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

Measure: Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract SurgeryFHIR

Official URL: https://madie.cms.gov/Measure/Cataracts2040BCVAwithin90DaysFHIR Version: 0.1.000
Draft as of 2024-07-09 ​ Responsible: American Academy of Ophthalmology Computable Name: Cataracts2040BCVAwithin90DaysFHIR
Other Identifiers: Short Name (use: usual, ), UUID:84905817-706b-48a8-a8f8-a05436cd6a0e (use: official, ), UUID:321a173e-3052-4091-a963-56bab3d8f0aa (use: official, ), Endorser (use: official, ), Publisher (use: official, )

Copyright/Legal: Copyright 2024 American Academy of Ophthalmology. All Rights Reserved.

Percentage of cataract surgeries for patients aged 18 and older with a diagnosis of uncomplicated cataract and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following the cataract surgery

UNKNOWN

Title: Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract SurgeryFHIR
Id: Cataracts2040BCVAwithin90DaysFHIR
Version: 0.1.000
Url: Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract SurgeryFHIR
short-name identifier:

CMS133FHIR

version-independent identifier:

urn:uuid:84905817-706b-48a8-a8f8-a05436cd6a0e

version-specific identifier:

urn:uuid:321a173e-3052-4091-a963-56bab3d8f0aa

endorser (CMS Consensus Based Entity) identifier:

0565e

publisher (CMS) identifier:

133FHIR

Effective Period: 2025-01-01..2025-12-31
Status: draft
Publisher: American Academy of Ophthalmology
Author: American Academy of Ophthalmology, American Medical Association (AMA)
Description:

Percentage of cataract surgeries for patients aged 18 and older with a diagnosis of uncomplicated cataract and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following the cataract surgery
Purpose:

UNKNOWN
Copyright:

Copyright 2024 American Academy of Ophthalmology. All Rights Reserved.
Disclaimer:

The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measure require a license agreement between the user and the American Academy of Ophthalmology (Academy). Neither the Academy, PCPI, nor the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor their members shall be responsible for any use of the Measure. The PCPI’s and AMA’s significant past efforts and contributions to the development and updating of the Measures are acknowledged. The National Committee for Quality Assurance’s significant past efforts and contributions to the development and updating of the Measure is acknowledged. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party’s use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measures. Any other use of CPT or other coding by the third party is strictly prohibited. The Academy, its members, the AMA, and former members of the PCPI disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) is copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2023 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R].
Rationale:

In the United States, cataracts affect more than 24 million adults over 40 years (National Eye Institute, 2019). According to the American Academy of Ophthalmology (2021), cataract surgery has a substantial beneficial impact on visual function and on quality of life. 1. Scientific basis for measuring visual acuity outcomes after cataract surgery The only reason to perform cataract surgery (other than for a limited set of medical indications) is to improve a patient's vision and associated functioning. The use of a 20/40 visual acuity threshold is based on several considerations. First, it is the level for unrestricted operation of a motor vehicle in the US. Second, it has been consistently used by the FDA in its assessment for approval of intraocular lens (IOL) and other vision devices. Third, it is the literature standard to denote success in cataract surgery. Fourth, work by West et al. in the Salisbury Eye Study suggests that 20/40 is a useful threshold for 50th percentile functioning for several vision-related tasks. Most patients achieve excellent visual acuity after cataract surgery (20/40 or better). This outcome is achieved consistently through careful attention through the accurate measurement of axial length and corneal power and the appropriate selection of an IOL power calculation formula. As such, it reflects the care and diligence with which the surgery is assessed, planned and executed. Failure to achieve this after surgery in eyes without comorbid ocular conditions that would impact the success of the surgery would reflect care that should be assessed for opportunities for improvement. The exclusion of patients with other ocular and systemic conditions known to increase the risk of an adverse outcome reflects the findings of the two published prediction rule papers for cataract surgery outcomes, by Mangione et al. (1995) and Steinberg et al. (1994). In both papers, the presence of comorbid glaucoma and macular degeneration negatively impacted the likelihood of successful outcomes of surgery. Further, as noted in the prior indicator, exclusion of eyes with ocular conditions that could impact the success of the surgery would NOT eliminate the large majority of eyes undergoing surgery while also minimizing the potential adverse selection that might otherwise occur relative to those patients with the most complex situations who might benefit the most from having surgery to maximize their remaining vision. 2. Evidence of a gap in care Cataract surgery successfully restores vision in the majority of people who have the procedure. Data from a study of 368,256 cataract surgeries show that corrected visual acuity (CDVA) of 0.5 (20/40) or better was achieved in 94.3% and CDVA of 1.0 (20/20) or better was achieved in 61.3% of cases (Lundstrom, Barry, Henry, Rosen & Stenevi, 2013). Additionally, data from a UK multi-center Cataract National Dataset found a postoperative visual acuity of 6/12 (20/40) or better was achieved for 94.7% of eyes with no co-pathologies and in 79.9% of eyes with one or more co-pathologies (Jaycock et al., 2009). A rate of 85.5-94.7% of patients achieving a 20/40 or better visual acuity in the context of approximately 3 million cataract surgeries in the US annually would mean that between 160,000 to 435,000 individuals would not achieve a 20/40 or better visual acuity which suggests an opportunity for improvement.
Clinical recommendation statement:

This is an outcome measure. As such, there is no statement in the guideline specific to this measurement topic.
Guidance (Usage): This eCQM is an episode-based measure. An episode for this measure is defined as each cataract surgery during the measurement period, including instances where more than one cataract procedure was performed during the measurement period. Every cataract surgery during the measurement period should be counted as a measurable denominator event for the measure calculation. Only procedures performed during January 1 - September 30 of the reporting period will be considered for this measure, in order to determine if 20/40 or better visual acuity has been achieved within the 90 days following the cataract procedure. Cataract procedures performed during October 1 - December 31 are excluded from the initial population. The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional or eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality. This measure is to be reported by the clinician performing the cataract surgery procedure. Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure. Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible encounter codes. This FHIR-based measure has been derived from the QDM-based measure: CMS133v13. 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).
Population Criteria:
64f75a7d56d636294b15818d
Initial Population: All cataract surgeries performed between January and September of the measurement period for patients 18 years and older
Denominator: Equals Initial Population
Denominator Exclusion: Cataract surgeries in patients with significant ocular conditions impacting the visual outcome of surgery
Numerator: Cataract surgeries with best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following cataract surgery
Supplemental Data Elements:

SDE Payer

SDE Ethnicity

SDE Race

SDE Sex
Supplemental Data Guidance : For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Payer SDE Ethnicity SDE Race SDE Sex
Libraries:
Cataracts2040BCVAwithin90DaysFHIR
Terminology and Other Dependencies:
  • Library/SupplementalDataElements|3.5.000
  • Library/QICoreCommon|2.1.000
  • Library/FHIRHelpers|4.4.000
  • AdministrativeGender
  • SNOMED CT (all versions)
  • Condition Clinical Status Codes
  • Cataract Surgery
  • Best Corrected Visual Acuity Exam Using Snellen Chart
  • Visual Acuity 20/40 or Better
  • Payer
  • Acute and Subacute Iridocyclitis
  • Amblyopia
  • Burn Confined to Eye and Adnexa
  • Cataract Secondary to Ocular Disorders
  • Cataract, Congenital
  • Cataract, Mature or Hypermature
  • Cataract, Posterior Polar
  • Central Corneal Ulcer
  • Certain Types of Iridocyclitis
  • Choroidal Degenerations
  • Choroidal Detachment
  • Choroidal Hemorrhage and Rupture
  • Chronic Iridocyclitis
  • Cloudy Cornea
  • Corneal Edema
  • Corneal Opacity and Other Disorders of Cornea
  • Degeneration of Macula and Posterior Pole
  • Degenerative Disorders of Globe
  • Diabetic Macular Edema
  • Diabetic Retinopathy
  • Disorders of Optic Chiasm
  • Disorders of Visual Cortex
  • Disseminated Chorioretinitis and Disseminated Retinochoroiditis
  • Focal Chorioretinitis and Focal Retinochoroiditis
  • Glaucoma
  • Glaucoma Associated with Congenital Anomalies, Dystrophies, and Systemic Syndromes
  • Hereditary Choroidal Dystrophies
  • Hereditary Corneal Dystrophies
  • Hereditary Retinal Dystrophies
  • Hypotony of Eye
  • Injury to Optic Nerve and Pathways
  • Macular Scar of Posterior Polar
  • Morgagnian Cataract
  • Nystagmus and Other Irregular Eye Movements
  • Open Wound of Eyeball
  • Optic Atrophy
  • Optic Neuritis
  • Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis
  • Other Background Retinopathy and Retinal Vascular Changes
  • Other Disorders of Optic Nerve
  • Other Endophthalmitis
  • Other Proliferative Retinopathy
  • Pathologic Myopia
  • Posterior Lenticonus
  • Prior Penetrating Keratoplasty
  • Purulent Endophthalmitis
  • Retinal Detachment with Retinal Defect
  • Retinal Vascular Occlusion
  • Retrolental Fibroplasias
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1226.1
  • Separation of Retinal Layers
  • Traumatic Cataract
  • Uveitis
  • Vascular Disorders of Iris and Ciliary Body
  • Visual Field Defects
    		•
    Parameters:
    name use min max type
    Measurement Period In 0 1 Period
    SDE Sex Out 0 1 Coding
    Numerator Out 0 * Resource
    Denominator Out 0 * Resource
    SDE Payer Out 0 * Resource
    Initial Population Out 0 * Resource
    SDE Ethnicity Out 0 1 Resource
    Denominator Exclusions Out 0 * Resource
    SDE Race Out 0 1 Resource
    DataRequirements:
    Resource Type Resource Elements Valueset Name Valueset
    Patient(QICorePatient) ethnicity race
    Procedure(QICoreProcedure) code performed status status.value Cataract Surgery Cataract Surgery
    Observation(QICoreObservation) code effective status status.value value
    Observation(QICoreObservation) code effective status status.value value Best Corrected Visual Acuity Exam Using Snellen Chart Best Corrected Visual Acuity Exam Using Snellen Chart
    Coverage(QICoreCoverage) type period Payer Type Payer
    Condition(QICoreCondition) code Acute and Subacute Iridocyclitis Acute and Subacute Iridocyclitis
    Condition(QICoreCondition) code Amblyopia Amblyopia
    Condition(QICoreCondition) code Burn Confined to Eye and Adnexa Burn Confined to Eye and Adnexa
    Condition(QICoreCondition) code Cataract Secondary to Ocular Disorders Cataract Secondary to Ocular Disorders
    Condition(QICoreCondition) code Cataract Congenital Cataract, Congenital
    Condition(QICoreCondition) code Cataract Mature or Hypermature Cataract, Mature or Hypermature
    Condition(QICoreCondition) code Cataract Posterior Polar Cataract, Posterior Polar
    Condition(QICoreCondition) code Central Corneal Ulcer Central Corneal Ulcer
    Condition(QICoreCondition) code Certain Types of Iridocyclitis Certain Types of Iridocyclitis
    Condition(QICoreCondition) code Choroidal Degenerations Choroidal Degenerations
    Condition(QICoreCondition) code Choroidal Detachment Choroidal Detachment
    Condition(QICoreCondition) code Choroidal Hemorrhage and Rupture Choroidal Hemorrhage and Rupture
    Condition(QICoreCondition) code Chronic Iridocyclitis Chronic Iridocyclitis
    Condition(QICoreCondition) code Cloudy Cornea Cloudy Cornea
    Condition(QICoreCondition) code Corneal Edema Corneal Edema
    Condition(QICoreCondition) code Disorders of Cornea Including Corneal Opacity Corneal Opacity and Other Disorders of Cornea
    Condition(QICoreCondition) code Degeneration of Macula and Posterior Pole Degeneration of Macula and Posterior Pole
    Condition(QICoreCondition) code Degenerative Disorders of Globe Degenerative Disorders of Globe
    Condition(QICoreCondition) code Diabetic Macular Edema Diabetic Macular Edema
    Condition(QICoreCondition) code Diabetic Retinopathy Diabetic Retinopathy
    Condition(QICoreCondition) code Disorders of Optic Chiasm Disorders of Optic Chiasm
    Condition(QICoreCondition) code Disorders of Visual Cortex Disorders of Visual Cortex
    Condition(QICoreCondition) code Disseminated Chorioretinitis and Disseminated Retinochoroiditis Disseminated Chorioretinitis and Disseminated Retinochoroiditis
    Condition(QICoreCondition) code Focal Chorioretinitis and Focal Retinochoroiditis Focal Chorioretinitis and Focal Retinochoroiditis
    Condition(QICoreCondition) code Glaucoma Glaucoma
    Condition(QICoreCondition) code Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes Glaucoma Associated with Congenital Anomalies, Dystrophies, and Systemic Syndromes
    Condition(QICoreCondition) code Hereditary Choroidal Dystrophies Hereditary Choroidal Dystrophies
    Condition(QICoreCondition) code Hereditary Corneal Dystrophies Hereditary Corneal Dystrophies
    Condition(QICoreCondition) code Hereditary Retinal Dystrophies Hereditary Retinal Dystrophies
    Condition(QICoreCondition) code Hypotony of Eye Hypotony of Eye
    Condition(QICoreCondition) code Injury to Optic Nerve and Pathways Injury to Optic Nerve and Pathways
    Condition(QICoreCondition) code Macular Scar of Posterior Polar Macular Scar of Posterior Polar
    Condition(QICoreCondition) code Morgagnian Cataract Morgagnian Cataract
    Condition(QICoreCondition) code Nystagmus and Other Irregular Eye Movements Nystagmus and Other Irregular Eye Movements
    Condition(QICoreCondition) code Open Wound of Eyeball Open Wound of Eyeball
    Condition(QICoreCondition) code Optic Atrophy Optic Atrophy
    Condition(QICoreCondition) code Optic Neuritis Optic Neuritis
    Condition(QICoreCondition) code Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis
    Condition(QICoreCondition) code Other Background Retinopathy and Retinal Vascular Changes Other Background Retinopathy and Retinal Vascular Changes
    Condition(QICoreCondition) code Other Disorders of Optic Nerve Other Disorders of Optic Nerve
    Condition(QICoreCondition) code Other Endophthalmitis Other Endophthalmitis
    Condition(QICoreCondition) code Other Proliferative Retinopathy Other Proliferative Retinopathy
    Condition(QICoreCondition) code Pathologic Myopia Pathologic Myopia
    Condition(QICoreCondition) code Posterior Lenticonus Posterior Lenticonus
    Condition(QICoreCondition) code Prior Penetrating Keratoplasty Prior Penetrating Keratoplasty
    Condition(QICoreCondition) code Purulent Endophthalmitis Purulent Endophthalmitis
    Condition(QICoreCondition) code Retinal Detachment with Retinal Defect Retinal Detachment with Retinal Defect
    Condition(QICoreCondition) code Retinal Vascular Occlusion Retinal Vascular Occlusion
    Condition(QICoreCondition) code Retrolental Fibroplasias Retrolental Fibroplasias
    Condition(QICoreCondition) code Scleritis http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1226.1
    Condition(QICoreCondition) code Separation of Retinal Layers Separation of Retinal Layers
    Condition(QICoreCondition) code Traumatic Cataract Traumatic Cataract
    Condition(QICoreCondition) code Uveitis Uveitis
    Condition(QICoreCondition) code Vascular Disorders of Iris and Ciliary Body Vascular Disorders of Iris and Ciliary Body
    Condition(QICoreCondition) code Visual Field Defects Visual Field Defects
    Direct Reference Codes:
    display code system
    Male M http://hl7.org/fhir/administrative-gender
    Female F http://hl7.org/fhir/administrative-gender
    Best corrected visual acuity (observable entity) 419775003 http://snomed.info/sct
    Active active http://terminology.hl7.org/CodeSystem/condition-clinical
    Recurrence recurrence http://terminology.hl7.org/CodeSystem/condition-clinical
    Relapse relapse http://terminology.hl7.org/CodeSystem/condition-clinical
    Logic Definitions:
    Group Scoring Population Criteria Expression
    64f75a7d56d636294b15818d Group scoring: proportion
    Type:

    Outcome

    Rate Aggregation: None
    Improvement Notation:

    increase

    Initial Population 
    define "Initial Population":
  "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed
    where AgeInYearsAt(date from start of "Measurement Period") >= 18
    Denominator 
    define "Denominator":
  "Initial Population"
    Denominator Exclusion 
    define "Denominator Exclusions":
  "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed
    with ( [Condition: "Acute and Subacute Iridocyclitis"]
      union [Condition: "Amblyopia"]
      union [Condition: "Burn Confined to Eye and Adnexa"]
      union [Condition: "Cataract Secondary to Ocular Disorders"]
      union [Condition: "Cataract Congenital"]
      union [Condition: "Cataract Mature or Hypermature"]
      union [Condition: "Cataract Posterior Polar"]
      union [Condition: "Central Corneal Ulcer"]
      union [Condition: "Certain Types of Iridocyclitis"]
      union [Condition: "Choroidal Degenerations"]
      union [Condition: "Choroidal Detachment"]
      union [Condition: "Choroidal Hemorrhage and Rupture"]
      union [Condition: "Chronic Iridocyclitis"]
      union [Condition: "Cloudy Cornea"]
      union [Condition: "Corneal Edema"]
      union [Condition: "Disorders of Cornea Including Corneal Opacity"]
      union [Condition: "Degeneration of Macula and Posterior Pole"]
      union [Condition: "Degenerative Disorders of Globe"]
      union [Condition: "Diabetic Macular Edema"]
      union [Condition: "Diabetic Retinopathy"]
      union [Condition: "Disorders of Optic Chiasm"]
      union [Condition: "Disorders of Visual Cortex"]
      union [Condition: "Disseminated Chorioretinitis and Disseminated Retinochoroiditis"]
      union [Condition: "Focal Chorioretinitis and Focal Retinochoroiditis"]
      union [Condition: "Glaucoma"]
      union [Condition: "Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes"]
      union [Condition: "Hereditary Choroidal Dystrophies"]
      union [Condition: "Hereditary Corneal Dystrophies"]
      union [Condition: "Hereditary Retinal Dystrophies"]
      union [Condition: "Hypotony of Eye"]
      union [Condition: "Injury to Optic Nerve and Pathways"]
      union [Condition: "Macular Scar of Posterior Polar"]
      union [Condition: "Morgagnian Cataract"]
      union [Condition: "Nystagmus and Other Irregular Eye Movements"]
      union [Condition: "Open Wound of Eyeball"]
      union [Condition: "Optic Atrophy"]
      union [Condition: "Optic Neuritis"]
      union [Condition: "Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis"]
      union [Condition: "Other Background Retinopathy and Retinal Vascular Changes"]
      union [Condition: "Other Disorders of Optic Nerve"]
      union [Condition: "Other Endophthalmitis"]
      union [Condition: "Other Proliferative Retinopathy"]
      union [Condition: "Pathologic Myopia"]
      union [Condition: "Posterior Lenticonus"]
      union [Condition: "Prior Penetrating Keratoplasty"]
      union [Condition: "Purulent Endophthalmitis"]
      union [Condition: "Retinal Detachment with Retinal Defect"]
      union [Condition: "Retinal Vascular Occlusion"]
      union [Condition: "Retrolental Fibroplasias"]
      union [Condition: "Scleritis"]
      union [Condition: "Separation of Retinal Layers"]
      union [Condition: "Traumatic Cataract"]
      union [Condition: "Uveitis"]
      union [Condition: "Vascular Disorders of Iris and Ciliary Body"]
      union [Condition: "Visual Field Defects"] ) ComorbidDiagnosis
      such that ComorbidDiagnosis.prevalenceInterval ( ) overlaps before CataractSurgeryPerformed.performed.toInterval ( )
        and ComorbidDiagnosis.isActive ( )
    Numerator 
    define "Numerator":
  "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed
    with ( [Observation: "Best corrected visual acuity (observable entity)"]
      union [Observation: "Best Corrected Visual Acuity Exam Using Snellen Chart"] ) VisualAcuityExamPerformed
      such that VisualAcuityExamPerformed.effective.toInterval ( ) 90 days or less after day of end of CataractSurgeryPerformed.performed.toInterval ( )
        and VisualAcuityExamPerformed.status in { 'final', 'amended', 'corrected', 'preliminary' }
        and VisualAcuityExamPerformed.value as Concept in "Visual Acuity 20/40 or Better"
    Library Name Name
    SupplementalDataElements SDE Sex 
    define "SDE Sex":
  case
    when Patient.gender = 'male' then "M"
    when Patient.gender = 'female' then "F"
    else null
  end
    Library Name Name
    Cataracts2040BCVAwithin90DaysFHIR SDE Sex 
    define "SDE Sex":
  SDE."SDE Sex"
    Library Name Name
    Cataracts2040BCVAwithin90DaysFHIR Cataract Surgery Between January and September of Measurement Period 
    define "Cataract Surgery Between January and September of Measurement Period":
  [Procedure: "Cataract Surgery"] CataractSurgery
    where CataractSurgery.performed.toInterval ( ) during "Measurement Period"
      and CataractSurgery.performed.toInterval ( ) starts 92 days or more before end of "Measurement Period"
      and CataractSurgery.status = 'completed'
    Library Name Name
    Cataracts2040BCVAwithin90DaysFHIR Numerator 
    define "Numerator":
  "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed
    with ( [Observation: "Best corrected visual acuity (observable entity)"]
      union [Observation: "Best Corrected Visual Acuity Exam Using Snellen Chart"] ) VisualAcuityExamPerformed
      such that VisualAcuityExamPerformed.effective.toInterval ( ) 90 days or less after day of end of CataractSurgeryPerformed.performed.toInterval ( )
        and VisualAcuityExamPerformed.status in { 'final', 'amended', 'corrected', 'preliminary' }
        and VisualAcuityExamPerformed.value as Concept in "Visual Acuity 20/40 or Better"
    Library Name Name
    Cataracts2040BCVAwithin90DaysFHIR Initial Population 
    define "Initial Population":
  "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed
    where AgeInYearsAt(date from start of "Measurement Period") >= 18
    Library Name Name
    Cataracts2040BCVAwithin90DaysFHIR Denominator 
    define "Denominator":
  "Initial Population"
    Library Name Name
    SupplementalDataElements SDE Payer 
    define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }
    Library Name Name
    Cataracts2040BCVAwithin90DaysFHIR SDE Payer 
    define "SDE Payer":
  SDE."SDE Payer"
    Library Name Name
    SupplementalDataElements SDE Ethnicity 
    define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }
    Library Name Name
    Cataracts2040BCVAwithin90DaysFHIR SDE Ethnicity 
    define "SDE Ethnicity":
  SDE."SDE Ethnicity"
    Library Name Name
    Cataracts2040BCVAwithin90DaysFHIR Denominator Exclusions 
    define "Denominator Exclusions":
  "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed
    with ( [Condition: "Acute and Subacute Iridocyclitis"]
      union [Condition: "Amblyopia"]
      union [Condition: "Burn Confined to Eye and Adnexa"]
      union [Condition: "Cataract Secondary to Ocular Disorders"]
      union [Condition: "Cataract Congenital"]
      union [Condition: "Cataract Mature or Hypermature"]
      union [Condition: "Cataract Posterior Polar"]
      union [Condition: "Central Corneal Ulcer"]
      union [Condition: "Certain Types of Iridocyclitis"]
      union [Condition: "Choroidal Degenerations"]
      union [Condition: "Choroidal Detachment"]
      union [Condition: "Choroidal Hemorrhage and Rupture"]
      union [Condition: "Chronic Iridocyclitis"]
      union [Condition: "Cloudy Cornea"]
      union [Condition: "Corneal Edema"]
      union [Condition: "Disorders of Cornea Including Corneal Opacity"]
      union [Condition: "Degeneration of Macula and Posterior Pole"]
      union [Condition: "Degenerative Disorders of Globe"]
      union [Condition: "Diabetic Macular Edema"]
      union [Condition: "Diabetic Retinopathy"]
      union [Condition: "Disorders of Optic Chiasm"]
      union [Condition: "Disorders of Visual Cortex"]
      union [Condition: "Disseminated Chorioretinitis and Disseminated Retinochoroiditis"]
      union [Condition: "Focal Chorioretinitis and Focal Retinochoroiditis"]
      union [Condition: "Glaucoma"]
      union [Condition: "Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes"]
      union [Condition: "Hereditary Choroidal Dystrophies"]
      union [Condition: "Hereditary Corneal Dystrophies"]
      union [Condition: "Hereditary Retinal Dystrophies"]
      union [Condition: "Hypotony of Eye"]
      union [Condition: "Injury to Optic Nerve and Pathways"]
      union [Condition: "Macular Scar of Posterior Polar"]
      union [Condition: "Morgagnian Cataract"]
      union [Condition: "Nystagmus and Other Irregular Eye Movements"]
      union [Condition: "Open Wound of Eyeball"]
      union [Condition: "Optic Atrophy"]
      union [Condition: "Optic Neuritis"]
      union [Condition: "Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis"]
      union [Condition: "Other Background Retinopathy and Retinal Vascular Changes"]
      union [Condition: "Other Disorders of Optic Nerve"]
      union [Condition: "Other Endophthalmitis"]
      union [Condition: "Other Proliferative Retinopathy"]
      union [Condition: "Pathologic Myopia"]
      union [Condition: "Posterior Lenticonus"]
      union [Condition: "Prior Penetrating Keratoplasty"]
      union [Condition: "Purulent Endophthalmitis"]
      union [Condition: "Retinal Detachment with Retinal Defect"]
      union [Condition: "Retinal Vascular Occlusion"]
      union [Condition: "Retrolental Fibroplasias"]
      union [Condition: "Scleritis"]
      union [Condition: "Separation of Retinal Layers"]
      union [Condition: "Traumatic Cataract"]
      union [Condition: "Uveitis"]
      union [Condition: "Vascular Disorders of Iris and Ciliary Body"]
      union [Condition: "Visual Field Defects"] ) ComorbidDiagnosis
      such that ComorbidDiagnosis.prevalenceInterval ( ) overlaps before CataractSurgeryPerformed.performed.toInterval ( )
        and ComorbidDiagnosis.isActive ( )
    Library Name Name
    SupplementalDataElements SDE Race 
    define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }
    Library Name Name
    Cataracts2040BCVAwithin90DaysFHIR SDE Race 
    define "SDE Race":
  SDE."SDE Race"
    Library Name Name
    FHIRHelpers ToString 
    define function ToString(value uri): value.value
    Library Name Name
    FHIRHelpers ToCode 
    /*
@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
        }
    Library Name Name
    QICoreCommon prevalenceInterval 
    /*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting 
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
    (end of condition.abatementInterval()) abatementDate
    return if abatementDate is null then
      Interval[start of condition.onset.toInterval(), abatementDate)
    else
      Interval[start of condition.onset.toInterval(), abatementDate]
    Library Name Name
    QICoreCommon isActive 
    /* Candidates for FHIRCommon */

/*
@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse
*/
define fluent function isActive(condition Condition):
  condition.clinicalStatus ~ "active"
    or condition.clinicalStatus ~ "recurrence"
    or condition.clinicalStatus ~ "relapse"