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" : "CMS996FHIRAptTxforSTEMI",
"meta" : {
"profile" : [
🔗 "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"
]
},
"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;\">Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department FHIR</td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Id: </b></th>\n <td style=\"padding-left: 4px;\">CMS996FHIRAptTxforSTEMI</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Version: </b></th>\n <td style=\"padding-left: 4px;\">1.2.001</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-CMS996FHIRAptTxforSTEMI.html\">Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department FHIR</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>CMS996FHIR</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:a48685e0-4926-4ae8-9eb3-d8e8839b1704</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:feb911dd-6b34-4b3f-866f-3059dd4d19d0</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>996FHIR</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;\">Centers for Medicare & Medicaid Services (CMS)</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Author: </b></th>\n <td style=\"padding-left: 4px;\">Acumen, LLC</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>Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival</p>\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>Limited proprietary coding is contained in these specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets.</p>\n<p>This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. All rights reserved.</p>\n<p>LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc.</p>\n<p>CPT(R) contained in the measure specifications is copyright 2004-2024 American Medical Association.</p>\n<p>ICD-10 is 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 specifications are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications.</p>\n<p>THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.</p>\n<p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</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>Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (Solhpour & Yusuf, 2013; Fibrinolytic Therapy Trialists’ Collaborative Group, 1994). For patients receiving fibrinolytic therapy, the American Heart Association (AHA) estimates that 65 lives will be saved per 1,000 patients if treatment is administered within the first hour of symptom onset, and 131 lives will be saved per 1,000 patients treated if fibrinolytic therapy is delivered within the first three hours (O’Connor et al., 2010).\nThe total ischemic time—that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy—is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O’Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O’Gara et al., 2013).\nImplementation of an eCQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the eCQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of ED Arrival (OP-2) measure and broaden the population for which performance scores could be publicly reported.</p>\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>Primary PCI in STEMI:\nThe 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that:</p>\n<ul>\n<li>"Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration."</li>\n<li>"Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact."</li>\n</ul>\n<p>Fibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact:\nThe 2013 American College of Cardiology Foundation (ACCF)/American Heart Association(AHA) clinical practice guideline for the management of STEMI recommends that:</p>\n<ul>\n<li>"In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact.”</li>\n</ul>\n<p>Transfer to a PCI-Capable Hospital after Fibrinolytic Therapy:\nThe 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that:</p>\n<ul>\n<li>Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe heart failure (HF), irrespective of the time delay from MI onset.</li>\n<li>Urgent transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who demonstrate evidence of failed reperfusion or reocclusion after fibrinolytic therapy.</li>\n<li>Transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy.</li>\n</ul>\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;\">In order to support the best outcomes for patients and align with other guidelines, PCI device deployment time should be used for calculating the “PCI is performed within 90 minutes of ED arrival” numerator criteria and not the start time of the procedure.\n\nThis eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS996v6. 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>6633d92a6c1d307ea36e74c0</b></th>\n </tr>\n \n \n <tr>\n <td>Initial Population:</td>\n\n \n \n <td>All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during an Emergency Department encounter that ends during the measurement period</td>\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>Patients with the following conditions are excluded from measure denominator:\n\nAt some point during ED encounter:\n- Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase\n\nStarts before the start of ED encounter and does not end before ED encounter:\n- Bleeding or bleeding diathesis (excluding menses)\n- Known malignant intracranial neoplasm (primary or metastatic)\n- Known structural cerebral vascular lesion (e.g., arteriovenous malformation)\n- Advanced dementia\n- Pregnancy\n- Diagnosis of allergy to thrombolytics\n\nAt the start of ED encounter, or most recent dose within 90 days or less of ED encounter:\n-Active oral anticoagulant therapy\n\nOccurs 24 hours or less before start of ED encounter or during ED encounter:\n- Aortic dissection or ruptured aortic aneurysm, Angina pectoris with documented spasm, Aneurysm of heart, Ventricular aneurysm due to and following acute myocardial infarction (disorder), Takotsubo cardiomyopathy or syndrome\n- Severe neurologic impairment\n- Mechanical circulatory assist device placement or removal, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device\n- Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation\n- Cardiopulmonary arrest, including: cardiac arrest, cardiopulmonary resuscitation (CPR), defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR\n\nOccurs 21 days or less before start of ED encounter:\n- Major surgery \n\nOccurs 90 days before start of or at start of ED encounter:\n- Ischemic stroke \n- Significant facial and/or closed head trauma \n- Peptic ulcer\n\nOccurs 90 days or less before start of ED encounter:\n- Intracranial or intraspinal surgery \n\nWith a discharge disposition of patient expired in the ED\n\nWith a discharge disposition of left against medical advice\n\nWith documentation of hospice services in the 6 months within start of ED encounter, or active hospice status at start of ED encounter</td>\n \n \n\n </tr>\n \n <tr>\n <td>Numerator:</td>\n\n \n \n <td>Emergency department encounters with a diagnosis of STEMI:\n - where time from ED arrival to fibrinolysis is 30 minutes or fewer;\nOR \n- where PCI is performed within 90 minutes of arrival; \nOR\n- where the patient is discharged to an acute care facility within 45 minutes of ED arrival</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator Exception:</td>\n\n \n \n <td>Emergency department encounters where the patient received fibrinolytic therapy at another facility within 24 hours.\nEmergency department encounters with a documented reason for not administering fibrinolytic therapy within 30 minutes of ED arrival.\nEmergency department encounters with a documented reason for not performing a PCI within 90 minutes of ED arrival.</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 </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-CMS996FHIRAptTxforSTEMI.html\">CMS996FHIRAptTxforSTEMI</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/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><code>Library/Status|1.8.000</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-v3-ActCode.html\">ActCode</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-allergyintolerance-clinical.html\">AllergyIntolerance Clinical Status Codes</a></li>\n \n <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a></li>\n \n <li><a href=\"http://hl7.org/fhir/R4/codesystem-snomedct.html\">SNOMED CT (all versions)</a></li>\n \n <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-observation-category.html\">Observation Category Codes</a></li>\n \n <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html\">Logical Observation Identifiers, Names and Codes (LOINC)</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion\">Emergency Department Visit</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4017/expansion\">STEMI</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4019/expansion\">Fibrinolytic Therapy</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/2.16.840.1.113883.3.3157.2000.5/expansion\">Percutaneous Coronary Intervention</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.87/expansion\">Discharge To Acute Care Facility</a></li>\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/2.16.840.1.113762.1.4.1170.4/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.4</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.6/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.6</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4036/expansion\">Active Bleeding or Bleeding Diathesis (Excluding Menses)</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.3/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.3</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4025/expansion\">Cerebral Vascular Lesion</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4043/expansion\">Dementia</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4055/expansion\">Pregnancy</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.5/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.5</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4045/expansion\">Anticoagulant Medications, Oral</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4028/expansion\">Aortic Dissection</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.114.12.1012/expansion\">Neurologic impairment</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4048/expansion\">Cardiopulmonary Arrest</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4056/expansion\">Major Surgical Procedure</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.69/expansion\">Endotracheal Intubation</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4052/expansion\">Mechanical Circulatory Assist Device</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/2.16.840.1.113883.3.3157.4026/expansion\">Closed Head Trauma</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4031/expansion\">Active Peptic Ulcer</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.2/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.2</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.309/expansion\">Patient Expired</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.308/expansion\">Left Against Medical Advice</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion\">Hospice Care Ambulatory</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165</a></li>\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/2.16.840.1.113762.1.4.1282.2/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1282.2</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1282.1/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1282.1</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 period\n \n status\n \n status.value\n \n class\n \n reasonCode\n \n hospitalization\n \n hospitalization.dischargeDisposition\n \n condition\n \n condition.reference\n \n condition.reference.value\n \n location\n \n location.type\n \n </td>\n <td>\n \n \n Emergency Department Evaluation and Management Visit\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion\">Emergency Department Visit</a></td>\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 status\n \n status.value\n \n class\n \n reasonCode\n \n condition\n \n condition.reference\n \n condition.reference.value\n \n location\n \n location.type\n \n </td>\n <td>\n \n \n Emergency Department Evaluation and Management Visit\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion\">Emergency Department Visit</a></td>\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 status\n \n status.value\n \n class\n \n reasonCode\n \n hospitalization\n \n hospitalization.dischargeDisposition\n \n condition\n \n condition.reference\n \n condition.reference.value\n \n location\n \n location.type\n \n </td>\n <td>\n \n \n Emergency Department Evaluation and Management Visit\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion\">Emergency Department Visit</a></td>\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 status\n \n status.value\n \n class\n \n reasonCode\n \n hospitalization\n \n hospitalization.dischargeDisposition\n \n condition\n \n condition.reference\n \n condition.reference.value\n \n location\n \n location.type\n \n </td>\n <td>\n \n \n Emergency Department Evaluation and Management Visit\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion\">Emergency Department Visit</a></td>\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 hospitalization\n \n hospitalization.dischargeDisposition\n \n period\n \n condition\n \n condition.reference\n \n condition.reference.value\n \n location\n \n location.type\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Encounter Inpatient\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</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 condition\n \n condition.reference\n \n condition.reference.value\n \n location\n \n location.type\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Hospice Encounter\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003</a></td>\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 status\n \n status.value\n \n class\n \n condition\n \n condition.reference\n \n condition.reference.value\n \n location\n \n location.type\n \n reasonCode\n \n </td>\n <td>\n \n \n Emergency Department Evaluation and Management Visit\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion\">Emergency Department Visit</a></td>\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 clinicalStatus\n \n </td>\n <td>\n \n \n STEMI\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4017/expansion\">STEMI</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 code\n \n </td>\n <td>\n \n \n Active Bleeding Excluding Menses or Bleeding Diathesis\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4036/expansion\">Active Bleeding or Bleeding Diathesis (Excluding Menses)</a></td>\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 </td>\n <td>\n \n \n Malignant Intracranial Neoplasm Group\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.3/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.3</a></td>\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 </td>\n <td>\n \n \n Cerebral Vascular Lesion\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4025/expansion\">Cerebral Vascular Lesion</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 code\n \n </td>\n <td>\n \n \n Dementia and Related Intracranial Pathologies\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4043/expansion\">Dementia</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 code\n \n </td>\n <td>\n \n \n Pregnant State\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4055/expansion\">Pregnancy</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 code\n \n </td>\n <td>\n \n \n Allergy to thrombolytics\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.5/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.5</a></td>\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 </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 </td>\n <td>\n \n \n Aortic Dissection or Ruptured Aortic Aneurysm\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4028/expansion\">Aortic Dissection</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 code\n \n </td>\n <td>\n \n \n Neurologic impairment\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.114.12.1012/expansion\">Neurologic impairment</a></td>\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 </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 </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 </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 </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 </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 </td>\n <td>\n \n \n Cardiopulmonary Arrest\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4048/expansion\">Cardiopulmonary Arrest</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 code\n \n </td>\n <td>\n \n \n Ischemic Stroke\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.247/expansion\">Ischemic Stroke</a></td>\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 </td>\n <td>\n \n \n Closed Head and Facial Trauma\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4026/expansion\">Closed Head Trauma</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 code\n \n </td>\n <td>\n \n \n Active Peptic Ulcer\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4031/expansion\">Active Peptic Ulcer</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 code\n \n </td>\n <td>\n \n \n Hospice Diagnosis\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165</a></td>\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 </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Location(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-location.html\">QICoreLocation</a>)</td>\n <td>\n \n id\n \n id.value\n \n </td>\n <td>\n \n </td>\n <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 Fibrinolytic Therapy\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4019/expansion\">Fibrinolytic Therapy</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 performed\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Percutaneous Coronary Intervention\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.2000.5/expansion\">Percutaneous Coronary Intervention</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 performed\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Major Surgical Procedure\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4056/expansion\">Major Surgical Procedure</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 performed\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Endotracheal Intubation\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.69/expansion\">Endotracheal Intubation</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 performed\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Insertion, Replacement, or Removal of Mechanical Circulatory Assist Device\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4052/expansion\">Mechanical Circulatory Assist Device</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 performed\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Intracranial or Intraspinal surgery\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.2/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.2</a></td>\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 performed\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Hospice Care Ambulatory\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion\">Hospice Care Ambulatory</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>AllergyIntolerance(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-allergyintolerance.html\">QICoreAllergyIntolerance</a>)</td>\n <td>\n \n code\n \n clinicalStatus\n \n onset\n \n </td>\n <td>\n \n \n Thrombolytic medications\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.4/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.4</a></td>\n </tr>\n \n <tr>\n <td>AdverseEvent(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-adverseevent.html\">QICoreAdverseEvent</a>)</td>\n <td>\n \n event\n \n recordedDate\n \n recordedDate.value\n \n actuality\n \n actuality.value\n \n </td>\n <td>\n \n \n Thrombolytics Adverse Event\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.6/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.6</a></td>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication.reference\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n authoredOn\n \n authoredOn.value\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n authoredOn\n \n authoredOn.value\n \n </td>\n <td>\n \n \n Oral Anticoagulant Medications\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4045/expansion\">Anticoagulant Medications, Oral</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 effective\n \n status\n \n status.value\n \n category\n \n </td>\n <td>\n \n </td>\n <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 authoredOn\n \n authoredOn.value\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n </td>\n <td>\n \n \n Hospice Care Ambulatory\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion\">Hospice Care Ambulatory</a></td>\n </tr>\n \n <tr>\n <td>Procedure(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedurenotdone.html\">QICoreProcedureNotDone</a>)</td>\n <td>\n \n code\n \n statusReason\n \n id\n \n id.value\n \n extension\n \n authoredOn\n \n </td>\n <td>\n \n \n Percutaneous Coronary Intervention\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.2000.5/expansion\">Percutaneous Coronary Intervention</a></td>\n </tr>\n \n <tr>\n <td>Procedure(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedurenotdone.html\">QICoreProcedureNotDone</a>)</td>\n <td>\n \n code\n \n statusReason\n \n id\n \n id.value\n \n extension\n \n authoredOn\n \n </td>\n <td>\n \n \n Percutaneous Coronary Intervention\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.2000.5/expansion\">Percutaneous Coronary Intervention</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 authoredOn\n \n </td>\n <td>\n \n \n Fibrinolytic Therapy\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4019/expansion\">Fibrinolytic Therapy</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 authoredOn\n \n </td>\n <td>\n \n \n Fibrinolytic Therapy\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4019/expansion\">Fibrinolytic Therapy</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>emergency</td>\n <td>EMER</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-ActCode.html\">http://terminology.hl7.org/CodeSystem/v3-ActCode</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>Active</td>\n <td>active</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-allergyintolerance-clinical.html\">http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical</a></td>\n </tr>\n \n <tr>\n <td>Long term (current) use of anticoagulants</td>\n <td>Z79.01</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html\">http://hl7.org/fhir/sid/icd-10-cm</a></td>\n </tr>\n \n <tr>\n <td>Angina pectoris with documented spasm</td>\n <td>I20.1</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html\">http://hl7.org/fhir/sid/icd-10-cm</a></td>\n </tr>\n \n <tr>\n <td>Ventricular aneurysm due to and following acute myocardial infarction (disorder)</td>\n <td>723858002</td>\n <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n </tr>\n \n <tr>\n <td>Aneurysm of heart</td>\n <td>I25.3</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html\">http://hl7.org/fhir/sid/icd-10-cm</a></td>\n </tr>\n \n <tr>\n <td>Takotsubo cardiomyopathy (disorder)</td>\n <td>441541008</td>\n <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n </tr>\n \n <tr>\n <td>Takotsubo syndrome</td>\n <td>I51.81</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html\">http://hl7.org/fhir/sid/icd-10-cm</a></td>\n </tr>\n \n <tr>\n <td>Discharge to home for hospice care (procedure)</td>\n <td>428361000124107</td>\n <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n </tr>\n \n <tr>\n <td>Discharge to healthcare facility for hospice care (procedure)</td>\n <td>428371000124100</td>\n <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n </tr>\n \n <tr>\n <td>survey</td>\n <td>survey</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-observation-category.html\">http://terminology.hl7.org/CodeSystem/observation-category</a></td>\n </tr>\n \n <tr>\n <td>Hospice care [Minimum Data Set]</td>\n <td>45755-6</td>\n <td><a href=\"https://loinc.org/\">http://loinc.org</a></td>\n </tr>\n \n <tr>\n <td>Yes (qualifier value)</td>\n <td>373066001</td>\n <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n </tr>\n \n <tr>\n <td>Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility</td>\n <td>Z92.82</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html\">http://hl7.org/fhir/sid/icd-10-cm</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> 6633d92a6c1d307ea36e74c0 </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 "ED Encounter with STEMI Diagnosis" EDwithSTEMI\n where AgeInYearsAt(date from start of(EDwithSTEMI.period)) >= 18</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 "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"\n union "Adverse Effect to Thrombolytic Medications Before End of ED Encounter"\n union "Active Exclusion Diagnosis at Start of ED Encounter"\n union "Active use of Anticoagulants"\n union "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"\n union "Major Surgical Procedure 21 Days or Less Before Start of ED Encounter"\n union "Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"\n union "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"\n union "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"\n union "ED Encounter with Discharge Disposition as Patient Expired"\n union "ED Encounter with Discharge Disposition as Left Against Medical Advice"\n union "ED Encounter with Hospice Services"</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 "Fibrinolytic Therapy within 30 Minutes of Arrival"\n union "PCI within 90 Minutes of Arrival"\n union "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival"</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 "Received tPA in Another Facility within 24 hours Prior to Admission"\n union "ED Encounter with a Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival"\n union "ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival"</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>CMS996FHIRAptTxforSTEMI</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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>ED Encounter During MP</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "ED Encounter During MP":\n ["Encounter": "Emergency Department Evaluation and Management Visit"] EDEncounter\n where EDEncounter.period ends during day of "Measurement Period"\n and EDEncounter.status = 'finished'\n and EDEncounter.class ~ "EMER"</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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>ED Encounter with STEMI Diagnosis</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "ED Encounter with STEMI Diagnosis":\n "ED Encounter During MP" EDEncounter\n where ( EDEncounter.reasonCode in "STEMI"\n or exists ( ( EDEncounter.encounterDiagnosis ( ) ) EncDiagnosis\n where EncDiagnosis.code in "STEMI"\n )\n or exists ( ["Condition": "STEMI"] DxSTEMI\n where DxSTEMI.clinicalStatus ~ QICoreCommon."active"\n and DxSTEMI.prevalenceInterval ( ) starts during EDEncounter.period\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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>Fibrinolytic Therapy within 30 Minutes of Arrival</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Fibrinolytic Therapy within 30 Minutes of Arrival":\n "ED Encounter with STEMI Diagnosis" EDwithSTEMI\n with ["MedicationAdministration": "Fibrinolytic Therapy"] Fibrinolytic\n such that Fibrinolytic.status = 'completed'\n and start of ( Fibrinolytic.effective.toInterval ( ) ) 30 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )</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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>PCI within 90 Minutes of Arrival</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "PCI within 90 Minutes of Arrival":\n "ED Encounter with STEMI Diagnosis" EDwithSTEMI\n with ["Procedure": "Percutaneous Coronary Intervention"] PCI\n such that PCI.performed.toInterval ( ) starts 90 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )\n and PCI.status = 'completed'</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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival":\n "ED Encounter with STEMI Diagnosis" EDwithSTEMI\n where EDwithSTEMI.currentemergencyDepartmentDepartTime ( ) 45 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )\n and EDwithSTEMI.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"</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>CMS996FHIRAptTxforSTEMI</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 "Fibrinolytic Therapy within 30 Minutes of Arrival"\n union "PCI within 90 Minutes of Arrival"\n union "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival"</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>CMS996FHIRAptTxforSTEMI</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 "ED Encounter with STEMI Diagnosis" EDwithSTEMI\n where AgeInYearsAt(date from start of(EDwithSTEMI.period)) >= 18</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>CMS996FHIRAptTxforSTEMI</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>CMS996FHIRAptTxforSTEMI</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>CMS996FHIRAptTxforSTEMI</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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter":\n "ED Encounter with STEMI Diagnosis" EDwSTEMI\n with ["AllergyIntolerance": "Thrombolytic medications"] ThrombolyticAllergy\n such that ThrombolyticAllergy.clinicalStatus ~ QICoreCommon."allergy-active"\n and ThrombolyticAllergy.onset.toInterval ( ) overlaps ( EDwSTEMI.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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>Adverse Effect to Thrombolytic Medications Before End of ED Encounter</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Adverse Effect to Thrombolytic Medications Before End of ED Encounter":\n "ED Encounter with STEMI Diagnosis" EDwSTEMI\n with [AdverseEvent: event in "Thrombolytics Adverse Event"] ThrombolyticAdverseEvent\n such that ThrombolyticAdverseEvent.recordedDate before end of ( EDwSTEMI.period )\n and ThrombolyticAdverseEvent.actuality = 'actual'</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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>Active Exclusion Diagnosis at Start of ED Encounter</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Active Exclusion Diagnosis at Start of ED Encounter":\n "ED Encounter with STEMI Diagnosis" EDwithSTEMI\n with ( ["Condition": "Active Bleeding Excluding Menses or Bleeding Diathesis"]\n union ["Condition": "Malignant Intracranial Neoplasm Group"]\n union ["Condition": "Cerebral Vascular Lesion"]\n union ["Condition": "Dementia and Related Intracranial Pathologies"]\n union ["Condition": "Pregnant State"]\n union ["Condition": "Allergy to thrombolytics"] ) ActiveExclusionDx\n such that ActiveExclusionDx.prevalenceInterval ( ) overlaps before ( EDwithSTEMI.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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>Active Oral Anticoagulant Medication at the Start of ED Encounter</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Active Oral Anticoagulant Medication at the Start of ED Encounter":\n "ED Encounter with STEMI Diagnosis" EDwithSTEMI\n with ["MedicationRequest": "Oral Anticoagulant Medications"] OralAnticoagulant\n such that OralAnticoagulant.status = 'active'\n and OralAnticoagulant.intent = 'order'\n and OralAnticoagulant.authoredOn 90 days or less before or on start of EDwithSTEMI.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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>Active Long Term use of Anticoagulants</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Active Long Term use of Anticoagulants":\n "ED Encounter with STEMI Diagnosis" EDwithSTEMI\n with ["Condition": "Long term (current) use of anticoagulants"] LongTermAnticoagulant\n such that ( LongTermAnticoagulant.prevalenceInterval ( ) starts before or on start of EDwithSTEMI.period\n and LongTermAnticoagulant.prevalenceInterval ( ) ends on or after start of EDwithSTEMI.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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>Active use of Anticoagulants</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Active use of Anticoagulants":\n "Active Oral Anticoagulant Medication at the Start of ED Encounter"\n union "Active Long Term use of Anticoagulants"</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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start":\n "ED Encounter with STEMI Diagnosis" EDwithSTEMI\n with ( ["Condition": "Aortic Dissection or Ruptured Aortic Aneurysm"]\n union ["Condition": "Neurologic impairment"]\n union ["Condition": "Angina pectoris with documented spasm"]\n union ["Condition": "Ventricular aneurysm due to and following acute myocardial infarction (disorder)"]\n union ["Condition": "Aneurysm of heart"]\n union ["Condition": "Takotsubo cardiomyopathy (disorder)"]\n union ["Condition": "Takotsubo syndrome"]\n union ["Condition": "Cardiopulmonary Arrest"] ) ExclusionDiagnosis\n such that ( ExclusionDiagnosis.prevalenceInterval ( ) starts during EDwithSTEMI.period )\n or ( ExclusionDiagnosis.prevalenceInterval ( ) starts 24 hours or less before start of EDwithSTEMI.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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>Major Surgical Procedure 21 Days or Less Before Start of ED Encounter</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Major Surgical Procedure 21 Days or Less Before Start of ED Encounter":\n "ED Encounter with STEMI Diagnosis" EDwithSTEMI\n with ["Procedure": "Major Surgical Procedure"] MajorSurgery\n such that MajorSurgery.performed.toInterval ( ) starts 21 days or less before start of ( EDwithSTEMI.period )\n and MajorSurgery.status = 'completed'</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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start":\n "ED Encounter with STEMI Diagnosis" EDwithSTEMI\n with ( ["Procedure": "Endotracheal Intubation"]\n union ["Procedure": "Insertion, Replacement, or Removal of Mechanical Circulatory Assist Device"] ) AirwayProcedure\n such that ( ( AirwayProcedure.performed.toInterval ( ) starts during ( EDwithSTEMI.period ) )\n or ( AirwayProcedure.performed.toInterval ( ) starts 24 hours or less before start of ( EDwithSTEMI.period ) )\n )\n and AirwayProcedure.status = 'completed'</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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter":\n "ED Encounter with STEMI Diagnosis" EDwSTEMI\n with ( ["Condition": "Ischemic Stroke"]\n union ["Condition": "Closed Head and Facial Trauma"]\n union ["Condition": "Active Peptic Ulcer"] ) ExclusionCondition\n such that ExclusionCondition.prevalenceInterval ( ) starts during Interval[start of ( EDwSTEMI.period ) - 90 days, start of ( EDwSTEMI.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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter":\n "ED Encounter with STEMI Diagnosis" EDwithSTEMI\n with ["Procedure": "Intracranial or Intraspinal surgery"] CranialorSpinalSurgery\n such that CranialorSpinalSurgery.performed.toInterval ( ) starts 90 days or less before start of ( EDwithSTEMI.period )\n and CranialorSpinalSurgery.status = 'completed'</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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>ED Encounter with Discharge Disposition as Patient Expired</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "ED Encounter with Discharge Disposition as Patient Expired":\n "ED Encounter with STEMI Diagnosis" EDwithSTEMI\n where EDwithSTEMI.hospitalization.dischargeDisposition in "Patient Expired"</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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>ED Encounter with Discharge Disposition as Left Against Medical Advice</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "ED Encounter with Discharge Disposition as Left Against Medical Advice":\n "ED Encounter with STEMI Diagnosis" EDwSTEMI\n where EDwSTEMI.hospitalization.dischargeDisposition in "Left Against Medical Advice"</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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>ED Encounter with Hospice Services</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "ED Encounter with Hospice Services":\n "ED Encounter with STEMI Diagnosis" EDwSTEMI\n where ( exists ( ( ( [Encounter: "Encounter Inpatient"] ).isEncounterPerformed ( ) ) InpatientEncounter\n where ( InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"\n or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"\n )\n and InpatientEncounter.period.toInterval ( ) starts before or on start of ( EDwSTEMI.period )\n and ( InpatientEncounter.period.toInterval ( ) ends 6 months or less before day of start of ( EDwSTEMI.period )\n or InpatientEncounter.period.toInterval ( ) ends on or after start of ( EDwSTEMI.period )\n )\n )\n or exists ( ( ( [Encounter: "Hospice Encounter"] ).isEncounterPerformed ( ) ) HospiceEncounter\n where HospiceEncounter.period.toInterval ( ) starts before or on start of ( EDwSTEMI.period )\n and ( HospiceEncounter.period.toInterval ( ) ends 6 months or less before day of start of ( EDwSTEMI.period )\n or HospiceEncounter.period.toInterval ( ) ends on or after start of ( EDwSTEMI.period )\n )\n )\n or exists ( ( ( [Observation: "Hospice care [Minimum Data Set]"] ).isAssessmentPerformed ( ) ) HospiceAssessment\n where HospiceAssessment.value ~ "Yes (qualifier value)"\n and HospiceAssessment.effective.toInterval ( ) starts before or on start of ( EDwSTEMI.period )\n and ( HospiceAssessment.effective.toInterval ( ) ends 6 months or less before day of start of ( EDwSTEMI.period )\n or HospiceAssessment.effective.toInterval ( ) ends on or after start of ( EDwSTEMI.period )\n )\n )\n or exists ( ( ( [ServiceRequest: "Hospice Care Ambulatory"] ).isInterventionOrder ( ) ) HospiceOrder\n where HospiceOrder.authoredOn.toInterval ( ) 6 months or less before start of ( EDwSTEMI.period )\n )\n or exists ( ( ( [Procedure: "Hospice Care Ambulatory"] ).isInterventionPerformed ( ) ) HospicePerformed\n where HospicePerformed.performed.toInterval ( ) starts before or on start of ( EDwSTEMI.period )\n and ( HospicePerformed.performed.toInterval ( ) ends 6 months or less before day of start of ( EDwSTEMI.period )\n or HospicePerformed.performed.toInterval ( ) ends on or after start of ( EDwSTEMI.period )\n )\n )\n or exists ( ( [Condition: "Hospice Diagnosis"] ) HospiceCareDiagnosis\n where HospiceCareDiagnosis.prevalenceInterval ( ) ends on or after start of ( EDwSTEMI.period )\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>CMS996FHIRAptTxforSTEMI</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 "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"\n union "Adverse Effect to Thrombolytic Medications Before End of ED Encounter"\n union "Active Exclusion Diagnosis at Start of ED Encounter"\n union "Active use of Anticoagulants"\n union "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"\n union "Major Surgical Procedure 21 Days or Less Before Start of ED Encounter"\n union "Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"\n union "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"\n union "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"\n union "ED Encounter with Discharge Disposition as Patient Expired"\n union "ED Encounter with Discharge Disposition as Left Against Medical Advice"\n union "ED Encounter with Hospice Services"</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>CMS996FHIRAptTxforSTEMI</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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>Received tPA in Another Facility within 24 hours Prior to Admission</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Received tPA in Another Facility within 24 hours Prior to Admission":\n "ED Encounter with STEMI Diagnosis" EDwithSTEMI\n with ( ["Condition": "Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility"] ) TPA\n such that TPA.prevalenceInterval ( ) starts during EDwithSTEMI.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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival</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 PCI Performed Within 90 Minutes of ED Arrival":\n ["ProcedureNotDone": "Percutaneous Coronary Intervention"] PCINotDone\n where ( PCINotDone.statusReason in "Patient Refusal"\n or PCINotDone.statusReason in "Procedure Not Indicated/Contraindicated"\n )\n return {\n id: PCINotDone.id,\n authoredOn: PCINotDone.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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>ED Encounter with a Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "ED Encounter with a Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival":\n "ED Encounter with STEMI Diagnosis" EDwSTEMI\n with "Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival" NoPCI\n such that NoPCI.authoredOn during EDwSTEMI.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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival</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 Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival":\n ["MedicationAdministrationNotDone": "Fibrinolytic Therapy"] FibrinolyticNoMed\n where ( FibrinolyticNoMed.statusReason in "Patient Refusal"\n or FibrinolyticNoMed.statusReason in "Drug Intervention Not Indicated/Contraindicated"\n )\n return {\n id: FibrinolyticNoMed.id,\n authoredOn: FibrinolyticNoMed.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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival":\n "ED Encounter with STEMI Diagnosis" EDwSTEMI\n with "Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival" NoFibrinolytic\n such that NoFibrinolytic.authoredOn during EDwSTEMI.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>CMS996FHIRAptTxforSTEMI</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 "Received tPA in Another Facility within 24 hours Prior to Admission"\n union "ED Encounter with a Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival"\n union "ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival"</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 <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>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>QICoreCommon</td>\n \n \n <td>prevalenceInterval</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting \ninterval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ "active"\n or condition.clinicalStatus ~ "recurrence"\n or condition.clinicalStatus ~ "relapse" then\n Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n (end of condition.abatementInterval()) abatementDate\n return if abatementDate is null then\n Interval[start of condition.onset.toInterval(), abatementDate)\n else\n Interval[start of condition.onset.toInterval(), abatementDate]</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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>currentemergencyDepartmentArrivalTime</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define fluent function currentemergencyDepartmentArrivalTime(EDEncounter Encounter):\n start of ( singleton from ( ( ( EDEncounter.location ) ) EDLocation\n where CQMCommon.GetLocation ( EDLocation.location ).type in "Emergency Department Visit"\n )\n ).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>CQMCommon</td>\n \n \n <td>GetLocation</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 Location resource specified by the given reference\n@deprecated: This function is deprecated. Use the fluent function `getLocation()` instead.\n*/\ndefine function "GetLocation"(reference Reference ):\n singleton from (\n [Location] L where L.id = reference.reference.getId()\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>CMS996FHIRAptTxforSTEMI</td>\n \n \n <td>currentemergencyDepartmentDepartTime</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define fluent function currentemergencyDepartmentDepartTime(EDEncounter Encounter):\n end of ( singleton from ( ( ( EDEncounter.location ) ) EDLocation\n where CQMCommon.GetLocation ( EDLocation.location ).type in "Emergency Department Visit"\n )\n ).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>Status</td>\n \n \n <td>isEncounterPerformed</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">//Encounter, Performed\n//General usage unless required otherwise by measure intent (e.g., follow-up encounters)\ndefine fluent function isEncounterPerformed(Enc List<Encounter>):\n Enc E\n where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}</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>toInterval</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in QICore, allowing this function to be used across any resource.\nThe input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.\nIf the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,\nand the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.\nIf the input is a DateTime Interval, the result is the input.\nIf the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result\nis a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending\nimmediately before one year later than the date the patient turned the age given as the end of the quantity interval.\nIf the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval\n*/\ndefine fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):\n case\n\t when choice is DateTime then\n \tInterval[choice as DateTime, choice as DateTime]\n\t\twhen choice is Interval<DateTime> then\n \t\tchoice as Interval<DateTime>\n\t\twhen choice is Quantity then\n\t\t Interval[Patient.birthDate + (choice as Quantity),\n\t\t\t Patient.birthDate + (choice as Quantity) + 1 year)\n\t\twhen choice is Interval<Quantity> then\n\t\t Interval[Patient.birthDate + (choice.low as Quantity),\n\t\t\t Patient.birthDate + (choice.high as Quantity) + 1 year)\n\t\twhen choice is Timing then\n Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>\n\t\telse\n\t\t\tnull as Interval<DateTime>\n\tend</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>Status</td>\n \n \n <td>isAssessmentPerformed</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">//This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA.\n\n//Assessment, Performed\ndefine fluent function isAssessmentPerformed(Obs List<Observation>):\n Obs O\n where O.status in { 'final', 'amended', 'corrected' }\n and exists ( O.category ObservationCategory\n where ( ObservationCategory ) ~ "survey"\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>Status</td>\n \n \n <td>isInterventionOrder</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">//Intervention, Order: active and completed only \ndefine fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):\n ServiceRequest S\n where S.status in { 'active', 'completed' }\n and S.intent = 'order'</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>Status</td>\n \n \n <td>isInterventionPerformed</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">//Intervention, Performed\ndefine fluent function isInterventionPerformed(Proc List<Procedure>):\n Proc P\n where P.status ~ 'completed'</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/v3-ActCode",
"code" : "EMER",
"display" : "emergency"
}
},
{
"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/allergyintolerance-clinical",
"code" : "active",
"display" : "Active"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://hl7.org/fhir/sid/icd-10-cm",
"code" : "Z79.01",
"display" : "Long term (current) use of anticoagulants"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://hl7.org/fhir/sid/icd-10-cm",
"code" : "I20.1",
"display" : "Angina pectoris with documented spasm"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "723858002",
"display" : "Ventricular aneurysm due to and following acute myocardial infarction (disorder)"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://hl7.org/fhir/sid/icd-10-cm",
"code" : "I25.3",
"display" : "Aneurysm of heart"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "441541008",
"display" : "Takotsubo cardiomyopathy (disorder)"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://hl7.org/fhir/sid/icd-10-cm",
"code" : "I51.81",
"display" : "Takotsubo syndrome"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "428361000124107",
"display" : "Discharge to home for hospice care (procedure)"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "428371000124100",
"display" : "Discharge to healthcare facility for hospice care (procedure)"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://terminology.hl7.org/CodeSystem/observation-category",
"code" : "survey",
"display" : "survey"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "45755-6",
"display" : "Hospice care [Minimum Data Set]"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "373066001",
"display" : "Yes (qualifier value)"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://hl7.org/fhir/sid/icd-10-cm",
"code" : "Z92.82",
"display" : "Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility"
}
},
{
"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" : "CMS996FHIRAptTxforSTEMI"
},
{
"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" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "ED Encounter During MP"
},
{
"url" : "statement",
"valueString" : "define \"ED Encounter During MP\":\n [\"Encounter\": \"Emergency Department Evaluation and Management Visit\"] EDEncounter\n where EDEncounter.period ends during day of \"Measurement Period\"\n and EDEncounter.status = 'finished'\n and EDEncounter.class ~ \"EMER\""
},
{
"url" : "displaySequence",
"valueInteger" : 2
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "ED Encounter with STEMI Diagnosis"
},
{
"url" : "statement",
"valueString" : "define \"ED Encounter with STEMI Diagnosis\":\n \"ED Encounter During MP\" EDEncounter\n where ( EDEncounter.reasonCode in \"STEMI\"\n or exists ( ( EDEncounter.encounterDiagnosis ( ) ) EncDiagnosis\n where EncDiagnosis.code in \"STEMI\"\n )\n or exists ( [\"Condition\": \"STEMI\"] DxSTEMI\n where DxSTEMI.clinicalStatus ~ QICoreCommon.\"active\"\n and DxSTEMI.prevalenceInterval ( ) starts during EDEncounter.period\n )\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 3
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Fibrinolytic Therapy within 30 Minutes of Arrival"
},
{
"url" : "statement",
"valueString" : "define \"Fibrinolytic Therapy within 30 Minutes of Arrival\":\n \"ED Encounter with STEMI Diagnosis\" EDwithSTEMI\n with [\"MedicationAdministration\": \"Fibrinolytic Therapy\"] Fibrinolytic\n such that Fibrinolytic.status = 'completed'\n and start of ( Fibrinolytic.effective.toInterval ( ) ) 30 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )"
},
{
"url" : "displaySequence",
"valueInteger" : 4
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "PCI within 90 Minutes of Arrival"
},
{
"url" : "statement",
"valueString" : "define \"PCI within 90 Minutes of Arrival\":\n \"ED Encounter with STEMI Diagnosis\" EDwithSTEMI\n with [\"Procedure\": \"Percutaneous Coronary Intervention\"] PCI\n such that PCI.performed.toInterval ( ) starts 90 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )\n and PCI.status = 'completed'"
},
{
"url" : "displaySequence",
"valueInteger" : 5
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival"
},
{
"url" : "statement",
"valueString" : "define \"ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival\":\n \"ED Encounter with STEMI Diagnosis\" EDwithSTEMI\n where EDwithSTEMI.currentemergencyDepartmentDepartTime ( ) 45 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )\n and EDwithSTEMI.hospitalization.dischargeDisposition in \"Discharge To Acute Care Facility\""
},
{
"url" : "displaySequence",
"valueInteger" : 6
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Numerator"
},
{
"url" : "statement",
"valueString" : "define \"Numerator\":\n \"Fibrinolytic Therapy within 30 Minutes of Arrival\"\n union \"PCI within 90 Minutes of Arrival\"\n union \"ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival\""
},
{
"url" : "displaySequence",
"valueInteger" : 7
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Initial Population"
},
{
"url" : "statement",
"valueString" : "define \"Initial Population\":\n \"ED Encounter with STEMI Diagnosis\" EDwithSTEMI\n where AgeInYearsAt(date from start of(EDwithSTEMI.period)) >= 18"
},
{
"url" : "displaySequence",
"valueInteger" : 8
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Denominator"
},
{
"url" : "statement",
"valueString" : "define \"Denominator\":\n \"Initial Population\""
},
{
"url" : "displaySequence",
"valueInteger" : 9
}
],
"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" : 10
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "SDE Payer"
},
{
"url" : "statement",
"valueString" : "define \"SDE Payer\":\n SDE.\"SDE Payer\""
},
{
"url" : "displaySequence",
"valueInteger" : 11
}
],
"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" : 12
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "SDE Ethnicity"
},
{
"url" : "statement",
"valueString" : "define \"SDE Ethnicity\":\n SDE.\"SDE Ethnicity\""
},
{
"url" : "displaySequence",
"valueInteger" : 13
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"
},
{
"url" : "statement",
"valueString" : "define \"Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter\":\n \"ED Encounter with STEMI Diagnosis\" EDwSTEMI\n with [\"AllergyIntolerance\": \"Thrombolytic medications\"] ThrombolyticAllergy\n such that ThrombolyticAllergy.clinicalStatus ~ QICoreCommon.\"allergy-active\"\n and ThrombolyticAllergy.onset.toInterval ( ) overlaps ( EDwSTEMI.period )"
},
{
"url" : "displaySequence",
"valueInteger" : 14
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Adverse Effect to Thrombolytic Medications Before End of ED Encounter"
},
{
"url" : "statement",
"valueString" : "define \"Adverse Effect to Thrombolytic Medications Before End of ED Encounter\":\n \"ED Encounter with STEMI Diagnosis\" EDwSTEMI\n with [AdverseEvent: event in \"Thrombolytics Adverse Event\"] ThrombolyticAdverseEvent\n such that ThrombolyticAdverseEvent.recordedDate before end of ( EDwSTEMI.period )\n and ThrombolyticAdverseEvent.actuality = 'actual'"
},
{
"url" : "displaySequence",
"valueInteger" : 15
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Active Exclusion Diagnosis at Start of ED Encounter"
},
{
"url" : "statement",
"valueString" : "define \"Active Exclusion Diagnosis at Start of ED Encounter\":\n \"ED Encounter with STEMI Diagnosis\" EDwithSTEMI\n with ( [\"Condition\": \"Active Bleeding Excluding Menses or Bleeding Diathesis\"]\n union [\"Condition\": \"Malignant Intracranial Neoplasm Group\"]\n union [\"Condition\": \"Cerebral Vascular Lesion\"]\n union [\"Condition\": \"Dementia and Related Intracranial Pathologies\"]\n union [\"Condition\": \"Pregnant State\"]\n union [\"Condition\": \"Allergy to thrombolytics\"] ) ActiveExclusionDx\n such that ActiveExclusionDx.prevalenceInterval ( ) overlaps before ( EDwithSTEMI.period )"
},
{
"url" : "displaySequence",
"valueInteger" : 16
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Active Oral Anticoagulant Medication at the Start of ED Encounter"
},
{
"url" : "statement",
"valueString" : "define \"Active Oral Anticoagulant Medication at the Start of ED Encounter\":\n \"ED Encounter with STEMI Diagnosis\" EDwithSTEMI\n with [\"MedicationRequest\": \"Oral Anticoagulant Medications\"] OralAnticoagulant\n such that OralAnticoagulant.status = 'active'\n and OralAnticoagulant.intent = 'order'\n and OralAnticoagulant.authoredOn 90 days or less before or on start of EDwithSTEMI.period"
},
{
"url" : "displaySequence",
"valueInteger" : 17
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Active Long Term use of Anticoagulants"
},
{
"url" : "statement",
"valueString" : "define \"Active Long Term use of Anticoagulants\":\n \"ED Encounter with STEMI Diagnosis\" EDwithSTEMI\n with [\"Condition\": \"Long term (current) use of anticoagulants\"] LongTermAnticoagulant\n such that ( LongTermAnticoagulant.prevalenceInterval ( ) starts before or on start of EDwithSTEMI.period\n and LongTermAnticoagulant.prevalenceInterval ( ) ends on or after start of EDwithSTEMI.period\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 18
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Active use of Anticoagulants"
},
{
"url" : "statement",
"valueString" : "define \"Active use of Anticoagulants\":\n \"Active Oral Anticoagulant Medication at the Start of ED Encounter\"\n union \"Active Long Term use of Anticoagulants\""
},
{
"url" : "displaySequence",
"valueInteger" : 19
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"
},
{
"url" : "statement",
"valueString" : "define \"Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start\":\n \"ED Encounter with STEMI Diagnosis\" EDwithSTEMI\n with ( [\"Condition\": \"Aortic Dissection or Ruptured Aortic Aneurysm\"]\n union [\"Condition\": \"Neurologic impairment\"]\n union [\"Condition\": \"Angina pectoris with documented spasm\"]\n union [\"Condition\": \"Ventricular aneurysm due to and following acute myocardial infarction (disorder)\"]\n union [\"Condition\": \"Aneurysm of heart\"]\n union [\"Condition\": \"Takotsubo cardiomyopathy (disorder)\"]\n union [\"Condition\": \"Takotsubo syndrome\"]\n union [\"Condition\": \"Cardiopulmonary Arrest\"] ) ExclusionDiagnosis\n such that ( ExclusionDiagnosis.prevalenceInterval ( ) starts during EDwithSTEMI.period )\n or ( ExclusionDiagnosis.prevalenceInterval ( ) starts 24 hours or less before start of EDwithSTEMI.period )"
},
{
"url" : "displaySequence",
"valueInteger" : 20
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Major Surgical Procedure 21 Days or Less Before Start of ED Encounter"
},
{
"url" : "statement",
"valueString" : "define \"Major Surgical Procedure 21 Days or Less Before Start of ED Encounter\":\n \"ED Encounter with STEMI Diagnosis\" EDwithSTEMI\n with [\"Procedure\": \"Major Surgical Procedure\"] MajorSurgery\n such that MajorSurgery.performed.toInterval ( ) starts 21 days or less before start of ( EDwithSTEMI.period )\n and MajorSurgery.status = 'completed'"
},
{
"url" : "displaySequence",
"valueInteger" : 21
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"
},
{
"url" : "statement",
"valueString" : "define \"Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start\":\n \"ED Encounter with STEMI Diagnosis\" EDwithSTEMI\n with ( [\"Procedure\": \"Endotracheal Intubation\"]\n union [\"Procedure\": \"Insertion, Replacement, or Removal of Mechanical Circulatory Assist Device\"] ) AirwayProcedure\n such that ( ( AirwayProcedure.performed.toInterval ( ) starts during ( EDwithSTEMI.period ) )\n or ( AirwayProcedure.performed.toInterval ( ) starts 24 hours or less before start of ( EDwithSTEMI.period ) )\n )\n and AirwayProcedure.status = 'completed'"
},
{
"url" : "displaySequence",
"valueInteger" : 22
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"
},
{
"url" : "statement",
"valueString" : "define \"Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter\":\n \"ED Encounter with STEMI Diagnosis\" EDwSTEMI\n with ( [\"Condition\": \"Ischemic Stroke\"]\n union [\"Condition\": \"Closed Head and Facial Trauma\"]\n union [\"Condition\": \"Active Peptic Ulcer\"] ) ExclusionCondition\n such that ExclusionCondition.prevalenceInterval ( ) starts during Interval[start of ( EDwSTEMI.period ) - 90 days, start of ( EDwSTEMI.period )]"
},
{
"url" : "displaySequence",
"valueInteger" : 23
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"
},
{
"url" : "statement",
"valueString" : "define \"Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter\":\n \"ED Encounter with STEMI Diagnosis\" EDwithSTEMI\n with [\"Procedure\": \"Intracranial or Intraspinal surgery\"] CranialorSpinalSurgery\n such that CranialorSpinalSurgery.performed.toInterval ( ) starts 90 days or less before start of ( EDwithSTEMI.period )\n and CranialorSpinalSurgery.status = 'completed'"
},
{
"url" : "displaySequence",
"valueInteger" : 24
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "ED Encounter with Discharge Disposition as Patient Expired"
},
{
"url" : "statement",
"valueString" : "define \"ED Encounter with Discharge Disposition as Patient Expired\":\n \"ED Encounter with STEMI Diagnosis\" EDwithSTEMI\n where EDwithSTEMI.hospitalization.dischargeDisposition in \"Patient Expired\""
},
{
"url" : "displaySequence",
"valueInteger" : 25
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "ED Encounter with Discharge Disposition as Left Against Medical Advice"
},
{
"url" : "statement",
"valueString" : "define \"ED Encounter with Discharge Disposition as Left Against Medical Advice\":\n \"ED Encounter with STEMI Diagnosis\" EDwSTEMI\n where EDwSTEMI.hospitalization.dischargeDisposition in \"Left Against Medical Advice\""
},
{
"url" : "displaySequence",
"valueInteger" : 26
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "ED Encounter with Hospice Services"
},
{
"url" : "statement",
"valueString" : "define \"ED Encounter with Hospice Services\":\n \"ED Encounter with STEMI Diagnosis\" EDwSTEMI\n where ( exists ( ( ( [Encounter: \"Encounter Inpatient\"] ).isEncounterPerformed ( ) ) InpatientEncounter\n where ( InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n or InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\"\n )\n and InpatientEncounter.period.toInterval ( ) starts before or on start of ( EDwSTEMI.period )\n and ( InpatientEncounter.period.toInterval ( ) ends 6 months or less before day of start of ( EDwSTEMI.period )\n or InpatientEncounter.period.toInterval ( ) ends on or after start of ( EDwSTEMI.period )\n )\n )\n or exists ( ( ( [Encounter: \"Hospice Encounter\"] ).isEncounterPerformed ( ) ) HospiceEncounter\n where HospiceEncounter.period.toInterval ( ) starts before or on start of ( EDwSTEMI.period )\n and ( HospiceEncounter.period.toInterval ( ) ends 6 months or less before day of start of ( EDwSTEMI.period )\n or HospiceEncounter.period.toInterval ( ) ends on or after start of ( EDwSTEMI.period )\n )\n )\n or exists ( ( ( [Observation: \"Hospice care [Minimum Data Set]\"] ).isAssessmentPerformed ( ) ) HospiceAssessment\n where HospiceAssessment.value ~ \"Yes (qualifier value)\"\n and HospiceAssessment.effective.toInterval ( ) starts before or on start of ( EDwSTEMI.period )\n and ( HospiceAssessment.effective.toInterval ( ) ends 6 months or less before day of start of ( EDwSTEMI.period )\n or HospiceAssessment.effective.toInterval ( ) ends on or after start of ( EDwSTEMI.period )\n )\n )\n or exists ( ( ( [ServiceRequest: \"Hospice Care Ambulatory\"] ).isInterventionOrder ( ) ) HospiceOrder\n where HospiceOrder.authoredOn.toInterval ( ) 6 months or less before start of ( EDwSTEMI.period )\n )\n or exists ( ( ( [Procedure: \"Hospice Care Ambulatory\"] ).isInterventionPerformed ( ) ) HospicePerformed\n where HospicePerformed.performed.toInterval ( ) starts before or on start of ( EDwSTEMI.period )\n and ( HospicePerformed.performed.toInterval ( ) ends 6 months or less before day of start of ( EDwSTEMI.period )\n or HospicePerformed.performed.toInterval ( ) ends on or after start of ( EDwSTEMI.period )\n )\n )\n or exists ( ( [Condition: \"Hospice Diagnosis\"] ) HospiceCareDiagnosis\n where HospiceCareDiagnosis.prevalenceInterval ( ) ends on or after start of ( EDwSTEMI.period )\n )\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 27
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Denominator Exclusions"
},
{
"url" : "statement",
"valueString" : "define \"Denominator Exclusions\":\n \"Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter\"\n union \"Adverse Effect to Thrombolytic Medications Before End of ED Encounter\"\n union \"Active Exclusion Diagnosis at Start of ED Encounter\"\n union \"Active use of Anticoagulants\"\n union \"Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start\"\n union \"Major Surgical Procedure 21 Days or Less Before Start of ED Encounter\"\n union \"Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start\"\n union \"Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter\"\n union \"Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter\"\n union \"ED Encounter with Discharge Disposition as Patient Expired\"\n union \"ED Encounter with Discharge Disposition as Left Against Medical Advice\"\n union \"ED Encounter with Hospice Services\""
},
{
"url" : "displaySequence",
"valueInteger" : 28
}
],
"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" : 29
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "SDE Race"
},
{
"url" : "statement",
"valueString" : "define \"SDE Race\":\n SDE.\"SDE Race\""
},
{
"url" : "displaySequence",
"valueInteger" : 30
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Received tPA in Another Facility within 24 hours Prior to Admission"
},
{
"url" : "statement",
"valueString" : "define \"Received tPA in Another Facility within 24 hours Prior to Admission\":\n \"ED Encounter with STEMI Diagnosis\" EDwithSTEMI\n with ( [\"Condition\": \"Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility\"] ) TPA\n such that TPA.prevalenceInterval ( ) starts during EDwithSTEMI.period"
},
{
"url" : "displaySequence",
"valueInteger" : 31
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival"
},
{
"url" : "statement",
"valueString" : "define \"Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival\":\n [\"ProcedureNotDone\": \"Percutaneous Coronary Intervention\"] PCINotDone\n where ( PCINotDone.statusReason in \"Patient Refusal\"\n or PCINotDone.statusReason in \"Procedure Not Indicated/Contraindicated\"\n )\n return {\n id: PCINotDone.id,\n authoredOn: PCINotDone.recorded\n }"
},
{
"url" : "displaySequence",
"valueInteger" : 32
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "ED Encounter with a Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival"
},
{
"url" : "statement",
"valueString" : "define \"ED Encounter with a Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival\":\n \"ED Encounter with STEMI Diagnosis\" EDwSTEMI\n with \"Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival\" NoPCI\n such that NoPCI.authoredOn during EDwSTEMI.period"
},
{
"url" : "displaySequence",
"valueInteger" : 33
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival"
},
{
"url" : "statement",
"valueString" : "define \"Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival\":\n [\"MedicationAdministrationNotDone\": \"Fibrinolytic Therapy\"] FibrinolyticNoMed\n where ( FibrinolyticNoMed.statusReason in \"Patient Refusal\"\n or FibrinolyticNoMed.statusReason in \"Drug Intervention Not Indicated/Contraindicated\"\n )\n return {\n id: FibrinolyticNoMed.id,\n authoredOn: FibrinolyticNoMed.recorded\n }"
},
{
"url" : "displaySequence",
"valueInteger" : 34
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival"
},
{
"url" : "statement",
"valueString" : "define \"ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival\":\n \"ED Encounter with STEMI Diagnosis\" EDwSTEMI\n with \"Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival\" NoFibrinolytic\n such that NoFibrinolytic.authoredOn during EDwSTEMI.period"
},
{
"url" : "displaySequence",
"valueInteger" : 35
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "Denominator Exceptions"
},
{
"url" : "statement",
"valueString" : "define \"Denominator Exceptions\":\n \"Received tPA in Another Facility within 24 hours Prior to Admission\"\n union \"ED Encounter with a Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival\"\n union \"ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival\""
},
{
"url" : "displaySequence",
"valueInteger" : 36
}
],
"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" : 37
}
],
"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" : 38
}
],
"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" : 39
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "QICoreCommon"
},
{
"url" : "name",
"valueString" : "prevalenceInterval"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting \ninterval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ \"active\"\n or condition.clinicalStatus ~ \"recurrence\"\n or condition.clinicalStatus ~ \"relapse\" then\n Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n (end of condition.abatementInterval()) abatementDate\n return if abatementDate is null then\n Interval[start of condition.onset.toInterval(), abatementDate)\n else\n Interval[start of condition.onset.toInterval(), abatementDate]"
},
{
"url" : "displaySequence",
"valueInteger" : 40
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "currentemergencyDepartmentArrivalTime"
},
{
"url" : "statement",
"valueString" : "define fluent function currentemergencyDepartmentArrivalTime(EDEncounter Encounter):\n start of ( singleton from ( ( ( EDEncounter.location ) ) EDLocation\n where CQMCommon.GetLocation ( EDLocation.location ).type in \"Emergency Department Visit\"\n )\n ).period"
},
{
"url" : "displaySequence",
"valueInteger" : 41
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CQMCommon"
},
{
"url" : "name",
"valueString" : "GetLocation"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Returns the Location resource specified by the given reference\n@deprecated: This function is deprecated. Use the fluent function `getLocation()` instead.\n*/\ndefine function \"GetLocation\"(reference Reference ):\n singleton from (\n [Location] L where L.id = reference.reference.getId()\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 42
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CMS996FHIRAptTxforSTEMI"
},
{
"url" : "name",
"valueString" : "currentemergencyDepartmentDepartTime"
},
{
"url" : "statement",
"valueString" : "define fluent function currentemergencyDepartmentDepartTime(EDEncounter Encounter):\n end of ( singleton from ( ( ( EDEncounter.location ) ) EDLocation\n where CQMCommon.GetLocation ( EDLocation.location ).type in \"Emergency Department Visit\"\n )\n ).period"
},
{
"url" : "displaySequence",
"valueInteger" : 43
}
],
"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" : 44
}
],
"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" : 45
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "Status"
},
{
"url" : "name",
"valueString" : "isEncounterPerformed"
},
{
"url" : "statement",
"valueString" : "//Encounter, Performed\n//General usage unless required otherwise by measure intent (e.g., follow-up encounters)\ndefine fluent function isEncounterPerformed(Enc List<Encounter>):\n Enc E\n where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}"
},
{
"url" : "displaySequence",
"valueInteger" : 46
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "QICoreCommon"
},
{
"url" : "name",
"valueString" : "toInterval"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in QICore, allowing this function to be used across any resource.\nThe input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.\nIf the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,\nand the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.\nIf the input is a DateTime Interval, the result is the input.\nIf the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result\nis a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending\nimmediately before one year later than the date the patient turned the age given as the end of the quantity interval.\nIf the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval\n*/\ndefine fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):\n case\n\t when choice is DateTime then\n \tInterval[choice as DateTime, choice as DateTime]\n\t\twhen choice is Interval<DateTime> then\n \t\tchoice as Interval<DateTime>\n\t\twhen choice is Quantity then\n\t\t Interval[Patient.birthDate + (choice as Quantity),\n\t\t\t Patient.birthDate + (choice as Quantity) + 1 year)\n\t\twhen choice is Interval<Quantity> then\n\t\t Interval[Patient.birthDate + (choice.low as Quantity),\n\t\t\t Patient.birthDate + (choice.high as Quantity) + 1 year)\n\t\twhen choice is Timing then\n Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>\n\t\telse\n\t\t\tnull as Interval<DateTime>\n\tend"
},
{
"url" : "displaySequence",
"valueInteger" : 47
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "Status"
},
{
"url" : "name",
"valueString" : "isAssessmentPerformed"
},
{
"url" : "statement",
"valueString" : "//This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA.\n\n//Assessment, Performed\ndefine fluent function isAssessmentPerformed(Obs List<Observation>):\n Obs O\n where O.status in { 'final', 'amended', 'corrected' }\n and exists ( O.category ObservationCategory\n where ( ObservationCategory ) ~ \"survey\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 48
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "Status"
},
{
"url" : "name",
"valueString" : "isInterventionOrder"
},
{
"url" : "statement",
"valueString" : "//Intervention, Order: active and completed only \ndefine fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):\n ServiceRequest S\n where S.status in { 'active', 'completed' }\n and S.intent = 'order'"
},
{
"url" : "displaySequence",
"valueInteger" : 49
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "Status"
},
{
"url" : "name",
"valueString" : "isInterventionPerformed"
},
{
"url" : "statement",
"valueString" : "//Intervention, Performed\ndefine fluent function isInterventionPerformed(Proc List<Procedure>):\n Proc P\n where P.status ~ 'completed'"
},
{
"url" : "displaySequence",
"valueInteger" : 50
}
],
"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 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" : "Library Status",
"resource" : "Library/Status|1.8.000"
},
{
"type" : "depends-on",
"display" : "Code system AdministrativeGender",
"resource" : "http://hl7.org/fhir/administrative-gender"
},
{
"type" : "depends-on",
"display" : "Code system ActCode",
"resource" : "http://terminology.hl7.org/CodeSystem/v3-ActCode"
},
{
"type" : "depends-on",
"display" : "Code system ConditionClinicalStatusCodes",
"resource" : "http://terminology.hl7.org/CodeSystem/condition-clinical"
},
{
"type" : "depends-on",
"display" : "Code system AllergyIntoleranceClinicalStatusCodes",
"resource" : "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical"
},
{
"type" : "depends-on",
"display" : "Code system ICD10CM",
"resource" : "http://hl7.org/fhir/sid/icd-10-cm"
},
{
"type" : "depends-on",
"display" : "Code system SNOMEDCT",
"resource" : "http://snomed.info/sct"
},
{
"type" : "depends-on",
"display" : "Code system ObservationCategoryCodes",
"resource" : "http://terminology.hl7.org/CodeSystem/observation-category"
},
{
"type" : "depends-on",
"display" : "Code system LOINC",
"resource" : "http://loinc.org"
},
{
"type" : "depends-on",
"display" : "Value set Emergency Department Evaluation and Management Visit",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010"
},
{
"type" : "depends-on",
"display" : "Value set STEMI",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4017"
},
{
"type" : "depends-on",
"display" : "Value set Fibrinolytic Therapy",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4019"
},
{
"type" : "depends-on",
"display" : "Value set Emergency Department Visit",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
},
{
"type" : "depends-on",
"display" : "Value set Percutaneous Coronary Intervention",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.2000.5"
},
{
"type" : "depends-on",
"display" : "Value set Discharge To Acute Care Facility",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87"
},
{
"type" : "depends-on",
"display" : "Value set Payer Type",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
},
{
"type" : "depends-on",
"display" : "Value set Thrombolytic medications",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.4"
},
{
"type" : "depends-on",
"display" : "Value set Thrombolytics Adverse Event",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.6"
},
{
"type" : "depends-on",
"display" : "Value set Active Bleeding Excluding Menses or Bleeding Diathesis",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4036"
},
{
"type" : "depends-on",
"display" : "Value set Malignant Intracranial Neoplasm Group",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.3"
},
{
"type" : "depends-on",
"display" : "Value set Cerebral Vascular Lesion",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4025"
},
{
"type" : "depends-on",
"display" : "Value set Dementia and Related Intracranial Pathologies",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4043"
},
{
"type" : "depends-on",
"display" : "Value set Pregnant State",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4055"
},
{
"type" : "depends-on",
"display" : "Value set Allergy to thrombolytics",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.5"
},
{
"type" : "depends-on",
"display" : "Value set Oral Anticoagulant Medications",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4045"
},
{
"type" : "depends-on",
"display" : "Value set Aortic Dissection or Ruptured Aortic Aneurysm",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4028"
},
{
"type" : "depends-on",
"display" : "Value set Neurologic impairment",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.114.12.1012"
},
{
"type" : "depends-on",
"display" : "Value set Cardiopulmonary Arrest",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4048"
},
{
"type" : "depends-on",
"display" : "Value set Major Surgical Procedure",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4056"
},
{
"type" : "depends-on",
"display" : "Value set Endotracheal Intubation",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.69"
},
{
"type" : "depends-on",
"display" : "Value set Insertion, Replacement, or Removal of Mechanical Circulatory Assist Device",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4052"
},
{
"type" : "depends-on",
"display" : "Value set Ischemic Stroke",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247"
},
{
"type" : "depends-on",
"display" : "Value set Closed Head and Facial Trauma",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4026"
},
{
"type" : "depends-on",
"display" : "Value set Active Peptic Ulcer",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4031"
},
{
"type" : "depends-on",
"display" : "Value set Intracranial or Intraspinal surgery",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.2"
},
{
"type" : "depends-on",
"display" : "Value set Patient Expired",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309"
},
{
"type" : "depends-on",
"display" : "Value set Left Against Medical Advice",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.308"
},
{
"type" : "depends-on",
"display" : "Value set Encounter Inpatient",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
},
{
"type" : "depends-on",
"display" : "Value set Hospice Encounter",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003"
},
{
"type" : "depends-on",
"display" : "Value set Hospice Care Ambulatory",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"
},
{
"type" : "depends-on",
"display" : "Value set Hospice Diagnosis",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165"
},
{
"type" : "depends-on",
"display" : "Value set Patient Refusal",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93"
},
{
"type" : "depends-on",
"display" : "Value set Procedure Not Indicated/Contraindicated",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1282.2"
},
{
"type" : "depends-on",
"display" : "Value set Drug Intervention Not Indicated/Contraindicated",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1282.1"
}
],
"parameter" : [
{
"name" : "Measurement Period",
"use" : "in",
"min" : 0,
"max" : "1",
"type" : "Period"
},
{
"name" : "SDE Sex",
"use" : "out",
"min" : 0,
"max" : "1",
"type" : "Coding"
},
{
"name" : "Numerator",
"use" : "out",
"min" : 0,
"max" : "*",
"type" : "Resource"
},
{
"name" : "Denominator",
"use" : "out",
"min" : 0,
"max" : "*",
"type" : "Resource"
},
{
"name" : "SDE Payer",
"use" : "out",
"min" : 0,
"max" : "*",
"type" : "Resource"
},
{
"name" : "Initial Population",
"use" : "out",
"min" : 0,
"max" : "*",
"type" : "Resource"
},
{
"name" : "SDE Ethnicity",
"use" : "out",
"min" : 0,
"max" : "1",
"type" : "Resource"
},
{
"name" : "Denominator Exclusions",
"use" : "out",
"min" : 0,
"max" : "*",
"type" : "Resource"
},
{
"name" : "SDE Race",
"use" : "out",
"min" : 0,
"max" : "1",
"type" : "Resource"
},
{
"name" : "Denominator Exceptions",
"use" : "out",
"min" : 0,
"max" : "*",
"type" : "Resource"
}
],
"dataRequirement" : [
{
"type" : "Patient",
"profile" : [
🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
],
"mustSupport" : [
"ethnicity",
"race"
]
},
{
"type" : "Encounter",
"profile" : [
🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
],
"mustSupport" : [
"type",
"period",
"status",
"status.value",
"class",
"reasonCode",
"hospitalization",
"hospitalization.dischargeDisposition",
"condition",
"condition.reference",
"condition.reference.value",
"location",
"location.type"
],
"codeFilter" : [
{
"path" : "type",
"valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010"
},
{
"path" : "status.value",
"code" : [
{
"code" : "finished"
}
]
},
{
"path" : "class"
},
{
"path" : "hospitalization.dischargeDisposition",
"valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87"
}
],
"dateFilter" : [
{
"path" : "period",
"valuePeriod" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
"valueExpression" : {
"language" : "text/cql-identifier",
"expression" : "Measurement Period"
}
}
]
}
}
]
},
{
"id" : "313",
"type" : "Encounter",
"profile" : [
🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
],
"mustSupport" : [
"type",
"period",
"status",
"status.value",
"class",
"reasonCode",
"condition",
"condition.reference",
"condition.reference.value",
"location",
"location.type"
],
"codeFilter" : [
{
"path" : "type",
"valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010"
},
{
"path" : "status.value",
"code" : [
{
"code" : "finished"
}
]
},
{
"path" : "class"
}
],
"dateFilter" : [
{
"path" : "period",
"valuePeriod" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
"valueExpression" : {
"language" : "text/cql-identifier",
"expression" : "Measurement Period"
}
}
]
}
}
]
},
{
"type" : "Encounter",
"profile" : [
🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
],
"mustSupport" : [
"type",
"period",
"status",
"status.value",
"class",
"reasonCode",
"hospitalization",
"hospitalization.dischargeDisposition",
"condition",
"condition.reference",
"condition.reference.value",
"location",
"location.type"
],
"codeFilter" : [
{
"path" : "type",
"valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010"
},
{
"path" : "status.value",
"code" : [
{
"code" : "finished"
}
]
},
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"codeFilter" : [
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"path" : "medication",
"valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4019"
}
]
}
]
}
],
"extension" : [
{
"id" : "supplementalDataGuidance",
"extension" : [
{
"url" : "guidance",
"valueString" : "For every patient evaluated by this measure also identify payer, race, ethnicity and sex "
},
{
"url" : "usage",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
"code" : "supplemental-data",
"display" : "Supplemental Data"
}
],
"text" : "Supplemental Data Guidance"
}
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem",
"valueReference" : {
"reference" : "Device/cqf-tooling"
}
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{
"id" : "effective-data-requirements",
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
"valueReference" : {
"reference" : "#effective-data-requirements"
}
}
],
"url" : "https://madie.cms.gov/Measure/CMS996FHIRAptTxforSTEMI",
"identifier" : [
{
"use" : "usual",
"type" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
"code" : "short-name",
"display" : "Short Name"
}
]
},
"system" : "https://madie.cms.gov/measure/shortName",
"value" : "CMS996FHIR"
},
{
"use" : "official",
"type" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
"code" : "version-independent",
"display" : "Version Independent"
}
]
},
"system" : "urn:ietf:rfc:3986",
"value" : "urn:uuid:a48685e0-4926-4ae8-9eb3-d8e8839b1704"
},
{
"use" : "official",
"type" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
"code" : "version-specific",
"display" : "Version Specific"
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]
},
"system" : "urn:ietf:rfc:3986",
"value" : "urn:uuid:feb911dd-6b34-4b3f-866f-3059dd4d19d0"
},
{
"use" : "official",
"type" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
"code" : "publisher",
"display" : "Publisher"
}
]
},
"system" : "https://madie.cms.gov/measure/cmsId",
"value" : "996FHIR",
"assigner" : {
"display" : "CMS"
}
}
],
"version" : "1.2.001",
"name" : "CMS996FHIRAptTxforSTEMI",
"title" : "Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department FHIR",
"status" : "active",
"experimental" : false,
"date" : "2024-12-18T21:25:47+00:00",
"publisher" : "Centers for Medicare & Medicaid Services (CMS)",
"contact" : [
{
"telecom" : [
{
"system" : "url",
"value" : "https://www.cms.gov/"
}
]
}
],
"description" : "Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival",
"purpose" : "UNKNOWN",
"usage" : "In order to support the best outcomes for patients and align with other guidelines, PCI device deployment time should be used for calculating the “PCI is performed within 90 minutes of ED arrival” numerator criteria and not the start time of the procedure.\n\nThis eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS996v6. 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" : "Limited proprietary coding is contained in these specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets.\n\nThis material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. All rights reserved.\n\nLOINC(R) copyright 2004-2024 Regenstrief Institute, Inc.\n\nCPT(R) contained in the measure specifications is copyright 2004-2024 American Medical Association.\n\nICD-10 is copyright 2024 World Health Organization. All Rights Reserved.",
"effectivePeriod" : {
"start" : "2026-01-01",
"end" : "2026-12-31"
},
"author" : [
{
"name" : "Acumen, LLC",
"telecom" : [
{
"system" : "url",
"value" : "https://www.acumenllc.com/"
}
]
}
],
"library" : [
🔗 "https://madie.cms.gov/Library/CMS996FHIRAptTxforSTEMI"
],
"disclaimer" : "These performance specifications are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications.\n\nTHE MEASURES AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.\n\nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
"rationale" : "Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (Solhpour & Yusuf, 2013; Fibrinolytic Therapy Trialists’ Collaborative Group, 1994). For patients receiving fibrinolytic therapy, the American Heart Association (AHA) estimates that 65 lives will be saved per 1,000 patients if treatment is administered within the first hour of symptom onset, and 131 lives will be saved per 1,000 patients treated if fibrinolytic therapy is delivered within the first three hours (O’Connor et al., 2010). \nThe total ischemic time—that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy—is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O’Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O’Gara et al., 2013).\nImplementation of an eCQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the eCQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of ED Arrival (OP-2) measure and broaden the population for which performance scores could be publicly reported.",
"clinicalRecommendationStatement" : "Primary PCI in STEMI:\nThe 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that:\n- \"Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration.\"\n- \"Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact.\"\n \nFibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact:\nThe 2013 American College of Cardiology Foundation (ACCF)/American Heart Association(AHA) clinical practice guideline for the management of STEMI recommends that:\n- \"In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact.”\n \nTransfer to a PCI-Capable Hospital after Fibrinolytic Therapy:\nThe 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that:\n- Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe heart failure (HF), irrespective of the time delay from MI onset.\n- Urgent transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who demonstrate evidence of failed reperfusion or reocclusion after fibrinolytic therapy. \n- Transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy.",
"guidance" : "In order to support the best outcomes for patients and align with other guidelines, PCI device deployment time should be used for calculating the “PCI is performed within 90 minutes of ED arrival” numerator criteria and not the start time of the procedure.\n\nThis eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS996v6. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).",
"group" : [
{
"id" : "6633d92a6c1d307ea36e74c0",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
"code" : "proportion",
"display" : "Proportion"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
"valueCode" : "Encounter"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-type",
"code" : "process",
"display" : "Process"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
"valueCode" : "None"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
"code" : "increase",
"display" : "Increased score indicates improvement"
}
]
}
}
],
"population" : [
{
"id" : "9368D43C-EC53-489B-BFAB-E61F16298E63",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "initial-population",
"display" : "Initial Population"
}
]
},
"description" : "All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during an Emergency Department encounter that ends during the measurement period",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Initial Population"
}
},
{
"id" : "EBF05C28-BF39-423D-A055-FCD964FE0333",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "denominator",
"display" : "Denominator"
}
]
},
"description" : "Equals Initial Population",
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"language" : "text/cql-identifier",
"expression" : "Denominator"
}
},
{
"id" : "9BDC7445-0BF6-4941-8732-893B185A378E",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "denominator-exclusion",
"display" : "Denominator Exclusion"
}
]
},
"description" : "Patients with the following conditions are excluded from measure denominator:\n\nAt some point during ED encounter:\n- Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase\n\nStarts before the start of ED encounter and does not end before ED encounter:\n- Bleeding or bleeding diathesis (excluding menses)\n- Known malignant intracranial neoplasm (primary or metastatic)\n- Known structural cerebral vascular lesion (e.g., arteriovenous malformation)\n- Advanced dementia\n- Pregnancy\n- Diagnosis of allergy to thrombolytics\n\nAt the start of ED encounter, or most recent dose within 90 days or less of ED encounter:\n-Active oral anticoagulant therapy\n\nOccurs 24 hours or less before start of ED encounter or during ED encounter:\n- Aortic dissection or ruptured aortic aneurysm, Angina pectoris with documented spasm, Aneurysm of heart, Ventricular aneurysm due to and following acute myocardial infarction (disorder), Takotsubo cardiomyopathy or syndrome\n- Severe neurologic impairment\n- Mechanical circulatory assist device placement or removal, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device\n- Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation\n- Cardiopulmonary arrest, including: cardiac arrest, cardiopulmonary resuscitation (CPR), defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR\n\nOccurs 21 days or less before start of ED encounter:\n- Major surgery \n\nOccurs 90 days before start of or at start of ED encounter:\n- Ischemic stroke \n- Significant facial and/or closed head trauma \n- Peptic ulcer\n\nOccurs 90 days or less before start of ED encounter:\n- Intracranial or intraspinal surgery \n\nWith a discharge disposition of patient expired in the ED\n\nWith a discharge disposition of left against medical advice\n\nWith documentation of hospice services in the 6 months within start of ED encounter, or active hospice status at start of ED encounter",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Denominator Exclusions"
}
},
{
"id" : "D66FC17B-ABED-4476-A524-B092500128D9",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "numerator",
"display" : "Numerator"
}
]
},
"description" : "Emergency department encounters with a diagnosis of STEMI:\n - where time from ED arrival to fibrinolysis is 30 minutes or fewer;\nOR \n- where PCI is performed within 90 minutes of arrival; \nOR\n- where the patient is discharged to an acute care facility within 45 minutes of ED arrival",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Numerator"
}
},
{
"id" : "752e3422-6975-4e47-8557-a2cb68f6adad",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "denominator-exception",
"display" : "Denominator Exception"
}
]
},
"description" : "Emergency department encounters where the patient received fibrinolytic therapy at another facility within 24 hours.\nEmergency department encounters with a documented reason for not administering fibrinolytic therapy within 30 minutes of ED arrival.\nEmergency department encounters with a documented reason for not performing a PCI within 90 minutes of ED arrival.",
"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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