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
| Active as of 2024-12-18 |
{
"resourceType" : "Measure",
"id" : "CMS72FHIRSTKAntithromboticDay2",
"meta" : {
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🔗 "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"🔗 ,
"http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"🔗 ,
"http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"
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"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <table class=\"grid dict\">\n \n <tr>\n <th scope=\"row\"><b>Title: </b></th>\n <td style=\"padding-left: 4px;\">Antithrombotic Therapy By End of Hospital Day 2FHIR</td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Id: </b></th>\n <td style=\"padding-left: 4px;\">CMS72FHIRSTKAntithromboticDay2</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Version: </b></th>\n <td style=\"padding-left: 4px;\">0.7.001</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Url: </b></th>\n <td style=\"padding-left: 4px;\"><a href=\"Measure-CMS72FHIRSTKAntithromboticDay2.html\">Antithrombotic Therapy By End of Hospital Day 2FHIR</a></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\">\n <b>\n \n \n Short Name Identifier:\n \n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>CMS72FHIR</span>\n </p>\n \n </td>\n </tr>\n \n <tr>\n <th scope=\"row\">\n <b>\n \n \n Version Independent Identifier:\n \n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>urn:uuid:b6ae4357-9baa-4195-a9cd-50391b7d0dab</span>\n </p>\n \n </td>\n </tr>\n \n <tr>\n <th scope=\"row\">\n <b>\n \n \n Version Specific Identifier:\n \n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>urn:uuid:e74bdff8-3857-471e-a0c5-b9307889bda6</span>\n </p>\n \n </td>\n </tr>\n \n <tr>\n <th scope=\"row\">\n <b>\n \n \n Publisher (CMS) Identifier:\n \n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>72FHIR</span>\n </p>\n \n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Effective Period: </b></th>\n <td style=\"padding-left: 4px;\">2026-01-01..2026-12-31</td>\n </tr>\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Publisher: </b></th>\n <td style=\"padding-left: 4px;\">The Joint Commission</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Author: </b></th>\n <td style=\"padding-left: 4px;\">The Joint Commission</td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Description: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2</p>\n</div></td>\n </tr>\n \n\n \n\n \n\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Purpose: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>UNKNOWN</p>\n</div></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Copyright: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>Measure specifications are in the Public Domain</p>\n<p>LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved.</p>\n</div></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Disclaimer: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>These performance measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.</p>\n</div></td>\n </tr>\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Rationale: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks (TIA) continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist.</p>\n<p>Aspirin is the recommended antithrombotic medication for early antithrombotic therapy and most frequently administered unless contraindicated. Anticoagulants at doses to prevent venous thromboembolism (VTE) are insufficient. Subcutaneous Lovenox (enoxaparin) and unfractionated heparin (UFH) SQ at lower dosages used for VTE prophylaxis (i.e., enoxaparin SQ 40 mg once daily; enoxaparin SQ 30 mg Q12 hours; UFH 5,000 units or less two or three times daily) are not sufficient for early antithrombotic therapy.</p>\n<p>Anticoagulants at doses to prevent VTE are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA.</p>\n</div></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Clinical recommendation statement: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>Antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist</p>\n</div></td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Guidance (Usage): </b></th>\n <td style=\"padding-left: 4px;\">The "Nonelective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient Encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective Inpatient Encounters include emergency, urgent, and unplanned admissions. \n\nNPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e., rectal or intravenous). \n\nIn the denominator exclusions, the intent is to only exclude patients with a total length of stay of <2 days, including Emergency Department (ED) visit (if there is one). For the eCQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits.\n\nThe denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.\n\nThis eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS72v14. 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>\n </tr>\n \n\n \n \n <tr>\n <th scope=\"row\"><b>Population Criteria: </b></th>\n <td style=\"padding-left: 4px;\">\n \n <table class=\"grid-dict\">\n \n <tr>\n <th><b>64f0d9e456d636294b157dec</b></th>\n </tr>\n \n \n <tr>\n <td>Initial Population:</td>\n\n \n \n <td>Inpatient hospitalization (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke that ends during the measurement period</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator:</td>\n\n \n \n <td>Equals Initial Population</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator Exclusion:</td>\n\n \n \n <td>- Inpatient hospitalization for patients who have a duration of stay less than 2 days.\n- Inpatient hospitalization for patients with comfort measures documented day of or the day after arrival.\n- Inpatient hospitalization for patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy administered within 24 hours prior to arrival or anytime during hospitalization.</td>\n \n \n\n </tr>\n \n <tr>\n <td>Numerator:</td>\n\n \n \n <td>Inpatient hospitalization for patients who had antithrombotic therapy administered the day of or day after hospital arrival</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator Exception:</td>\n\n \n \n <td>- Inpatient hospitalization for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival\n- Inpatient hospitalization for patients who receive Prasugrel as an antithrombotic therapy the day of or day after hospital arrival\n- Inpatient hospitalization for patients with an international normalised ratio (INR) greater than 3.5</td>\n \n \n\n </tr>\n \n \n </table>\n \n </td>\n </tr>\n \n \n\n \n <tr>\n <th scope=\"row\"><b> Supplemental Data Elements: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n \n <p>SDE Ethnicity</p>\n \n \n \n \n \n <p>SDE Payer</p>\n \n \n \n \n \n <p>SDE Race</p>\n \n \n \n \n \n <p>SDE Sex</p>\n \n \n \n </td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\">\n <b> Supplemental Data Guidance\n : </b></th>\n <td style=\"padding-left: 4px;\"> For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity-Patient's Ethnicity:\nHispanic or Latino\nNot Hispanic or Latino \n SDE Payer-Patient's Payer:\nCategories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system\n \n SDE Race-Patient's Race:\nNative Hawaiian or Other Pacific Islander\nAsian\nAmerican Indian or Alaska Native\nOther Race\nWhite\nBlack or African American \n SDE Sex-Patient's Sex:\nGender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories. \n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Libraries: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n \n <tr>\n <td><a href=\"Library-CMS72FHIRSTKAntithromboticDay2.html\">CMS72FHIRSTKAntithromboticDay2</a></td>\n </tr>\n \n </table>\n </td>\n </tr>\n \n\n \n\n \n \n <tr>\n <th scope=\"row\"><b>Terminology and Other Dependencies: </b></th>\n <td style=\"padding-left: 4px;\">\n \n <li><code>Library/SupplementalDataElements|3.5.000</code></li>\n \n <li><code>Library/TJCOverall|8.15.000</code></li>\n \n <li><code>Library/FHIRHelpers|4.4.000</code></li>\n \n <li><code>Library/CQMCommon|2.2.000</code></li>\n \n <li><code>Library/QICoreCommon|2.1.000</code></li>\n \n <li><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">AdministrativeGender</a></li>\n \n <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-diagnosis-role.html\">Diagnosis Role</a></li>\n \n <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html\">Condition Clinical Status Codes</a></li>\n \n <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-ver-status.html\">ConditionVerificationStatus</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.424/expansion\">Non-Elective Inpatient Encounter</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.247/expansion\">Ischemic Stroke</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.62/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion\">Observation Services</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion\">Emergency Department Visit</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/1.3.6.1.4.1.33895.1.3.0.45/expansion\">Comfort Measures</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.226/expansion\">Thrombolytic (t-PA) Therapy</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.21/expansion\">Intravenous or Intra-arterial Thrombolytic (t-PA) Therapy</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.21/expansion\">Intravenous or Intra arterial Thrombolytic (tPA) Therapy Prior to Arrival</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.473/expansion\">Medical Reason</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.93/expansion\">Patient Refusal</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.52/expansion\">Pharmacological Contraindications For Antithrombotic Therapy</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.213/expansion\">INR</a></li>\n \n </td>\n </tr>\n <tr>\n <th scope=\"row\"><b>Parameters:</b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr>\n <th><b>name</b></th>\n <th><b>use</b></th>\n <th><b>min</b></th>\n <th><b>max</b></th>\n <th><b>type</b></th>\n </tr>\n \n <tr>\n <td>Measurement Period</td>\n <td>In</td>\n <td>0</td>\n <td>1</td>\n <td>Period</td>\n </tr>\n \n <tr>\n <td>SDE Sex</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>Coding</td>\n </tr>\n \n <tr>\n <td>Numerator</td>\n <td>Out</td>\n <td>0</td>\n <td>*</td>\n <td>Resource</td>\n </tr>\n \n <tr>\n <td>Denominator</td>\n <td>Out</td>\n <td>0</td>\n <td>*</td>\n <td>Resource</td>\n </tr>\n \n <tr>\n <td>SDE Payer</td>\n <td>Out</td>\n <td>0</td>\n <td>*</td>\n <td>Resource</td>\n </tr>\n \n <tr>\n <td>Initial Population</td>\n <td>Out</td>\n <td>0</td>\n <td>*</td>\n <td>Resource</td>\n </tr>\n \n <tr>\n <td>SDE Ethnicity</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>Resource</td>\n </tr>\n \n <tr>\n <td>Denominator Exclusions</td>\n <td>Out</td>\n <td>0</td>\n <td>*</td>\n <td>Resource</td>\n </tr>\n \n <tr>\n <td>SDE Race</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>Resource</td>\n </tr>\n \n <tr>\n <td>Denominator Exceptions</td>\n <td>Out</td>\n <td>0</td>\n <td>*</td>\n <td>Resource</td>\n </tr>\n \n </table>\n </td>\n </tr>\n\n <tr>\n <th scope=\"row\"><b>DataRequirements:</b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr>\n <th><b>Resource Type</b></th>\n <th><b>Resource Elements</b></th>\n <th><b>Valueset Name</b></th>\n <th><b>Valueset</b></th>\n </tr>\n \n <tr>\n <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n <td>\n \n ethnicity\n \n race\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n rank\n \n rank.value\n \n use\n \n condition\n \n condition.reference\n \n condition.reference.value\n \n </td>\n <td>\n \n \n Observation Services\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion\">Observation Services</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n rank\n \n rank.value\n \n use\n \n condition\n \n condition.reference\n \n condition.reference.value\n \n </td>\n <td>\n \n \n Emergency Department Visit\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion\">Emergency Department Visit</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n period\n \n rank\n \n rank.value\n \n use\n \n condition\n \n condition.reference\n \n condition.reference.value\n \n </td>\n <td>\n \n \n Nonelective Inpatient Encounter\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.424/expansion\">Non-Elective Inpatient Encounter</a></td>\n </tr>\n \n <tr>\n <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n <td>\n \n id\n \n id.value\n \n code\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n <td>\n \n code\n \n recordedDate\n \n recordedDate.value\n \n verificationStatus\n \n </td>\n <td>\n \n \n Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.21/expansion\">Intravenous or Intra arterial Thrombolytic (tPA) Therapy Prior to Arrival</a></td>\n </tr>\n \n <tr>\n <td>MedicationAdministration(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationadministration.html\">QICoreMedicationAdministration</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n effective\n \n </td>\n <td>\n \n \n Antithrombotic Therapy for Ischemic Stroke\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.62/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62</a></td>\n </tr>\n \n <tr>\n <td>MedicationAdministration(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationadministration.html\">QICoreMedicationAdministration</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n id\n \n id.value\n \n effective\n \n </td>\n <td>\n \n \n Thrombolytic tPA Therapy\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.226/expansion\">Thrombolytic (t-PA) Therapy</a></td>\n </tr>\n \n <tr>\n <td>MedicationAdministration(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationadministration.html\">QICoreMedicationAdministration</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n effective\n \n </td>\n <td>\n \n \n Pharmacological Contraindications For Antithrombotic Therapy\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.52/expansion\">Pharmacological Contraindications For Antithrombotic Therapy</a></td>\n </tr>\n \n <tr>\n <td>Coverage(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html\">QICoreCoverage</a>)</td>\n <td>\n \n type\n \n period\n \n </td>\n <td>\n \n \n Payer Type\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer</a></td>\n </tr>\n \n <tr>\n <td>ServiceRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html\">QICoreServiceRequest</a>)</td>\n <td>\n \n code\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n doNotPerform\n \n doNotPerform.value\n \n </td>\n <td>\n \n \n Comfort Measures\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/1.3.6.1.4.1.33895.1.3.0.45/expansion\">Comfort Measures</a></td>\n </tr>\n \n <tr>\n <td>Procedure(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html\">QICoreProcedure</a>)</td>\n <td>\n \n code\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Comfort Measures\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/1.3.6.1.4.1.33895.1.3.0.45/expansion\">Comfort Measures</a></td>\n </tr>\n \n <tr>\n <td>Procedure(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html\">QICoreProcedure</a>)</td>\n <td>\n \n code\n \n status\n \n status.value\n \n id\n \n id.value\n \n performed\n \n </td>\n <td>\n \n \n Intravenous or Intraarterial Thrombolytic tPA Therapy\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.21/expansion\">Intravenous or Intra-arterial Thrombolytic (t-PA) Therapy</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-mednotrequested.html\">QICoreMedicationNotRequested</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n reasonCode\n \n id\n \n id.value\n \n authoredOn\n \n authoredOn.value\n \n </td>\n <td>\n \n \n Antithrombotic Therapy for Ischemic Stroke\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.62/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62</a></td>\n </tr>\n \n <tr>\n <td>MedicationAdministration(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-mednotadministered.html\">QICoreMedicationAdministrationNotDone</a>)</td>\n <td>\n \n medication\n \n statusReason\n \n id\n \n id.value\n \n extension\n \n </td>\n <td>\n \n \n Antithrombotic Therapy for Ischemic Stroke\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.62/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62</a></td>\n </tr>\n \n <tr>\n <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n <td>\n \n code\n \n value\n \n status\n \n status.value\n \n issued\n \n issued.value\n \n </td>\n <td>\n \n \n INR\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.213/expansion\">INR</a></td>\n </tr>\n \n </table>\n </td>\n </tr>\n\n \n <tr>\n <th scope=\"row\"><b>Direct Reference Codes:</b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr>\n <th><b>display</b></th>\n <th><b>code</b></th>\n <th><b>system</b></th>\n </tr>\n \n <tr>\n <td>Male</td>\n <td>M</td>\n <td><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">http://hl7.org/fhir/administrative-gender</a></td>\n </tr>\n \n <tr>\n <td>Female</td>\n <td>F</td>\n <td><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">http://hl7.org/fhir/administrative-gender</a></td>\n </tr>\n \n <tr>\n <td>Billing</td>\n <td>billing</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-diagnosis-role.html\">http://terminology.hl7.org/CodeSystem/diagnosis-role</a></td>\n </tr>\n \n <tr>\n <td>Active</td>\n <td>active</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html\">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>\n </tr>\n \n <tr>\n <td>Recurrence</td>\n <td>recurrence</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html\">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>\n </tr>\n \n <tr>\n <td>Relapse</td>\n <td>relapse</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html\">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>\n </tr>\n \n <tr>\n <td>Confirmed</td>\n <td>confirmed</td>\n <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>\n </tr>\n \n </table>\n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Logic Definitions:</b></th>\n <td style=\"padding-left: 4px;\">\n \n <table class=\"grid-dict\">\n <tr>\n <th><b>Group</b></th>\n <th><b>Scoring</b></th>\n <th><b>Population Criteria</b></th>\n <th><b>Expression</b></th>\n </tr>\n <tr>\n \n <td> 64f0d9e456d636294b157dec </td>\n <td colspan=\"3\" style=\"padding-left: 4px;\">\n \n <b>Group scoring:</b>\n \n <span> proportion </span>\n \n \n\n \n\n \n\n \n\n \n <tr>\n \n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Process </span>\n </p>\n \n \n \n </td>\n \n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Rate Aggregation: </b></th>\n <td colspan=\"3\" style=\"padding-left: 4px;\">None</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Improvement Notation: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Increased score indicates improvement </span>\n </p>\n \n \n \n \n </td>\n </tr>\n \n\n \n\n </td>\n \n <tr>\n <td/>\n <td/>\n <td>Initial Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Initial Population":\n TJC."Ischemic Stroke Encounter"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Denominator":\n "Initial Population"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator Exclusion</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Denominator Exclusions":\n "Encounter Less Than Two Days"\n union "Encounter With Comfort Measures During Day Of Or Day After Arrival"\n union "Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Numerator</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Numerator":\n "Encounter With Antithrombotic Therapy"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator Exception</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Denominator Exceptions":\n "Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival"\n union "Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival"\n union "Encounter With An INR Greater Than 3.5"</code></pre>\n \n </td>\n </tr>\n \n \n \n </tr>\n </table>\n \n\n <table class=\"grid-dict\">\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>SupplementalDataElements</td>\n \n \n <td>SDE Sex</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "SDE Sex":\n case\n when Patient.gender = 'male' then "M"\n when Patient.gender = 'female' then "F"\n else null\n end</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>SDE Sex</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "SDE Sex":\n SDE."SDE Sex"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>TJCOverall</td>\n \n \n <td>Non Elective Inpatient Encounter With Age</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Non Elective Inpatient Encounter With Age":\n ["Encounter": "Nonelective Inpatient Encounter"] NonElectiveEncounter\n where AgeInYearsAt(date from start of NonElectiveEncounter.period ) >= 18\n and NonElectiveEncounter.period ends during day of "Measurement Period"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>TJCOverall</td>\n \n \n <td>Ischemic Stroke Encounter</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Ischemic Stroke Encounter":\n "Non Elective Inpatient Encounter With Age" NonElectiveEncounterWithAge\n where NonElectiveEncounterWithAge.principalDiagnosis().code in "Ischemic Stroke"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Encounter With Antithrombotic Therapy</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Encounter With Antithrombotic Therapy":\n TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n with ["MedicationAdministration": medication in "Antithrombotic Therapy for Ischemic Stroke"] Antithrombotic\n such that Antithrombotic.status in { 'in-progress', 'completed' }\n and Antithrombotic.effective.toInterval ( ) starts during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Numerator</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Numerator":\n "Encounter With Antithrombotic Therapy"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Initial Population</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Initial Population":\n TJC."Ischemic Stroke Encounter"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Denominator</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Denominator":\n "Initial Population"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>SupplementalDataElements</td>\n \n \n <td>SDE Payer</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "SDE Payer":\n [Coverage: type in "Payer Type"] Payer\n return {\n code: Payer.type,\n period: Payer.period\n }</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>SDE Payer</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "SDE Payer":\n SDE."SDE Payer"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>SupplementalDataElements</td>\n \n \n <td>SDE Ethnicity</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "SDE Ethnicity":\n Patient.ethnicity E\n return Tuple {\n codes: { E.ombCategory } union E.detailed,\n display: E.text\n }</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>SDE Ethnicity</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "SDE Ethnicity":\n SDE."SDE Ethnicity"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Encounter Less Than Two Days</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Encounter Less Than Two Days":\n TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n where IschemicStrokeEncounter.hospitalizationWithObservation ( ).lengthInDays ( ) < 2</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>TJCOverall</td>\n \n \n <td>Intervention Comfort Measures</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Intervention Comfort Measures":\n ( ["ServiceRequest": code in "Comfort Measures"] SR\n where SR.status in { 'active', 'completed', 'on-hold' }\n and SR.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n and SR.doNotPerform is not true\n ) \n union ( ["Procedure": "Comfort Measures"] InterventionPerformed\n where InterventionPerformed.status in { 'completed', 'in-progress' }\n )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Encounter With Comfort Measures During Day Of Or Day After Arrival</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Encounter With Comfort Measures During Day Of Or Day After Arrival":\n TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n with TJC."Intervention Comfort Measures" ComfortMeasure\n such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Thrombolytic Therapy Medication Or Procedures</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Thrombolytic Therapy Medication Or Procedures":\n ( ["MedicationAdministration": medication in "Thrombolytic tPA Therapy"] ThrombolyticMedication\n where ThrombolyticMedication.status in { 'in-progress', 'completed' }\n return {\n id: ThrombolyticMedication.id,\n effective: ThrombolyticMedication.effective\n }\n )\n union ( ["Procedure": "Intravenous or Intraarterial Thrombolytic tPA Therapy"] ThrombolyticProcedure\n where ThrombolyticProcedure.status = 'completed'\n return {\n id: ThrombolyticProcedure.id,\n effective: ThrombolyticProcedure.performed\n }\n )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Encounter With Thrombolytic Therapy Medication Or Procedures</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Encounter With Thrombolytic Therapy Medication Or Procedures":\n TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n with "Thrombolytic Therapy Medication Or Procedures" ThrombolyticTherapy\n such that ThrombolyticTherapy.effective.toInterval ( ) starts during Interval[start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) - 24 hours, end of IschemicStrokeEncounter.hospitalizationWithObservation ( ) )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Encounter With Thrombolytic Therapy Prior To Arrival</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Encounter With Thrombolytic Therapy Prior To Arrival":\n TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n where exists ( ( IschemicStrokeEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n where ( EncounterDiagnosis.code in "Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival" )\n )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Encounter With Thrombolytic Therapy Documented As Already Given</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Encounter With Thrombolytic Therapy Documented As Already Given":\n TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n with [Condition: "Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival"] PriorTPA\n such that PriorTPA.recordedDate during CQMCommon."HospitalizationWithObservation" ( IschemicStrokeEncounter )\n and PriorTPA.isActive ( )\n and PriorTPA.verificationStatus is not null\n and PriorTPA.verificationStatus ~ QICoreCommon."confirmed"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization":\n "Encounter With Thrombolytic Therapy Medication Or Procedures"\n union "Encounter With Thrombolytic Therapy Prior To Arrival"\n union "Encounter With Thrombolytic Therapy Documented As Already Given"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Denominator Exclusions</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Denominator Exclusions":\n "Encounter Less Than Two Days"\n union "Encounter With Comfort Measures During Day Of Or Day After Arrival"\n union "Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>SupplementalDataElements</td>\n \n \n <td>SDE Race</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "SDE Race":\n Patient.race R\n return Tuple {\n codes: R.ombCategory union R.detailed,\n display: R.text\n }</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>SDE Race</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "SDE Race":\n SDE."SDE Race"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Reason For Not Ordering Antithrombotic</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Reason For Not Ordering Antithrombotic":\n ["MedicationNotRequested": medication in "Antithrombotic Therapy for Ischemic Stroke"] NoAntithromboticOrder\n where NoAntithromboticOrder.status = 'completed'\n and NoAntithromboticOrder.intent = 'order'\n and ( NoAntithromboticOrder.reasonCode in "Medical Reason for Not Providing Treatment"\n or NoAntithromboticOrder.reasonCode in "Patient Refusal"\n )\n return {\n id: NoAntithromboticOrder.id,\n authoredOn: NoAntithromboticOrder.authoredOn\n }</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Reason For Not Administering Antithrombotic</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Reason For Not Administering Antithrombotic":\n ["MedicationAdministrationNotDone": medication in "Antithrombotic Therapy for Ischemic Stroke"] MedicationAdm\n where ( MedicationAdm.statusReason in "Medical Reason for Not Providing Treatment"\n or MedicationAdm.statusReason in "Patient Refusal"\n )\n return {\n id: MedicationAdm.id,\n authoredOn: MedicationAdm.recorded\n }</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Documented Reason For No Antithrombotic Ordered Or Administered</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Documented Reason For No Antithrombotic Ordered Or Administered":\n "Reason For Not Ordering Antithrombotic"\n union "Reason For Not Administering Antithrombotic"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival":\n TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n with "Documented Reason For No Antithrombotic Ordered Or Administered" NoAntithrombotic\n such that NoAntithrombotic.authoredOn during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival":\n TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n with ["MedicationAdministration": medication in "Pharmacological Contraindications For Antithrombotic Therapy"] PharmacologicalContraindications\n such that PharmacologicalContraindications.status in { 'in-progress', 'completed' }\n and PharmacologicalContraindications.effective.toInterval ( ) starts during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Encounter With An INR Greater Than 3.5</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Encounter With An INR Greater Than 3.5":\n TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter\n with ["Observation": "INR"] INR\n such that INR.value as Quantity > 3.5\n and INR.status in { 'final', 'amended', 'corrected' }\n and INR.issued during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CMS72FHIRSTKAntithromboticDay2</td>\n \n \n <td>Denominator Exceptions</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Denominator Exceptions":\n "Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival"\n union "Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival"\n union "Encounter With An INR Greater Than 3.5"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CQMCommon</td>\n \n \n <td>principalDiagnosis</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns the condition that is specified as the principal diagnosis for the encounter\n*/\ndefine fluent function principalDiagnosis(Encounter Encounter ):\n\tsingleton from ((Encounter.diagnosis D where D.rank = 1 and D.use ~ "Billing") PD\n return singleton from ([Condition] C where C.id = PD.condition.reference.getId())\n\t)</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>QICoreCommon</td>\n \n \n <td>getId</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).\n@comment: This function can be used to determine the logical id of a given resource. It can be used in\na single-server environment to trace references. However, this function does not attempt to resolve\nor distinguish the base of the given url, and so cannot be used safely in multi-server environments.\n*/\ndefine fluent function getId(uri String):\n Last(Split(uri, '/'))</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>TJCOverall</td>\n \n \n <td>CalendarDayOfOrDayAfter</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define fluent function CalendarDayOfOrDayAfter(StartValue DateTime):\n Interval [date from (StartValue), date from (StartValue) + 1 day]</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CQMCommon</td>\n \n \n <td>hospitalizationWithObservation</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter\n*/\ndefine fluent function hospitalizationWithObservation(TheEncounter Encounter ):\n TheEncounter Visit\n \t\tlet ObsVisit: Last([Encounter: "Observation Services"] LastObs\n \t\t\t\twhere LastObs.status = 'finished'\n and LastObs.period ends 1 hour or less on or before start of Visit.period\n \t\t\t\tsort by end of period\n \t\t\t),\n \t\t\tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n \t\t\tEDVisit: Last([Encounter: "Emergency Department Visit"] LastED\n \t\t\t\twhere LastED.status = 'finished'\n and LastED.period ends 1 hour or less on or before VisitStart\n \t\t\t\tsort by end of period\n \t\t\t)\n \t\treturn Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>FHIRHelpers</td>\n \n \n <td>ToString</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function ToString(value uri): value.value</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>FHIRHelpers</td>\n \n \n <td>ToCode</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n if coding is null then\n null\n else\n System.Code {\n code: coding.code.value,\n system: coding.system.value,\n version: coding.version.value,\n display: coding.display.value\n }</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CQMCommon</td>\n \n \n <td>lengthInDays</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Calculates the difference in calendar days between the start and end of the given interval.\n*/\ndefine fluent function lengthInDays(Value Interval<DateTime> ):\n difference in days between start of Value and end of Value</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CQMCommon</td>\n \n \n <td>encounterDiagnosis</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns the Condition resources referenced by the diagnosis element of the Encounter\n*/\ndefine fluent function encounterDiagnosis(Encounter Encounter ):\n Encounter.diagnosis D\n return singleton from ([Condition] C where C.id = D.condition.reference.getId())</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CQMCommon</td>\n \n \n <td>HospitalizationWithObservation</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter\n@deprecated: This function is deprecated. Use the fluent function `hospitalizationWithObservation()` instead.\n*/\ndefine function "HospitalizationWithObservation"(TheEncounter Encounter ):\n TheEncounter Visit\n \t\tlet ObsVisit: Last([Encounter: "Observation Services"] LastObs\n \t\t\t\twhere LastObs.status = 'finished'\n and LastObs.period ends 1 hour or less on or before start of Visit.period\n \t\t\t\tsort by end of period\n \t\t\t),\n \t\t\tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n \t\t\tEDVisit: Last([Encounter: "Emergency Department Visit"] LastED\n \t\t\t\twhere LastED.status = 'finished'\n and LastED.period ends 1 hour or less on or before VisitStart\n \t\t\t\tsort by end of period\n \t\t\t)\n \t\treturn Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>QICoreCommon</td>\n \n \n <td>isActive</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/* Candidates for FHIRCommon */\n\n/*\n@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse\n*/\ndefine fluent function isActive(condition Condition):\n condition.clinicalStatus ~ "active"\n or condition.clinicalStatus ~ "recurrence"\n or condition.clinicalStatus ~ "relapse"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>FHIRHelpers</td>\n \n \n <td>ToConcept</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n if concept is null then\n null\n else\n System.Concept {\n codes: concept.coding C return ToCode(C),\n display: concept.text.value\n }</code></pre>\n </td>\n \n </tr>\n \n </table>\n </td>\n </tr>\n \n \n \n\n </table>\n</div>"
},
"contained" : [
{
"resourceType" : "Library",
"id" : "effective-data-requirements",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://hl7.org/fhir/administrative-gender",
"code" : "M",
"display" : "Male"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://hl7.org/fhir/administrative-gender",
"code" : "F",
"display" : "Female"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://terminology.hl7.org/CodeSystem/diagnosis-role",
"code" : "billing",
"display" : "Billing"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code" : "active",
"display" : "Active"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code" : "recurrence",
"display" : "Recurrence"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code" : "relapse",
"display" : "Relapse"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code" : "confirmed",
"display" : "Confirmed"
}
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "SupplementalDataElements"
},
{
"url" : "name",
"valueString" : "SDE Sex"
},
{
"url" : "statement",
"valueString" : "define \"SDE Sex\":\n case\n when Patient.gender = 'male' then \"M\"\n when Patient.gender = 'female' then \"F\"\n else null\n end"
},
{
"url" : "displaySequence",
"valueInteger" : 0
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "SDE Sex"
},
{
"url" : "statement",
"valueString" : "define \"SDE Sex\":\n SDE.\"SDE Sex\""
},
{
"url" : "displaySequence",
"valueInteger" : 1
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "TJCOverall"
},
{
"url" : "name",
"valueString" : "Non Elective Inpatient Encounter With Age"
},
{
"url" : "statement",
"valueString" : "define \"Non Elective Inpatient Encounter With Age\":\n [\"Encounter\": \"Nonelective Inpatient Encounter\"] NonElectiveEncounter\n where AgeInYearsAt(date from start of NonElectiveEncounter.period ) >= 18\n and NonElectiveEncounter.period ends during day of \"Measurement Period\""
},
{
"url" : "displaySequence",
"valueInteger" : 2
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "TJCOverall"
},
{
"url" : "name",
"valueString" : "Ischemic Stroke Encounter"
},
{
"url" : "statement",
"valueString" : "define \"Ischemic Stroke Encounter\":\n \"Non Elective Inpatient Encounter With Age\" NonElectiveEncounterWithAge\n where NonElectiveEncounterWithAge.principalDiagnosis().code in \"Ischemic Stroke\""
},
{
"url" : "displaySequence",
"valueInteger" : 3
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Encounter With Antithrombotic Therapy"
},
{
"url" : "statement",
"valueString" : "define \"Encounter With Antithrombotic Therapy\":\n TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n with [\"MedicationAdministration\": medication in \"Antithrombotic Therapy for Ischemic Stroke\"] Antithrombotic\n such that Antithrombotic.status in { 'in-progress', 'completed' }\n and Antithrombotic.effective.toInterval ( ) starts during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )"
},
{
"url" : "displaySequence",
"valueInteger" : 4
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Numerator"
},
{
"url" : "statement",
"valueString" : "define \"Numerator\":\n \"Encounter With Antithrombotic Therapy\""
},
{
"url" : "displaySequence",
"valueInteger" : 5
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Initial Population"
},
{
"url" : "statement",
"valueString" : "define \"Initial Population\":\n TJC.\"Ischemic Stroke Encounter\""
},
{
"url" : "displaySequence",
"valueInteger" : 6
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Denominator"
},
{
"url" : "statement",
"valueString" : "define \"Denominator\":\n \"Initial Population\""
},
{
"url" : "displaySequence",
"valueInteger" : 7
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "SupplementalDataElements"
},
{
"url" : "name",
"valueString" : "SDE Payer"
},
{
"url" : "statement",
"valueString" : "define \"SDE Payer\":\n [Coverage: type in \"Payer Type\"] Payer\n return {\n code: Payer.type,\n period: Payer.period\n }"
},
{
"url" : "displaySequence",
"valueInteger" : 8
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "SDE Payer"
},
{
"url" : "statement",
"valueString" : "define \"SDE Payer\":\n SDE.\"SDE Payer\""
},
{
"url" : "displaySequence",
"valueInteger" : 9
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "SupplementalDataElements"
},
{
"url" : "name",
"valueString" : "SDE Ethnicity"
},
{
"url" : "statement",
"valueString" : "define \"SDE Ethnicity\":\n Patient.ethnicity E\n return Tuple {\n codes: { E.ombCategory } union E.detailed,\n display: E.text\n }"
},
{
"url" : "displaySequence",
"valueInteger" : 10
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "SDE Ethnicity"
},
{
"url" : "statement",
"valueString" : "define \"SDE Ethnicity\":\n SDE.\"SDE Ethnicity\""
},
{
"url" : "displaySequence",
"valueInteger" : 11
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Encounter Less Than Two Days"
},
{
"url" : "statement",
"valueString" : "define \"Encounter Less Than Two Days\":\n TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n where IschemicStrokeEncounter.hospitalizationWithObservation ( ).lengthInDays ( ) < 2"
},
{
"url" : "displaySequence",
"valueInteger" : 12
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "TJCOverall"
},
{
"url" : "name",
"valueString" : "Intervention Comfort Measures"
},
{
"url" : "statement",
"valueString" : "define \"Intervention Comfort Measures\":\n ( [\"ServiceRequest\": code in \"Comfort Measures\"] SR\n where SR.status in { 'active', 'completed', 'on-hold' }\n and SR.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n and SR.doNotPerform is not true\n ) \n union ( [\"Procedure\": \"Comfort Measures\"] InterventionPerformed\n where InterventionPerformed.status in { 'completed', 'in-progress' }\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 13
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Encounter With Comfort Measures During Day Of Or Day After Arrival"
},
{
"url" : "statement",
"valueString" : "define \"Encounter With Comfort Measures During Day Of Or Day After Arrival\":\n TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n with TJC.\"Intervention Comfort Measures\" ComfortMeasure\n such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )"
},
{
"url" : "displaySequence",
"valueInteger" : 14
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Thrombolytic Therapy Medication Or Procedures"
},
{
"url" : "statement",
"valueString" : "define \"Thrombolytic Therapy Medication Or Procedures\":\n ( [\"MedicationAdministration\": medication in \"Thrombolytic tPA Therapy\"] ThrombolyticMedication\n where ThrombolyticMedication.status in { 'in-progress', 'completed' }\n return {\n id: ThrombolyticMedication.id,\n effective: ThrombolyticMedication.effective\n }\n )\n union ( [\"Procedure\": \"Intravenous or Intraarterial Thrombolytic tPA Therapy\"] ThrombolyticProcedure\n where ThrombolyticProcedure.status = 'completed'\n return {\n id: ThrombolyticProcedure.id,\n effective: ThrombolyticProcedure.performed\n }\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 15
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Encounter With Thrombolytic Therapy Medication Or Procedures"
},
{
"url" : "statement",
"valueString" : "define \"Encounter With Thrombolytic Therapy Medication Or Procedures\":\n TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n with \"Thrombolytic Therapy Medication Or Procedures\" ThrombolyticTherapy\n such that ThrombolyticTherapy.effective.toInterval ( ) starts during Interval[start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) - 24 hours, end of IschemicStrokeEncounter.hospitalizationWithObservation ( ) )"
},
{
"url" : "displaySequence",
"valueInteger" : 16
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Encounter With Thrombolytic Therapy Prior To Arrival"
},
{
"url" : "statement",
"valueString" : "define \"Encounter With Thrombolytic Therapy Prior To Arrival\":\n TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n where exists ( ( IschemicStrokeEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n where ( EncounterDiagnosis.code in \"Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival\" )\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 17
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Encounter With Thrombolytic Therapy Documented As Already Given"
},
{
"url" : "statement",
"valueString" : "define \"Encounter With Thrombolytic Therapy Documented As Already Given\":\n TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n with [Condition: \"Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival\"] PriorTPA\n such that PriorTPA.recordedDate during CQMCommon.\"HospitalizationWithObservation\" ( IschemicStrokeEncounter )\n and PriorTPA.isActive ( )\n and PriorTPA.verificationStatus is not null\n and PriorTPA.verificationStatus ~ QICoreCommon.\"confirmed\""
},
{
"url" : "displaySequence",
"valueInteger" : 18
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization"
},
{
"url" : "statement",
"valueString" : "define \"Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization\":\n \"Encounter With Thrombolytic Therapy Medication Or Procedures\"\n union \"Encounter With Thrombolytic Therapy Prior To Arrival\"\n union \"Encounter With Thrombolytic Therapy Documented As Already Given\""
},
{
"url" : "displaySequence",
"valueInteger" : 19
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Denominator Exclusions"
},
{
"url" : "statement",
"valueString" : "define \"Denominator Exclusions\":\n \"Encounter Less Than Two Days\"\n union \"Encounter With Comfort Measures During Day Of Or Day After Arrival\"\n union \"Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization\""
},
{
"url" : "displaySequence",
"valueInteger" : 20
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "SupplementalDataElements"
},
{
"url" : "name",
"valueString" : "SDE Race"
},
{
"url" : "statement",
"valueString" : "define \"SDE Race\":\n Patient.race R\n return Tuple {\n codes: R.ombCategory union R.detailed,\n display: R.text\n }"
},
{
"url" : "displaySequence",
"valueInteger" : 21
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "SDE Race"
},
{
"url" : "statement",
"valueString" : "define \"SDE Race\":\n SDE.\"SDE Race\""
},
{
"url" : "displaySequence",
"valueInteger" : 22
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Reason For Not Ordering Antithrombotic"
},
{
"url" : "statement",
"valueString" : "define \"Reason For Not Ordering Antithrombotic\":\n [\"MedicationNotRequested\": medication in \"Antithrombotic Therapy for Ischemic Stroke\"] NoAntithromboticOrder\n where NoAntithromboticOrder.status = 'completed'\n and NoAntithromboticOrder.intent = 'order'\n and ( NoAntithromboticOrder.reasonCode in \"Medical Reason for Not Providing Treatment\"\n or NoAntithromboticOrder.reasonCode in \"Patient Refusal\"\n )\n return {\n id: NoAntithromboticOrder.id,\n authoredOn: NoAntithromboticOrder.authoredOn\n }"
},
{
"url" : "displaySequence",
"valueInteger" : 23
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Reason For Not Administering Antithrombotic"
},
{
"url" : "statement",
"valueString" : "define \"Reason For Not Administering Antithrombotic\":\n [\"MedicationAdministrationNotDone\": medication in \"Antithrombotic Therapy for Ischemic Stroke\"] MedicationAdm\n where ( MedicationAdm.statusReason in \"Medical Reason for Not Providing Treatment\"\n or MedicationAdm.statusReason in \"Patient Refusal\"\n )\n return {\n id: MedicationAdm.id,\n authoredOn: MedicationAdm.recorded\n }"
},
{
"url" : "displaySequence",
"valueInteger" : 24
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Documented Reason For No Antithrombotic Ordered Or Administered"
},
{
"url" : "statement",
"valueString" : "define \"Documented Reason For No Antithrombotic Ordered Or Administered\":\n \"Reason For Not Ordering Antithrombotic\"\n union \"Reason For Not Administering Antithrombotic\""
},
{
"url" : "displaySequence",
"valueInteger" : 25
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival"
},
{
"url" : "statement",
"valueString" : "define \"Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival\":\n TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n with \"Documented Reason For No Antithrombotic Ordered Or Administered\" NoAntithrombotic\n such that NoAntithrombotic.authoredOn during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )"
},
{
"url" : "displaySequence",
"valueInteger" : 26
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival"
},
{
"url" : "statement",
"valueString" : "define \"Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival\":\n TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n with [\"MedicationAdministration\": medication in \"Pharmacological Contraindications For Antithrombotic Therapy\"] PharmacologicalContraindications\n such that PharmacologicalContraindications.status in { 'in-progress', 'completed' }\n and PharmacologicalContraindications.effective.toInterval ( ) starts during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )"
},
{
"url" : "displaySequence",
"valueInteger" : 27
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Encounter With An INR Greater Than 3.5"
},
{
"url" : "statement",
"valueString" : "define \"Encounter With An INR Greater Than 3.5\":\n TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n with [\"Observation\": \"INR\"] INR\n such that INR.value as Quantity > 3.5\n and INR.status in { 'final', 'amended', 'corrected' }\n and INR.issued during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )"
},
{
"url" : "displaySequence",
"valueInteger" : 28
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS72FHIRSTKAntithromboticDay2"
},
{
"url" : "name",
"valueString" : "Denominator Exceptions"
},
{
"url" : "statement",
"valueString" : "define \"Denominator Exceptions\":\n \"Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival\"\n union \"Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival\"\n union \"Encounter With An INR Greater Than 3.5\""
},
{
"url" : "displaySequence",
"valueInteger" : 29
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CQMCommon"
},
{
"url" : "name",
"valueString" : "principalDiagnosis"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Returns the condition that is specified as the principal diagnosis for the encounter\n*/\ndefine fluent function principalDiagnosis(Encounter Encounter ):\n\tsingleton from ((Encounter.diagnosis D where D.rank = 1 and D.use ~ \"Billing\") PD\n return singleton from ([Condition] C where C.id = PD.condition.reference.getId())\n\t)"
},
{
"url" : "displaySequence",
"valueInteger" : 30
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "QICoreCommon"
},
{
"url" : "name",
"valueString" : "getId"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).\n@comment: This function can be used to determine the logical id of a given resource. It can be used in\na single-server environment to trace references. However, this function does not attempt to resolve\nor distinguish the base of the given url, and so cannot be used safely in multi-server environments.\n*/\ndefine fluent function getId(uri String):\n Last(Split(uri, '/'))"
},
{
"url" : "displaySequence",
"valueInteger" : 31
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "TJCOverall"
},
{
"url" : "name",
"valueString" : "CalendarDayOfOrDayAfter"
},
{
"url" : "statement",
"valueString" : "define fluent function CalendarDayOfOrDayAfter(StartValue DateTime):\n Interval [date from (StartValue), date from (StartValue) + 1 day]"
},
{
"url" : "displaySequence",
"valueInteger" : 32
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CQMCommon"
},
{
"url" : "name",
"valueString" : "hospitalizationWithObservation"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter\n*/\ndefine fluent function hospitalizationWithObservation(TheEncounter Encounter ):\n TheEncounter Visit\n \t\tlet ObsVisit: Last([Encounter: \"Observation Services\"] LastObs\n \t\t\t\twhere LastObs.status = 'finished'\n and LastObs.period ends 1 hour or less on or before start of Visit.period\n \t\t\t\tsort by end of period\n \t\t\t),\n \t\t\tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n \t\t\tEDVisit: Last([Encounter: \"Emergency Department Visit\"] LastED\n \t\t\t\twhere LastED.status = 'finished'\n and LastED.period ends 1 hour or less on or before VisitStart\n \t\t\t\tsort by end of period\n \t\t\t)\n \t\treturn Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]"
},
{
"url" : "displaySequence",
"valueInteger" : 33
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "FHIRHelpers"
},
{
"url" : "name",
"valueString" : "ToString"
},
{
"url" : "statement",
"valueString" : "define function ToString(value uri): value.value"
},
{
"url" : "displaySequence",
"valueInteger" : 34
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "FHIRHelpers"
},
{
"url" : "name",
"valueString" : "ToCode"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n if coding is null then\n null\n else\n System.Code {\n code: coding.code.value,\n system: coding.system.value,\n version: coding.version.value,\n display: coding.display.value\n }"
},
{
"url" : "displaySequence",
"valueInteger" : 35
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CQMCommon"
},
{
"url" : "name",
"valueString" : "lengthInDays"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Calculates the difference in calendar days between the start and end of the given interval.\n*/\ndefine fluent function lengthInDays(Value Interval<DateTime> ):\n difference in days between start of Value and end of Value"
},
{
"url" : "displaySequence",
"valueInteger" : 36
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CQMCommon"
},
{
"url" : "name",
"valueString" : "encounterDiagnosis"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Returns the Condition resources referenced by the diagnosis element of the Encounter\n*/\ndefine fluent function encounterDiagnosis(Encounter Encounter ):\n Encounter.diagnosis D\n return singleton from ([Condition] C where C.id = D.condition.reference.getId())"
},
{
"url" : "displaySequence",
"valueInteger" : 37
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CQMCommon"
},
{
"url" : "name",
"valueString" : "HospitalizationWithObservation"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter\n@deprecated: This function is deprecated. Use the fluent function `hospitalizationWithObservation()` instead.\n*/\ndefine function \"HospitalizationWithObservation\"(TheEncounter Encounter ):\n TheEncounter Visit\n \t\tlet ObsVisit: Last([Encounter: \"Observation Services\"] LastObs\n \t\t\t\twhere LastObs.status = 'finished'\n and LastObs.period ends 1 hour or less on or before start of Visit.period\n \t\t\t\tsort by end of period\n \t\t\t),\n \t\t\tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n \t\t\tEDVisit: Last([Encounter: \"Emergency Department Visit\"] LastED\n \t\t\t\twhere LastED.status = 'finished'\n and LastED.period ends 1 hour or less on or before VisitStart\n \t\t\t\tsort by end of period\n \t\t\t)\n \t\treturn Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]"
},
{
"url" : "displaySequence",
"valueInteger" : 38
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "QICoreCommon"
},
{
"url" : "name",
"valueString" : "isActive"
},
{
"url" : "statement",
"valueString" : "/* Candidates for FHIRCommon */\n\n/*\n@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse\n*/\ndefine fluent function isActive(condition Condition):\n condition.clinicalStatus ~ \"active\"\n or condition.clinicalStatus ~ \"recurrence\"\n or condition.clinicalStatus ~ \"relapse\""
},
{
"url" : "displaySequence",
"valueInteger" : 39
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "FHIRHelpers"
},
{
"url" : "name",
"valueString" : "ToConcept"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n if concept is null then\n null\n else\n System.Concept {\n codes: concept.coding C return ToCode(C),\n display: concept.text.value\n }"
},
{
"url" : "displaySequence",
"valueInteger" : 40
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
}
],
"name" : "EffectiveDataRequirements",
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/library-type",
"code" : "module-definition"
}
]
},
"relatedArtifact" : [
{
"type" : "depends-on",
"display" : "Library SDE",
"resource" : "Library/SupplementalDataElements|3.5.000"
},
{
"type" : "depends-on",
"display" : "Library TJC",
"resource" : "Library/TJCOverall|8.15.000"
},
{
"type" : "depends-on",
"display" : "Library FHIRHelpers",
"resource" : "Library/FHIRHelpers|4.4.000"
},
{
"type" : "depends-on",
"display" : "Library CQMCommon",
"resource" : "Library/CQMCommon|2.2.000"
},
{
"type" : "depends-on",
"display" : "Library QICoreCommon",
"resource" : "Library/QICoreCommon|2.1.000"
},
{
"type" : "depends-on",
"display" : "Code system AdministrativeGender",
"resource" : "http://hl7.org/fhir/administrative-gender"
},
{
"type" : "depends-on",
"display" : "Code system DiagnosisRole",
"resource" : "http://terminology.hl7.org/CodeSystem/diagnosis-role"
},
{
"type" : "depends-on",
"display" : "Code system ConditionClinicalStatusCodes",
"resource" : "http://terminology.hl7.org/CodeSystem/condition-clinical"
},
{
"type" : "depends-on",
"display" : "Code system ConditionVerificationStatusCodes",
"resource" : "http://terminology.hl7.org/CodeSystem/condition-ver-status"
},
{
"type" : "depends-on",
"display" : "Value set Nonelective Inpatient Encounter",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
},
{
"type" : "depends-on",
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],
"url" : "https://madie.cms.gov/Measure/CMS72FHIRSTKAntithromboticDay2",
"identifier" : [
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"value" : "urn:uuid:e74bdff8-3857-471e-a0c5-b9307889bda6"
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"code" : "publisher",
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"value" : "72FHIR",
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"name" : "CMS72FHIRSTKAntithromboticDay2",
"title" : "Antithrombotic Therapy By End of Hospital Day 2FHIR",
"status" : "active",
"experimental" : false,
"date" : "2024-12-18T21:25:48+00:00",
"publisher" : "The Joint Commission",
"contact" : [
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"value" : "https://www.jointcommission.org/"
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],
"description" : "Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2",
"purpose" : "UNKNOWN",
"usage" : "The \"Nonelective Inpatient Encounter\" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the \"Inpatient Encounter\" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective Inpatient Encounters include emergency, urgent, and unplanned admissions. \n\nNPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e., rectal or intravenous). \n\nIn the denominator exclusions, the intent is to only exclude patients with a total length of stay of <2 days, including Emergency Department (ED) visit (if there is one). For the eCQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits.\n\nThe denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.\n\nThis eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS72v14. 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" : "Measure specifications are in the Public Domain\n\nLOINC(R) copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved.",
"effectivePeriod" : {
"start" : "2026-01-01",
"end" : "2026-12-31"
},
"author" : [
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"name" : "The Joint Commission",
"telecom" : [
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"value" : "https://www.jointcommission.org/"
}
]
}
],
"library" : [
🔗 "https://madie.cms.gov/Library/CMS72FHIRSTKAntithromboticDay2"
],
"disclaimer" : "These performance measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.",
"rationale" : "The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks (TIA) continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist.\n\nAspirin is the recommended antithrombotic medication for early antithrombotic therapy and most frequently administered unless contraindicated. Anticoagulants at doses to prevent venous thromboembolism (VTE) are insufficient. Subcutaneous Lovenox (enoxaparin) and unfractionated heparin (UFH) SQ at lower dosages used for VTE prophylaxis (i.e., enoxaparin SQ 40 mg once daily; enoxaparin SQ 30 mg Q12 hours; UFH 5,000 units or less two or three times daily) are not sufficient for early antithrombotic therapy.\n\nAnticoagulants at doses to prevent VTE are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA.",
"clinicalRecommendationStatement" : "Antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist",
"guidance" : "The \"Nonelective Inpatient Encounter\" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the \"Inpatient Encounter\" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective Inpatient Encounters include emergency, urgent, and unplanned admissions. \n\nNPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e., rectal or intravenous). \n\nIn the denominator exclusions, the intent is to only exclude patients with a total length of stay of <2 days, including Emergency Department (ED) visit (if there is one). For the eCQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits.\n\nThe denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.\n\nThis eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS72v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).",
"group" : [
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"extension" : [
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"valueCodeableConcept" : {
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"code" : "proportion",
"display" : "Proportion"
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"valueCode" : "Encounter"
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"valueCode" : "None"
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],
"description" : "Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2",
"population" : [
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"id" : "671415E2-A9AB-4A88-8D9F-E13567DB60DE",
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"display" : "Initial Population"
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},
"description" : "Inpatient hospitalization (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke that ends during the measurement period",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Initial Population"
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},
{
"id" : "66E700CD-3526-4907-B48F-20A3C99FF470",
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},
{
"id" : "0B767BB2-1D05-4020-B629-548946B64CBD",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "denominator-exclusion",
"display" : "Denominator Exclusion"
}
]
},
"description" : "- Inpatient hospitalization for patients who have a duration of stay less than 2 days.\n- Inpatient hospitalization for patients with comfort measures documented day of or the day after arrival.\n- Inpatient hospitalization for patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy administered within 24 hours prior to arrival or anytime during hospitalization.",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Denominator Exclusions"
}
},
{
"id" : "DADB9060-BF4C-4032-94D5-8D981DDFDD1B",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "numerator",
"display" : "Numerator"
}
]
},
"description" : "Inpatient hospitalization for patients who had antithrombotic therapy administered the day of or day after hospital arrival",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Numerator"
}
},
{
"id" : "998D63FA-104C-4FFB-9641-37E14045AF9D",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "denominator-exception",
"display" : "Denominator Exception"
}
]
},
"description" : "- Inpatient hospitalization for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival\n- Inpatient hospitalization for patients who receive Prasugrel as an antithrombotic therapy the day of or day after hospital arrival\n- Inpatient hospitalization for patients with an international normalised ratio (INR) greater than 3.5",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Denominator Exceptions"
}
}
]
}
],
"supplementalData" : [
{
"id" : "sde-ethnicity",
"usage" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code" : "supplemental-data"
}
]
}
],
"description" : "SDE Ethnicity",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "SDE Ethnicity"
}
},
{
"id" : "sde-payer",
"usage" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code" : "supplemental-data"
}
]
}
],
"description" : "SDE Payer",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "SDE Payer"
}
},
{
"id" : "sde-race",
"usage" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code" : "supplemental-data"
}
]
}
],
"description" : "SDE Race",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "SDE Race"
}
},
{
"id" : "sde-sex",
"usage" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code" : "supplemental-data"
}
]
}
],
"description" : "SDE Sex",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "SDE Sex"
}
}
]
}
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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