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="CMSFHIR844HybridHospitalWideMortality"/>
<meta>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"/>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"/>
<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<table class="grid dict">
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">Core Clinical Data Elements for the Hybrid Hospital Wide All Condition All Procedure Risk Standardized Mortality Measure HWMFHIR</td>
</tr>
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">CMSFHIR844HybridHospitalWideMortality</td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">0.1.001</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="Measure-CMSFHIR844HybridHospitalWideMortality.html">Core Clinical Data Elements for the Hybrid Hospital Wide All Condition All Procedure Risk Standardized Mortality Measure HWMFHIR</a></td>
</tr>
<tr>
<th scope="row">
<b>
Short Name Identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>CMS844FHIR</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:965255e9-dfeb-42d0-8416-2c4b7ecc5109</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:bdfb568a-0f3f-4885-be0c-7bc971fe8b65</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
Endorser (CMS Consensus Based Entity) Identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>3502</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>844FHIR</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Effective Period: </b></th>
<td style="padding-left: 4px;">2026-07-01..2027-06-30</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;">Lantana Consulting Group, Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation</td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;"><div><p>This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from hospitalizations for adult Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) patients admitted to acute care hospitals.</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>
</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>The intent of this logic is to extract the FIRST valid set of clinical data elements from hospital electronic health records (EHRs) for all qualifying hospitalizations. The data will be linked with administrative claims to risk adjust the Hybrid HWM outcome measure. This work addresses stakeholder concerns that clinical data garnered from patients and used by clinicians to guide diagnostic decisions and treatment, are preferable to administrative claims data when profiling hospitals’ case mix. We are calling the list of data elements for extraction the "HWM-specific core clinical data elements" (CCDE). The CCDEs are the first set of vital signs and basic laboratory tests resulted from hospitalizations for adult Medicare FFS and MA patients, age 65 through 94 years (Initial Population), after they arrive at the hospital to which they are subsequently admitted. For example, this first set of data values are often captured in the emergency department or in the pre-operative area, sometimes hours before a patient is admitted to that same facility.</p>
<p>Hospitalizations over the age of 94 years are not included to avoid holding hospitals responsible for the survival of the oldest elderly patients, who may be less likely to have survival as a primary goal. While we acknowledge that many elderly patients do have survival beyond 30 days as a primary goal for their hospitalization, with input from our Technical Expert Panel and work groups, we decided to only include hospitalizations between 65 and 94 years of age.</p>
<p>These CCDEs were selected because they: 1. reflect patients' clinical status when they first present to the hospital; 2. are clinically and statistically relevant to patient outcomes; 3. are consistently obtained during adult inpatient hospitalizations based on current clinical practice; 4. are captured with a standard definition and recorded in a standard format across providers; and 5. are entered in structured fields that are feasibly retrieved from current EHR systems (YNHHSC/CORE, 2015).</p>
<p>Additional data called Linking Variables are used to link EHR data files with administrative claims data for CMS to calculate results for the Hybrid HWM measure, which are: CMS Certification Number (CCN); Medicare Beneficiary Identifier (MBI); Inpatient Admission Date; and Discharge Date.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Clinical recommendation statement: </b></th>
<td style="padding-left: 4px;"><div><p>The logic is not meant to guide or alter the care patients receive. The purpose of this CCDE logic is to extract clinical data that are already routinely captured in EHRs from hospitalizations for adult patients. It is not intended to require that clinical staff perform additional measurements or tests that are not needed for diagnostic assessment or treatment of patients.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Guidance (Usage): </b></th>
<td style="padding-left: 4px;">These specifications are for use for data with discharges that occur between July 1, 2026 and June 30, 2027. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2028.
This logic guides the user to extract the FIRST valid resulted HWM-specific CCDEs for all Medicare FFS and MA hospitalizations for patients aged 65 through 94 years (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area, such as the emergency department or hospital outpatient location.
The logic supports extraction of the FIRST resulted vital signs and laboratory tests, where the result is not null, during the patient encounter or episode of care. This may include values captured after inpatient admission, as well as prior to inpatient admission, for example from the emergency department, pre-operative, or other outpatient areas associated with the hospital, as long as the values fall within the allowed timeframes specified in the measure logic. All clinical systems used in inpatient and outpatient locations associated with the hospital facility should be queried for core clinical data element values related to a patient who is subsequently admitted.
Patients who arrive at the hospital on oxygen therapy will be flagged in the logic, and an abnormal value for oxygen therapy will be imputed in the data. Rationale: patients who arrive on oxygen may appear in better condition, that is, having a higher oxygen saturation due to oxygen administration, that is not truly reflective of the patient's status upon arrival.
Value sets for the laboratory tests are represented using Logical Observation Identifiers Names and Codes (LOINC) currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements.
NOTE: It is recommended hospitals only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. Hospitals may also choose to report ALL values on an encounter during their entire admission; however, only the first resulted values are utilized in the logic for measure calculation.
For each CCDE, it is recommended that hospitals report the below Unified Code for Units of Measure (UCUM) units, however, any unit may be submitted. Where the reported unit is not easily converted to the requested UCUM units, the value will be set to missing and multiple imputation will be used to impute a value based on the characteristics of the CCDE reported.
CCDE UCUM Unit:
Bicarbonate--------------------------------------meq/L
mmol/L
Creatinine-----------------------------------------mg/dL
Heart rate-----------------------------------------{Beats}/min
Hematocrit ---------------------------------------%
Oxygen saturation (by pulse oximetry)----%
Platelet--------------------------------------------10*3/uL
Sodium--------------------------------------------meq/L
mmol/L
Systolic blood pressure-----------------------mm[Hg]
Temperature-------------------------------------Cel
[degF]
White blood cell count -----------------------{Cells}/uL
10*3/uL
10*9/L
For each hospitalization please also submit the following Linking Variables:
CMS Certification Number (CCN);
Medicare Beneficiary Identifier (MBI);
Inpatient Admission Date; and
Discharge Date.
This eCQM is an encounter-based measure. The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.
This FHIR-based measure has been derived from the QDM-based measure: CMS844v6.
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>67533db0670f1c0879cef5cb</b></th>
</tr>
<tr>
<td>Initial Population:</td>
<td>All Medicare FFS and MA hospitalizations for patients aged 65 through 94 years at the start of an inpatient admission, where the length of stay is less than 365 days, and the hospitalization ends during the measurement period.
NOTE: All Medicare FFS and MA hospitalizations meeting the above criteria should be included, regardless of whether Medicare FFS/MA is the primary, secondary, or tertiary payer.</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>
<p>Encounter with First Bicarbonate Lab Test</p>
<p>Encounter with First Body Temperature</p>
<p>Encounter with First Creatinine Lab Test</p>
<p>Encounter with First Heart Rate</p>
<p>Encounter with First Hematocrit Lab Test</p>
<p>Encounter with First Oxygen Saturation</p>
<p>Encounter with First Platelet Lab Test</p>
<p>Encounter with First Sodium Lab Test</p>
<p>Encounter with First White Blood Cells Lab Test</p>
<p>Encounter with First Systolic Blood Pressure</p>
</td>
</tr>
<tr>
<th scope="row">
<b> Supplemental Data Guidance
: </b></th>
<td style="padding-left: 4px;"> For hospitalizations in the Initial Population, report the FIRST resulted vital signs (physical exams) during current hospitalization.
The physical exam CCDEs are as follows:
Body Temperature
Heart rate
Oxygen saturation (by pulse oximetry)
Systolic blood pressure
For laboratory test results, report the FIRST resulted laboratory tests where result is not null during current hospitalization.
The laboratory tests CCDEs are as follows:
Bicarbonate (or carbon dioxide, see Bicarbonate Lab Test value set)
Creatinine
Hematocrit
Platelet
Sodium
White blood cell count
First values for the CCDEs may be resulted in the emergency department or other hospital outpatient locations within the hospital facility before a patient is subsequently admitted to the same hospital. First values for these data elements may also be resulted in an inpatient location for directly admitted patients who do not receive care in the emergency department or other hospital outpatient/same day surgery locations before admission.
NOTE: Hospitals may choose to submit all, or only report the FIRST resulted value for EACH CCDE collected in the appropriate timeframe, if available.
For every patient in the Initial Population, 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-CMSFHIR844HybridHospitalWideMortality.html">CMSFHIR844HybridHospitalWideMortality</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/CQMCommon|2.2.000</code></li>
<li><code>Library/FHIRHelpers|4.4.000</code></li>
<li><code>Library/QICoreCommon|2.1.000</code></li>
<li><code>Library/SupplementalDataElements|3.5.000</code></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="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">AdministrativeGender</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/2.16.840.1.113762.1.4.1104.10/expansion">Medicare payer</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1104.12/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.12</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion">Observation Services</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/2.16.840.1.113762.1.4.1110.38/expansion">Outpatient Surgery Service</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.139/expansion">Bicarbonate lab test</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.129/expansion">White blood cells count lab test</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.114/expansion">Hematocrit lab test</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.127/expansion">Platelet count lab test</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.2363/expansion">Creatinine lab test</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/2.16.840.1.113762.1.4.1045.151/expansion">Oxygen Saturation in Arterial Blood by Pulse Oximetry</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.119/expansion">Sodium lab test</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>Encounter with First Bicarbonate Lab Test</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Encounter with First Heart Rate</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Encounter with First White Blood Cells Lab Test</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Encounter with First Hematocrit Lab Test</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Encounter with First Platelet Lab Test</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>Encounter with First Systolic Blood Pressure</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>SDE Sex</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>Coding</td>
</tr>
<tr>
<td>Encounter with First Creatinine Lab Test</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Encounter with First Body Temperature</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>Encounter with First Oxygen Saturation</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Encounter with First Sodium Lab Test</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>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
id
id.value
</td>
<td>
Observation Services
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion">Observation Services</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
id
id.value
</td>
<td>
Emergency Department Visit
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion">Emergency Department Visit</a></td>
</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
id
id.value
</td>
<td>
Outpatient Surgery Service
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.38/expansion">Outpatient Surgery Service</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
id
id.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>Patient(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a>)</td>
<td>
race
ethnicity
</td>
<td>
</td>
<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
</td>
<td>
Medicare FFS payer
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1104.10/expansion">Medicare payer</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
</td>
<td>
Medicare Advantage payer
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1104.12/expansion">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.12</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>Observation(<a href="http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html">US Core Laboratory Result Observation Profile</a>)</td>
<td>
code
effective
status
status.value
value
issued
issued.value
</td>
<td>
Bicarbonate lab test
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.139/expansion">Bicarbonate lab test</a></td>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html">US Core Laboratory Result Observation Profile</a>)</td>
<td>
code
effective
status
status.value
value
issued
issued.value
</td>
<td>
White blood cells count lab test
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.129/expansion">White blood cells count lab test</a></td>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html">US Core Laboratory Result Observation Profile</a>)</td>
<td>
code
effective
status
status.value
value
issued
issued.value
</td>
<td>
Hematocrit lab test
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.114/expansion">Hematocrit lab test</a></td>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html">US Core Laboratory Result Observation Profile</a>)</td>
<td>
code
effective
status
status.value
value
issued
issued.value
</td>
<td>
Platelet count lab test
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.127/expansion">Platelet count lab test</a></td>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html">US Core Laboratory Result Observation Profile</a>)</td>
<td>
code
effective
status
status.value
value
issued
issued.value
</td>
<td>
Creatinine lab test
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.2363/expansion">Creatinine lab test</a></td>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html">US Core Laboratory Result Observation Profile</a>)</td>
<td>
code
effective
status
status.value
value
issued
issued.value
</td>
<td>
Sodium lab test
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.119/expansion">Sodium lab test</a></td>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/R4/heartrate.html">Observation Heart Rate Profile</a>)</td>
<td>
effective
status
status.value
value
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/R4/bp.html">Observation Blood Pressure Profile</a>)</td>
<td>
effective
status
status.value
component
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/R4/bodytemp.html">Observation Body Temperature Profile</a>)</td>
<td>
effective
status
status.value
value
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
<td>
code
effective
status
status.value
value
</td>
<td>
Oxygen Saturation by Pulse Oximetry
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.151/expansion">Oxygen Saturation in Arterial Blood by Pulse Oximetry</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>Systolic BP</td>
<td>8480-6</td>
<td><a href="https://loinc.org/">http://loinc.org</a></td>
</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>
</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> 67533db0670f1c0879cef5cb </td>
<td colspan="3" style="padding-left: 4px;">
<b>Group scoring:</b>
<span> cohort </span>
<tr>
<th scope="row"><b>Type: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>Outcome </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>decrease </span>
</p>
</td>
</tr>
</td>
<tr>
<td/>
<td/>
<td>Initial Population</td>
<td>
<pre><code class="language-cql">define "Initial Population":
"Inpatient Encounters"</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>CMSFHIR844HybridHospitalWideMortality</td>
<td>Inpatient Encounters</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Inpatient Encounters":
[Encounter: "Encounter Inpatient"] EncounterInpatient
with ( [Coverage: "Medicare FFS payer"]
union [Coverage: "Medicare Advantage payer"] ) MedicarePayer
such that ( EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService ( ).lengthInDays ( ) ) < 365
and EncounterInpatient.status = 'finished'
and AgeInYearsAt(date from start of EncounterInpatient.period) in Interval[65, 94]
and EncounterInpatient.period ends during day of "Measurement Period"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMSFHIR844HybridHospitalWideMortality</td>
<td>Encounter with First Bicarbonate Lab Test</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with First Bicarbonate Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstBicarbonateLab: First(["USCoreLaboratoryResultObservationProfile": "Bicarbonate lab test"] BicarbonateLab
where BicarbonateLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and BicarbonateLab.status in { 'final', 'amended', 'corrected' }
and BicarbonateLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstBicarbonateResult: FirstBicarbonateLab.value as Quantity,
Timing: FirstBicarbonateLab.issued
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMSFHIR844HybridHospitalWideMortality</td>
<td>Encounter with First Heart Rate</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with First Heart Rate":
"Inpatient Encounters" EncounterInpatient
let FirstHeartRate: First(["observation-heartrate"] HeartRate
where HeartRate.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and HeartRate.status in { 'final', 'amended', 'corrected' }
and HeartRate.value is not null
sort by effective.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstHeartRateResult: FirstHeartRate.value as Quantity,
Timing: FirstHeartRate.effective.earliest ( )
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMSFHIR844HybridHospitalWideMortality</td>
<td>Encounter with First White Blood Cells Lab Test</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with First White Blood Cells Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstWhiteBloodCellLab: First(["USCoreLaboratoryResultObservationProfile": "White blood cells count lab test"] WhiteBloodCellLab
where WhiteBloodCellLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and WhiteBloodCellLab.status in { 'final', 'amended', 'corrected' }
and WhiteBloodCellLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstWhiteBloodCellResult: FirstWhiteBloodCellLab.value as Quantity,
Timing: FirstWhiteBloodCellLab.issued
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMSFHIR844HybridHospitalWideMortality</td>
<td>Encounter with First Hematocrit Lab Test</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with First Hematocrit Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstHematocritLab: First(["USCoreLaboratoryResultObservationProfile": "Hematocrit lab test"] HematocritLab
where HematocritLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and HematocritLab.status in { 'final', 'amended', 'corrected' }
and HematocritLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstHematocritResult: FirstHematocritLab.value as Quantity,
Timing: FirstHematocritLab.issued
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMSFHIR844HybridHospitalWideMortality</td>
<td>Encounter with First Platelet Lab Test</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with First Platelet Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstPlateletLab: First(["USCoreLaboratoryResultObservationProfile": "Platelet count lab test"] PlateletLab
where PlateletLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and PlateletLab.status in { 'final', 'amended', 'corrected' }
and PlateletLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstPlateletResult: FirstPlateletLab.value as Quantity,
Timing: FirstPlateletLab.issued
}</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>CMSFHIR844HybridHospitalWideMortality</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>CMSFHIR844HybridHospitalWideMortality</td>
<td>Encounter with First Systolic Blood Pressure</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with First Systolic Blood Pressure":
"Inpatient Encounters" EncounterInpatient
let FirstSystolicBP: First(["observation-bp"] BP
where BP.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and BP.status in { 'final', 'amended', 'corrected' }
and BP.component.value is not null
sort by effective.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstSBPResult: FirstSystolicBP.component C
where C.code ~ "Systolic blood pressure"
return C.value as Quantity,
Timing: FirstSystolicBP.effective.earliest ( )
}</code></pre>
</td>
</tr>
<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>CMSFHIR844HybridHospitalWideMortality</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>CMSFHIR844HybridHospitalWideMortality</td>
<td>Encounter with First Creatinine Lab Test</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with First Creatinine Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstCreatinineLab: First(["USCoreLaboratoryResultObservationProfile": "Creatinine lab test"] CreatinineLab
where CreatinineLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and CreatinineLab.status in { 'final', 'amended', 'corrected' }
and CreatinineLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstCreatinineResult: FirstCreatinineLab.value as Quantity,
Timing: FirstCreatinineLab.issued
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMSFHIR844HybridHospitalWideMortality</td>
<td>Encounter with First Body Temperature</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with First Body Temperature":
"Inpatient Encounters" EncounterInpatient
let FirstTemperature: First(["observation-bodytemp"] temperature
where temperature.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and temperature.status in { 'final', 'amended', 'corrected' }
and temperature.value is not null
sort by effective.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstTemperatureResult: FirstTemperature.value as Quantity,
Timing: FirstTemperature.effective.earliest ( )
}</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>CMSFHIR844HybridHospitalWideMortality</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>CMSFHIR844HybridHospitalWideMortality</td>
<td>Initial Population</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Initial Population":
"Inpatient Encounters"</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>CMSFHIR844HybridHospitalWideMortality</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>CMSFHIR844HybridHospitalWideMortality</td>
<td>Encounter with First Oxygen Saturation</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with First Oxygen Saturation":
"Inpatient Encounters" EncounterInpatient
let FirstOxygenSat: First([Observation: "Oxygen Saturation by Pulse Oximetry"] O2Saturation
where O2Saturation.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and O2Saturation.status in { 'final', 'amended', 'corrected' }
and O2Saturation.value is not null
sort by effective.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstOxygenSatResult: FirstOxygenSat.value as Quantity,
Timing: FirstOxygenSat.effective.earliest ( )
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CMSFHIR844HybridHospitalWideMortality</td>
<td>Encounter with First Sodium Lab Test</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter with First Sodium Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstSodiumLab: First(["USCoreLaboratoryResultObservationProfile": "Sodium lab test"] SodiumLab
where SodiumLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and SodiumLab.status in { 'final', 'amended', 'corrected' }
and SodiumLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstSodiumResult: FirstSodiumLab.value as Quantity,
Timing: FirstSodiumLab.issued
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CQMCommon</td>
<td>lengthInDays</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Calculates the difference in calendar days between the start and end of the given interval.
*/
define fluent function lengthInDays(Value Interval<DateTime> ):
difference in days between start of Value and end of Value</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CQMCommon</td>
<td>hospitalizationWithObservationAndOutpatientSurgeryService</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Hospitalization with Observation and Outpatient Surgery Service returns the total interval from the start of any immediately prior emergency department visit, outpatient surgery visit or observation visit to the discharge of the given encounter.
*/
define fluent function hospitalizationWithObservationAndOutpatientSurgeryService(TheEncounter "Encounter" ):
TheEncounter Visit
let ObsVisit: Last([Encounter: "Observation Services"] LastObs
where LastObs.status = 'finished'
and LastObs.period ends 1 hour or less on or before start of Visit.period
sort by end of period
),
VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
where LastED.status = 'finished'
and LastED.period ends 1 hour or less on or before VisitStart
sort by end of period
),
VisitStartWithED: Coalesce(start of EDVisit.period, VisitStart),
OutpatientSurgeryVisit: Last([Encounter: "Outpatient Surgery Service"] LastSurgeryOP
where LastSurgeryOP.period ends 1 hour or less on or before VisitStartWithED
sort by end of period
)
return Interval[Coalesce(start of OutpatientSurgeryVisit.period, VisitStartWithED), end of Visit.period]</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>earliest</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Given an interval, return the starting point if the interval has a starting boundary specified,
otherwise, return the ending point
*/
define fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
(choice.toInterval()) period
return
if (period."hasStart"()) then start of period
else end of 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>
</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://loinc.org"/>
<code value="8480-6"/>
<display value="Systolic BP"/>
</valueCoding>
</extension>
<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-logicDefinition">
<extension url="libraryName">
<valueString value="CMSFHIR844HybridHospitalWideMortality"/>
</extension>
<extension url="name">
<valueString value="Inpatient Encounters"/>
</extension>
<extension url="statement">
<valueString
value="define "Inpatient Encounters":
[Encounter: "Encounter Inpatient"] EncounterInpatient
with ( [Coverage: "Medicare FFS payer"]
union [Coverage: "Medicare Advantage payer"] ) MedicarePayer
such that ( EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService ( ).lengthInDays ( ) ) < 365
and EncounterInpatient.status = 'finished'
and AgeInYearsAt(date from start of EncounterInpatient.period) in Interval[65, 94]
and EncounterInpatient.period ends during day of "Measurement Period""/>
</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="CMSFHIR844HybridHospitalWideMortality"/>
</extension>
<extension url="name">
<valueString value="Encounter with First Bicarbonate Lab Test"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First Bicarbonate Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstBicarbonateLab: First(["USCoreLaboratoryResultObservationProfile": "Bicarbonate lab test"] BicarbonateLab
where BicarbonateLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and BicarbonateLab.status in { 'final', 'amended', 'corrected' }
and BicarbonateLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstBicarbonateResult: FirstBicarbonateLab.value as Quantity,
Timing: FirstBicarbonateLab.issued
}"/>
</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="CMSFHIR844HybridHospitalWideMortality"/>
</extension>
<extension url="name">
<valueString value="Encounter with First Heart Rate"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First Heart Rate":
"Inpatient Encounters" EncounterInpatient
let FirstHeartRate: First(["observation-heartrate"] HeartRate
where HeartRate.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and HeartRate.status in { 'final', 'amended', 'corrected' }
and HeartRate.value is not null
sort by effective.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstHeartRateResult: FirstHeartRate.value as Quantity,
Timing: FirstHeartRate.effective.earliest ( )
}"/>
</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="CMSFHIR844HybridHospitalWideMortality"/>
</extension>
<extension url="name">
<valueString
value="Encounter with First White Blood Cells Lab Test"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First White Blood Cells Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstWhiteBloodCellLab: First(["USCoreLaboratoryResultObservationProfile": "White blood cells count lab test"] WhiteBloodCellLab
where WhiteBloodCellLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and WhiteBloodCellLab.status in { 'final', 'amended', 'corrected' }
and WhiteBloodCellLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstWhiteBloodCellResult: FirstWhiteBloodCellLab.value as Quantity,
Timing: FirstWhiteBloodCellLab.issued
}"/>
</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="CMSFHIR844HybridHospitalWideMortality"/>
</extension>
<extension url="name">
<valueString value="Encounter with First Hematocrit Lab Test"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First Hematocrit Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstHematocritLab: First(["USCoreLaboratoryResultObservationProfile": "Hematocrit lab test"] HematocritLab
where HematocritLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and HematocritLab.status in { 'final', 'amended', 'corrected' }
and HematocritLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstHematocritResult: FirstHematocritLab.value as Quantity,
Timing: FirstHematocritLab.issued
}"/>
</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="CMSFHIR844HybridHospitalWideMortality"/>
</extension>
<extension url="name">
<valueString value="Encounter with First Platelet Lab Test"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First Platelet Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstPlateletLab: First(["USCoreLaboratoryResultObservationProfile": "Platelet count lab test"] PlateletLab
where PlateletLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and PlateletLab.status in { 'final', 'amended', 'corrected' }
and PlateletLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstPlateletResult: FirstPlateletLab.value as Quantity,
Timing: FirstPlateletLab.issued
}"/>
</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="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="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMSFHIR844HybridHospitalWideMortality"/>
</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="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMSFHIR844HybridHospitalWideMortality"/>
</extension>
<extension url="name">
<valueString value="Encounter with First Systolic Blood Pressure"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First Systolic Blood Pressure":
"Inpatient Encounters" EncounterInpatient
let FirstSystolicBP: First(["observation-bp"] BP
where BP.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and BP.status in { 'final', 'amended', 'corrected' }
and BP.component.value is not null
sort by effective.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstSBPResult: FirstSystolicBP.component C
where C.code ~ "Systolic blood pressure"
return C.value as Quantity,
Timing: FirstSystolicBP.effective.earliest ( )
}"/>
</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="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="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMSFHIR844HybridHospitalWideMortality"/>
</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="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMSFHIR844HybridHospitalWideMortality"/>
</extension>
<extension url="name">
<valueString value="Encounter with First Creatinine Lab Test"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First Creatinine Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstCreatinineLab: First(["USCoreLaboratoryResultObservationProfile": "Creatinine lab test"] CreatinineLab
where CreatinineLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and CreatinineLab.status in { 'final', 'amended', 'corrected' }
and CreatinineLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstCreatinineResult: FirstCreatinineLab.value as Quantity,
Timing: FirstCreatinineLab.issued
}"/>
</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="CMSFHIR844HybridHospitalWideMortality"/>
</extension>
<extension url="name">
<valueString value="Encounter with First Body Temperature"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First Body Temperature":
"Inpatient Encounters" EncounterInpatient
let FirstTemperature: First(["observation-bodytemp"] temperature
where temperature.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and temperature.status in { 'final', 'amended', 'corrected' }
and temperature.value is not null
sort by effective.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstTemperatureResult: FirstTemperature.value as Quantity,
Timing: FirstTemperature.effective.earliest ( )
}"/>
</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="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="13"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMSFHIR844HybridHospitalWideMortality"/>
</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="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMSFHIR844HybridHospitalWideMortality"/>
</extension>
<extension url="name">
<valueString value="Initial Population"/>
</extension>
<extension url="statement">
<valueString
value="define "Initial Population":
"Inpatient Encounters""/>
</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="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="16"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMSFHIR844HybridHospitalWideMortality"/>
</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="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CMSFHIR844HybridHospitalWideMortality"/>
</extension>
<extension url="name">
<valueString value="Encounter with First Oxygen Saturation"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First Oxygen Saturation":
"Inpatient Encounters" EncounterInpatient
let FirstOxygenSat: First([Observation: "Oxygen Saturation by Pulse Oximetry"] O2Saturation
where O2Saturation.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and O2Saturation.status in { 'final', 'amended', 'corrected' }
and O2Saturation.value is not null
sort by effective.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstOxygenSatResult: FirstOxygenSat.value as Quantity,
Timing: FirstOxygenSat.effective.earliest ( )
}"/>
</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="CMSFHIR844HybridHospitalWideMortality"/>
</extension>
<extension url="name">
<valueString value="Encounter with First Sodium Lab Test"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter with First Sodium Lab Test":
"Inpatient Encounters" EncounterInpatient
let FirstSodiumLab: First(["USCoreLaboratoryResultObservationProfile": "Sodium lab test"] SodiumLab
where SodiumLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
and SodiumLab.status in { 'final', 'amended', 'corrected' }
and SodiumLab.value is not null
sort by issued.earliest()
)
return {
EncounterId: EncounterInpatient.id,
FirstSodiumResult: FirstSodiumLab.value as Quantity,
Timing: FirstSodiumLab.issued
}"/>
</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="CQMCommon"/>
</extension>
<extension url="name">
<valueString value="lengthInDays"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Calculates the difference in calendar days between the start and end of the given interval.
*/
define fluent function lengthInDays(Value Interval<DateTime> ):
difference in days between start of Value and end of Value"/>
</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="CQMCommon"/>
</extension>
<extension url="name">
<valueString
value="hospitalizationWithObservationAndOutpatientSurgeryService"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Hospitalization with Observation and Outpatient Surgery Service returns the total interval from the start of any immediately prior emergency department visit, outpatient surgery visit or observation visit to the discharge of the given encounter.
*/
define fluent function hospitalizationWithObservationAndOutpatientSurgeryService(TheEncounter "Encounter" ):
TheEncounter Visit
let ObsVisit: Last([Encounter: "Observation Services"] LastObs
where LastObs.status = 'finished'
and LastObs.period ends 1 hour or less on or before start of Visit.period
sort by end of period
),
VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
where LastED.status = 'finished'
and LastED.period ends 1 hour or less on or before VisitStart
sort by end of period
),
VisitStartWithED: Coalesce(start of EDVisit.period, VisitStart),
OutpatientSurgeryVisit: Last([Encounter: "Outpatient Surgery Service"] LastSurgeryOP
where LastSurgeryOP.period ends 1 hour or less on or before VisitStartWithED
sort by end of period
)
return Interval[Coalesce(start of OutpatientSurgeryVisit.period, VisitStartWithED), end of Visit.period]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="earliest"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Given an interval, return the starting point if the interval has a starting boundary specified,
otherwise, return the ending point
*/
define fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
(choice.toInterval()) period
return
if (period."hasStart"()) then start of period
else end of period"/>
</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="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="23"/>
</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="24"/>
</extension>
</extension>
<name value="EffectiveDataRequirements"/>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library CQMCommon"/>
<resource value="Library/CQMCommon|2.2.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource value="Library/FHIRHelpers|4.4.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library QICoreCommon"/>
<resource value="Library/QICoreCommon|2.1.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library SDE"/>
<resource value="Library/SupplementalDataElements|3.5.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system LOINC"/>
<resource value="http://loinc.org"/>
</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="Value set Encounter Inpatient"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Medicare FFS payer"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.10"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Medicare Advantage payer"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.12"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Observation Services"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"/>
</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 Outpatient Surgery Service"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.38"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Bicarbonate lab test"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.139"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set White blood cells count lab test"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.129"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Hematocrit lab test"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.114"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Platelet count lab test"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.127"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Creatinine lab test"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.2363"/>
</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 Oxygen Saturation by Pulse Oximetry"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.151"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Sodium lab test"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.119"/>
</relatedArtifact>
<parameter>
<name value="Measurement Period"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="Period"/>
</parameter>
<parameter>
<name value="Encounter with First Bicarbonate Lab Test"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Encounter with First Heart Rate"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Encounter with First White Blood Cells Lab Test"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Encounter with First Hematocrit Lab Test"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Encounter with First Platelet Lab Test"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="SDE Race"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Encounter with First Systolic Blood Pressure"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="SDE Sex"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Coding"/>
</parameter>
<parameter>
<name value="Encounter with First Creatinine Lab Test"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Encounter with First Body Temperature"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="SDE Payer"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Initial Population"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="SDE Ethnicity"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Encounter with First Oxygen Saturation"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Encounter with First Sodium Lab Test"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"/>
</codeFilter>
<codeFilter>
<path value="status.value"/>
<code>
<code value="finished"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"/>
</codeFilter>
<codeFilter>
<path value="status.value"/>
<code>
<code value="finished"/>
</code>
</codeFilter>
<dateFilter>
<path value="period"/>
<valuePeriod>
<extension url="http://hl7.org/fhir/uv/crmi-analysisException">
<valueString
value="Error attempting to determine filter value: toFhirValue not implemented for Subtract"/>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.38"/>
</codeFilter>
<dateFilter>
<path value="period"/>
<valuePeriod>
<extension url="http://hl7.org/fhir/uv/crmi-analysisException">
<valueString
value="Error attempting to determine filter value: toFhirValue not implemented for Subtract"/>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<mustSupport value="id"/>
<mustSupport value="id.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
</codeFilter>
<codeFilter>
<path value="status.value"/>
<code>
<code value="finished"/>
</code>
</codeFilter>
<dateFilter>
<path value="period"/>
<valuePeriod>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
<valueExpression>
<language value="text/cql-identifier"/>
<expression value="Measurement Period"/>
</valueExpression>
</extension>
</valuePeriod>
</dateFilter>
</dataRequirement>
<dataRequirement>
<type value="Patient"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
<mustSupport value="race"/>
<mustSupport value="ethnicity"/>
</dataRequirement>
<dataRequirement>
<type value="Coverage"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
<mustSupport value="type"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.10"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Coverage"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
<mustSupport value="type"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.12"/>
</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="Observation"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab"/>
<mustSupport value="code"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<mustSupport value="issued"/>
<mustSupport value="issued.value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.139"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab"/>
<mustSupport value="code"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<mustSupport value="issued"/>
<mustSupport value="issued.value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.129"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab"/>
<mustSupport value="code"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<mustSupport value="issued"/>
<mustSupport value="issued.value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.114"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab"/>
<mustSupport value="code"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<mustSupport value="issued"/>
<mustSupport value="issued.value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.127"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab"/>
<mustSupport value="code"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<mustSupport value="issued"/>
<mustSupport value="issued.value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.2363"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab"/>
<mustSupport value="code"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<mustSupport value="issued"/>
<mustSupport value="issued.value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.119"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/heartrate"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/bp"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="component"/>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/bodytemp"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
<mustSupport value="code"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.151"/>
</codeFilter>
</dataRequirement>
</Library>
</contained>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" id="supplementalDataGuidance">
<extension url="guidance">
<valueString
value="For hospitalizations in the Initial Population, report the FIRST resulted vital signs (physical exams) during current hospitalization.
The physical exam CCDEs are as follows:
Body Temperature
Heart rate
Oxygen saturation (by pulse oximetry)
Systolic blood pressure
For laboratory test results, report the FIRST resulted laboratory tests where result is not null during current hospitalization.
The laboratory tests CCDEs are as follows:
Bicarbonate (or carbon dioxide, see Bicarbonate Lab Test value set)
Creatinine
Hematocrit
Platelet
Sodium
White blood cell count
First values for the CCDEs may be resulted in the emergency department or other hospital outpatient locations within the hospital facility before a patient is subsequently admitted to the same hospital. First values for these data elements may also be resulted in an inpatient location for directly admitted patients who do not receive care in the emergency department or other hospital outpatient/same day surgery locations before admission.
NOTE: Hospitals may choose to submit all, or only report the FIRST resulted value for EACH CCDE collected in the appropriate timeframe, if available.
For every patient in the Initial Population, 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/CMSFHIR844HybridHospitalWideMortality"/>
<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="CMS844FHIR"/>
</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:965255e9-dfeb-42d0-8416-2c4b7ecc5109"/>
</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:bdfb568a-0f3f-4885-be0c-7bc971fe8b65"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="endorser"/>
<display value="Endorser"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/cbeId"/>
<value value="3502"/>
<assigner>
<display value="CMS Consensus Based Entity"/>
</assigner>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="publisher"/>
<display value="Publisher"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/cmsId"/>
<value value="844FHIR"/>
<assigner>
<display value="CMS"/>
</assigner>
</identifier>
<version value="0.1.001"/>
<name value="CMSFHIR844HybridHospitalWideMortality"/>
<title
value="Core Clinical Data Elements for the Hybrid Hospital Wide All Condition All Procedure Risk Standardized Mortality Measure HWMFHIR"/>
<status value="active"/>
<experimental value="false"/>
<date value="2024-12-18T21:25:46+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="This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from hospitalizations for adult Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) patients admitted to acute care hospitals."/>
<purpose value="UNKNOWN"/>
<usage
value="These specifications are for use for data with discharges that occur between July 1, 2026 and June 30, 2027. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2028.
This logic guides the user to extract the FIRST valid resulted HWM-specific CCDEs for all Medicare FFS and MA hospitalizations for patients aged 65 through 94 years (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area, such as the emergency department or hospital outpatient location.
The logic supports extraction of the FIRST resulted vital signs and laboratory tests, where the result is not null, during the patient encounter or episode of care. This may include values captured after inpatient admission, as well as prior to inpatient admission, for example from the emergency department, pre-operative, or other outpatient areas associated with the hospital, as long as the values fall within the allowed timeframes specified in the measure logic. All clinical systems used in inpatient and outpatient locations associated with the hospital facility should be queried for core clinical data element values related to a patient who is subsequently admitted.
Patients who arrive at the hospital on oxygen therapy will be flagged in the logic, and an abnormal value for oxygen therapy will be imputed in the data. Rationale: patients who arrive on oxygen may appear in better condition, that is, having a higher oxygen saturation due to oxygen administration, that is not truly reflective of the patient's status upon arrival.
Value sets for the laboratory tests are represented using Logical Observation Identifiers Names and Codes (LOINC) currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements.
NOTE: It is recommended hospitals only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. Hospitals may also choose to report ALL values on an encounter during their entire admission; however, only the first resulted values are utilized in the logic for measure calculation.
For each CCDE, it is recommended that hospitals report the below Unified Code for Units of Measure (UCUM) units, however, any unit may be submitted. Where the reported unit is not easily converted to the requested UCUM units, the value will be set to missing and multiple imputation will be used to impute a value based on the characteristics of the CCDE reported.
CCDE UCUM Unit:
Bicarbonate--------------------------------------meq/L
mmol/L
Creatinine-----------------------------------------mg/dL
Heart rate-----------------------------------------{Beats}/min
Hematocrit ---------------------------------------%
Oxygen saturation (by pulse oximetry)----%
Platelet--------------------------------------------10*3/uL
Sodium--------------------------------------------meq/L
mmol/L
Systolic blood pressure-----------------------mm[Hg]
Temperature-------------------------------------Cel
[degF]
White blood cell count -----------------------{Cells}/uL
10*3/uL
10*9/L
For each hospitalization please also submit the following Linking Variables:
CMS Certification Number (CCN);
Medicare Beneficiary Identifier (MBI);
Inpatient Admission Date; and
Discharge Date.
This eCQM is an encounter-based measure. The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.
This FHIR-based measure has been derived from the QDM-based measure: CMS844v6.
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."/>
<effectivePeriod>
<start value="2026-07-01"/>
<end value="2027-06-30"/>
</effectivePeriod>
<author>
<name value="Lantana Consulting Group"/>
<telecom>
<system value="url"/>
<value value="https://www.lantanagroup.com/"/>
</telecom>
</author>
<author>
<name
value="Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation"/>
<telecom>
<system value="url"/>
<value value="https://medicine.yale.edu/core/"/>
</telecom>
</author>
<library
value="https://madie.cms.gov/Library/CMSFHIR844HybridHospitalWideMortality"/>
<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="The intent of this logic is to extract the FIRST valid set of clinical data elements from hospital electronic health records (EHRs) for all qualifying hospitalizations. The data will be linked with administrative claims to risk adjust the Hybrid HWM outcome measure. This work addresses stakeholder concerns that clinical data garnered from patients and used by clinicians to guide diagnostic decisions and treatment, are preferable to administrative claims data when profiling hospitals’ case mix. We are calling the list of data elements for extraction the "HWM-specific core clinical data elements" (CCDE). The CCDEs are the first set of vital signs and basic laboratory tests resulted from hospitalizations for adult Medicare FFS and MA patients, age 65 through 94 years (Initial Population), after they arrive at the hospital to which they are subsequently admitted. For example, this first set of data values are often captured in the emergency department or in the pre-operative area, sometimes hours before a patient is admitted to that same facility.
Hospitalizations over the age of 94 years are not included to avoid holding hospitals responsible for the survival of the oldest elderly patients, who may be less likely to have survival as a primary goal. While we acknowledge that many elderly patients do have survival beyond 30 days as a primary goal for their hospitalization, with input from our Technical Expert Panel and work groups, we decided to only include hospitalizations between 65 and 94 years of age.
These CCDEs were selected because they: 1. reflect patients' clinical status when they first present to the hospital; 2. are clinically and statistically relevant to patient outcomes; 3. are consistently obtained during adult inpatient hospitalizations based on current clinical practice; 4. are captured with a standard definition and recorded in a standard format across providers; and 5. are entered in structured fields that are feasibly retrieved from current EHR systems (YNHHSC/CORE, 2015).
Additional data called Linking Variables are used to link EHR data files with administrative claims data for CMS to calculate results for the Hybrid HWM measure, which are: CMS Certification Number (CCN); Medicare Beneficiary Identifier (MBI); Inpatient Admission Date; and Discharge Date."/>
<clinicalRecommendationStatement
value="The logic is not meant to guide or alter the care patients receive. The purpose of this CCDE logic is to extract clinical data that are already routinely captured in EHRs from hospitalizations for adult patients. It is not intended to require that clinical staff perform additional measurements or tests that are not needed for diagnostic assessment or treatment of patients."/>
<guidance
value="These specifications are for use for data with discharges that occur between July 1, 2026 and June 30, 2027. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2028.
This logic guides the user to extract the FIRST valid resulted HWM-specific CCDEs for all Medicare FFS and MA hospitalizations for patients aged 65 through 94 years (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area, such as the emergency department or hospital outpatient location.
The logic supports extraction of the FIRST resulted vital signs and laboratory tests, where the result is not null, during the patient encounter or episode of care. This may include values captured after inpatient admission, as well as prior to inpatient admission, for example from the emergency department, pre-operative, or other outpatient areas associated with the hospital, as long as the values fall within the allowed timeframes specified in the measure logic. All clinical systems used in inpatient and outpatient locations associated with the hospital facility should be queried for core clinical data element values related to a patient who is subsequently admitted.
Patients who arrive at the hospital on oxygen therapy will be flagged in the logic, and an abnormal value for oxygen therapy will be imputed in the data. Rationale: patients who arrive on oxygen may appear in better condition, that is, having a higher oxygen saturation due to oxygen administration, that is not truly reflective of the patient's status upon arrival.
Value sets for the laboratory tests are represented using Logical Observation Identifiers Names and Codes (LOINC) currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements.
NOTE: It is recommended hospitals only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. Hospitals may also choose to report ALL values on an encounter during their entire admission; however, only the first resulted values are utilized in the logic for measure calculation.
For each CCDE, it is recommended that hospitals report the below Unified Code for Units of Measure (UCUM) units, however, any unit may be submitted. Where the reported unit is not easily converted to the requested UCUM units, the value will be set to missing and multiple imputation will be used to impute a value based on the characteristics of the CCDE reported.
CCDE UCUM Unit:
Bicarbonate--------------------------------------meq/L
mmol/L
Creatinine-----------------------------------------mg/dL
Heart rate-----------------------------------------{Beats}/min
Hematocrit ---------------------------------------%
Oxygen saturation (by pulse oximetry)----%
Platelet--------------------------------------------10*3/uL
Sodium--------------------------------------------meq/L
mmol/L
Systolic blood pressure-----------------------mm[Hg]
Temperature-------------------------------------Cel
[degF]
White blood cell count -----------------------{Cells}/uL
10*3/uL
10*9/L
For each hospitalization please also submit the following Linking Variables:
CMS Certification Number (CCN);
Medicare Beneficiary Identifier (MBI);
Inpatient Admission Date; and
Discharge Date.
This eCQM is an encounter-based measure. The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.
This FHIR-based measure has been derived from the QDM-based measure: CMS844v6.
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="67533db0670f1c0879cef5cb">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="cohort"/>
<display value="Cohort"/>
</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="outcome"/>
<display value="Outcome"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation">
<valueCode value="None"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
<code value="decrease"/>
<display value="decrease"/>
</coding>
</valueCodeableConcept>
</extension>
<description
value="This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from hospitalizations for adult Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) patients admitted to acute care hospitals."/>
<population id="24BB5BA9-820F-4958-B8AA-AA8962E9E398">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</code>
<description
value="All Medicare FFS and MA hospitalizations for patients aged 65 through 94 years at the start of an inpatient admission, where the length of stay is less than 365 days, and the hospitalization ends during the measurement period.
NOTE: All Medicare FFS and MA hospitalizations meeting the above criteria should be included, regardless of whether Medicare FFS/MA is the primary, secondary, or tertiary payer."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
</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>
<supplementalData id="encounter-with-first-bicarbonate-lab-test">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First Bicarbonate Lab Test"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First Bicarbonate Lab Test"/>
</criteria>
</supplementalData>
<supplementalData id="encounter-with-first-body-temperature">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First Body Temperature"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First Body Temperature"/>
</criteria>
</supplementalData>
<supplementalData id="encounter-with-first-creatinine-lab-test">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First Creatinine Lab Test"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First Creatinine Lab Test"/>
</criteria>
</supplementalData>
<supplementalData id="encounter-with-first-heart-rate">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First Heart Rate"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First Heart Rate"/>
</criteria>
</supplementalData>
<supplementalData id="encounter-with-first-hematocrit-lab-test">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First Hematocrit Lab Test"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First Hematocrit Lab Test"/>
</criteria>
</supplementalData>
<supplementalData id="encounter-with-first-oxygen-saturation">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First Oxygen Saturation"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First Oxygen Saturation"/>
</criteria>
</supplementalData>
<supplementalData id="encounter-with-first-platelet-lab-test">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First Platelet Lab Test"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First Platelet Lab Test"/>
</criteria>
</supplementalData>
<supplementalData id="encounter-with-first-sodium-lab-test">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First Sodium Lab Test"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First Sodium Lab Test"/>
</criteria>
</supplementalData>
<supplementalData id="encounter-with-first-white-blood-cells-lab-test">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First White Blood Cells Lab Test"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First White Blood Cells Lab Test"/>
</criteria>
</supplementalData>
<supplementalData id="encounter-with-first-systolic-blood-pressure">
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<description value="Encounter with First Systolic Blood Pressure"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Encounter with First Systolic Blood Pressure"/>
</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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