Pacer"] ImplantedCardiacPacer
with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
such that ImplantedCardiacPacer.performed.toInterval ( ) starts before end of CADEncounterMI.period
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer":
"Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI"
and not "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and Prior MI"
and not "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Denominator Exceptions 2</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@commentedOut: "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
@commentedOutReason: Negation issue noted in https://github.com/cqframework/cql-execution/issues/296, which is tied to https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1455
*/
define "Denominator Exceptions 2":
"Has Arrhythmia with Qualifying CAD Encounter and Prior MI"
or "Has Asthma with Qualifying CAD Encounter and Prior MI"
or "Has Bradycardia with Qualifying CAD Encounter and Prior MI"
or "Has Hypotension with Qualifying CAD Encounter and Prior MI"
or "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI"
or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI"
or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI"
//or "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
or "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Race</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Race":
Patient.race R
return Tuple {
codes: R.ombCategory union R.detailed,
display: R.text
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>SDE Race</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Race":
SDE."SDE Race"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>Denominator 1</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator 1":
"Initial Population"
and exists "Qualifying CAD Encounter and History of Moderate or Severe LVSD"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>overlapsDayOfEncounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function overlapsDayOfEncounter(Diagnosis Condition, TheEncounter Encounter):
TheEncounter Visit
where Diagnosis.isConfirmedActiveDiagnosis ( )
return Diagnosis.prevalenceInterval ( ) overlaps day of Visit.period</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>AHAOverall</td>
<td>isConfirmedActiveDiagnosis</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns true if the given Condition is confirmed as active
*/
define fluent function isConfirmedActiveDiagnosis(condition Condition):
condition.isActive()
and condition.verificationStatus ~ QICoreCommon."confirmed"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>isActive</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/* Candidates for FHIRCommon */
/*
@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse
*/
define fluent function isActive(condition Condition):
condition.clinicalStatus ~ "active"
or condition.clinicalStatus ~ "recurrence"
or condition.clinicalStatus ~ "relapse"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>prevalenceInterval</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
or condition.clinicalStatus ~ "recurrence"
or condition.clinicalStatus ~ "relapse" then
Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
(end of condition.abatementInterval()) abatementDate
return if abatementDate is null then
Interval[start of condition.onset.toInterval(), abatementDate)
else
Interval[start of condition.onset.toInterval(), abatementDate]</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>overlapsAfterDayOfEncounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function overlapsAfterDayOfEncounter(Event Choice<AllergyIntolerance, Condition>, EncounterList List<Encounter>):
AnyTrue(EncounterList Visit
return case
when Event is AllergyIntolerance then Interval[start of Event.onset.toInterval(), Event.lastOccurrence]overlaps after day of Visit.period
and(Event.clinicalStatus is null
or Event.clinicalStatus ~ QICoreCommon."allergy-active"
)
when Event is Condition then Event.isConfirmedActiveDiagnosis()
and Event.prevalenceInterval() overlaps after day of Visit.period
and Event.verificationStatus ~ QICoreCommon."confirmed"
else false
end
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CADBetaBlockerTherapyPriorMIorLVSDFHIR</td>
<td>authoredDuringDayOfEncounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function authoredDuringDayOfEncounter(Order Choice<MedicationRequest, MedicationNotRequested>, EncounterList List<Encounter>):
AnyTrue(EncounterList Visit
return case
when Order is MedicationRequest then Order.authoredOn during day of Visit.period
and Order.status in { 'active', 'completed' }
and Order.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
and Order.doNotPerform is not true
when Order is MedicationNotRequested then Order.authoredOn during day of Visit.period
and Order.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
else false
end
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>FHIRHelpers</td>
<td>ToString</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define function ToString(value uri): value.value</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>FHIRHelpers</td>
<td>ToCode</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
if coding is null then
null
else
System.Code {
code: coding.code.value,
system: coding.system.value,
version: coding.version.value,
display: coding.display.value
}</code></pre>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</text>
<contained>
<Library>
<id value="effective-data-requirements"/>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/administrative-gender"/>
<code value="M"/>
<display value="Male"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/administrative-gender"/>
<code value="F"/>
<display value="Female"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="active"/>
<display value="Active"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="recurrence"/>
<display value="Recurrence"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="relapse"/>
<display value="Relapse"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
<code value="confirmed"/>
<display value="Confirmed"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="134401001"/>
<display value="Left ventricular systolic dysfunction (disorder)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="373254001"/>
<display
value="Substance with beta adrenergic receptor antagonist mechanism of action (substance)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical"/>
<code value="active"/>
<display value="Active"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Sex"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Sex":
case
when Patient.gender = 'male' then "M"
when Patient.gender = 'female' then "F"
else null
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Sex"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Sex":
SDE."SDE Sex""/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Qualifying Encounter During Measurement Period"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualifying Encounter During Measurement Period":
( [Encounter: "Office Visit"]
union [Encounter: "Outpatient Consultation"]
union [Encounter: "Nursing Facility Visit"]
union [Encounter: "Care Services in Long Term Residential Facility"]
union [Encounter: "Home Healthcare Services"]
union [Encounter: "Patient Provider Interaction"] ) ValidEncounter
where ValidEncounter.period during day of "Measurement Period"
and ValidEncounter.status = 'finished'"/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Outpatient Encounter During Measurement Period"/>
</extension>
<extension url="statement">
<valueString
value="define "Outpatient Encounter During Measurement Period":
( [Encounter: "Office Visit"]
union [Encounter: "Outpatient Consultation"]
union [Encounter: "Care Services in Long Term Residential Facility"]
union [Encounter: "Home Healthcare Services"]
union [Encounter: "Nursing Facility Visit"] ) QualifyingEncounter
where QualifyingEncounter.period during day of "Measurement Period"
and QualifyingEncounter.status = 'finished'"/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="Coronary Artery Disease Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Coronary Artery Disease Encounter":
"Outpatient Encounter During Measurement Period" ValidQualifyingEncounter
with [Condition: "Coronary Artery Disease No MI"] CoronaryArteryDisease
such that CoronaryArteryDisease.overlapsDayOfEncounter ( ValidQualifyingEncounter )"/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="History of Cardiac Surgery Prior to Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "History of Cardiac Surgery Prior to Encounter":
"Outpatient Encounter During Measurement Period" ValidQualifyingEncounter
with [Procedure: "Cardiac Surgery"] CardiacSurgery
such that CardiacSurgery.performed.toInterval ( ) starts before end of ValidQualifyingEncounter.period
and CardiacSurgery.status = 'completed'"/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="Qualifying CAD Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualifying CAD Encounter":
"Coronary Artery Disease Encounter"
union "History of Cardiac Surgery Prior to Encounter""/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="Initial Population"/>
</extension>
<extension url="statement">
<valueString
value="define "Initial Population":
AgeInYearsAt(date from start of "Measurement Period") >= 18
and exists ( "Qualifying Encounter During Measurement Period" Encounter1
with "Qualifying Encounter During Measurement Period" Encounter2
such that Encounter2.id !~ Encounter1.id
)
and exists "Qualifying CAD Encounter""/>
</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="AHAOverall"/>
</extension>
<extension url="name">
<valueString value="Moderate or Severe LVSD Findings"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns a union of the following:
* Observations where the final, amended or correction ejection fraction result is <= 40
* Moderate or Severe LVSD conditions where the diagnosis has been confirmed as active
*/
define "Moderate or Severe LVSD Findings":
( [Observation: "Ejection Fraction"] EjectionFraction
where EjectionFraction.value as Quantity <= 40 '%'
and EjectionFraction.status in {'final', 'amended', 'corrected'}
)
union (
( [Condition: "Moderate or Severe LVSD"]
union ( [Condition: "Left ventricular systolic dysfunction (disorder)"] LVSDDiagnosis
where LVSDDiagnosis.severity in "Moderate or Severe" )
) ModerateOrSevereLVSD
where ModerateOrSevereLVSD.isConfirmedActiveDiagnosis()
)"/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualifying CAD Encounter and Prior MI":
"Qualifying CAD Encounter" EncounterWithCADProxy
with [Condition: "Myocardial Infarction"] MyocardialInfarction
such that MyocardialInfarction.prevalenceInterval ( ) starts 3 years or less before day of start of EncounterWithCADProxy.period
and not exists AHA."Moderate or Severe LVSD Findings""/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator 2"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator 2":
"Initial Population"
and exists "Qualifying CAD Encounter and Prior MI""/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualifying CAD Encounter and History of Moderate or Severe LVSD":
"Qualifying CAD Encounter" EncounterWithCADProxy
with AHA."Moderate or Severe LVSD Findings" LVSDFindings
such that Coalesce(LVSDFindings.prevalenceInterval(), LVSDFindings.effective.toInterval()) starts before end of EncounterWithCADProxy.period"/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [Condition: "Arrhythmia"] ArrhythmiaDiagnosis
where ArrhythmiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)"/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [Condition: "Asthma"] AsthmaDiagnosis
where AsthmaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)"/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [Condition: "Bradycardia"] BradycardiaDiagnosis
where BradycardiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)"/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [Condition: "Hypotension"] HypotensionDiagnosis
where HypotensionDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)"/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="/*
* @code: Heart rate - 8867-4
* @profile: http://hl7.org/fhir/StructureDefinition/heartrate
*/
define "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( from
["observation-heartrate"] HeartRate,
"Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
let PriorHeartRate: Last(["observation-heartrate"] MostRecentPriorHeartRate
where MostRecentPriorHeartRate.effective.toInterval() during CADEncounterModerateOrSevereLVSD.period
and MostRecentPriorHeartRate.effective.toInterval() before HeartRate.effective.toInterval()
sort by start of effective.toInterval()
)
where HeartRate.effective.toInterval ( ) during CADEncounterModerateOrSevereLVSD.period
and HeartRate.value < 50 '/min'
and PriorHeartRate.value < 50 '/min'
)"/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( ( [AllergyIntolerance: "Beta Blocker Therapy Ingredient"]
union [AllergyIntolerance: "Substance with beta adrenergic receptor antagonist mechanism of action (substance)"] ) BetaBlockerAllergyIntolerance
where BetaBlockerAllergyIntolerance.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)"/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( ( [Condition: "Allergy to Beta Blocker Therapy"]
union [Condition: "Intolerance to Beta Blocker Therapy"] ) BetaBlockerAllergyOrIntoleranceDiagnosis
where BetaBlockerAllergyOrIntoleranceDiagnosis.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)"/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [Condition: "Atrioventricular Block"] AtrioventricularBlock
where AtrioventricularBlock.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)"/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [Condition: "Cardiac Pacer in Situ"] CardiacPacerDiagnosis
where CardiacPacerDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)"/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and History of Moderate or Severe LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
exists ( [Procedure: "Cardiac Pacer"] ImplantedCardiacPacer
with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
such that ImplantedCardiacPacer.performed.toInterval ( ) starts before end of CADEncounterModerateOrSevereLVSD.period
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer":
"Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
and not "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
and not "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and History of Moderate or Severe LVSD""/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator Exceptions 1"/>
</extension>
<extension url="statement">
<valueString
value="/*
@commentedOut: "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
@commentedOutReason: Negation issue noted in https://github.com/cqframework/cql-execution/issues/296, which is tied to https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1455
*/
define "Denominator Exceptions 1":
"Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
//or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
or "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer""/>
</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="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="Has Beta Blocker Therapy for LVSD Ordered"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Beta Blocker Therapy for LVSD Ordered":
exists ( [MedicationRequest: medication in "Beta Blocker Therapy for LVSD"] BetaBlockerForLVSDOrdered
where BetaBlockerForLVSDOrdered.authoredDuringDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="24"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Is Currently Taking Beta Blocker Therapy for LVSD"/>
</extension>
<extension url="statement">
<valueString
value="define "Is Currently Taking Beta Blocker Therapy for LVSD":
exists ( [MedicationRequest: medication in "Beta Blocker Therapy for LVSD"] ActiveBetaBlockerForLVSD
with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
such that First((collapse(ActiveBetaBlockerForLVSD.dosageInstruction.timing.repeat.bounds DoseTime
return DoseTime.toInterval()
)) DrugPeriod
sort by start of $this
) overlaps after day of CADEncounterModerateOrSevereLVSD.period
where ActiveBetaBlockerForLVSD.status in { 'active', 'completed' }
and ActiveBetaBlockerForLVSD.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="25"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="Numerator 1"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator 1":
"Has Beta Blocker Therapy for LVSD Ordered"
or "Is Currently Taking Beta Blocker Therapy for LVSD""/>
</extension>
<extension url="displaySequence">
<valueInteger value="26"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Payer"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Payer":
[Coverage: type in "Payer Type"] Payer
return {
code: Payer.type,
period: Payer.period
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="27"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Payer"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Payer":
SDE."SDE Payer""/>
</extension>
<extension url="displaySequence">
<valueInteger value="28"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="Has Beta Blocker Therapy Ordered"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Beta Blocker Therapy Ordered":
exists ( [MedicationRequest: medication in "Beta Blocker Therapy"] BetaBlockerOrdered
where BetaBlockerOrdered.authoredDuringDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="29"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="Is Currently Taking Beta Blocker Therapy"/>
</extension>
<extension url="statement">
<valueString
value="define "Is Currently Taking Beta Blocker Therapy":
exists ( [MedicationRequest: medication in "Beta Blocker Therapy"] ActiveBetaBlocker
with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
such that First((collapse(ActiveBetaBlocker.dosageInstruction.timing.repeat.bounds DoseTime
return DoseTime.toInterval()
)) DrugPeriod
sort by start of $this
) overlaps after day of CADEncounterMI.period
where ActiveBetaBlocker.status in { 'active', 'completed' }
and ActiveBetaBlocker.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="30"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="Numerator 2"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator 2":
"Has Beta Blocker Therapy Ordered"
or "Is Currently Taking Beta Blocker Therapy""/>
</extension>
<extension url="displaySequence">
<valueInteger value="31"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Ethnicity"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Ethnicity":
Patient.ethnicity E
return Tuple {
codes: { E.ombCategory } union E.detailed,
display: E.text
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="32"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Ethnicity"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Ethnicity":
SDE."SDE Ethnicity""/>
</extension>
<extension url="displaySequence">
<valueInteger value="33"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Arrhythmia with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Arrhythmia with Qualifying CAD Encounter and Prior MI":
exists ( [Condition: "Arrhythmia"] ArrhythmiaDiagnosis
where ArrhythmiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="34"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Asthma with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Asthma with Qualifying CAD Encounter and Prior MI":
exists ( [Condition: "Asthma"] AsthmaDiagnosis
where AsthmaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="35"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Bradycardia with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Bradycardia with Qualifying CAD Encounter and Prior MI":
exists ( [Condition: "Bradycardia"] BradycardiaDiagnosis
where BradycardiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="36"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Hypotension with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Hypotension with Qualifying CAD Encounter and Prior MI":
exists ( [Condition: "Hypotension"] HypotensionDiagnosis
where HypotensionDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="37"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="/*
* @code: Heart rate - 8867-4
* @profile: http://hl7.org/fhir/StructureDefinition/heartrate
*/
define "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI":
exists ( from
["observation-heartrate"] HeartRate,
"Qualifying CAD Encounter and Prior MI" CADEncounterMI
let PriorHeartRate: Last(["observation-heartrate"] MostRecentPriorHeartRate
where MostRecentPriorHeartRate.effective.toInterval() during CADEncounterMI.period
and MostRecentPriorHeartRate.status in { 'final', 'amended', 'corrected' }
and MostRecentPriorHeartRate.effective.toInterval() before HeartRate.effective.toInterval()
sort by start of effective.toInterval()
)
where HeartRate.effective.toInterval ( ) during CADEncounterMI.period
and HeartRate.status in { 'final', 'amended', 'corrected' }
and HeartRate.value < 50 '/min'
and PriorHeartRate.value < 50 '/min'
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="38"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI":
exists ( ( [AllergyIntolerance: "Beta Blocker Therapy Ingredient"]
union [AllergyIntolerance: "Substance with beta adrenergic receptor antagonist mechanism of action (substance)"] ) BetaBlockerAllergyIntolerance
where BetaBlockerAllergyIntolerance.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="39"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI":
exists ( ( [Condition: "Allergy to Beta Blocker Therapy"]
union [Condition: "Intolerance to Beta Blocker Therapy"] ) BetaBlockerAllergyOrIntoleranceDiagnosis
where BetaBlockerAllergyOrIntoleranceDiagnosis.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="40"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI":
exists ( [Condition: "Atrioventricular Block"] AtrioventricularBlock
where AtrioventricularBlock.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="41"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and Prior MI":
exists ( [Condition: "Cardiac Pacer in Situ"] CardiacPacerDiagnosis
where CardiacPacerDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="42"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI":
exists ( [Procedure: "Cardiac Pacer"] ImplantedCardiacPacer
with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
such that ImplantedCardiacPacer.performed.toInterval ( ) starts before end of CADEncounterMI.period
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="43"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString
value="Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer":
"Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI"
and not "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and Prior MI"
and not "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI""/>
</extension>
<extension url="displaySequence">
<valueInteger value="44"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator Exceptions 2"/>
</extension>
<extension url="statement">
<valueString
value="/*
@commentedOut: "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
@commentedOutReason: Negation issue noted in https://github.com/cqframework/cql-execution/issues/296, which is tied to https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1455
*/
define "Denominator Exceptions 2":
"Has Arrhythmia with Qualifying CAD Encounter and Prior MI"
or "Has Asthma with Qualifying CAD Encounter and Prior MI"
or "Has Bradycardia with Qualifying CAD Encounter and Prior MI"
or "Has Hypotension with Qualifying CAD Encounter and Prior MI"
or "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI"
or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI"
or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI"
//or "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
or "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer""/>
</extension>
<extension url="displaySequence">
<valueInteger value="45"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Race"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Race":
Patient.race R
return Tuple {
codes: R.ombCategory union R.detailed,
display: R.text
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="46"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Race"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Race":
SDE."SDE Race""/>
</extension>
<extension url="displaySequence">
<valueInteger value="47"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator 1"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator 1":
"Initial Population"
and exists "Qualifying CAD Encounter and History of Moderate or Severe LVSD""/>
</extension>
<extension url="displaySequence">
<valueInteger value="48"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="overlapsDayOfEncounter"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function overlapsDayOfEncounter(Diagnosis Condition, TheEncounter Encounter):
TheEncounter Visit
where Diagnosis.isConfirmedActiveDiagnosis ( )
return Diagnosis.prevalenceInterval ( ) overlaps day of Visit.period"/>
</extension>
<extension url="displaySequence">
<valueInteger value="49"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="AHAOverall"/>
</extension>
<extension url="name">
<valueString value="isConfirmedActiveDiagnosis"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns true if the given Condition is confirmed as active
*/
define fluent function isConfirmedActiveDiagnosis(condition Condition):
condition.isActive()
and condition.verificationStatus ~ QICoreCommon."confirmed""/>
</extension>
<extension url="displaySequence">
<valueInteger value="50"/>
</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="isActive"/>
</extension>
<extension url="statement">
<valueString
value="/* Candidates for FHIRCommon */
/*
@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse
*/
define fluent function isActive(condition Condition):
condition.clinicalStatus ~ "active"
or condition.clinicalStatus ~ "recurrence"
or condition.clinicalStatus ~ "relapse""/>
</extension>
<extension url="displaySequence">
<valueInteger value="51"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="prevalenceInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
or condition.clinicalStatus ~ "recurrence"
or condition.clinicalStatus ~ "relapse" then
Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
(end of condition.abatementInterval()) abatementDate
return if abatementDate is null then
Interval[start of condition.onset.toInterval(), abatementDate)
else
Interval[start of condition.onset.toInterval(), abatementDate]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="52"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="overlapsAfterDayOfEncounter"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function overlapsAfterDayOfEncounter(Event Choice<AllergyIntolerance, Condition>, EncounterList List<Encounter>):
AnyTrue(EncounterList Visit
return case
when Event is AllergyIntolerance then Interval[start of Event.onset.toInterval(), Event.lastOccurrence]overlaps after day of Visit.period
and(Event.clinicalStatus is null
or Event.clinicalStatus ~ QICoreCommon."allergy-active"
)
when Event is Condition then Event.isConfirmedActiveDiagnosis()
and Event.prevalenceInterval() overlaps after day of Visit.period
and Event.verificationStatus ~ QICoreCommon."confirmed"
else false
end
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="53"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
</extension>
<extension url="name">
<valueString value="authoredDuringDayOfEncounter"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function authoredDuringDayOfEncounter(Order Choice<MedicationRequest, MedicationNotRequested>, EncounterList List<Encounter>):
AnyTrue(EncounterList Visit
return case
when Order is MedicationRequest then Order.authoredOn during day of Visit.period
and Order.status in { 'active', 'completed' }
and Order.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
and Order.doNotPerform is not true
when Order is MedicationNotRequested then Order.authoredOn during day of Visit.period
and Order.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
else false
end
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="54"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value uri): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="55"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToCode"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
if coding is null then
null
else
System.Code {
code: coding.code.value,
system: coding.system.value,
version: coding.version.value,
display: coding.display.value
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="56"/>
</extension>
</extension>
<name value="EffectiveDataRequirements"/>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library SDE"/>
<resource value="Library/SupplementalDataElements|3.5.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource value="Library/FHIRHelpers|4.4.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library AHA"/>
<resource value="Library/AHAOverall|2.8.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library QICoreCommon"/>
<resource value="Library/QICoreCommon|2.1.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system AdministrativeGender"/>
<resource value="http://hl7.org/fhir/administrative-gender"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ConditionClinicalStatusCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ConditionVerificationStatusCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/>
</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 AllergyIntoleranceClinicalStatusCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical"/>
</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 Nursing Facility Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Care Services in Long Term Residential Facility"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014"/>
</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 Patient Provider Interaction"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Coronary Artery Disease No MI"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.369"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Cardiac Surgery"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.371"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Myocardial Infarction"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.403"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Ejection Fraction"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1134"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Moderate or Severe LVSD"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Moderate or Severe"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1092"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Arrhythmia"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.366"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Asthma"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.362"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Bradycardia"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.412"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Hypotension"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.370"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Beta Blocker Therapy Ingredient"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1493"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Allergy to Beta Blocker Therapy"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1177"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Intolerance to Beta Blocker Therapy"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1178"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Atrioventricular Block"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.367"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Cardiac Pacer in Situ"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.368"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Cardiac Pacer"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.53"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Beta Blocker Therapy for LVSD"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1184"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Payer Type"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Beta Blocker Therapy"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1174"/>
</relatedArtifact>
<parameter>
<name value="Measurement Period"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="Period"/>
</parameter>
<parameter>
<name value="SDE Sex"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Coding"/>
</parameter>
<parameter>
<name value="Denominator 2"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Denominator Exceptions 1"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Numerator 1"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="SDE Payer"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Numerator 2"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Initial Population"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="SDE Ethnicity"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Denominator Exceptions 2"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="SDE Race"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Denominator 1"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<dataRequirement>
<type value="Patient"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
<mustSupport value="ethnicity"/>
<mustSupport value="race"/>
</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"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012"/>
</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"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014"/>
</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"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012"/>
</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/2.16.840.1.113883.3.526.3.369"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
<mustSupport value="code"/>
<mustSupport value="severity"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://snomed.info/sct"/>
<code value="134401001"/>
<display
value="Left ventricular systolic dysfunction (disorder)"/>
</code>
</codeFilter>
<codeFilter>
<path value="severity"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1092"/>
</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/2.16.840.1.113883.3.526.3.1090"/>
</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/2.16.840.1.113883.3.526.3.403"/>
</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/2.16.840.1.113883.3.526.3.366"/>
</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/2.16.840.1.113883.3.526.3.362"/>
</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/2.16.840.1.113883.3.526.3.412"/>
</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/2.16.840.1.113883.3.526.3.370"/>
</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/2.16.840.1.113883.3.526.3.1177"/>
</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/2.16.840.1.113883.3.526.3.1178"/>
</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/2.16.840.1.113883.3.526.3.367"/>
</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/2.16.840.1.113883.3.526.3.368"/>
</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/2.16.840.1.113883.3.526.3.371"/>
</codeFilter>
<codeFilter>
<path value="status.value"/>
<code>
<code value="completed"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
<mustSupport value="code"/>
<mustSupport value="performed"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.53"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
<mustSupport value="code"/>
<mustSupport value="value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1134"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/heartrate"/>
<mustSupport value="effective"/>
<mustSupport value="value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
</dataRequirement>
<dataRequirement>
<type value="AllergyIntolerance"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1493"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="AllergyIntolerance"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://snomed.info/sct"/>
<code value="373254001"/>
<display
value="Substance with beta adrenergic receptor antagonist mechanism of action (substance)"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"/>
<mustSupport value="medication"/>
<mustSupport value="dosageInstruction"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="intent"/>
<mustSupport value="intent.value"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1184"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"/>
<mustSupport value="medication"/>
<mustSupport value="dosageInstruction"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="intent"/>
<mustSupport value="intent.value"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1174"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Coverage"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
</codeFilter>
</dataRequirement>
</Library>
</contained>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" id="supplementalDataGuidance">
<extension url="guidance">
<valueString
value="For every patient evaluated by this measure also identify payer, race, ethnicity and sex"/>
</extension>
<extension url="usage">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
<display value="Supplemental Data"/>
</coding>
<text value="Supplemental Data Guidance"/>
</valueCodeableConcept>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem">
<valueReference>
<reference value="Device/cqf-tooling"/>
</valueReference>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements" id="effective-data-requirements">
<valueReference>
<reference value="#effective-data-requirements"/>
</valueReference>
</extension>
<url
value="https://madie.cms.gov/Measure/CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
<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="CMS145FHIR"/>
</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:466e5d36-1e01-478b-9dcb-edac33594dd5"/>
</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:b4533eba-331a-4cb7-88b3-6f2d07e225e9"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="endorser"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/cbeId"/>
<value value="0070e"/>
<assigner>
<display value="CMS Consensus Based Entity"/>
</assigner>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="publisher"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/cmsId"/>
<value value="145FHIR"/>
<assigner>
<display value="CMS"/>
</assigner>
</identifier>
<version value="0.2.000"/>
<name value="CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
<title
value="Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF less than or equal to 40%)FHIR"/>
<status value="draft"/>
<experimental value="false"/>
<date value="2024-12-18T21:25:48+00:00"/>
<publisher value="American Heart Association"/>
<contact>
<telecom>
<system value="url"/>
<value value="https://www.heart.org/"/>
</telecom>
</contact>
<description
value="Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior left ventricular ejection fraction (LVEF) <=40% who were prescribed beta-blocker therapy"/>
<purpose value="UNKNOWN"/>
<usage
value="Beta-blocker therapy:
- For patients with prior MI, beta-blocker therapy includes any agent within the beta-blocker drug class. As of 2015, no recommendations or evidence are cited in current stable ischemic heart disease guidelines for preferential use of specific agents.
- For patients with prior LVEF <=40%, beta-blocker therapy includes the following: bisoprolol, carvedilol, or sustained release metoprolol succinate.
The requirement of two or more visits is to establish that the eligible clinician has an existing relationship with the patient.
A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than or equal to 40% threshold noted in the denominator logic. A range that is greater than 40% would not meet the measure requirement.
In order for the Ejection Fraction result pathway to be recognized as below 40%, the result must be reported as a number with unit of %. A text string of "below 40%" or "ejection fraction between 35 and 40%" will not be recognized through electronic data capture. Although, this criteria can also be met using the Diagnosis pathway if specified as "Moderate or Severe."
If a patient has had a myocardial infarction (MI) within the past 3 years and a current or prior LVEF <=40% (or moderate or severe LVSD), the patient should only be counted in Population Criteria 1.
This eCQM is a patient-based measure.
This FHIR-based measure has been derived from the QDM-based measure: CMS145v13.
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="Copyright 2024 American College of Cardiology and American Heart Association. All Rights Reserved."/>
<effectivePeriod>
<start value="2025-01-01"/>
<end value="2025-12-31"/>
</effectivePeriod>
<author>
<name value="American Heart Association"/>
<telecom>
<system value="url"/>
<value value="https://www.heart.org/"/>
</telecom>
</author>
<author>
<name value="American Medical Association (AMA)"/>
<telecom>
<system value="url"/>
<value value="https://www.ama-assn.org/"/>
</telecom>
</author>
<author>
<name
value="American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)"/>
<telecom>
<system value="url"/>
<value value="https://www.ama-assn.org/"/>
</telecom>
</author>
<library
value="https://madie.cms.gov/Library/CADBetaBlockerTherapyPriorMIorLVSDFHIR"/>
<disclaimer
value="The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.
The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, 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.
Commercial uses of the Measure require a license agreement between the user and the American College of Cardiology (ACC) or the American Heart Association (AHA). Neither the ACC, nor AHA, nor their members shall be responsible for any use of the Measure.
ACC and AHA encourage use of the Measure by other health care professionals, where appropriate.
THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The ACC and AHA and their members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications.
CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) is copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2023 World Health Organization. All Rights Reserved.
The American Medical Association’s and the PCPI(R) Foundation’s significant past efforts and contributions to the performance measure are gratefully acknowledged.
Due to technical limitations, registered trademarks are indicated by (R) or [R]."/>
<scoring>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</scoring>
<rationale
value="For patients with coronary artery disease (CAD), beta-blockers are recommended for 3 years after myocardial infarction or acute coronary syndrome. Beta-blockers, particularly carvedilol, metoprolol succinate, or bisoprolol which have been shown to reduce risk of death, are recommended indefinitely for patients with CAD and LV systolic dysfunction. These agents have proven efficacy in reducing angina onset and improving the ischemic threshold during exercise. In patients who have suffered an MI, beta-blockers significantly reduce deaths and recurrent MIs (Fihn et al., 2012).
Nonadherence to cardioprotective medications is prevalent among outpatients with CAD and can be associated with a broad range of adverse outcomes, including all-cause and cardiovascular mortality, cardiovascular hospitalizations, and the need for revascularization procedures (Gibbons et al., 2002).
This measure is intended to promote beta-blocker usage in select patients with CAD."/>
<clinicalRecommendationStatement
value="Beta-blocker therapy should be started and continued for 3 years in all patients with normal LV function after MI or acute coronary syndrome (ACS) (Class I, Level of Evidence: B) (Fihn et al., 2012).
Beta-blocker therapy should be used in all patients with LV systolic dysfunction (EF <= 40%) with heart failure or prior MI, unless contraindicated. (Use should be limited to carvedilol, metoprolol succinate, or bisoprolol, which have been shown to reduce risk of death.) (Class I, Level of Evidence: A) (Fihn et al., 2012).
In patients with chronic coronary disease (CCD) and LVEF ≤40% with or without previous MI, the use of beta-blocker therapy is recommended to reduce the risk of future Major Adverse Cardiac Events (MACE), including cardiovascular death. (Class 1, Level of Evidence: A) (Virani et al., 2023)"/>
<group id="6643a4bda7a1805d3b73744c">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
<valueCode value="boolean"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="process"/>
<display value="Process"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation">
<valueCode
value="This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes:
- Population 1: Patients with left ventricular systolic dysfunction (LVEF <=40%)
- Population 2: Patients with a prior (within the past 3 years) myocardial infarction
For the purposes of this measure, a single performance rate can be calculated as follows:
Performance Rate = (Numerator 1 + Numerator 2)/ [(Denominator 1 - Denominator Exceptions 1) + (Denominator 2 - Denominator Exceptions 2)]"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
<code value="increase"/>
<display value="Increased score indicates improvement"/>
</coding>
</valueCodeableConcept>
</extension>
<population id="52BDC293-998E-455E-B68D-B0BB8B6C974B">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</code>
<description
value="All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of coronary artery disease"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
</criteria>
</population>
<population id="26866751-5751-420F-BD5D-90F99B79E263">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator"/>
<display value="Denominator"/>
</coding>
</code>
<description
value="Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <=40%"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator 1"/>
</criteria>
</population>
<population id="9488860B-5AF1-4580-833A-83E017169EC9">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator"/>
<display value="Numerator"/>
</coding>
</code>
<description value="Patients who were prescribed beta-blocker therapy"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator 1"/>
</criteria>
</population>
<population id="686674D8-324B-49E1-A885-DF9E28538F0F">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exception"/>
<display value="Denominator Exception"/>
</coding>
</code>
<description
value="Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., arrhythmia, asthma, bradycardia, hypotension, patients with atrioventricular block without cardiac pacer, observation of consecutive heart rates <50, allergy, intolerance, other medical reasons).
Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons)."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exceptions 1"/>
</criteria>
</population>
</group>
<group id="6643a4bda7a1805d3b73744d">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
<valueCode value="boolean"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="process"/>
<display value="Process"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation">
<valueCode
value="This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes:
- Population 1: Patients with left ventricular systolic dysfunction (LVEF <=40%)
- Population 2: Patients with a prior (within the past 3 years) myocardial infarction
For the purposes of this measure, a single performance rate can be calculated as follows:
Performance Rate = (Numerator 1 + Numerator 2)/ [(Denominator 1 - Denominator Exceptions 1) + (Denominator 2 - Denominator Exceptions 2)]"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
<code value="increase"/>
<display value="Increased score indicates improvement"/>
</coding>
</valueCodeableConcept>
</extension>
<population id="E529AF68-95B2-4D98-830D-D9D98EB22CEC">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</code>
<description
value="All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of coronary artery disease"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
</criteria>
</population>
<population id="6925A32F-AA11-4830-8553-B2AD5F57A302">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator"/>
<display value="Denominator"/>
</coding>
</code>
<description
value="Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <=40%"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator 2"/>
</criteria>
</population>
<population id="D786FE18-9B4D-4B59-9D44-DD72AC2F66DE">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator"/>
<display value="Numerator"/>
</coding>
</code>
<description value="Patients who were prescribed beta-blocker therapy"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator 2"/>
</criteria>
</population>
<population id="3C509632-5ABE-436D-ACEE-F06A031F7466">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exception"/>
<display value="Denominator Exception"/>
</coding>
</code>
<description
value="Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., arrhythmia, asthma, bradycardia, hypotension, patients with atrioventricular block without cardiac pacer, observation of consecutive heart rates <50, allergy, intolerance, other medical reasons).
Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons)."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exceptions 2"/>
</criteria>
</population>
</group>
<supplementalData id="sde-sex">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Sex"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Sex"/>
</criteria>
</supplementalData>
<supplementalData id="sde-race">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Race"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Race"/>
</criteria>
</supplementalData>
<supplementalData id="sde-payer">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Payer"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Payer"/>
</criteria>
</supplementalData>
<supplementalData id="sde-ethnicity">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Ethnicity"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Ethnicity"/>
</criteria>
</supplementalData>
</Measure>
IG © 2023+ cqframework. Package gov.healthit.ecqi.ecqms#2024.0.0 based on FHIR 4.0.1. Generated 2024-12-19
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