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

: Discharged on Antithrombotic TherapyFHIR - JSON Representation

Draft as of 2024-12-18

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{
  "resourceType" : "Measure",
  "id" : "DischargedonAntithromboticTherapyFHIR",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"🔗 ,
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"🔗 ,
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n    <table class=\"grid dict\">\n        \n            <tr>\n                <th scope=\"row\"><b>Title: </b></th>\n                <td style=\"padding-left: 4px;\">Discharged on Antithrombotic TherapyFHIR</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Id: </b></th>\n                <td style=\"padding-left: 4px;\">DischargedonAntithromboticTherapyFHIR</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Version: </b></th>\n                <td style=\"padding-left: 4px;\">0.9.000</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Url: </b></th>\n                <td style=\"padding-left: 4px;\"><a href=\"Measure-DischargedonAntithromboticTherapyFHIR.html\">Discharged on Antithrombotic TherapyFHIR</a></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                short-name identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>CMS104FHIR</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                version-independent identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>urn:uuid:4f57e4a2-097b-45f8-9c85-91b35ea92dc1</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                version-specific identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>urn:uuid:9b96b5de-f0b8-412a-8523-ed2918efeb19</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                publisher (CMS) identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>104FHIR</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Effective Period: </b></th>\n                <td style=\"padding-left: 4px;\">2025-01-01..2025-12-31</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Status: </b></th>\n                <td style=\"padding-left: 4px;\">draft</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Publisher: </b></th>\n                <td style=\"padding-left: 4px;\">The Joint Commission</td>\n            </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Author: </b></th>\n            <td style=\"padding-left: 4px;\">The Joint Commission</td>\n        </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Description: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge</p>\n</div></td>\n            </tr>\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Purpose: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>UNKNOWN</p>\n</div></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Copyright: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>Measure specifications are in the Public Domain  LOINC(R) 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 copyright 2023 World Health Organization. All Rights Reserved.</p>\n</div></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Disclaimer: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.</p>\n</div></td>\n            </tr>\n        \n\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Scoring: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    \n                        \n                            <p style=\"margin-bottom: 5px;\">\n                                <span>Proportion </span>\n                            </p>\n                        \n                    \n                    \n                </td>\n            </tr>\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Rationale: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity if no contraindications exist.   For patients with a stroke due to a cardioembolic source (e.g., atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. In recent years, novel oral anticoagulant agents (NOACs) have been developed and approved by the U.S. Food and Drug Administration (FDA)    for stroke prevention and may be considered as an alternative to warfarin for select patients. Anticoagulation therapy is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke   Anticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or transient ischemic attack (TIA).</p>\n</div></td>\n        </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Clinical recommendation statement: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>Clinical trial results suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity if no contraindications exist</p>\n</div></td>\n        </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Guidance (Usage): </b></th>\n                <td style=\"padding-left: 4px;\">The &quot;Nonelective Inpatient Encounter&quot; value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the &quot;Inpatient encounter&quot; value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions.  The &quot;Medication, Discharge&quot; datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use.  The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.  This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS104v13. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).</td>\n            </tr>\n        \n\n        \n            \n                <tr>\n                    <th scope=\"row\"><b>Population Criteria: </b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                            <table class=\"grid-dict\">\n                                \n                                    <tr>\n                                        <th><b>64f0daaf56d636294b157ea1</b></th>\n                                    </tr>\n                                \n                                \n                                    <tr>\n                                        <td>Initial Population:</td>\n\n                                        \n                                            \n                                                <td>Inpatient hospitalizations (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke, and ends during the measurement period</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator:</td>\n\n                                        \n                                            \n                                                <td>Equals Initial Population</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator Exclusion:</td>\n\n                                        \n                                            \n                                                <td>- Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations. - Inpatient hospitalizations for patients discharged to another hospital - Inpatient hospitalizations for patients who left against medical advice - Inpatient hospitalizations for patients who expired - Inpatient hospitalizations for patients discharged to home for hospice care - Inpatient hospitalizations for patients discharged to a health care facility for hospice care - Inpatient hospitalizations for patients with comfort measures documented</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Numerator:</td>\n\n                                        \n                                            \n                                                <td>Inpatient hospitalizations for patients prescribed or continuing to take antithrombotic therapy at hospital discharge</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator Exception:</td>\n\n                                        \n                                            \n                                                <td>- Inpatient hospitalizations for patients with a documented reason for not prescribing antithrombotic therapy at discharge. - Inpatient hospitalizations for patients who receive Prasugrel as an antithrombotic therapy at discharge.</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                \n                            </table>\n                        \n                    </td>\n                </tr>\n            \n        \n\n        \n            <tr>\n                <th scope=\"row\"><b> Supplemental Data Elements: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    \n                        \n                            \n                                <p>SDE Ethnicity</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>SDE Payer</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>SDE Race</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>SDE Sex</p>\n                            \n                        \n                    \n                </td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\">\n                    <b> Supplemental Data Guidance\n                        : </b></th>\n                <td style=\"padding-left: 4px;\"> For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity-Patient's Ethnicity: Hispanic or Latino Not Hispanic or Latino    SDE Payer-Patient's Payer: Categories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system    SDE Race-Patient's Race: Native Hawaiian or Other Pacific Islander Asian American Indian or Alaska Native Other Race White Black or African American    SDE Sex-Patient's Sex: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.     </td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Libraries: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    <table class=\"grid-dict\">\n                        \n                            <tr>\n                                <td><a href=\"Library-DischargedonAntithromboticTherapyFHIR.html\">DischargedonAntithromboticTherapyFHIR</a></td>\n                            </tr>\n                        \n                    </table>\n                </td>\n            </tr>\n        \n\n        \n\n        \n            \n                <tr>\n                    <th scope=\"row\"><b>Terminology and Other Dependencies: </b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                            <li><code>Library/SupplementalDataElements|3.5.000</code></li>\n                        \n                            <li><code>Library/TJCOverall|8.14.000</code></li>\n                        \n                            <li><code>Library/FHIRHelpers|4.4.000</code></li>\n                        \n                            <li><code>Library/CQMCommon|2.2.000</code></li>\n                        \n                            <li><code>Library/QICoreCommon|2.1.000</code></li>\n                        \n                            <li><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">AdministrativeGender</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-diagnosis-role.html\">Diagnosis Role</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-medicationrequest-category.html\">MedicationRequest Category Codes</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.424/expansion\">Non-Elective Inpatient Encounter</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.247/expansion\">Ischemic Stroke</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.62/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.87/expansion\">Discharge To Acute Care Facility</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.308/expansion\">Left Against Medical Advice</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.309/expansion\">Patient Expired</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.209/expansion\">Discharged to Home for Hospice Care</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.207/expansion\">Discharged to Health Care Facility for Hospice Care</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/1.3.6.1.4.1.33895.1.3.0.45/expansion\">Comfort Measures</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion\">Observation Services</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion\">Emergency Department Visit</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.473/expansion\">Medical Reason</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.93/expansion\">Patient Refusal</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.52/expansion\">Pharmacological Contraindications For Antithrombotic Therapy</a></li>\n                        \n                    </td>\n                </tr>\n                <tr>\n                    <th scope=\"row\"><b>Parameters:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>name</b></th>\n                                <th><b>use</b></th>\n                                <th><b>min</b></th>\n                                <th><b>max</b></th>\n                                <th><b>type</b></th>\n                            </tr>\n                            \n                                <tr>\n                                    <td>Measurement Period</td>\n                                    <td>In</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Period</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Sex</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Coding</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Numerator</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Denominator</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Payer</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Initial Population</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Ethnicity</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Denominator Exclusions</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Race</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Denominator Exceptions</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                        </table>\n                    </td>\n                </tr>\n\n                <tr>\n                    <th scope=\"row\"><b>DataRequirements:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>Resource Type</b></th>\n                                <th><b>Resource Elements</b></th>\n                                <th><b>Valueset Name</b></th>\n                                <th><b>Valueset</b></th>\n                            </tr>\n                            \n                                <tr>\n                                    <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n                                    <td>\n                                        \n                                            ethnicity\n                                        \n                                            race\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            period\n                                        \n                                            rank\n                                        \n                                            rank.value\n                                        \n                                            use\n                                        \n                                            condition\n                                        \n                                            condition.reference\n                                        \n                                            condition.reference.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Observation Services\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion\">Observation Services</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            period\n                                        \n                                            rank\n                                        \n                                            rank.value\n                                        \n                                            use\n                                        \n                                            condition\n                                        \n                                            condition.reference\n                                        \n                                            condition.reference.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Emergency Department Visit\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion\">Emergency Department Visit</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                            rank\n                                        \n                                            rank.value\n                                        \n                                            use\n                                        \n                                            condition\n                                        \n                                            condition.reference\n                                        \n                                            condition.reference.value\n                                        \n                                            hospitalization\n                                        \n                                            hospitalization.dischargeDisposition\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Nonelective Inpatient Encounter\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.424/expansion\">Non-Elective Inpatient Encounter</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            id\n                                        \n                                            id.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n                                    <td>\n                                        \n                                            id\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n                                    <td>\n                                        \n                                            id\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n                                    <td>\n                                        \n                                            medication\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            intent\n                                        \n                                            intent.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Antithrombotic Therapy for Ischemic Stroke\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.62/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n                                    <td>\n                                        \n                                            medication.reference\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            intent\n                                        \n                                            intent.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n                                    <td>\n                                        \n                                            medication\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            intent\n                                        \n                                            intent.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Pharmacological Contraindications For Antithrombotic Therapy\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.52/expansion\">Pharmacological Contraindications For Antithrombotic Therapy</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Coverage(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html\">QICoreCoverage</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Payer Type\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>ServiceRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html\">QICoreServiceRequest</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            intent\n                                        \n                                            intent.value\n                                        \n                                            doNotPerform\n                                        \n                                            doNotPerform.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Comfort Measures\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/1.3.6.1.4.1.33895.1.3.0.45/expansion\">Comfort Measures</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Procedure(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html\">QICoreProcedure</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Comfort Measures\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/1.3.6.1.4.1.33895.1.3.0.45/expansion\">Comfort Measures</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-mednotrequested.html\">QICoreMedicationNotRequested</a>)</td>\n                                    <td>\n                                        \n                                            medication\n                                        \n                                            reasonCode\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Antithrombotic Therapy for Ischemic Stroke\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.62/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-mednotrequested.html\">QICoreMedicationNotRequested</a>)</td>\n                                    <td>\n                                        \n                                            medication\n                                        \n                                            reasonCode\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Antithrombotic Therapy for Ischemic Stroke\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.62/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62</a></td>\n                                </tr>\n                            \n                        </table>\n                    </td>\n                </tr>\n\n                \n                    <tr>\n                        <th scope=\"row\"><b>Direct Reference Codes:</b></th>\n                        <td style=\"padding-left: 4px;\">\n                            <table class=\"grid-dict\">\n                                <tr>\n                                    <th><b>display</b></th>\n                                    <th><b>code</b></th>\n                                    <th><b>system</b></th>\n                                </tr>\n                                \n                                    <tr>\n                                        <td>Male</td>\n                                        <td>M</td>\n                                        <td><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">http://hl7.org/fhir/administrative-gender</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Female</td>\n                                        <td>F</td>\n                                        <td><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">http://hl7.org/fhir/administrative-gender</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Billing</td>\n                                        <td>billing</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-diagnosis-role.html\">http://terminology.hl7.org/CodeSystem/diagnosis-role</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Community</td>\n                                        <td>community</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-medicationrequest-category.html\">http://terminology.hl7.org/CodeSystem/medicationrequest-category</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Discharge</td>\n                                        <td>discharge</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-medicationrequest-category.html\">http://terminology.hl7.org/CodeSystem/medicationrequest-category</a></td>\n                                    </tr>\n                                \n                            </table>\n                        </td>\n                    </tr>\n                \n\n                \n                <tr>\n                    <th scope=\"row\"><b>Logic Definitions:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>Group</b></th>\n                                <th><b>Scoring</b></th>\n                                <th><b>Population Criteria</b></th>\n                                <th><b>Expression</b></th>\n                            </tr>\n                            <tr>\n                                \n                                <td> 64f0daaf56d636294b157ea1 </td>\n                                <td colspan=\"3\" style=\"padding-left: 4px;\">\n                                    \n                                        <b>Group scoring:</b>\n                                        \n                                            <span>  proportion </span>\n                                        \n                                    \n\n                                    \n\n                                    \n                                        <b>Measure scoring:</b>\n                                        \n                                            <p style=\"margin-bottom: 5px;\">\n                                                <span>Proportion</span>\n                                            </p>\n                                        \n                                    \n\n                                    \n\n                                    \n                                        <tr>\n                                        \n                                            <th scope=\"row\"><b>Type: </b></th>\n                                            <td style=\"padding-left: 4px;\">\n                                                \n                                                    \n                                                        <p style=\"margin-bottom: 5px;\">\n                                                            <span>Process </span>\n                                                        </p>\n                                                    \n                                                \n                                                \n                                            </td>\n                                        \n                                        </tr>\n                                    \n\n                                    \n\n                                    \n                                    <tr>\n                                        <th scope=\"row\"><b>Rate Aggregation: </b></th>\n                                        <td colspan=\"3\" style=\"padding-left: 4px;\">None</td>\n                                    </tr>\n                                    \n\n                                    \n                                        <tr>\n                                            <th scope=\"row\"><b>Improvement Notation: </b></th>\n                                            <td style=\"padding-left: 4px;\">\n                                            \n                                                \n                                                    \n                                                        <p style=\"margin-bottom: 5px;\">\n                                                            <span>increase </span>\n                                                        </p>\n                                                    \n                                                \n                                                \n                                            \n                                            </td>\n                                        </tr>\n                                    \n\n                                    \n\n                                </td>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Initial Population</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  TJC.&quot;Ischemic Stroke Encounter&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Denominator&quot;:\n  &quot;Initial Population&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator Exclusion</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Denominator Exclusions&quot;:\n  TJC.&quot;Ischemic Stroke Encounters with Discharge Disposition&quot;\n    union &quot;Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Numerator</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Numerator&quot;:\n  TJC.&quot;Ischemic Stroke Encounter&quot; IschemicStrokeEncounter\n    with [&quot;MedicationRequest&quot;: &quot;Antithrombotic Therapy for Ischemic Stroke&quot;] DischargeAntithrombotic\n      such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator Exception</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Denominator Exceptions&quot;:\n  &quot;Encounter with Documented Reason for No Antithrombotic At Discharge&quot;\n    union &quot;Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                \n                            \n                            </tr>\n                        </table>\n                \n\n                <table class=\"grid-dict\">\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElements</td>\n                            \n                            \n                                <td>SDE Sex</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Sex&quot;:\n  case\n    when Patient.gender = 'male' then &quot;M&quot;\n    when Patient.gender = 'female' then &quot;F&quot;\n    else null\n  end</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIR</td>\n                            \n                            \n                                <td>SDE Sex</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Sex&quot;:\n  SDE.&quot;SDE Sex&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>TJCOverall</td>\n                            \n                            \n                                <td>Non Elective Inpatient Encounter with Age</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Non Elective Inpatient Encounter with Age&quot;:\n  [&quot;Encounter&quot;: &quot;Nonelective Inpatient Encounter&quot;] NonElectiveEncounter\n        where AgeInYearsAt(date from start of NonElectiveEncounter.period ) &gt;= 18\n         and NonElectiveEncounter.period ends during day of &quot;Measurement Period&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>TJCOverall</td>\n                            \n                            \n                                <td>Ischemic Stroke Encounter</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Ischemic Stroke Encounter&quot;:\n  &quot;Non Elective Inpatient Encounter with Age&quot; NonElectiveEncounterWithAge\n    where NonElectiveEncounterWithAge.principalDiagnosis().code in &quot;Ischemic Stroke&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIR</td>\n                            \n                            \n                                <td>Numerator</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Numerator&quot;:\n  TJC.&quot;Ischemic Stroke Encounter&quot; IschemicStrokeEncounter\n    with [&quot;MedicationRequest&quot;: &quot;Antithrombotic Therapy for Ischemic Stroke&quot;] DischargeAntithrombotic\n      such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIR</td>\n                            \n                            \n                                <td>Initial Population</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  TJC.&quot;Ischemic Stroke Encounter&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIR</td>\n                            \n                            \n                                <td>Denominator</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator&quot;:\n  &quot;Initial Population&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElements</td>\n                            \n                            \n                                <td>SDE Payer</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Payer&quot;:\n  [Coverage: type in &quot;Payer Type&quot;] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIR</td>\n                            \n                            \n                                <td>SDE Payer</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Payer&quot;:\n  SDE.&quot;SDE Payer&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElements</td>\n                            \n                            \n                                <td>SDE Ethnicity</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Ethnicity&quot;:\n  Patient.ethnicity E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIR</td>\n                            \n                            \n                                <td>SDE Ethnicity</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Ethnicity&quot;:\n  SDE.&quot;SDE Ethnicity&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>TJCOverall</td>\n                            \n                            \n                                <td>Ischemic Stroke Encounters with Discharge Disposition</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Ischemic Stroke Encounters with Discharge Disposition&quot;:\n  &quot;Ischemic Stroke Encounter&quot; IschemicStrokeEncounter\n  let DischDisp: IschemicStrokeEncounter.hospitalization.dischargeDisposition\n  \twhere  DischDisp in &quot;Discharge To Acute Care Facility&quot;\n\t\tor DischDisp in &quot;Left Against Medical Advice&quot;\n\t\tor DischDisp in &quot;Patient Expired&quot;\n\t\tor DischDisp in &quot;Discharged to Home for Hospice Care&quot;\n\t\tor DischDisp in &quot;Discharged to Health Care Facility for Hospice Care&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>TJCOverall</td>\n                            \n                            \n                                <td>Intervention Comfort Measures</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Intervention Comfort Measures&quot;:\n  ( [&quot;ServiceRequest&quot;: code in &quot;Comfort Measures&quot;] SR\n    where SR.status in { 'active', 'completed', 'on-hold' }\n      and SR.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n      and SR.doNotPerform is not true\n  )  \n  union ( [&quot;Procedure&quot;: &quot;Comfort Measures&quot;] InterventionPerformed\n        where InterventionPerformed.status in { 'completed', 'in-progress' }\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIR</td>\n                            \n                            \n                                <td>Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke&quot;:\n  &quot;Denominator&quot; Encounter\n    with TJC.&quot;Intervention Comfort Measures&quot; ComfortMeasure\n      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during Encounter.hospitalizationWithObservation ( )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIR</td>\n                            \n                            \n                                <td>Denominator Exclusions</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator Exclusions&quot;:\n  TJC.&quot;Ischemic Stroke Encounters with Discharge Disposition&quot;\n    union &quot;Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElements</td>\n                            \n                            \n                                <td>SDE Race</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Race&quot;:\n  Patient.race R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIR</td>\n                            \n                            \n                                <td>SDE Race</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Race&quot;:\n  SDE.&quot;SDE Race&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIR</td>\n                            \n                            \n                                <td>Reason for Not Giving Antithrombotic at Discharge</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Reason for Not Giving Antithrombotic at Discharge&quot;:\n  [&quot;MedicationNotRequested&quot;: &quot;Antithrombotic Therapy for Ischemic Stroke&quot;] NoAntithromboticDischarge\n    where ( NoAntithromboticDischarge.reasonCode in &quot;Medical Reason For Not Providing Treatment&quot;\n        or NoAntithromboticDischarge.reasonCode in &quot;Patient Refusal&quot;\n    )\n      and ( NoAntithromboticDischarge.isCommunity ( )\n          or NoAntithromboticDischarge.isDischarge ( )\n      )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIR</td>\n                            \n                            \n                                <td>Encounter with Documented Reason for No Antithrombotic At Discharge</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Encounter with Documented Reason for No Antithrombotic At Discharge&quot;:\n  TJC.&quot;Ischemic Stroke Encounter&quot; IschemicStrokeEncounter\n    with &quot;Reason for Not Giving Antithrombotic at Discharge&quot; NoDischargeAntithrombotic\n      such that NoDischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIR</td>\n                            \n                            \n                                <td>Pharmacological Contraindications for Antithrombotic Therapy at Discharge</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Pharmacological Contraindications for Antithrombotic Therapy at Discharge&quot;:\n  [&quot;MedicationRequest&quot;: &quot;Pharmacological Contraindications For Antithrombotic Therapy&quot;] Pharmacological\n    where ( Pharmacological.isCommunity ( )\n        or Pharmacological.isDischarge ( )\n    )\n      and Pharmacological.status in { 'active', 'completed' }\n      and Pharmacological.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIR</td>\n                            \n                            \n                                <td>Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">//BONNIEMAT-1617-Since there is an anticipated resolution for STU 5 for Medication.Discharge which leaves one blockers on coverage, will leave the assertion logic as is and update the test cases for coverage.\n\n\ndefine &quot;Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge&quot;:\n  TJC.&quot;Ischemic Stroke Encounter&quot; IschemicStrokeEncounter\n    with &quot;Pharmacological Contraindications for Antithrombotic Therapy at Discharge&quot; DischargePharmacological\n      such that DischargePharmacological.authoredOn during IschemicStrokeEncounter.period</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIR</td>\n                            \n                            \n                                <td>Denominator Exceptions</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator Exceptions&quot;:\n  &quot;Encounter with Documented Reason for No Antithrombotic At Discharge&quot;\n    union &quot;Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CQMCommon</td>\n                            \n                            \n                                <td>principalDiagnosis</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns the condition that is specified as the principal diagnosis for the encounter\n*/\ndefine fluent function principalDiagnosis(Encounter Encounter ):\n\tsingleton from ((Encounter.diagnosis D where D.rank = 1 and D.use ~ &quot;Billing&quot;) PD\n      return singleton from ([Condition] C where C.id = PD.condition.reference.getId())\n\t)</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>QICoreCommon</td>\n                            \n                            \n                                <td>getId</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).\n@comment: This function can be used to determine the logical id of a given resource. It can be used in\na single-server environment to trace references. However, this function does not attempt to resolve\nor distinguish the base of the given url, and so cannot be used safely in multi-server environments.\n*/\ndefine fluent function getId(uri String):\n  Last(Split(uri, '/'))</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>FHIRHelpers</td>\n                            \n                            \n                                <td>ToString</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function ToString(value uri): value.value</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>FHIRHelpers</td>\n                            \n                            \n                                <td>ToCode</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CQMCommon</td>\n                            \n                            \n                                <td>hospitalizationWithObservation</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter\n*/\ndefine fluent function hospitalizationWithObservation(TheEncounter Encounter ):\n  TheEncounter Visit\n  \t\tlet ObsVisit: Last([Encounter: &quot;Observation Services&quot;] LastObs\n  \t\t\t\twhere LastObs.status = 'finished'\n            and LastObs.period ends 1 hour or less on or before start of Visit.period\n  \t\t\t\tsort by end of period\n  \t\t\t),\n  \t\t\tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n  \t\t\tEDVisit: Last([Encounter: &quot;Emergency Department Visit&quot;] LastED\n  \t\t\t\twhere LastED.status = 'finished'\n            and LastED.period ends 1 hour or less on or before VisitStart\n  \t\t\t\tsort by end of period\n  \t\t\t)\n  \t\treturn Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>FHIRHelpers</td>\n                            \n                            \n                                <td>ToConcept</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>QICoreCommon</td>\n                            \n                            \n                                <td>isCommunity</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns true if the given MedicationRequest has a category of Community\n*/\ndefine fluent function isCommunity(medicationRequest MedicationNotRequested):\n  exists (medicationRequest.category C\n    where C ~ Community\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>QICoreCommon</td>\n                            \n                            \n                                <td>isDischarge</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns true if the given MedicationRequest has a category of Discharge\n*/\ndefine fluent function isDischarge(medicationRequest MedicationNotRequested):\n  exists (medicationRequest.category C\n    where C ~ Discharge\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                    </table>\n                </td>\n            </tr>\n            \n        \n    \n\n    </table>\n</div>"
  },
  "contained" : [
    {
      "resourceType" : "Library",
      "id" : "effective-data-requirements",
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding" : {
            "system" : "http://hl7.org/fhir/administrative-gender",
            "code" : "M",
            "display" : "Male"
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding" : {
            "system" : "http://hl7.org/fhir/administrative-gender",
            "code" : "F",
            "display" : "Female"
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding" : {
            "system" : "http://terminology.hl7.org/CodeSystem/diagnosis-role",
            "code" : "billing",
            "display" : "Billing"
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding" : {
            "system" : "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
            "code" : "community",
            "display" : "Community"
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding" : {
            "system" : "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
            "code" : "discharge",
            "display" : "Discharge"
          }
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "SupplementalDataElements"
            },
            {
              "url" : "name",
              "valueString" : "SDE Sex"
            },
            {
              "url" : "statement",
              "valueString" : "define \"SDE Sex\":\n  case\n    when Patient.gender = 'male' then \"M\"\n    when Patient.gender = 'female' then \"F\"\n    else null\n  end"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 0
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "DischargedonAntithromboticTherapyFHIR"
            },
            {
              "url" : "name",
              "valueString" : "SDE Sex"
            },
            {
              "url" : "statement",
              "valueString" : "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 1
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "TJCOverall"
            },
            {
              "url" : "name",
              "valueString" : "Non Elective Inpatient Encounter with Age"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Non Elective Inpatient Encounter with Age\":\n  [\"Encounter\": \"Nonelective Inpatient Encounter\"] NonElectiveEncounter\n        where AgeInYearsAt(date from start of NonElectiveEncounter.period ) >= 18\n         and NonElectiveEncounter.period ends during day of \"Measurement Period\""
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 2
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "TJCOverall"
            },
            {
              "url" : "name",
              "valueString" : "Ischemic Stroke Encounter"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Ischemic Stroke Encounter\":\n  \"Non Elective Inpatient Encounter with Age\" NonElectiveEncounterWithAge\n    where NonElectiveEncounterWithAge.principalDiagnosis().code in \"Ischemic Stroke\""
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 3
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "DischargedonAntithromboticTherapyFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Numerator"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Numerator\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with [\"MedicationRequest\": \"Antithrombotic Therapy for Ischemic Stroke\"] DischargeAntithrombotic\n      such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 4
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "DischargedonAntithromboticTherapyFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Initial Population"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Initial Population\":\n  TJC.\"Ischemic Stroke Encounter\""
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 5
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "DischargedonAntithromboticTherapyFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Denominator"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Denominator\":\n  \"Initial Population\""
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 6
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "SupplementalDataElements"
            },
            {
              "url" : "name",
              "valueString" : "SDE Payer"
            },
            {
              "url" : "statement",
              "valueString" : "define \"SDE Payer\":\n  [Coverage: type in \"Payer Type\"] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 7
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "DischargedonAntithromboticTherapyFHIR"
            },
            {
              "url" : "name",
              "valueString" : "SDE Payer"
            },
            {
              "url" : "statement",
              "valueString" : "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 8
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "SupplementalDataElements"
            },
            {
              "url" : "name",
              "valueString" : "SDE Ethnicity"
            },
            {
              "url" : "statement",
              "valueString" : "define \"SDE Ethnicity\":\n  Patient.ethnicity E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 9
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "DischargedonAntithromboticTherapyFHIR"
            },
            {
              "url" : "name",
              "valueString" : "SDE Ethnicity"
            },
            {
              "url" : "statement",
              "valueString" : "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 10
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "TJCOverall"
            },
            {
              "url" : "name",
              "valueString" : "Ischemic Stroke Encounters with Discharge Disposition"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Ischemic Stroke Encounters with Discharge Disposition\":\n  \"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n  let DischDisp: IschemicStrokeEncounter.hospitalization.dischargeDisposition\n  \twhere  DischDisp in \"Discharge To Acute Care Facility\"\n\t\tor DischDisp in \"Left Against Medical Advice\"\n\t\tor DischDisp in \"Patient Expired\"\n\t\tor DischDisp in \"Discharged to Home for Hospice Care\"\n\t\tor DischDisp in \"Discharged to Health Care Facility for Hospice Care\""
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 11
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "TJCOverall"
            },
            {
              "url" : "name",
              "valueString" : "Intervention Comfort Measures"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Intervention Comfort Measures\":\n  ( [\"ServiceRequest\": code in \"Comfort Measures\"] SR\n    where SR.status in { 'active', 'completed', 'on-hold' }\n      and SR.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n      and SR.doNotPerform is not true\n  )  \n  union ( [\"Procedure\": \"Comfort Measures\"] InterventionPerformed\n        where InterventionPerformed.status in { 'completed', 'in-progress' }\n  )"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 12
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "DischargedonAntithromboticTherapyFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke\":\n  \"Denominator\" Encounter\n    with TJC.\"Intervention Comfort Measures\" ComfortMeasure\n      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during Encounter.hospitalizationWithObservation ( )"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 13
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "DischargedonAntithromboticTherapyFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Denominator Exclusions"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Denominator Exclusions\":\n  TJC.\"Ischemic Stroke Encounters with Discharge Disposition\"\n    union \"Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke\""
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 14
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "SupplementalDataElements"
            },
            {
              "url" : "name",
              "valueString" : "SDE Race"
            },
            {
              "url" : "statement",
              "valueString" : "define \"SDE Race\":\n  Patient.race R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 15
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "DischargedonAntithromboticTherapyFHIR"
            },
            {
              "url" : "name",
              "valueString" : "SDE Race"
            },
            {
              "url" : "statement",
              "valueString" : "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 16
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "DischargedonAntithromboticTherapyFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Reason for Not Giving Antithrombotic at Discharge"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Reason for Not Giving Antithrombotic at Discharge\":\n  [\"MedicationNotRequested\": \"Antithrombotic Therapy for Ischemic Stroke\"] NoAntithromboticDischarge\n    where ( NoAntithromboticDischarge.reasonCode in \"Medical Reason For Not Providing Treatment\"\n        or NoAntithromboticDischarge.reasonCode in \"Patient Refusal\"\n    )\n      and ( NoAntithromboticDischarge.isCommunity ( )\n          or NoAntithromboticDischarge.isDischarge ( )\n      )"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 17
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "DischargedonAntithromboticTherapyFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Encounter with Documented Reason for No Antithrombotic At Discharge"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Encounter with Documented Reason for No Antithrombotic At Discharge\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with \"Reason for Not Giving Antithrombotic at Discharge\" NoDischargeAntithrombotic\n      such that NoDischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 18
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "DischargedonAntithromboticTherapyFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Pharmacological Contraindications for Antithrombotic Therapy at Discharge"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Pharmacological Contraindications for Antithrombotic Therapy at Discharge\":\n  [\"MedicationRequest\": \"Pharmacological Contraindications For Antithrombotic Therapy\"] Pharmacological\n    where ( Pharmacological.isCommunity ( )\n        or Pharmacological.isDischarge ( )\n    )\n      and Pharmacological.status in { 'active', 'completed' }\n      and Pharmacological.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 19
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "DischargedonAntithromboticTherapyFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge"
            },
            {
              "url" : "statement",
              "valueString" : "//BONNIEMAT-1617-Since there is an anticipated resolution for STU 5 for Medication.Discharge which leaves one blockers on coverage, will leave the assertion logic as is and update the test cases for coverage.\n\n\ndefine \"Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with \"Pharmacological Contraindications for Antithrombotic Therapy at Discharge\" DischargePharmacological\n      such that DischargePharmacological.authoredOn during IschemicStrokeEncounter.period"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 20
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "DischargedonAntithromboticTherapyFHIR"
            },
            {
              "url" : "name",
              "valueString" : "Denominator Exceptions"
            },
            {
              "url" : "statement",
              "valueString" : "define \"Denominator Exceptions\":\n  \"Encounter with Documented Reason for No Antithrombotic At Discharge\"\n    union \"Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge\""
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 21
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "CQMCommon"
            },
            {
              "url" : "name",
              "valueString" : "principalDiagnosis"
            },
            {
              "url" : "statement",
              "valueString" : "/*\n@description: Returns the condition that is specified as the principal diagnosis for the encounter\n*/\ndefine fluent function principalDiagnosis(Encounter Encounter ):\n\tsingleton from ((Encounter.diagnosis D where D.rank = 1 and D.use ~ \"Billing\") PD\n      return singleton from ([Condition] C where C.id = PD.condition.reference.getId())\n\t)"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 22
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "QICoreCommon"
            },
            {
              "url" : "name",
              "valueString" : "getId"
            },
            {
              "url" : "statement",
              "valueString" : "/*\n@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).\n@comment: This function can be used to determine the logical id of a given resource. It can be used in\na single-server environment to trace references. However, this function does not attempt to resolve\nor distinguish the base of the given url, and so cannot be used safely in multi-server environments.\n*/\ndefine fluent function getId(uri String):\n  Last(Split(uri, '/'))"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 23
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "FHIRHelpers"
            },
            {
              "url" : "name",
              "valueString" : "ToString"
            },
            {
              "url" : "statement",
              "valueString" : "define function ToString(value uri): value.value"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 24
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "FHIRHelpers"
            },
            {
              "url" : "name",
              "valueString" : "ToCode"
            },
            {
              "url" : "statement",
              "valueString" : "/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 25
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "CQMCommon"
            },
            {
              "url" : "name",
              "valueString" : "hospitalizationWithObservation"
            },
            {
              "url" : "statement",
              "valueString" : "/*\n@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter\n*/\ndefine fluent function hospitalizationWithObservation(TheEncounter Encounter ):\n  TheEncounter Visit\n  \t\tlet ObsVisit: Last([Encounter: \"Observation Services\"] LastObs\n  \t\t\t\twhere LastObs.status = 'finished'\n            and LastObs.period ends 1 hour or less on or before start of Visit.period\n  \t\t\t\tsort by end of period\n  \t\t\t),\n  \t\t\tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n  \t\t\tEDVisit: Last([Encounter: \"Emergency Department Visit\"] LastED\n  \t\t\t\twhere LastED.status = 'finished'\n            and LastED.period ends 1 hour or less on or before VisitStart\n  \t\t\t\tsort by end of period\n  \t\t\t)\n  \t\treturn Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 26
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "FHIRHelpers"
            },
            {
              "url" : "name",
              "valueString" : "ToConcept"
            },
            {
              "url" : "statement",
              "valueString" : "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 27
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "QICoreCommon"
            },
            {
              "url" : "name",
              "valueString" : "isCommunity"
            },
            {
              "url" : "statement",
              "valueString" : "/*\n@description: Returns true if the given MedicationRequest has a category of Community\n*/\ndefine fluent function isCommunity(medicationRequest MedicationNotRequested):\n  exists (medicationRequest.category C\n    where C ~ Community\n  )"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 28
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension" : [
            {
              "url" : "libraryName",
              "valueString" : "QICoreCommon"
            },
            {
              "url" : "name",
              "valueString" : "isDischarge"
            },
            {
              "url" : "statement",
              "valueString" : "/*\n@description: Returns true if the given MedicationRequest has a category of Discharge\n*/\ndefine fluent function isDischarge(medicationRequest MedicationNotRequested):\n  exists (medicationRequest.category C\n    where C ~ Discharge\n  )"
            },
            {
              "url" : "displaySequence",
              "valueInteger" : 29
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        }
      ],
      "name" : "EffectiveDataRequirements",
      "status" : "active",
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/library-type",
            "code" : "module-definition"
          }
        ]
      },
      "relatedArtifact" : [
        {
          "type" : "depends-on",
          "display" : "Library SDE",
          "resource" : "Library/SupplementalDataElements|3.5.000"
        },
        {
          "type" : "depends-on",
          "display" : "Library TJC",
          "resource" : "Library/TJCOverall|8.14.000"
        },
        {
          "type" : "depends-on",
          "display" : "Library FHIRHelpers",
          "resource" : "Library/FHIRHelpers|4.4.000"
        },
        {
          "type" : "depends-on",
          "display" : "Library CQMCommon",
          "resource" : "Library/CQMCommon|2.2.000"
        },
        {
          "type" : "depends-on",
          "display" : "Library QICoreCommon",
          "resource" : "Library/QICoreCommon|2.1.000"
        },
        {
          "type" : "depends-on",
          "display" : "Code system AdministrativeGender",
          "resource" : "http://hl7.org/fhir/administrative-gender"
        },
        {
          "type" : "depends-on",
          "display" : "Code system DiagnosisRole",
          "resource" : "http://terminology.hl7.org/CodeSystem/diagnosis-role"
        },
        {
          "type" : "depends-on",
          "display" : "Code system MedicationRequestCategory",
          "resource" : "http://terminology.hl7.org/CodeSystem/medicationrequest-category"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Nonelective Inpatient Encounter",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Ischemic Stroke",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Antithrombotic Therapy for Ischemic Stroke",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Payer Type",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Discharge To Acute Care Facility",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Left Against Medical Advice",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.308"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Patient Expired",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Discharged to Home for Hospice Care",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.209"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Discharged to Health Care Facility for Hospice Care",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.207"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Comfort Measures",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Observation Services",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Emergency Department Visit",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Medical Reason For Not Providing Treatment",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Patient Refusal",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Pharmacological Contraindications For Antithrombotic Therapy",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52"
        }
      ],
      "parameter" : [
        {
          "name" : "Measurement Period",
          "use" : "in",
          "min" : 0,
          "max" : "1",
          "type" : "Period"
        },
        {
          "name" : "SDE Sex",
          "use" : "out",
          "min" : 0,
          "max" : "1",
          "type" : "Coding"
        },
        {
          "name" : "Numerator",
          "use" : "out",
          "min" : 0,
          "max" : "*",
          "type" : "Resource"
        },
        {
          "name" : "Denominator",
          "use" : "out",
          "min" : 0,
          "max" : "*",
          "type" : "Resource"
        },
        {
          "name" : "SDE Payer",
          "use" : "out",
          "min" : 0,
          "max" : "*",
          "type" : "Resource"
        },
        {
          "name" : "Initial Population",
          "use" : "out",
          "min" : 0,
          "max" : "*",
          "type" : "Resource"
        },
        {
          "name" : "SDE Ethnicity",
          "use" : "out",
          "min" : 0,
          "max" : "1",
          "type" : "Resource"
        },
        {
          "name" : "Denominator Exclusions",
          "use" : "out",
          "min" : 0,
          "max" : "*",
          "type" : "Resource"
        },
        {
          "name" : "SDE Race",
          "use" : "out",
          "min" : 0,
          "max" : "1",
          "type" : "Resource"
        },
        {
          "name" : "Denominator Exceptions",
          "use" : "out",
          "min" : 0,
          "max" : "*",
          "type" : "Resource"
        }
      ],
      "dataRequirement" : [
        {
          "type" : "Patient",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport" : [
            "ethnicity",
            "race"
          ]
        },
        {
          "type" : "Encounter",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport" : [
            "type",
            "status",
            "status.value",
            "period",
            "rank",
            "rank.value",
            "use",
            "condition",
            "condition.reference",
            "condition.reference.value"
          ],
          "codeFilter" : [
            {
              "path" : "type",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"
            },
            {
              "path" : "status.value",
              "code" : [
                {
                  "code" : "finished"
                }
              ]
            }
          ]
        },
        {
          "type" : "Encounter",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport" : [
            "type",
            "status",
            "status.value",
            "period",
            "rank",
            "rank.value",
            "use",
            "condition",
            "condition.reference",
            "condition.reference.value"
          ],
          "codeFilter" : [
            {
              "path" : "type",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
            },
            {
              "path" : "status.value",
              "code" : [
                {
                  "code" : "finished"
                }
              ]
            }
          ],
          "dateFilter" : [
            {
              "path" : "period",
              "valuePeriod" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/uv/crmi-analysisException",
                    "valueString" : "Error attempting to determine filter value: toFhirValue not implemented for Subtract"
                  }
                ]
              }
            }
          ]
        },
        {
          "type" : "Encounter",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport" : [
            "type",
            "period",
            "rank",
            "rank.value",
            "use",
            "condition",
            "condition.reference",
            "condition.reference.value",
            "hospitalization",
            "hospitalization.dischargeDisposition"
          ],
          "codeFilter" : [
            {
              "path" : "type",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
            }
          ],
          "dateFilter" : [
            {
              "path" : "period",
              "valuePeriod" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
                    "valueExpression" : {
                      "language" : "text/cql-identifier",
                      "expression" : "Measurement Period"
                    }
                  }
                ]
              }
            }
          ]
        },
        {
          "type" : "Condition",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"
          ],
          "mustSupport" : [
            "id",
            "id.value"
          ]
        },
        {
          "type" : "Medication",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"
          ],
          "mustSupport" : [
            "id"
          ]
        },
        {
          "type" : "Medication",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"
          ],
          "mustSupport" : [
            "id"
          ]
        },
        {
          "type" : "MedicationRequest",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
          ],
          "mustSupport" : [
            "medication",
            "authoredOn",
            "authoredOn.value",
            "status",
            "status.value",
            "intent",
            "intent.value"
          ],
          "codeFilter" : [
            {
              "path" : "medication",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
            }
          ]
        },
        {
          "type" : "MedicationRequest",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
          ],
          "mustSupport" : [
            "medication.reference",
            "authoredOn",
            "authoredOn.value",
            "status",
            "status.value",
            "intent",
            "intent.value"
          ]
        },
        {
          "type" : "MedicationRequest",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
          ],
          "mustSupport" : [
            "medication",
            "authoredOn",
            "authoredOn.value",
            "status",
            "status.value",
            "intent",
            "intent.value"
          ],
          "codeFilter" : [
            {
              "path" : "medication",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52"
            }
          ]
        },
        {
          "type" : "Coverage",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"
          ],
          "mustSupport" : [
            "type",
            "period"
          ],
          "codeFilter" : [
            {
              "path" : "type",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
            }
          ]
        },
        {
          "type" : "ServiceRequest",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"
          ],
          "mustSupport" : [
            "code",
            "status",
            "status.value",
            "intent",
            "intent.value",
            "doNotPerform",
            "doNotPerform.value"
          ],
          "codeFilter" : [
            {
              "path" : "code",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"
            }
          ]
        },
        {
          "type" : "Procedure",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport" : [
            "code",
            "status",
            "status.value"
          ],
          "codeFilter" : [
            {
              "path" : "code",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"
            }
          ]
        },
        {
          "type" : "MedicationRequest",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotrequested"
          ],
          "mustSupport" : [
            "medication",
            "reasonCode",
            "authoredOn",
            "authoredOn.value"
          ],
          "codeFilter" : [
            {
              "path" : "medication",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
            }
          ]
        },
        {
          "type" : "MedicationRequest",
          "profile" : [
            🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotrequested"
          ],
          "mustSupport" : [
            "medication",
            "reasonCode",
            "authoredOn",
            "authoredOn.value"
          ],
          "codeFilter" : [
            {
              "path" : "medication",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
            }
          ]
        }
      ]
    }
  ],
  "extension" : [
    {
      "id" : "supplementalDataGuidance",
      "extension" : [
        {
          "url" : "guidance",
          "valueString" : "For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity-Patient's Ethnicity: Hispanic or Latino Not Hispanic or Latino    SDE Payer-Patient's Payer: Categories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system    SDE Race-Patient's Race: Native Hawaiian or Other Pacific Islander Asian American Indian or Alaska Native Other Race White Black or African American    SDE Sex-Patient's Sex: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.    "
        },
        {
          "url" : "usage",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                "code" : "supplemental-data",
                "display" : "Supplemental Data"
              }
            ],
            "text" : "Supplemental Data Guidance"
          }
        }
      ],
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance"
    },
    {
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem",
      "valueReference" : {
        "reference" : "Device/cqf-tooling"
      }
    },
    {
      "id" : "effective-data-requirements",
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
      "valueReference" : {
        "reference" : "#effective-data-requirements"
      }
    }
  ],
  "url" : "https://madie.cms.gov/Measure/DischargedonAntithromboticTherapyFHIR",
  "identifier" : [
    {
      "use" : "usual",
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code" : "short-name"
          }
        ]
      },
      "system" : "https://madie.cms.gov/measure/shortName",
      "value" : "CMS104FHIR"
    },
    {
      "use" : "official",
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code" : "version-independent"
          }
        ]
      },
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:uuid:4f57e4a2-097b-45f8-9c85-91b35ea92dc1"
    },
    {
      "use" : "official",
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code" : "version-specific"
          }
        ]
      },
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:uuid:9b96b5de-f0b8-412a-8523-ed2918efeb19"
    },
    {
      "use" : "official",
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code" : "publisher"
          }
        ]
      },
      "system" : "https://madie.cms.gov/measure/cmsId",
      "value" : "104FHIR",
      "assigner" : {
        "display" : "CMS"
      }
    }
  ],
  "version" : "0.9.000",
  "name" : "DischargedonAntithromboticTherapyFHIR",
  "title" : "Discharged on Antithrombotic TherapyFHIR",
  "status" : "draft",
  "experimental" : false,
  "date" : "2024-12-18T16:19:09+00:00",
  "publisher" : "The Joint Commission",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "https://www.jointcommission.org/"
        }
      ]
    }
  ],
  "description" : "Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge",
  "purpose" : "UNKNOWN",
  "usage" : "The \"Nonelective Inpatient Encounter\" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the \"Inpatient encounter\" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions.  The \"Medication, Discharge\" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use.  The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.  This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS104v13. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).",
  "copyright" : "Measure specifications are in the Public Domain  LOINC(R) 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 copyright 2023 World Health Organization. All Rights Reserved.",
  "effectivePeriod" : {
    "start" : "2025-01-01",
    "end" : "2025-12-31"
  },
  "author" : [
    {
      "name" : "The Joint Commission",
      "telecom" : [
        {
          "system" : "url",
          "value" : "https://www.jointcommission.org/"
        }
      ]
    }
  ],
  "library" : [
    🔗 "https://madie.cms.gov/Library/DischargedonAntithromboticTherapyFHIR"
  ],
  "disclaimer" : "These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.",
  "scoring" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
        "code" : "proportion",
        "display" : "Proportion"
      }
    ]
  },
  "rationale" : "The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity if no contraindications exist.   For patients with a stroke due to a cardioembolic source (e.g., atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. In recent years, novel oral anticoagulant agents (NOACs) have been developed and approved by the U.S. Food and Drug Administration (FDA)    for stroke prevention and may be considered as an alternative to warfarin for select patients. Anticoagulation therapy is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke   Anticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or transient ischemic attack (TIA).",
  "clinicalRecommendationStatement" : "Clinical trial results suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity if no contraindications exist",
  "group" : [
    {
      "id" : "64f0daaf56d636294b157ea1",
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
                "code" : "proportion",
                "display" : "Proportion"
              }
            ]
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
          "valueCode" : "Encounter"
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-type",
                "code" : "process",
                "display" : "Process"
              }
            ]
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode" : "None"
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code" : "decrease",
                "display" : "increase"
              }
            ]
          }
        }
      ],
      "description" : "Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge",
      "population" : [
        {
          "id" : "937BAF2A-D36A-4EE5-B2B2-762A0FE04502",
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "initial-population",
                "display" : "Initial Population"
              }
            ]
          },
          "description" : "Inpatient hospitalizations (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke, and ends during the measurement period",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Initial Population"
          }
        },
        {
          "id" : "302C1DCC-7FE6-41EF-A94E-FDAE24B7BB1B",
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "denominator",
                "display" : "Denominator"
              }
            ]
          },
          "description" : "Equals Initial Population",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Denominator"
          }
        },
        {
          "id" : "4B649804-9C55-4949-8CE0-01B462CAA74C",
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "denominator-exclusion",
                "display" : "Denominator Exclusion"
              }
            ]
          },
          "description" : "- Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations. - Inpatient hospitalizations for patients discharged to another hospital - Inpatient hospitalizations for patients who left against medical advice - Inpatient hospitalizations for patients who expired - Inpatient hospitalizations for patients discharged to home for hospice care - Inpatient hospitalizations for patients discharged to a health care facility for hospice care - Inpatient hospitalizations for patients with comfort measures documented",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Denominator Exclusions"
          }
        },
        {
          "id" : "99961E3A-EFC4-4858-A3EE-F7F1D5B222FB",
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "numerator",
                "display" : "Numerator"
              }
            ]
          },
          "description" : "Inpatient hospitalizations for patients prescribed or continuing to take antithrombotic therapy at hospital discharge",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Numerator"
          }
        },
        {
          "id" : "516A3DD0-69B0-49EF-BBD3-12809CDC843E",
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "denominator-exception",
                "display" : "Denominator Exception"
              }
            ]
          },
          "description" : "- Inpatient hospitalizations for patients with a documented reason for not prescribing antithrombotic therapy at discharge. - Inpatient hospitalizations for patients who receive Prasugrel as an antithrombotic therapy at discharge.",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Denominator Exceptions"
          }
        }
      ]
    }
  ],
  "supplementalData" : [
    {
      "id" : "sde-ethnicity",
      "usage" : [
        {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code" : "supplemental-data"
            }
          ]
        }
      ],
      "description" : "SDE Ethnicity",
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "SDE Ethnicity"
      }
    },
    {
      "id" : "sde-payer",
      "usage" : [
        {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code" : "supplemental-data"
            }
          ]
        }
      ],
      "description" : "SDE Payer",
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "SDE Payer"
      }
    },
    {
      "id" : "sde-race",
      "usage" : [
        {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code" : "supplemental-data"
            }
          ]
        }
      ],
      "description" : "SDE Race",
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "SDE Race"
      }
    },
    {
      "id" : "sde-sex",
      "usage" : [
        {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code" : "supplemental-data"
            }
          ]
        }
      ],
      "description" : "SDE Sex",
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "SDE Sex"
      }
    }
  ]
}