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 |
<Measure xmlns="http://hl7.org/fhir">
<id value="CMS996FHIRAptTxforSTEMI"/>
<meta>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"/>
<profile
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<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"/>
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<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<table class="grid dict">
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department FHIR</td>
</tr>
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">CMS996FHIRAptTxforSTEMI</td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">1.2.001</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<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>
</tr>
<tr>
<th scope="row">
<b>
Short Name Identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>CMS996FHIR</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
Version Independent Identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>urn:uuid:a48685e0-4926-4ae8-9eb3-d8e8839b1704</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
Version Specific Identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>urn:uuid:feb911dd-6b34-4b3f-866f-3059dd4d19d0</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
Publisher (CMS) Identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>996FHIR</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Effective Period: </b></th>
<td style="padding-left: 4px;">2026-01-01..2026-12-31</td>
</tr>
<tr>
<th scope="row"><b>Publisher: </b></th>
<td style="padding-left: 4px;">Centers for Medicare & Medicaid Services (CMS)</td>
</tr>
<tr>
<th scope="row"><b>Author: </b></th>
<td style="padding-left: 4px;">Acumen, LLC</td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;"><div><p>Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Purpose: </b></th>
<td style="padding-left: 4px;"><div><p>UNKNOWN</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Copyright: </b></th>
<td style="padding-left: 4px;"><div><p>Limited proprietary coding is contained in these specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets.</p>
<p>This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. All rights reserved.</p>
<p>LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc.</p>
<p>CPT(R) contained in the measure specifications is copyright 2004-2024 American Medical Association.</p>
<p>ICD-10 is copyright 2024 World Health Organization. All Rights Reserved.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Disclaimer: </b></th>
<td style="padding-left: 4px;"><div><p>These performance specifications are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications.</p>
<p>THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.</p>
<p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Rationale: </b></th>
<td style="padding-left: 4px;"><div><p>Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (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).
The total ischemic time—that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy—is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O’Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O’Gara et al., 2013).
Implementation of an eCQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the eCQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of ED Arrival (OP-2) measure and broaden the population for which performance scores could be publicly reported.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Clinical recommendation statement: </b></th>
<td style="padding-left: 4px;"><div><p>Primary PCI in STEMI:
The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that:</p>
<ul>
<li>"Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration."</li>
<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>
</ul>
<p>Fibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact:
The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association(AHA) clinical practice guideline for the management of STEMI recommends that:</p>
<ul>
<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>
</ul>
<p>Transfer to a PCI-Capable Hospital after Fibrinolytic Therapy:
The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that:</p>
<ul>
<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>
<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>
<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>
</ul>
</div></td>
</tr>
<tr>
<th scope="row"><b>Guidance (Usage): </b></th>
<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.
This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI.
This FHIR-based measure has been derived from the QDM-based measure: 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>
</tr>
<tr>
<th scope="row"><b>Population Criteria: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>6633d92a6c1d307ea36e74c0</b></th>
</tr>
<tr>
<td>Initial Population:</td>
<td>All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during an Emergency Department encounter that ends during the measurement period</td>
</tr>
<tr>
<td>Denominator:</td>
<td>Equals Initial Population</td>
</tr>
<tr>
<td>Denominator Exclusion:</td>
<td>Patients with the following conditions are excluded from measure denominator:
At some point during ED encounter:
- Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase
Starts before the start of ED encounter and does not end before ED encounter:
- Bleeding or bleeding diathesis (excluding menses)
- Known malignant intracranial neoplasm (primary or metastatic)
- Known structural cerebral vascular lesion (e.g., arteriovenous malformation)
- Advanced dementia
- Pregnancy
- Diagnosis of allergy to thrombolytics
At the start of ED encounter, or most recent dose within 90 days or less of ED encounter:
-Active oral anticoagulant therapy
Occurs 24 hours or less before start of ED encounter or during ED encounter:
- Aortic dissection or ruptured aortic aneurysm, Angina pectoris with documented spasm, Aneurysm of heart, Ventricular aneurysm due to and following acute myocardial infarction (disorder), Takotsubo cardiomyopathy or syndrome
- Severe neurologic impairment
- 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
- Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation
- Cardiopulmonary arrest, including: cardiac arrest, cardiopulmonary resuscitation (CPR), defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR
Occurs 21 days or less before start of ED encounter:
- Major surgery
Occurs 90 days before start of or at start of ED encounter:
- Ischemic stroke
- Significant facial and/or closed head trauma
- Peptic ulcer
Occurs 90 days or less before start of ED encounter:
- Intracranial or intraspinal surgery
With a discharge disposition of patient expired in the ED
With a discharge disposition of left against medical advice
With documentation of hospice services in the 6 months within start of ED encounter, or active hospice status at start of ED encounter</td>
</tr>
<tr>
<td>Numerator:</td>
<td>Emergency department encounters with a diagnosis of STEMI:
- where time from ED arrival to fibrinolysis is 30 minutes or fewer;
OR
- where PCI is performed within 90 minutes of arrival;
OR
- where the patient is discharged to an acute care facility within 45 minutes of ED arrival</td>
</tr>
<tr>
<td>Denominator Exception:</td>
<td>Emergency department encounters where the patient received fibrinolytic therapy at another facility within 24 hours.
Emergency department encounters with a documented reason for not administering fibrinolytic therapy within 30 minutes of ED arrival.
Emergency department encounters with a documented reason for not performing a PCI within 90 minutes of ED arrival.</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b> Supplemental Data Elements: </b></th>
<td style="padding-left: 4px;">
<p>SDE Ethnicity</p>
<p>SDE Payer</p>
<p>SDE Race</p>
<p>SDE Sex</p>
</td>
</tr>
<tr>
<th scope="row">
<b> Supplemental Data Guidance
: </b></th>
<td style="padding-left: 4px;"> For every patient evaluated by this measure also identify payer, race, ethnicity and sex </td>
</tr>
<tr>
<th scope="row"><b>Libraries: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td><a href="Library-CMS996FHIRAptTxforSTEMI.html">CMS996FHIRAptTxforSTEMI</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Terminology and Other Dependencies: </b></th>
<td style="padding-left: 4px;">
<li><code>Library/SupplementalDataElements|3.5.000</code></li>
<li><code>Library/FHIRHelpers|4.4.000</code></li>
<li><code>Library/CQMCommon|2.2.000</code></li>
<li><code>Library/QICoreCommon|2.1.000</code></li>
<li><code>Library/Status|1.8.000</code></li>
<li><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">AdministrativeGender</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-ActCode.html">ActCode</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html">Condition Clinical Status Codes</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-allergyintolerance-clinical.html">AllergyIntolerance Clinical Status Codes</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a></li>
<li><a href="http://hl7.org/fhir/R4/codesystem-snomedct.html">SNOMED CT (all versions)</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-observation-category.html">Observation Category Codes</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html">Logical Observation Identifiers, Names and Codes (LOINC)</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion">Emergency Department Visit</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4017/expansion">STEMI</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4019/expansion">Fibrinolytic Therapy</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion">Emergency Department Visit</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.2000.5/expansion">Percutaneous Coronary Intervention</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.87/expansion">Discharge To Acute Care Facility</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.4/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.4</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.6/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.6</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4036/expansion">Active Bleeding or Bleeding Diathesis (Excluding Menses)</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.3/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.3</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4025/expansion">Cerebral Vascular Lesion</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4043/expansion">Dementia</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4055/expansion">Pregnancy</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.5/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.5</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4045/expansion">Anticoagulant Medications, Oral</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4028/expansion">Aortic Dissection</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.114.12.1012/expansion">Neurologic impairment</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4048/expansion">Cardiopulmonary Arrest</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4056/expansion">Major Surgical Procedure</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.69/expansion">Endotracheal Intubation</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4052/expansion">Mechanical Circulatory Assist Device</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.247/expansion">Ischemic Stroke</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4026/expansion">Closed Head Trauma</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4031/expansion">Active Peptic Ulcer</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.2/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.2</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.309/expansion">Patient Expired</a></li>
<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>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.93/expansion">Patient Refusal</a></li>
<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>
<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>
</td>
</tr>
<tr>
<th scope="row"><b>Parameters:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>name</b></th>
<th><b>use</b></th>
<th><b>min</b></th>
<th><b>max</b></th>
<th><b>type</b></th>
</tr>
<tr>
<td>Measurement Period</td>
<td>In</td>
<td>0</td>
<td>1</td>
<td>Period</td>
</tr>
<tr>
<td>SDE Sex</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>Coding</td>
</tr>
<tr>
<td>Numerator</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Denominator</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>SDE Payer</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Initial Population</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>SDE Ethnicity</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>Resource</td>
</tr>
<tr>
<td>Denominator Exclusions</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>SDE Race</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>Resource</td>
</tr>
<tr>
<td>Denominator Exceptions</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>DataRequirements:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>Resource Type</b></th>
<th><b>Resource Elements</b></th>
<th><b>Valueset Name</b></th>
<th><b>Valueset</b></th>
</tr>
<tr>
<td>Patient(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a>)</td>
<td>
ethnicity
race
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
class
reasonCode
hospitalization
hospitalization.dischargeDisposition
condition
condition.reference
condition.reference.value
location
location.type
</td>
<td>
Emergency Department Evaluation and Management Visit
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion">Emergency Department Visit</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
class
reasonCode
condition
condition.reference
condition.reference.value
location
location.type
</td>
<td>
Emergency Department Evaluation and Management Visit
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion">Emergency Department Visit</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
class
reasonCode
hospitalization
hospitalization.dischargeDisposition
condition
condition.reference
condition.reference.value
location
location.type
</td>
<td>
Emergency Department Evaluation and Management Visit
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion">Emergency Department Visit</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
class
reasonCode
hospitalization
hospitalization.dischargeDisposition
condition
condition.reference
condition.reference.value
location
location.type
</td>
<td>
Emergency Department Evaluation and Management Visit
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion">Emergency Department Visit</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
hospitalization
hospitalization.dischargeDisposition
period
condition
condition.reference
condition.reference.value
location
location.type
status
status.value
</td>
<td>
Encounter Inpatient
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
condition
condition.reference
condition.reference.value
location
location.type
status
status.value
</td>
<td>
Hospice Encounter
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
class
condition
condition.reference
condition.reference.value
location
location.type
reasonCode
</td>
<td>
Emergency Department Evaluation and Management Visit
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion">Emergency Department Visit</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
id
id.value
code
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
clinicalStatus
</td>
<td>
STEMI
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4017/expansion">STEMI</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Active Bleeding Excluding Menses or Bleeding Diathesis
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4036/expansion">Active Bleeding or Bleeding Diathesis (Excluding Menses)</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Malignant Intracranial Neoplasm Group
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.3/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.3</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Cerebral Vascular Lesion
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4025/expansion">Cerebral Vascular Lesion</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Dementia and Related Intracranial Pathologies
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4043/expansion">Dementia</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Pregnant State
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4055/expansion">Pregnancy</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Allergy to thrombolytics
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.5/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.5</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Aortic Dissection or Ruptured Aortic Aneurysm
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4028/expansion">Aortic Dissection</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Neurologic impairment
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.114.12.1012/expansion">Neurologic impairment</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Cardiopulmonary Arrest
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4048/expansion">Cardiopulmonary Arrest</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Ischemic Stroke
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.247/expansion">Ischemic Stroke</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Closed Head and Facial Trauma
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4026/expansion">Closed Head Trauma</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Active Peptic Ulcer
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4031/expansion">Active Peptic Ulcer</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Hospice Diagnosis
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165</a></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Location(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-location.html">QICoreLocation</a>)</td>
<td>
id
id.value
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>MedicationAdministration(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationadministration.html">QICoreMedicationAdministration</a>)</td>
<td>
medication
status
status.value
effective
</td>
<td>
Fibrinolytic Therapy
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4019/expansion">Fibrinolytic Therapy</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
performed
status
status.value
</td>
<td>
Percutaneous Coronary Intervention
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.2000.5/expansion">Percutaneous Coronary Intervention</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
performed
status
status.value
</td>
<td>
Major Surgical Procedure
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4056/expansion">Major Surgical Procedure</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
performed
status
status.value
</td>
<td>
Endotracheal Intubation
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.69/expansion">Endotracheal Intubation</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
performed
status
status.value
</td>
<td>
Insertion, Replacement, or Removal of Mechanical Circulatory Assist Device
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4052/expansion">Mechanical Circulatory Assist Device</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
performed
status
status.value
</td>
<td>
Intracranial or Intraspinal surgery
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.2/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.2</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
performed
status
status.value
</td>
<td>
Hospice Care Ambulatory
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</a></td>
</tr>
<tr>
<td>Coverage(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html">QICoreCoverage</a>)</td>
<td>
type
period
</td>
<td>
Payer Type
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a></td>
</tr>
<tr>
<td>AllergyIntolerance(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-allergyintolerance.html">QICoreAllergyIntolerance</a>)</td>
<td>
code
clinicalStatus
onset
</td>
<td>
Thrombolytic medications
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.4/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.4</a></td>
</tr>
<tr>
<td>AdverseEvent(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-adverseevent.html">QICoreAdverseEvent</a>)</td>
<td>
event
recordedDate
recordedDate.value
actuality
actuality.value
</td>
<td>
Thrombolytics Adverse Event
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.6/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.6</a></td>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication.reference
status
status.value
intent
intent.value
authoredOn
authoredOn.value
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
authoredOn
authoredOn.value
</td>
<td>
Oral Anticoagulant Medications
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4045/expansion">Anticoagulant Medications, Oral</a></td>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
<td>
code
value
effective
status
status.value
category
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>ServiceRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html">QICoreServiceRequest</a>)</td>
<td>
code
authoredOn
authoredOn.value
status
status.value
intent
intent.value
</td>
<td>
Hospice Care Ambulatory
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedurenotdone.html">QICoreProcedureNotDone</a>)</td>
<td>
code
statusReason
id
id.value
extension
authoredOn
</td>
<td>
Percutaneous Coronary Intervention
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.2000.5/expansion">Percutaneous Coronary Intervention</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedurenotdone.html">QICoreProcedureNotDone</a>)</td>
<td>
code
statusReason
id
id.value
extension
authoredOn
</td>
<td>
Percutaneous Coronary Intervention
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.2000.5/expansion">Percutaneous Coronary Intervention</a></td>
</tr>
<tr>
<td>MedicationAdministration(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-mednotadministered.html">QICoreMedicationAdministrationNotDone</a>)</td>
<td>
medication
statusReason
id
id.value
extension
authoredOn
</td>
<td>
Fibrinolytic Therapy
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4019/expansion">Fibrinolytic Therapy</a></td>
</tr>
<tr>
<td>MedicationAdministration(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-mednotadministered.html">QICoreMedicationAdministrationNotDone</a>)</td>
<td>
medication
statusReason
id
id.value
extension
authoredOn
</td>
<td>
Fibrinolytic Therapy
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.3157.4019/expansion">Fibrinolytic Therapy</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Direct Reference Codes:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>display</b></th>
<th><b>code</b></th>
<th><b>system</b></th>
</tr>
<tr>
<td>Male</td>
<td>M</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">http://hl7.org/fhir/administrative-gender</a></td>
</tr>
<tr>
<td>Female</td>
<td>F</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">http://hl7.org/fhir/administrative-gender</a></td>
</tr>
<tr>
<td>emergency</td>
<td>EMER</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-ActCode.html">http://terminology.hl7.org/CodeSystem/v3-ActCode</a></td>
</tr>
<tr>
<td>Active</td>
<td>active</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
</tr>
<tr>
<td>Active</td>
<td>active</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-allergyintolerance-clinical.html">http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical</a></td>
</tr>
<tr>
<td>Long term (current) use of anticoagulants</td>
<td>Z79.01</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html">http://hl7.org/fhir/sid/icd-10-cm</a></td>
</tr>
<tr>
<td>Angina pectoris with documented spasm</td>
<td>I20.1</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html">http://hl7.org/fhir/sid/icd-10-cm</a></td>
</tr>
<tr>
<td>Ventricular aneurysm due to and following acute myocardial infarction (disorder)</td>
<td>723858002</td>
<td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
</tr>
<tr>
<td>Aneurysm of heart</td>
<td>I25.3</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html">http://hl7.org/fhir/sid/icd-10-cm</a></td>
</tr>
<tr>
<td>Takotsubo cardiomyopathy (disorder)</td>
<td>441541008</td>
<td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
</tr>
<tr>
<td>Takotsubo syndrome</td>
<td>I51.81</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html">http://hl7.org/fhir/sid/icd-10-cm</a></td>
</tr>
<tr>
<td>Discharge to home for hospice care (procedure)</td>
<td>428361000124107</td>
<td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
</tr>
<tr>
<td>Discharge to healthcare facility for hospice care (procedure)</td>
<td>428371000124100</td>
<td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
</tr>
<tr>
<td>survey</td>
<td>survey</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-observation-category.html">http://terminology.hl7.org/CodeSystem/observation-category</a></td>
</tr>
<tr>
<td>Hospice care [Minimum Data Set]</td>
<td>45755-6</td>
<td><a href="https://loinc.org/">http://loinc.org</a></td>
</tr>
<tr>
<td>Yes (qualifier value)</td>
<td>373066001</td>
<td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
</tr>
<tr>
<td>Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility</td>
<td>Z92.82</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html">http://hl7.org/fhir/sid/icd-10-cm</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Logic Definitions:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>Group</b></th>
<th><b>Scoring</b></th>
<th><b>Population Criteria</b></th>
<th><b>Expression</b></th>
</tr>
<tr>
<td> 6633d92a6c1d307ea36e74c0 </td>
<td colspan="3" style="padding-left: 4px;">
<b>Group scoring:</b>
<span> proportion </span>
<tr>
<th scope="row"><b>Type: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>Process </span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Rate Aggregation: </b></th>
<td colspan="3" style="padding-left: 4px;">None</td>
</tr>
<tr>
<th scope="row"><b>Improvement Notation: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>Increased score indicates improvement </span>
</p>
</td>
</tr>
</td>
<tr>
<td/>
<td/>
<td>Initial Population</td>
<td>
<pre><code class="language-cql">define "Initial Population":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
where AgeInYearsAt(date from start of(EDwithSTEMI.period)) >= 18</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator</td>
<td>
<pre><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exclusion</td>
<td>
<pre><code class="language-cql">define "Denominator Exclusions":
"Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"
union "Adverse Effect to Thrombolytic Medications Before End of ED Encounter"
union "Active Exclusion Diagnosis at Start of ED Encounter"
union "Active use of Anticoagulants"
union "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"
union "Major Surgical Procedure 21 Days or Less Before Start of ED Encounter"
union "Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"
union "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"
union "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"
union "ED Encounter with Discharge Disposition as Patient Expired"
union "ED Encounter with Discharge Disposition as Left Against Medical Advice"
union "ED Encounter with Hospice Services"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator</td>
<td>
<pre><code class="language-cql">define "Numerator":
"Fibrinolytic Therapy within 30 Minutes of Arrival"
union "PCI within 90 Minutes of Arrival"
union "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exception</td>
<td>
<pre><code class="language-cql">define "Denominator Exceptions":
"Received tPA in Another Facility within 24 hours Prior to Admission"
union "ED Encounter with a Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival"
union "ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival"</code></pre>
</td>
</tr>
</tr>
</table>
<table class="grid-dict">
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Sex</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Sex":
case
when Patient.gender = 'male' then "M"
when Patient.gender = 'female' then "F"
else null
end</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>SDE Sex</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Sex":
SDE."SDE Sex"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>ED Encounter During MP</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "ED Encounter During MP":
["Encounter": "Emergency Department Evaluation and Management Visit"] EDEncounter
where EDEncounter.period ends during day of "Measurement Period"
and EDEncounter.status = 'finished'
and EDEncounter.class ~ "EMER"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>ED Encounter with STEMI Diagnosis</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "ED Encounter with STEMI Diagnosis":
"ED Encounter During MP" EDEncounter
where ( EDEncounter.reasonCode in "STEMI"
or exists ( ( EDEncounter.encounterDiagnosis ( ) ) EncDiagnosis
where EncDiagnosis.code in "STEMI"
)
or exists ( ["Condition": "STEMI"] DxSTEMI
where DxSTEMI.clinicalStatus ~ QICoreCommon."active"
and DxSTEMI.prevalenceInterval ( ) starts during EDEncounter.period
)
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Fibrinolytic Therapy within 30 Minutes of Arrival</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Fibrinolytic Therapy within 30 Minutes of Arrival":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["MedicationAdministration": "Fibrinolytic Therapy"] Fibrinolytic
such that Fibrinolytic.status = 'completed'
and start of ( Fibrinolytic.effective.toInterval ( ) ) 30 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>PCI within 90 Minutes of Arrival</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "PCI within 90 Minutes of Arrival":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["Procedure": "Percutaneous Coronary Intervention"] PCI
such that PCI.performed.toInterval ( ) starts 90 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )
and PCI.status = 'completed'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
where EDwithSTEMI.currentemergencyDepartmentDepartTime ( ) 45 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )
and EDwithSTEMI.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Numerator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Numerator":
"Fibrinolytic Therapy within 30 Minutes of Arrival"
union "PCI within 90 Minutes of Arrival"
union "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Initial Population</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Initial Population":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
where AgeInYearsAt(date from start of(EDwithSTEMI.period)) >= 18</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Denominator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Payer</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Payer":
[Coverage: type in "Payer Type"] Payer
return {
code: Payer.type,
period: Payer.period
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>SDE Payer</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Payer":
SDE."SDE Payer"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Ethnicity</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Ethnicity":
Patient.ethnicity E
return Tuple {
codes: { E.ombCategory } union E.detailed,
display: E.text
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>SDE Ethnicity</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Ethnicity":
SDE."SDE Ethnicity"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with ["AllergyIntolerance": "Thrombolytic medications"] ThrombolyticAllergy
such that ThrombolyticAllergy.clinicalStatus ~ QICoreCommon."allergy-active"
and ThrombolyticAllergy.onset.toInterval ( ) overlaps ( EDwSTEMI.period )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Adverse Effect to Thrombolytic Medications Before End of ED Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Adverse Effect to Thrombolytic Medications Before End of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with [AdverseEvent: event in "Thrombolytics Adverse Event"] ThrombolyticAdverseEvent
such that ThrombolyticAdverseEvent.recordedDate before end of ( EDwSTEMI.period )
and ThrombolyticAdverseEvent.actuality = 'actual'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Active Exclusion Diagnosis at Start of ED Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Active Exclusion Diagnosis at Start of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ( ["Condition": "Active Bleeding Excluding Menses or Bleeding Diathesis"]
union ["Condition": "Malignant Intracranial Neoplasm Group"]
union ["Condition": "Cerebral Vascular Lesion"]
union ["Condition": "Dementia and Related Intracranial Pathologies"]
union ["Condition": "Pregnant State"]
union ["Condition": "Allergy to thrombolytics"] ) ActiveExclusionDx
such that ActiveExclusionDx.prevalenceInterval ( ) overlaps before ( EDwithSTEMI.period )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Active Oral Anticoagulant Medication at the Start of ED Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Active Oral Anticoagulant Medication at the Start of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["MedicationRequest": "Oral Anticoagulant Medications"] OralAnticoagulant
such that OralAnticoagulant.status = 'active'
and OralAnticoagulant.intent = 'order'
and OralAnticoagulant.authoredOn 90 days or less before or on start of EDwithSTEMI.period</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Active Long Term use of Anticoagulants</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Active Long Term use of Anticoagulants":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["Condition": "Long term (current) use of anticoagulants"] LongTermAnticoagulant
such that ( LongTermAnticoagulant.prevalenceInterval ( ) starts before or on start of EDwithSTEMI.period
and LongTermAnticoagulant.prevalenceInterval ( ) ends on or after start of EDwithSTEMI.period
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Active use of Anticoagulants</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Active use of Anticoagulants":
"Active Oral Anticoagulant Medication at the Start of ED Encounter"
union "Active Long Term use of Anticoagulants"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ( ["Condition": "Aortic Dissection or Ruptured Aortic Aneurysm"]
union ["Condition": "Neurologic impairment"]
union ["Condition": "Angina pectoris with documented spasm"]
union ["Condition": "Ventricular aneurysm due to and following acute myocardial infarction (disorder)"]
union ["Condition": "Aneurysm of heart"]
union ["Condition": "Takotsubo cardiomyopathy (disorder)"]
union ["Condition": "Takotsubo syndrome"]
union ["Condition": "Cardiopulmonary Arrest"] ) ExclusionDiagnosis
such that ( ExclusionDiagnosis.prevalenceInterval ( ) starts during EDwithSTEMI.period )
or ( ExclusionDiagnosis.prevalenceInterval ( ) starts 24 hours or less before start of EDwithSTEMI.period )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Major Surgical Procedure 21 Days or Less Before Start of ED Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Major Surgical Procedure 21 Days or Less Before Start of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["Procedure": "Major Surgical Procedure"] MajorSurgery
such that MajorSurgery.performed.toInterval ( ) starts 21 days or less before start of ( EDwithSTEMI.period )
and MajorSurgery.status = 'completed'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ( ["Procedure": "Endotracheal Intubation"]
union ["Procedure": "Insertion, Replacement, or Removal of Mechanical Circulatory Assist Device"] ) AirwayProcedure
such that ( ( AirwayProcedure.performed.toInterval ( ) starts during ( EDwithSTEMI.period ) )
or ( AirwayProcedure.performed.toInterval ( ) starts 24 hours or less before start of ( EDwithSTEMI.period ) )
)
and AirwayProcedure.status = 'completed'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with ( ["Condition": "Ischemic Stroke"]
union ["Condition": "Closed Head and Facial Trauma"]
union ["Condition": "Active Peptic Ulcer"] ) ExclusionCondition
such that ExclusionCondition.prevalenceInterval ( ) starts during Interval[start of ( EDwSTEMI.period ) - 90 days, start of ( EDwSTEMI.period )]</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["Procedure": "Intracranial or Intraspinal surgery"] CranialorSpinalSurgery
such that CranialorSpinalSurgery.performed.toInterval ( ) starts 90 days or less before start of ( EDwithSTEMI.period )
and CranialorSpinalSurgery.status = 'completed'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>ED Encounter with Discharge Disposition as Patient Expired</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "ED Encounter with Discharge Disposition as Patient Expired":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
where EDwithSTEMI.hospitalization.dischargeDisposition in "Patient Expired"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>ED Encounter with Discharge Disposition as Left Against Medical Advice</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "ED Encounter with Discharge Disposition as Left Against Medical Advice":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
where EDwSTEMI.hospitalization.dischargeDisposition in "Left Against Medical Advice"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>ED Encounter with Hospice Services</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "ED Encounter with Hospice Services":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
where ( exists ( ( ( [Encounter: "Encounter Inpatient"] ).isEncounterPerformed ( ) ) InpatientEncounter
where ( InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
)
and InpatientEncounter.period.toInterval ( ) starts before or on start of ( EDwSTEMI.period )
and ( InpatientEncounter.period.toInterval ( ) ends 6 months or less before day of start of ( EDwSTEMI.period )
or InpatientEncounter.period.toInterval ( ) ends on or after start of ( EDwSTEMI.period )
)
)
or exists ( ( ( [Encounter: "Hospice Encounter"] ).isEncounterPerformed ( ) ) HospiceEncounter
where HospiceEncounter.period.toInterval ( ) starts before or on start of ( EDwSTEMI.period )
and ( HospiceEncounter.period.toInterval ( ) ends 6 months or less before day of start of ( EDwSTEMI.period )
or HospiceEncounter.period.toInterval ( ) ends on or after start of ( EDwSTEMI.period )
)
)
or exists ( ( ( [Observation: "Hospice care [Minimum Data Set]"] ).isAssessmentPerformed ( ) ) HospiceAssessment
where HospiceAssessment.value ~ "Yes (qualifier value)"
and HospiceAssessment.effective.toInterval ( ) starts before or on start of ( EDwSTEMI.period )
and ( HospiceAssessment.effective.toInterval ( ) ends 6 months or less before day of start of ( EDwSTEMI.period )
or HospiceAssessment.effective.toInterval ( ) ends on or after start of ( EDwSTEMI.period )
)
)
or exists ( ( ( [ServiceRequest: "Hospice Care Ambulatory"] ).isInterventionOrder ( ) ) HospiceOrder
where HospiceOrder.authoredOn.toInterval ( ) 6 months or less before start of ( EDwSTEMI.period )
)
or exists ( ( ( [Procedure: "Hospice Care Ambulatory"] ).isInterventionPerformed ( ) ) HospicePerformed
where HospicePerformed.performed.toInterval ( ) starts before or on start of ( EDwSTEMI.period )
and ( HospicePerformed.performed.toInterval ( ) ends 6 months or less before day of start of ( EDwSTEMI.period )
or HospicePerformed.performed.toInterval ( ) ends on or after start of ( EDwSTEMI.period )
)
)
or exists ( ( [Condition: "Hospice Diagnosis"] ) HospiceCareDiagnosis
where HospiceCareDiagnosis.prevalenceInterval ( ) ends on or after start of ( EDwSTEMI.period )
)
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Denominator Exclusions</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator Exclusions":
"Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"
union "Adverse Effect to Thrombolytic Medications Before End of ED Encounter"
union "Active Exclusion Diagnosis at Start of ED Encounter"
union "Active use of Anticoagulants"
union "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"
union "Major Surgical Procedure 21 Days or Less Before Start of ED Encounter"
union "Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"
union "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"
union "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"
union "ED Encounter with Discharge Disposition as Patient Expired"
union "ED Encounter with Discharge Disposition as Left Against Medical Advice"
union "ED Encounter with Hospice Services"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Race</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Race":
Patient.race R
return Tuple {
codes: R.ombCategory union R.detailed,
display: R.text
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>SDE Race</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Race":
SDE."SDE Race"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Received tPA in Another Facility within 24 hours Prior to Admission</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Received tPA in Another Facility within 24 hours Prior to Admission":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ( ["Condition": "Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility"] ) TPA
such that TPA.prevalenceInterval ( ) starts during EDwithSTEMI.period</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival":
["ProcedureNotDone": "Percutaneous Coronary Intervention"] PCINotDone
where ( PCINotDone.statusReason in "Patient Refusal"
or PCINotDone.statusReason in "Procedure Not Indicated/Contraindicated"
)
return {
id: PCINotDone.id,
authoredOn: PCINotDone.recorded
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>ED Encounter with a Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival</td>
</tr>
<tr>
<td/>
<td>
<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":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with "Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival" NoPCI
such that NoPCI.authoredOn during EDwSTEMI.period</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival":
["MedicationAdministrationNotDone": "Fibrinolytic Therapy"] FibrinolyticNoMed
where ( FibrinolyticNoMed.statusReason in "Patient Refusal"
or FibrinolyticNoMed.statusReason in "Drug Intervention Not Indicated/Contraindicated"
)
return {
id: FibrinolyticNoMed.id,
authoredOn: FibrinolyticNoMed.recorded
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival</td>
</tr>
<tr>
<td/>
<td>
<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":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with "Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival" NoFibrinolytic
such that NoFibrinolytic.authoredOn during EDwSTEMI.period</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>Denominator Exceptions</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator Exceptions":
"Received tPA in Another Facility within 24 hours Prior to Admission"
union "ED Encounter with a Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival"
union "ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>FHIRHelpers</td>
<td>ToConcept</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
if concept is null then
null
else
System.Concept {
codes: concept.coding C return ToCode(C),
display: concept.text.value
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CQMCommon</td>
<td>encounterDiagnosis</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns the Condition resources referenced by the diagnosis element of the Encounter
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
Encounter.diagnosis D
return singleton from ([Condition] C where C.id = D.condition.reference.getId())</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>getId</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).
@comment: This function can be used to determine the logical id of a given resource. It can be used in
a single-server environment to trace references. However, this function does not attempt to resolve
or distinguish the base of the given url, and so cannot be used safely in multi-server environments.
*/
define fluent function getId(uri String):
Last(Split(uri, '/'))</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>prevalenceInterval</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
or condition.clinicalStatus ~ "recurrence"
or condition.clinicalStatus ~ "relapse" then
Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
(end of condition.abatementInterval()) abatementDate
return if abatementDate is null then
Interval[start of condition.onset.toInterval(), abatementDate)
else
Interval[start of condition.onset.toInterval(), abatementDate]</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>currentemergencyDepartmentArrivalTime</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function currentemergencyDepartmentArrivalTime(EDEncounter Encounter):
start of ( singleton from ( ( ( EDEncounter.location ) ) EDLocation
where CQMCommon.GetLocation ( EDLocation.location ).type in "Emergency Department Visit"
)
).period</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CQMCommon</td>
<td>GetLocation</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns the Location resource specified by the given reference
@deprecated: This function is deprecated. Use the fluent function `getLocation()` instead.
*/
define function "GetLocation"(reference Reference ):
singleton from (
[Location] L where L.id = reference.reference.getId()
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMS996FHIRAptTxforSTEMI</td>
<td>currentemergencyDepartmentDepartTime</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function currentemergencyDepartmentDepartTime(EDEncounter Encounter):
end of ( singleton from ( ( ( EDEncounter.location ) ) EDLocation
where CQMCommon.GetLocation ( EDLocation.location ).type in "Emergency Department Visit"
)
).period</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>FHIRHelpers</td>
<td>ToString</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define function ToString(value uri): value.value</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>FHIRHelpers</td>
<td>ToCode</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
if coding is null then
null
else
System.Code {
code: coding.code.value,
system: coding.system.value,
version: coding.version.value,
display: coding.display.value
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>Status</td>
<td>isEncounterPerformed</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">//Encounter, Performed
//General usage unless required otherwise by measure intent (e.g., follow-up encounters)
define fluent function isEncounterPerformed(Enc List<Encounter>):
Enc E
where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>toInterval</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
case
when choice is DateTime then
Interval[choice as DateTime, choice as DateTime]
when choice is Interval<DateTime> then
choice as Interval<DateTime>
when choice is Quantity then
Interval[Patient.birthDate + (choice as Quantity),
Patient.birthDate + (choice as Quantity) + 1 year)
when choice is Interval<Quantity> then
Interval[Patient.birthDate + (choice.low as Quantity),
Patient.birthDate + (choice.high as Quantity) + 1 year)
when choice is Timing then
Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
else
null as Interval<DateTime>
end</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>Status</td>
<td>isAssessmentPerformed</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">//This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA.
//Assessment, Performed
define fluent function isAssessmentPerformed(Obs List<Observation>):
Obs O
where O.status in { 'final', 'amended', 'corrected' }
and exists ( O.category ObservationCategory
where ( ObservationCategory ) ~ "survey"
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>Status</td>
<td>isInterventionOrder</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">//Intervention, Order: active and completed only
define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):
ServiceRequest S
where S.status in { 'active', 'completed' }
and S.intent = 'order'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>Status</td>
<td>isInterventionPerformed</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">//Intervention, Performed
define fluent function isInterventionPerformed(Proc List<Procedure>):
Proc P
where P.status ~ 'completed'</code></pre>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</text>
<contained>
<Library>
<id value="effective-data-requirements"/>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/administrative-gender"/>
<code value="M"/>
<display value="Male"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/administrative-gender"/>
<code value="F"/>
<display value="Female"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="EMER"/>
<display value="emergency"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="active"/>
<display value="Active"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical"/>
<code value="active"/>
<display value="Active"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/sid/icd-10-cm"/>
<code value="Z79.01"/>
<display value="Long term (current) use of anticoagulants"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/sid/icd-10-cm"/>
<code value="I20.1"/>
<display value="Angina pectoris with documented spasm"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="723858002"/>
<display
value="Ventricular aneurysm due to and following acute myocardial infarction (disorder)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/sid/icd-10-cm"/>
<code value="I25.3"/>
<display value="Aneurysm of heart"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="441541008"/>
<display value="Takotsubo cardiomyopathy (disorder)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/sid/icd-10-cm"/>
<code value="I51.81"/>
<display value="Takotsubo syndrome"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="428361000124107"/>
<display value="Discharge to home for hospice care (procedure)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="428371000124100"/>
<display
value="Discharge to healthcare facility for hospice care (procedure)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/observation-category"/>
<code value="survey"/>
<display value="survey"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://loinc.org"/>
<code value="45755-6"/>
<display value="Hospice care [Minimum Data Set]"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="373066001"/>
<display value="Yes (qualifier value)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://hl7.org/fhir/sid/icd-10-cm"/>
<code value="Z92.82"/>
<display
value="Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Sex"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Sex":
case
when Patient.gender = 'male' then "M"
when Patient.gender = 'female' then "F"
else null
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString value="SDE Sex"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Sex":
SDE."SDE Sex""/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString value="ED Encounter During MP"/>
</extension>
<extension url="statement">
<valueString
value="define "ED Encounter During MP":
["Encounter": "Emergency Department Evaluation and Management Visit"] EDEncounter
where EDEncounter.period ends during day of "Measurement Period"
and EDEncounter.status = 'finished'
and EDEncounter.class ~ "EMER""/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString value="ED Encounter with STEMI Diagnosis"/>
</extension>
<extension url="statement">
<valueString
value="define "ED Encounter with STEMI Diagnosis":
"ED Encounter During MP" EDEncounter
where ( EDEncounter.reasonCode in "STEMI"
or exists ( ( EDEncounter.encounterDiagnosis ( ) ) EncDiagnosis
where EncDiagnosis.code in "STEMI"
)
or exists ( ["Condition": "STEMI"] DxSTEMI
where DxSTEMI.clinicalStatus ~ QICoreCommon."active"
and DxSTEMI.prevalenceInterval ( ) starts during EDEncounter.period
)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="Fibrinolytic Therapy within 30 Minutes of Arrival"/>
</extension>
<extension url="statement">
<valueString
value="define "Fibrinolytic Therapy within 30 Minutes of Arrival":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["MedicationAdministration": "Fibrinolytic Therapy"] Fibrinolytic
such that Fibrinolytic.status = 'completed'
and start of ( Fibrinolytic.effective.toInterval ( ) ) 30 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString value="PCI within 90 Minutes of Arrival"/>
</extension>
<extension url="statement">
<valueString
value="define "PCI within 90 Minutes of Arrival":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["Procedure": "Percutaneous Coronary Intervention"] PCI
such that PCI.performed.toInterval ( ) starts 90 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )
and PCI.status = 'completed'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival"/>
</extension>
<extension url="statement">
<valueString
value="define "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
where EDwithSTEMI.currentemergencyDepartmentDepartTime ( ) 45 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )
and EDwithSTEMI.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility""/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString value="Numerator"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator":
"Fibrinolytic Therapy within 30 Minutes of Arrival"
union "PCI within 90 Minutes of Arrival"
union "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival""/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString value="Initial Population"/>
</extension>
<extension url="statement">
<valueString
value="define "Initial Population":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
where AgeInYearsAt(date from start of(EDwithSTEMI.period)) >= 18"/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString value="Denominator"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator":
"Initial Population""/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Payer"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Payer":
[Coverage: type in "Payer Type"] Payer
return {
code: Payer.type,
period: Payer.period
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString value="SDE Payer"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Payer":
SDE."SDE Payer""/>
</extension>
<extension url="displaySequence">
<valueInteger value="11"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Ethnicity"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Ethnicity":
Patient.ethnicity E
return Tuple {
codes: { E.ombCategory } union E.detailed,
display: E.text
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="12"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString value="SDE Ethnicity"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Ethnicity":
SDE."SDE Ethnicity""/>
</extension>
<extension url="displaySequence">
<valueInteger value="13"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with ["AllergyIntolerance": "Thrombolytic medications"] ThrombolyticAllergy
such that ThrombolyticAllergy.clinicalStatus ~ QICoreCommon."allergy-active"
and ThrombolyticAllergy.onset.toInterval ( ) overlaps ( EDwSTEMI.period )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="Adverse Effect to Thrombolytic Medications Before End of ED Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Adverse Effect to Thrombolytic Medications Before End of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with [AdverseEvent: event in "Thrombolytics Adverse Event"] ThrombolyticAdverseEvent
such that ThrombolyticAdverseEvent.recordedDate before end of ( EDwSTEMI.period )
and ThrombolyticAdverseEvent.actuality = 'actual'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="Active Exclusion Diagnosis at Start of ED Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Active Exclusion Diagnosis at Start of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ( ["Condition": "Active Bleeding Excluding Menses or Bleeding Diathesis"]
union ["Condition": "Malignant Intracranial Neoplasm Group"]
union ["Condition": "Cerebral Vascular Lesion"]
union ["Condition": "Dementia and Related Intracranial Pathologies"]
union ["Condition": "Pregnant State"]
union ["Condition": "Allergy to thrombolytics"] ) ActiveExclusionDx
such that ActiveExclusionDx.prevalenceInterval ( ) overlaps before ( EDwithSTEMI.period )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="16"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="Active Oral Anticoagulant Medication at the Start of ED Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Active Oral Anticoagulant Medication at the Start of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["MedicationRequest": "Oral Anticoagulant Medications"] OralAnticoagulant
such that OralAnticoagulant.status = 'active'
and OralAnticoagulant.intent = 'order'
and OralAnticoagulant.authoredOn 90 days or less before or on start of EDwithSTEMI.period"/>
</extension>
<extension url="displaySequence">
<valueInteger value="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString value="Active Long Term use of Anticoagulants"/>
</extension>
<extension url="statement">
<valueString
value="define "Active Long Term use of Anticoagulants":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["Condition": "Long term (current) use of anticoagulants"] LongTermAnticoagulant
such that ( LongTermAnticoagulant.prevalenceInterval ( ) starts before or on start of EDwithSTEMI.period
and LongTermAnticoagulant.prevalenceInterval ( ) ends on or after start of EDwithSTEMI.period
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="18"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString value="Active use of Anticoagulants"/>
</extension>
<extension url="statement">
<valueString
value="define "Active use of Anticoagulants":
"Active Oral Anticoagulant Medication at the Start of ED Encounter"
union "Active Long Term use of Anticoagulants""/>
</extension>
<extension url="displaySequence">
<valueInteger value="19"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"/>
</extension>
<extension url="statement">
<valueString
value="define "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ( ["Condition": "Aortic Dissection or Ruptured Aortic Aneurysm"]
union ["Condition": "Neurologic impairment"]
union ["Condition": "Angina pectoris with documented spasm"]
union ["Condition": "Ventricular aneurysm due to and following acute myocardial infarction (disorder)"]
union ["Condition": "Aneurysm of heart"]
union ["Condition": "Takotsubo cardiomyopathy (disorder)"]
union ["Condition": "Takotsubo syndrome"]
union ["Condition": "Cardiopulmonary Arrest"] ) ExclusionDiagnosis
such that ( ExclusionDiagnosis.prevalenceInterval ( ) starts during EDwithSTEMI.period )
or ( ExclusionDiagnosis.prevalenceInterval ( ) starts 24 hours or less before start of EDwithSTEMI.period )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="20"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="Major Surgical Procedure 21 Days or Less Before Start of ED Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Major Surgical Procedure 21 Days or Less Before Start of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["Procedure": "Major Surgical Procedure"] MajorSurgery
such that MajorSurgery.performed.toInterval ( ) starts 21 days or less before start of ( EDwithSTEMI.period )
and MajorSurgery.status = 'completed'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"/>
</extension>
<extension url="statement">
<valueString
value="define "Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ( ["Procedure": "Endotracheal Intubation"]
union ["Procedure": "Insertion, Replacement, or Removal of Mechanical Circulatory Assist Device"] ) AirwayProcedure
such that ( ( AirwayProcedure.performed.toInterval ( ) starts during ( EDwithSTEMI.period ) )
or ( AirwayProcedure.performed.toInterval ( ) starts 24 hours or less before start of ( EDwithSTEMI.period ) )
)
and AirwayProcedure.status = 'completed'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="22"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with ( ["Condition": "Ischemic Stroke"]
union ["Condition": "Closed Head and Facial Trauma"]
union ["Condition": "Active Peptic Ulcer"] ) ExclusionCondition
such that ExclusionCondition.prevalenceInterval ( ) starts during Interval[start of ( EDwSTEMI.period ) - 90 days, start of ( EDwSTEMI.period )]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="23"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ["Procedure": "Intracranial or Intraspinal surgery"] CranialorSpinalSurgery
such that CranialorSpinalSurgery.performed.toInterval ( ) starts 90 days or less before start of ( EDwithSTEMI.period )
and CranialorSpinalSurgery.status = 'completed'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="24"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="ED Encounter with Discharge Disposition as Patient Expired"/>
</extension>
<extension url="statement">
<valueString
value="define "ED Encounter with Discharge Disposition as Patient Expired":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
where EDwithSTEMI.hospitalization.dischargeDisposition in "Patient Expired""/>
</extension>
<extension url="displaySequence">
<valueInteger value="25"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="ED Encounter with Discharge Disposition as Left Against Medical Advice"/>
</extension>
<extension url="statement">
<valueString
value="define "ED Encounter with Discharge Disposition as Left Against Medical Advice":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
where EDwSTEMI.hospitalization.dischargeDisposition in "Left Against Medical Advice""/>
</extension>
<extension url="displaySequence">
<valueInteger value="26"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString value="ED Encounter with Hospice Services"/>
</extension>
<extension url="statement">
<valueString
value="define "ED Encounter with Hospice Services":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
where ( exists ( ( ( [Encounter: "Encounter Inpatient"] ).isEncounterPerformed ( ) ) InpatientEncounter
where ( InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
)
and InpatientEncounter.period.toInterval ( ) starts before or on start of ( EDwSTEMI.period )
and ( InpatientEncounter.period.toInterval ( ) ends 6 months or less before day of start of ( EDwSTEMI.period )
or InpatientEncounter.period.toInterval ( ) ends on or after start of ( EDwSTEMI.period )
)
)
or exists ( ( ( [Encounter: "Hospice Encounter"] ).isEncounterPerformed ( ) ) HospiceEncounter
where HospiceEncounter.period.toInterval ( ) starts before or on start of ( EDwSTEMI.period )
and ( HospiceEncounter.period.toInterval ( ) ends 6 months or less before day of start of ( EDwSTEMI.period )
or HospiceEncounter.period.toInterval ( ) ends on or after start of ( EDwSTEMI.period )
)
)
or exists ( ( ( [Observation: "Hospice care [Minimum Data Set]"] ).isAssessmentPerformed ( ) ) HospiceAssessment
where HospiceAssessment.value ~ "Yes (qualifier value)"
and HospiceAssessment.effective.toInterval ( ) starts before or on start of ( EDwSTEMI.period )
and ( HospiceAssessment.effective.toInterval ( ) ends 6 months or less before day of start of ( EDwSTEMI.period )
or HospiceAssessment.effective.toInterval ( ) ends on or after start of ( EDwSTEMI.period )
)
)
or exists ( ( ( [ServiceRequest: "Hospice Care Ambulatory"] ).isInterventionOrder ( ) ) HospiceOrder
where HospiceOrder.authoredOn.toInterval ( ) 6 months or less before start of ( EDwSTEMI.period )
)
or exists ( ( ( [Procedure: "Hospice Care Ambulatory"] ).isInterventionPerformed ( ) ) HospicePerformed
where HospicePerformed.performed.toInterval ( ) starts before or on start of ( EDwSTEMI.period )
and ( HospicePerformed.performed.toInterval ( ) ends 6 months or less before day of start of ( EDwSTEMI.period )
or HospicePerformed.performed.toInterval ( ) ends on or after start of ( EDwSTEMI.period )
)
)
or exists ( ( [Condition: "Hospice Diagnosis"] ) HospiceCareDiagnosis
where HospiceCareDiagnosis.prevalenceInterval ( ) ends on or after start of ( EDwSTEMI.period )
)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="27"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString value="Denominator Exclusions"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator Exclusions":
"Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"
union "Adverse Effect to Thrombolytic Medications Before End of ED Encounter"
union "Active Exclusion Diagnosis at Start of ED Encounter"
union "Active use of Anticoagulants"
union "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"
union "Major Surgical Procedure 21 Days or Less Before Start of ED Encounter"
union "Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"
union "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"
union "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"
union "ED Encounter with Discharge Disposition as Patient Expired"
union "ED Encounter with Discharge Disposition as Left Against Medical Advice"
union "ED Encounter with Hospice Services""/>
</extension>
<extension url="displaySequence">
<valueInteger value="28"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Race"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Race":
Patient.race R
return Tuple {
codes: R.ombCategory union R.detailed,
display: R.text
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="29"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString value="SDE Race"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Race":
SDE."SDE Race""/>
</extension>
<extension url="displaySequence">
<valueInteger value="30"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="Received tPA in Another Facility within 24 hours Prior to Admission"/>
</extension>
<extension url="statement">
<valueString
value="define "Received tPA in Another Facility within 24 hours Prior to Admission":
"ED Encounter with STEMI Diagnosis" EDwithSTEMI
with ( ["Condition": "Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility"] ) TPA
such that TPA.prevalenceInterval ( ) starts during EDwithSTEMI.period"/>
</extension>
<extension url="displaySequence">
<valueInteger value="31"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival"/>
</extension>
<extension url="statement">
<valueString
value="define "Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival":
["ProcedureNotDone": "Percutaneous Coronary Intervention"] PCINotDone
where ( PCINotDone.statusReason in "Patient Refusal"
or PCINotDone.statusReason in "Procedure Not Indicated/Contraindicated"
)
return {
id: PCINotDone.id,
authoredOn: PCINotDone.recorded
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="32"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="ED Encounter with a Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival"/>
</extension>
<extension url="statement">
<valueString
value="define "ED Encounter with a Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with "Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival" NoPCI
such that NoPCI.authoredOn during EDwSTEMI.period"/>
</extension>
<extension url="displaySequence">
<valueInteger value="33"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival"/>
</extension>
<extension url="statement">
<valueString
value="define "Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival":
["MedicationAdministrationNotDone": "Fibrinolytic Therapy"] FibrinolyticNoMed
where ( FibrinolyticNoMed.statusReason in "Patient Refusal"
or FibrinolyticNoMed.statusReason in "Drug Intervention Not Indicated/Contraindicated"
)
return {
id: FibrinolyticNoMed.id,
authoredOn: FibrinolyticNoMed.recorded
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="34"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString
value="ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival"/>
</extension>
<extension url="statement">
<valueString
value="define "ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival":
"ED Encounter with STEMI Diagnosis" EDwSTEMI
with "Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival" NoFibrinolytic
such that NoFibrinolytic.authoredOn during EDwSTEMI.period"/>
</extension>
<extension url="displaySequence">
<valueInteger value="35"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString value="Denominator Exceptions"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator Exceptions":
"Received tPA in Another Facility within 24 hours Prior to Admission"
union "ED Encounter with a Documented Reason for No PCI Performed Within 90 Minutes of ED Arrival"
union "ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy Within 30 Minutes of ED Arrival""/>
</extension>
<extension url="displaySequence">
<valueInteger value="36"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToConcept"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
if concept is null then
null
else
System.Concept {
codes: concept.coding C return ToCode(C),
display: concept.text.value
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="37"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CQMCommon"/>
</extension>
<extension url="name">
<valueString value="encounterDiagnosis"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the Condition resources referenced by the diagnosis element of the Encounter
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
Encounter.diagnosis D
return singleton from ([Condition] C where C.id = D.condition.reference.getId())"/>
</extension>
<extension url="displaySequence">
<valueInteger value="38"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="getId"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).
@comment: This function can be used to determine the logical id of a given resource. It can be used in
a single-server environment to trace references. However, this function does not attempt to resolve
or distinguish the base of the given url, and so cannot be used safely in multi-server environments.
*/
define fluent function getId(uri String):
Last(Split(uri, '/'))"/>
</extension>
<extension url="displaySequence">
<valueInteger value="39"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="prevalenceInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
or condition.clinicalStatus ~ "recurrence"
or condition.clinicalStatus ~ "relapse" then
Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
(end of condition.abatementInterval()) abatementDate
return if abatementDate is null then
Interval[start of condition.onset.toInterval(), abatementDate)
else
Interval[start of condition.onset.toInterval(), abatementDate]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="40"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString value="currentemergencyDepartmentArrivalTime"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function currentemergencyDepartmentArrivalTime(EDEncounter Encounter):
start of ( singleton from ( ( ( EDEncounter.location ) ) EDLocation
where CQMCommon.GetLocation ( EDLocation.location ).type in "Emergency Department Visit"
)
).period"/>
</extension>
<extension url="displaySequence">
<valueInteger value="41"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CQMCommon"/>
</extension>
<extension url="name">
<valueString value="GetLocation"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the Location resource specified by the given reference
@deprecated: This function is deprecated. Use the fluent function `getLocation()` instead.
*/
define function "GetLocation"(reference Reference ):
singleton from (
[Location] L where L.id = reference.reference.getId()
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="42"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMS996FHIRAptTxforSTEMI"/>
</extension>
<extension url="name">
<valueString value="currentemergencyDepartmentDepartTime"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function currentemergencyDepartmentDepartTime(EDEncounter Encounter):
end of ( singleton from ( ( ( EDEncounter.location ) ) EDLocation
where CQMCommon.GetLocation ( EDLocation.location ).type in "Emergency Department Visit"
)
).period"/>
</extension>
<extension url="displaySequence">
<valueInteger value="43"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value uri): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="44"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToCode"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
if coding is null then
null
else
System.Code {
code: coding.code.value,
system: coding.system.value,
version: coding.version.value,
display: coding.display.value
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="45"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="Status"/>
</extension>
<extension url="name">
<valueString value="isEncounterPerformed"/>
</extension>
<extension url="statement">
<valueString
value="//Encounter, Performed
//General usage unless required otherwise by measure intent (e.g., follow-up encounters)
define fluent function isEncounterPerformed(Enc List<Encounter>):
Enc E
where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="46"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="toInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
case
when choice is DateTime then
Interval[choice as DateTime, choice as DateTime]
when choice is Interval<DateTime> then
choice as Interval<DateTime>
when choice is Quantity then
Interval[Patient.birthDate + (choice as Quantity),
Patient.birthDate + (choice as Quantity) + 1 year)
when choice is Interval<Quantity> then
Interval[Patient.birthDate + (choice.low as Quantity),
Patient.birthDate + (choice.high as Quantity) + 1 year)
when choice is Timing then
Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
else
null as Interval<DateTime>
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="47"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="Status"/>
</extension>
<extension url="name">
<valueString value="isAssessmentPerformed"/>
</extension>
<extension url="statement">
<valueString
value="//This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA.
//Assessment, Performed
define fluent function isAssessmentPerformed(Obs List<Observation>):
Obs O
where O.status in { 'final', 'amended', 'corrected' }
and exists ( O.category ObservationCategory
where ( ObservationCategory ) ~ "survey"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="48"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="Status"/>
</extension>
<extension url="name">
<valueString value="isInterventionOrder"/>
</extension>
<extension url="statement">
<valueString
value="//Intervention, Order: active and completed only
define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):
ServiceRequest S
where S.status in { 'active', 'completed' }
and S.intent = 'order'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="49"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="Status"/>
</extension>
<extension url="name">
<valueString value="isInterventionPerformed"/>
</extension>
<extension url="statement">
<valueString
value="//Intervention, Performed
define fluent function isInterventionPerformed(Proc List<Procedure>):
Proc P
where P.status ~ 'completed'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="50"/>
</extension>
</extension>
<name value="EffectiveDataRequirements"/>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library SDE"/>
<resource value="Library/SupplementalDataElements|3.5.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource value="Library/FHIRHelpers|4.4.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library CQMCommon"/>
<resource value="Library/CQMCommon|2.2.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library QICoreCommon"/>
<resource value="Library/QICoreCommon|2.1.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Status"/>
<resource value="Library/Status|1.8.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system AdministrativeGender"/>
<resource value="http://hl7.org/fhir/administrative-gender"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ActCode"/>
<resource value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ConditionClinicalStatusCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system AllergyIntoleranceClinicalStatusCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ICD10CM"/>
<resource value="http://hl7.org/fhir/sid/icd-10-cm"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system SNOMEDCT"/>
<resource value="http://snomed.info/sct"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ObservationCategoryCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/observation-category"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system LOINC"/>
<resource value="http://loinc.org"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Emergency Department Evaluation and Management Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set STEMI"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4017"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Fibrinolytic Therapy"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4019"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Emergency Department Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Percutaneous Coronary Intervention"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.2000.5"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Discharge To Acute Care Facility"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Payer Type"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Thrombolytic medications"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.4"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Thrombolytics Adverse Event"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.6"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Active Bleeding Excluding Menses or Bleeding Diathesis"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4036"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Malignant Intracranial Neoplasm Group"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.3"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Cerebral Vascular Lesion"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4025"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Dementia and Related Intracranial Pathologies"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4043"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Pregnant State"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4055"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Allergy to thrombolytics"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.5"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Oral Anticoagulant Medications"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4045"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Aortic Dissection or Ruptured Aortic Aneurysm"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4028"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Neurologic impairment"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.114.12.1012"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Cardiopulmonary Arrest"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4048"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Major Surgical Procedure"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4056"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Endotracheal Intubation"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.69"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Insertion, Replacement, or Removal of Mechanical Circulatory Assist Device"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4052"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Ischemic Stroke"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Closed Head and Facial Trauma"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4026"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Active Peptic Ulcer"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4031"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Intracranial or Intraspinal surgery"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.2"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Patient Expired"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Left Against Medical Advice"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.308"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Encounter Inpatient"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
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value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Coverage"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="AllergyIntolerance"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance"/>
<mustSupport value="code"/>
<mustSupport value="clinicalStatus"/>
<mustSupport value="onset"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.4"/>
</codeFilter>
<codeFilter>
<path value="clinicalStatus"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="AdverseEvent"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-adverseevent"/>
<mustSupport value="event"/>
<mustSupport value="recordedDate"/>
<mustSupport value="recordedDate.value"/>
<mustSupport value="actuality"/>
<mustSupport value="actuality.value"/>
<codeFilter>
<path value="event"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.6"/>
</codeFilter>
<codeFilter>
<path value="actuality.value"/>
<code>
<code value="actual"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-relatedRequirement">
<extension url="targetId">
<valueString value="579"/>
</extension>
<extension url="targetProperty">
<valueString value="medication"/>
</extension>
</extension>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement id="579">
<type value="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"/>
<mustSupport value="medication.reference"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="intent"/>
<mustSupport value="intent.value"/>
<mustSupport value="authoredOn"/>
<mustSupport value="authoredOn.value"/>
</dataRequirement>
<dataRequirement>
<type value="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"/>
<mustSupport value="medication"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="intent"/>
<mustSupport value="intent.value"/>
<mustSupport value="authoredOn"/>
<mustSupport value="authoredOn.value"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4045"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
<mustSupport value="code"/>
<mustSupport value="value"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="category"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://loinc.org"/>
<code value="45755-6"/>
<display value="Hospice care [Minimum Data Set]"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="ServiceRequest"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"/>
<mustSupport value="code"/>
<mustSupport value="authoredOn"/>
<mustSupport value="authoredOn.value"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="intent"/>
<mustSupport value="intent.value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedurenotdone"/>
<mustSupport value="code"/>
<mustSupport value="statusReason"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<mustSupport value="extension"/>
<mustSupport value="authoredOn"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.2000.5"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedurenotdone"/>
<mustSupport value="code"/>
<mustSupport value="statusReason"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<mustSupport value="extension"/>
<mustSupport value="authoredOn"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.2000.5"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotadministered"/>
<mustSupport value="medication"/>
<mustSupport value="statusReason"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<mustSupport value="extension"/>
<mustSupport value="authoredOn"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4019"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotadministered"/>
<mustSupport value="medication"/>
<mustSupport value="statusReason"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<mustSupport value="extension"/>
<mustSupport value="authoredOn"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4019"/>
</codeFilter>
</dataRequirement>
</Library>
</contained>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" id="supplementalDataGuidance">
<extension url="guidance">
<valueString
value="For every patient evaluated by this measure also identify payer, race, ethnicity and sex "/>
</extension>
<extension url="usage">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
<display value="Supplemental Data"/>
</coding>
<text value="Supplemental Data Guidance"/>
</valueCodeableConcept>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem">
<valueReference>
<reference value="Device/cqf-tooling"/>
</valueReference>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements" id="effective-data-requirements">
<valueReference>
<reference value="#effective-data-requirements"/>
</valueReference>
</extension>
<url value="https://madie.cms.gov/Measure/CMS996FHIRAptTxforSTEMI"/>
<identifier>
<use value="usual"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="short-name"/>
<display value="Short Name"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/shortName"/>
<value value="CMS996FHIR"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="version-independent"/>
<display value="Version Independent"/>
</coding>
</type>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:a48685e0-4926-4ae8-9eb3-d8e8839b1704"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="version-specific"/>
<display value="Version Specific"/>
</coding>
</type>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:feb911dd-6b34-4b3f-866f-3059dd4d19d0"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="publisher"/>
<display value="Publisher"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/cmsId"/>
<value value="996FHIR"/>
<assigner>
<display value="CMS"/>
</assigner>
</identifier>
<version value="1.2.001"/>
<name value="CMS996FHIRAptTxforSTEMI"/>
<title
value="Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department FHIR"/>
<status value="active"/>
<experimental value="false"/>
<date value="2024-12-18T21:25:47+00:00"/>
<publisher value="Centers for Medicare & Medicaid Services (CMS)"/>
<contact>
<telecom>
<system value="url"/>
<value value="https://www.cms.gov/"/>
</telecom>
</contact>
<description
value="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 value="UNKNOWN"/>
<usage
value="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.
This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI.
This FHIR-based measure has been derived from the QDM-based measure: 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
value="Limited proprietary coding is contained in these specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets.
This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. All rights reserved.
LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc.
CPT(R) contained in the measure specifications is copyright 2004-2024 American Medical Association.
ICD-10 is copyright 2024 World Health Organization. All Rights Reserved."/>
<effectivePeriod>
<start value="2026-01-01"/>
<end value="2026-12-31"/>
</effectivePeriod>
<author>
<name value="Acumen, LLC"/>
<telecom>
<system value="url"/>
<value value="https://www.acumenllc.com/"/>
</telecom>
</author>
<library value="https://madie.cms.gov/Library/CMS996FHIRAptTxforSTEMI"/>
<disclaimer
value="These performance specifications are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications.
THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]."/>
<rationale
value="Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (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).
The total ischemic time—that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy—is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O’Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O’Gara et al., 2013).
Implementation of an eCQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the eCQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of ED Arrival (OP-2) measure and broaden the population for which performance scores could be publicly reported."/>
<clinicalRecommendationStatement
value="Primary PCI in STEMI:
The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that:
- "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration."
- "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact."
Fibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact:
The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association(AHA) clinical practice guideline for the management of STEMI recommends that:
- "In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact.”
Transfer to a PCI-Capable Hospital after Fibrinolytic Therapy:
The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that:
- Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe heart failure (HF), irrespective of the time delay from MI onset.
- Urgent transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who demonstrate evidence of failed reperfusion or reocclusion after fibrinolytic therapy.
- Transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy."/>
<guidance
value="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.
This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI.
This FHIR-based measure has been derived from the QDM-based measure: 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
value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
<valueCode value="Encounter"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="process"/>
<display value="Process"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation">
<valueCode value="None"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
<code value="increase"/>
<display value="Increased score indicates improvement"/>
</coding>
</valueCodeableConcept>
</extension>
<population id="9368D43C-EC53-489B-BFAB-E61F16298E63">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</code>
<description
value="All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during an Emergency Department encounter that ends during the measurement period"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
</criteria>
</population>
<population id="EBF05C28-BF39-423D-A055-FCD964FE0333">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator"/>
<display value="Denominator"/>
</coding>
</code>
<description value="Equals Initial Population"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator"/>
</criteria>
</population>
<population id="9BDC7445-0BF6-4941-8732-893B185A378E">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exclusion"/>
<display value="Denominator Exclusion"/>
</coding>
</code>
<description
value="Patients with the following conditions are excluded from measure denominator:
At some point during ED encounter:
- Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase
Starts before the start of ED encounter and does not end before ED encounter:
- Bleeding or bleeding diathesis (excluding menses)
- Known malignant intracranial neoplasm (primary or metastatic)
- Known structural cerebral vascular lesion (e.g., arteriovenous malformation)
- Advanced dementia
- Pregnancy
- Diagnosis of allergy to thrombolytics
At the start of ED encounter, or most recent dose within 90 days or less of ED encounter:
-Active oral anticoagulant therapy
Occurs 24 hours or less before start of ED encounter or during ED encounter:
- Aortic dissection or ruptured aortic aneurysm, Angina pectoris with documented spasm, Aneurysm of heart, Ventricular aneurysm due to and following acute myocardial infarction (disorder), Takotsubo cardiomyopathy or syndrome
- Severe neurologic impairment
- 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
- Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation
- Cardiopulmonary arrest, including: cardiac arrest, cardiopulmonary resuscitation (CPR), defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR
Occurs 21 days or less before start of ED encounter:
- Major surgery
Occurs 90 days before start of or at start of ED encounter:
- Ischemic stroke
- Significant facial and/or closed head trauma
- Peptic ulcer
Occurs 90 days or less before start of ED encounter:
- Intracranial or intraspinal surgery
With a discharge disposition of patient expired in the ED
With a discharge disposition of left against medical advice
With documentation of hospice services in the 6 months within start of ED encounter, or active hospice status at start of ED encounter"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exclusions"/>
</criteria>
</population>
<population id="D66FC17B-ABED-4476-A524-B092500128D9">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator"/>
<display value="Numerator"/>
</coding>
</code>
<description
value="Emergency department encounters with a diagnosis of STEMI:
- where time from ED arrival to fibrinolysis is 30 minutes or fewer;
OR
- where PCI is performed within 90 minutes of arrival;
OR
- where the patient is discharged to an acute care facility within 45 minutes of ED arrival"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator"/>
</criteria>
</population>
<population id="752e3422-6975-4e47-8557-a2cb68f6adad">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exception"/>
<display value="Denominator Exception"/>
</coding>
</code>
<description
value="Emergency department encounters where the patient received fibrinolytic therapy at another facility within 24 hours.
Emergency department encounters with a documented reason for not administering fibrinolytic therapy within 30 minutes of ED arrival.
Emergency department encounters with a documented reason for not performing a PCI within 90 minutes of ED arrival."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exceptions"/>
</criteria>
</population>
</group>
<supplementalData id="sde-ethnicity">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Ethnicity"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Ethnicity"/>
</criteria>
</supplementalData>
<supplementalData id="sde-payer">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Payer"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Payer"/>
</criteria>
</supplementalData>
<supplementalData id="sde-race">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Race"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Race"/>
</criteria>
</supplementalData>
<supplementalData id="sde-sex">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="SDE Sex"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Sex"/>
</criteria>
</supplementalData>
</Measure>
IG © 2023+ cqframework. Package gov.healthit.ecqi.ecqms#2024.0.0 based on FHIR 4.0.1. Generated 2024-12-19
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