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

: HIV Annual Retention in CareFHIR - XML Representation

Draft as of 2024-07-09

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<Measure xmlns="http://hl7.org/fhir">
  <id value="HIVRetentionFHIR"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"/>
    <profile
             value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"/>
    <profile
             value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
    <table class="grid dict">
        
            <tr>
                <th scope="row"><b>Title: </b></th>
                <td style="padding-left: 4px;">HIV Annual Retention in CareFHIR</td>
            </tr>
        

        

        
            <tr>
                <th scope="row"><b>Id: </b></th>
                <td style="padding-left: 4px;">HIVRetentionFHIR</td>
            </tr>
        

        
            <tr>
                <th scope="row"><b>Version: </b></th>
                <td style="padding-left: 4px;">0.1.000</td>
            </tr>
        

        
            <tr>
                <th scope="row"><b>Url: </b></th>
                <td style="padding-left: 4px;"><a href="Measure-HIVRetentionFHIR.html">HIV Annual Retention in CareFHIR</a></td>
            </tr>
        

        
            <tr>
                <th scope="row">
                    <b>
                        
                            
                                short-name identifier:
                            
                        
                    </b>
                </th>

                <td style="padding-left: 4px;">
                    
                        <p style="margin-bottom: 5px;">
                            <span>CMS1157FHIR</span>
                        </p>
                    
                </td>
            </tr>
        
            <tr>
                <th scope="row">
                    <b>
                        
                            
                                version-independent identifier:
                            
                        
                    </b>
                </th>

                <td style="padding-left: 4px;">
                    
                        <p style="margin-bottom: 5px;">
                            <span>urn:uuid:03878bb8-1209-4f3f-91f6-52b655092251</span>
                        </p>
                    
                </td>
            </tr>
        
            <tr>
                <th scope="row">
                    <b>
                        
                            
                                version-specific identifier:
                            
                        
                    </b>
                </th>

                <td style="padding-left: 4px;">
                    
                        <p style="margin-bottom: 5px;">
                            <span>urn:uuid:0d43cbbd-6020-43b4-bfb2-40d2b4529b97</span>
                        </p>
                    
                </td>
            </tr>
        
            <tr>
                <th scope="row">
                    <b>
                        
                            
                                publisher (CMS) identifier:
                            
                        
                    </b>
                </th>

                <td style="padding-left: 4px;">
                    
                        <p style="margin-bottom: 5px;">
                            <span>1157FHIR</span>
                        </p>
                    
                </td>
            </tr>
        

        
            <tr>
                <th scope="row"><b>Effective Period: </b></th>
                <td style="padding-left: 4px;">2025-01-01..2025-12-31</td>
            </tr>
        

        
            <tr>
                <th scope="row"><b>Status: </b></th>
                <td style="padding-left: 4px;">draft</td>
            </tr>
        

        

        
            <tr>
                <th scope="row"><b>Publisher: </b></th>
                <td style="padding-left: 4px;">Health Resources &amp; Services Administration</td>
            </tr>
        

        
        <tr>
            <th scope="row"><b>Author: </b></th>
            <td style="padding-left: 4px;">Health Resources &amp; Services Administration</td>
        </tr>
        

        

        
            <tr>
                <th scope="row"><b>Description: </b></th>
                <td style="padding-left: 4px;"><div><p>Percentage of patients, regardless of age, with a diagnosis of HIV who had at least two eligible encounters or at least one eligible encounter and one HIV viral load test that were at least 90 days apart within the measurement period</p>
</div></td>
            </tr>
        

        

        

        

        

        

        
            <tr>
                <th scope="row"><b>Purpose: </b></th>
                <td style="padding-left: 4px;"><div><p>UNKNOWN</p>
</div></td>
            </tr>
        

        
            <tr>
                <th scope="row"><b>Copyright: </b></th>
                <td style="padding-left: 4px;"><div><p>This measure was developed by the Health Resources and Services Administration of the U.S. Department for Health and Human Services. It is in the public domain.   Citation of HRSA as the source of the original measure is appreciated. Any modified versions may not be represented as approved, endorsed, or authorized by HRSA or HHS. 42 U.S.C. Section 1320b-10. Users of modified versions should clearly explain how they deviate from HRSA's original measure.  Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets.   CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) is copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2023 World Health Organization. All Rights Reserved.  Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>
</div></td>
            </tr>
        

        
            <tr>
                <th scope="row"><b>Disclaimer: </b></th>
                <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 &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.  Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>
</div></td>
            </tr>
        

        

        

        

        

        

        

        

        
        <tr>
            <th scope="row"><b>Rationale: </b></th>
            <td style="padding-left: 4px;"><div><p>The HIV &quot;continuum of care&quot; is the process of HIV testing, linkage to HIV care, initiation of ART, adherence to treatment, retention in care, and virologic suppression (Gardner et al 2011). Poor retention in care is associated with lower rates of ART use (Giordano et al 2003), delayed viral suppression (Crawford et al 2014), and increased risk of mortality (Giordano et al 2007; Mugavero et al 2009). This measure will help providers direct their attention and quality improvement efforts towards improving retention in care.</p>
</div></td>
        </tr>
        

        
        <tr>
            <th scope="row"><b>Clinical recommendation statement: </b></th>
            <td style="padding-left: 4px;"><div><p>&quot;Retention in care should be routinely monitored. There are various ways to measure retention, including measures based on attended visits over a defined period of time (constancy measures) and measures based on missed visits. Both approaches are valid and independently predict survival. Missed visits and a prolonged time since the last visit are relatively easy to measure and should trigger efforts to retain or re-engage a person in care. Constancy measures (e.g., at least two visits that are at least 90 days apart over 1 year or at least one visit every 6 months over the last 2 years) can be used as clinic quality assurance measures.&quot; (Panel on Antiretroviral Guidelines for Adults and Adolescents, p. L-4)  &quot;Poor retention in HIV care is associated with greater risk of death. Poor retention is more common in people who use substances, have serious mental health problems, have unmet socioeconomic needs (e.g., housing, food, transportation), lack financial resources or health insurance, have schedules that complicate adherence, have been recently incarcerated, or face stigma. At the provider and health system level, low trust in providers and a poor patient-provider relationship have been associated with lower retention, as has lower satisfaction with the clinic experience. Availability of appointments and timeliness of appointments (i.e., long delay from the request for an appointment to the appointment's date) and scheduling convenience are also factors.&quot; (Panel on Antiretroviral Guidelines for Adults and Adolescents, p. L-3)  &quot;Recommendation 2: Systematic monitoring of retention in HIV care is recommended for all patients (II A): Retention in care is associated with improved individual health outcomes, including HIV biomarker and clinical variables, and may reduce community-level viral burden, with implications for secondary prevention. Although monitoring retention is routinely recommended, specific details, such as retention measures to be used and desired visit frequency, vary among jurisdictions and programs and should be in harmony with national and international guidelines. Many retention measures (for example, visit adherence, gaps in care, and visits per interval of time) and data sources (for example, surveillance, medical records, and administrative databases) have been used and may be applied in accordance with local resources and standards of care. As with monitoring of linkage, integration of data sources may enhance monitoring of retention.&quot; (International Association of Physicians in AIDS Care panel, page 4)</p>
</div></td>
        </tr>
        

        

        
            <tr>
                <th scope="row"><b>Guidance (Usage): </b></th>
                <td style="padding-left: 4px;">A patient would be included in the measure numerator if they have either two eligible encounters or one eligible encounter and one viral load test at least 90 days apart from each other. The encounter or encounters that cause a patient to be included in the numerator do not need to include the encounter that caused the patient to be included in the denominator.  This eCQM is a patient-based measure. This measure is to be submitted a minimum of once per measurement period for patients with a diagnosis of HIV during the first eight months of the measurement period.  This FHIR-based measure has been derived from the QDM-based measure: CMS1157v1. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).</td>
            </tr>
        

        
            
                <tr>
                    <th scope="row"><b>Population Criteria: </b></th>
                    <td style="padding-left: 4px;">
                        
                            <table class="grid-dict">
                                
                                    <tr>
                                        <th><b>64f88520da013638e7b3d74c</b></th>
                                    </tr>
                                
                                
                                    <tr>
                                        <td>Initial Population:</td>

                                        
                                            
                                                <td>All patients, regardless of age, with a diagnosis of HIV during the first 8 months of the measurement period or before the measurement period who had at least one eligible encounter during the first 8 months of the measurement period</td>
                                            
                                        

                                    </tr>
                                
                                    <tr>
                                        <td>Denominator:</td>

                                        
                                            
                                                <td>Equals Initial Population</td>
                                            
                                        

                                    </tr>
                                
                                    <tr>
                                        <td>Numerator:</td>

                                        
                                            
                                                <td>Number of patients who had at least two eligible encounters or at least one eligible encounter and one HIV viral load test at least 90 days apart within a 12-month measurement year</td>
                                            
                                        

                                    </tr>
                                
                                
                            </table>
                        
                    </td>
                </tr>
            
        

        
            <tr>
                <th scope="row"><b> Supplemental Data Elements: </b></th>
                <td style="padding-left: 4px;">
                    
                        
                            
                                <p>SDE Ethnicity</p>
                            
                        
                    
                        
                            
                                <p>SDE Payer</p>
                            
                        
                    
                        
                            
                                <p>SDE Race</p>
                            
                        
                    
                        
                            
                                <p>SDE Sex</p>
                            
                        
                    
                </td>
            </tr>
        

        

        
            <tr>
                <th scope="row">
                    <b> Supplemental Data Guidance
                        : </b></th>
                <td style="padding-left: 4px;"> For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity-For every patient evaluated by this measure also identify payer, race, ethnicity and sex   SDE Payer   SDE Race   SDE Sex    </td>
            </tr>
        

        
            <tr>
                <th scope="row"><b>Libraries: </b></th>
                <td style="padding-left: 4px;">
                    <table class="grid-dict">
                        
                            <tr>
                                <td><a href="Library-HIVRetentionFHIR.html">HIVRetentionFHIR</a></td>
                            </tr>
                        
                    </table>
                </td>
            </tr>
        

        

        
            
                <tr>
                    <th scope="row"><b>Terminology and Other Dependencies: </b></th>
                    <td style="padding-left: 4px;">
                        
                            <li><code>Library/SupplementalDataElements|3.5.000</code></li>
                        
                            <li><code>Library/FHIRHelpers|4.4.000</code></li>
                        
                            <li><code>Library/QICoreCommon|2.1.000</code></li>
                        
                            <li><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">AdministrativeGender</a></li>
                        
                            <li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html">Condition Clinical Status Codes</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion">Office Visit</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1008/expansion">Outpatient Consultation</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion">Annual Wellness Visit</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1048/expansion">Face-to-Face Interaction</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion">Home Healthcare Services</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion">Preventive Care Services - Established Office Visit, 18 and Up</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion">Preventive Care Services-Initial Office Visit, 18 and Up</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1022/expansion">Preventive Care Services, Initial Office Visit, 0 to 17</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1024/expansion">Preventive Care, Established Office Visit, 0 to 17</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion">Telephone Visits</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.11.1150/expansion">Preventive Care Services - Other</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.120.12.1003/expansion">HIV</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.120.12.1002/expansion">HIV Viral Load</a></li>
                        
                            <li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a></li>
                        
                    </td>
                </tr>
                <tr>
                    <th scope="row"><b>Parameters:</b></th>
                    <td style="padding-left: 4px;">
                        <table class="grid-dict">
                            <tr>
                                <th><b>name</b></th>
                                <th><b>use</b></th>
                                <th><b>min</b></th>
                                <th><b>max</b></th>
                                <th><b>type</b></th>
                            </tr>
                            
                                <tr>
                                    <td>Measurement Period</td>
                                    <td>In</td>
                                    <td>0</td>
                                    <td>1</td>
                                    <td>Period</td>
                                </tr>
                            
                                <tr>
                                    <td>SDE Sex</td>
                                    <td>Out</td>
                                    <td>0</td>
                                    <td>1</td>
                                    <td>Coding</td>
                                </tr>
                            
                                <tr>
                                    <td>Numerator</td>
                                    <td>Out</td>
                                    <td>0</td>
                                    <td>1</td>
                                    <td>boolean</td>
                                </tr>
                            
                                <tr>
                                    <td>Denominator</td>
                                    <td>Out</td>
                                    <td>0</td>
                                    <td>1</td>
                                    <td>boolean</td>
                                </tr>
                            
                                <tr>
                                    <td>SDE Payer</td>
                                    <td>Out</td>
                                    <td>0</td>
                                    <td>*</td>
                                    <td>Resource</td>
                                </tr>
                            
                                <tr>
                                    <td>Initial Population</td>
                                    <td>Out</td>
                                    <td>0</td>
                                    <td>1</td>
                                    <td>boolean</td>
                                </tr>
                            
                                <tr>
                                    <td>SDE Ethnicity</td>
                                    <td>Out</td>
                                    <td>0</td>
                                    <td>1</td>
                                    <td>Resource</td>
                                </tr>
                            
                                <tr>
                                    <td>SDE Race</td>
                                    <td>Out</td>
                                    <td>0</td>
                                    <td>1</td>
                                    <td>Resource</td>
                                </tr>
                            
                        </table>
                    </td>
                </tr>

                <tr>
                    <th scope="row"><b>DataRequirements:</b></th>
                    <td style="padding-left: 4px;">
                        <table class="grid-dict">
                            <tr>
                                <th><b>Resource Type</b></th>
                                <th><b>Resource Elements</b></th>
                                <th><b>Valueset Name</b></th>
                                <th><b>Valueset</b></th>
                            </tr>
                            
                                <tr>
                                    <td>Patient(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a>)</td>
                                    <td>
                                        
                                            ethnicity
                                        
                                            race
                                        
                                    </td>
                                    <td>
                                        
                                    </td>
                                    <td/>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Office Visit
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion">Office Visit</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Outpatient Consultation
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1008/expansion">Outpatient Consultation</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Annual Wellness Visit
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion">Annual Wellness Visit</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Face-to-Face Interaction
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1048/expansion">Face-to-Face Interaction</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Home Healthcare Services
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion">Home Healthcare Services</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Preventive Care Services Established Office Visit, 18 and Up
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion">Preventive Care Services - Established Office Visit, 18 and Up</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Preventive Care Services Initial Office Visit, 18 and Up
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion">Preventive Care Services-Initial Office Visit, 18 and Up</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Preventive Care Services, Initial Office Visit, 0 to 17
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1022/expansion">Preventive Care Services, Initial Office Visit, 0 to 17</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Preventive Care, Established Office Visit, 0 to 17
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1024/expansion">Preventive Care, Established Office Visit, 0 to 17</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Telephone Visits
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion">Telephone Visits</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Preventive Care Services Other
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.11.1150/expansion">Preventive Care Services - Other</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 HIV
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.120.12.1003/expansion">HIV</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
                                    <td>
                                        
                                            code
                                        
                                            effective
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 HIV Viral Load
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.120.12.1002/expansion">HIV Viral Load</a></td>
                                </tr>
                            
                                <tr>
                                    <td>Coverage(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html">QICoreCoverage</a>)</td>
                                    <td>
                                        
                                            type
                                        
                                            period
                                        
                                    </td>
                                    <td>
                                        
                                            
                                                 Payer Type
                                            
                                        
                                    </td>
                                    <td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer</a></td>
                                </tr>
                            
                        </table>
                    </td>
                </tr>

                
                    <tr>
                        <th scope="row"><b>Direct Reference Codes:</b></th>
                        <td style="padding-left: 4px;">
                            <table class="grid-dict">
                                <tr>
                                    <th><b>display</b></th>
                                    <th><b>code</b></th>
                                    <th><b>system</b></th>
                                </tr>
                                
                                    <tr>
                                        <td>Male</td>
                                        <td>M</td>
                                        <td><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">http://hl7.org/fhir/administrative-gender</a></td>
                                    </tr>
                                
                                    <tr>
                                        <td>Female</td>
                                        <td>F</td>
                                        <td><a href="http://hl7.org/fhir/R4/codesystem-administrative-gender.html">http://hl7.org/fhir/administrative-gender</a></td>
                                    </tr>
                                
                                    <tr>
                                        <td>Active</td>
                                        <td>active</td>
                                        <td><a href="http://hl7.org/fhir/R4/codesystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
                                    </tr>
                                
                                    <tr>
                                        <td>Recurrence</td>
                                        <td>recurrence</td>
                                        <td><a href="http://hl7.org/fhir/R4/codesystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
                                    </tr>
                                
                                    <tr>
                                        <td>Relapse</td>
                                        <td>relapse</td>
                                        <td><a href="http://hl7.org/fhir/R4/codesystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
                                    </tr>
                                
                            </table>
                        </td>
                    </tr>
                

                
                <tr>
                    <th scope="row"><b>Logic Definitions:</b></th>
                    <td style="padding-left: 4px;">
                        
                        <table class="grid-dict">
                            <tr>
                                <th><b>Group</b></th>
                                <th><b>Scoring</b></th>
                                <th><b>Population Criteria</b></th>
                                <th><b>Expression</b></th>
                            </tr>
                            <tr>
                                
                                <td> 64f88520da013638e7b3d74c </td>
                                <td colspan="3" style="padding-left: 4px;">
                                    
                                        <b>Group scoring:</b>
                                        
                                            <span>  proportion </span>
                                        
                                    

                                    

                                    

                                    

                                    
                                        <tr>
                                        
                                            <th scope="row"><b>Type: </b></th>
                                            <td style="padding-left: 4px;">
                                                
                                                    
                                                        <p style="margin-bottom: 5px;">
                                                            <span>Process </span>
                                                        </p>
                                                    
                                                
                                                
                                            </td>
                                        
                                        </tr>
                                    

                                    

                                    
                                    <tr>
                                        <th scope="row"><b>Rate Aggregation: </b></th>
                                        <td colspan="3" style="padding-left: 4px;">None</td>
                                    </tr>
                                    

                                    
                                        <tr>
                                            <th scope="row"><b>Improvement Notation: </b></th>
                                            <td style="padding-left: 4px;">
                                            
                                                
                                                    
                                                        <p style="margin-bottom: 5px;">
                                                            <span>increase </span>
                                                        </p>
                                                    
                                                
                                                
                                            
                                            </td>
                                        </tr>
                                    

                                    

                                </td>
                                
                                <tr>
                                    <td/>
                                    <td/>
                                    <td>Initial Population</td>
                                    <td>
                                        
                                            <pre><code class="language-cql">define &quot;Initial Population&quot;:
  &quot;Has Active HIV Diagnosis Starts On or Before First 240 Days of Measurement Period&quot;
    and &quot;Has Qualifying Encounter During First 240 Days of Measurement Period&quot;</code></pre>
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td/>
                                    <td/>
                                    <td>Denominator</td>
                                    <td>
                                        
                                            <pre><code class="language-cql">define &quot;Denominator&quot;:
  &quot;Initial Population&quot;</code></pre>
                                        
                                    </td>
                                </tr>
                                
                                <tr>
                                    <td/>
                                    <td/>
                                    <td>Numerator</td>
                                    <td>
                                        
                                            <pre><code class="language-cql">define &quot;Numerator&quot;:
  &quot;Has One Encounter With HIV and One Viral Load Test At Least 90 Days Apart&quot;
    or &quot;Has Two Encounters With HIV At Least 90 Days Apart&quot;</code></pre>
                                        
                                    </td>
                                </tr>
                                
                                
                            
                            </tr>
                        </table>
                

                <table class="grid-dict">
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>SupplementalDataElements</td>
                            
                            
                                <td>SDE Sex</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Sex&quot;:
  case
    when Patient.gender = 'male' then &quot;M&quot;
    when Patient.gender = 'female' then &quot;F&quot;
    else null
  end</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>HIVRetentionFHIR</td>
                            
                            
                                <td>SDE Sex</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Sex&quot;:
  SDE.&quot;SDE Sex&quot;</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>HIVRetentionFHIR</td>
                            
                            
                                <td>Encounter During Measurement Period With HIV</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Encounter During Measurement Period With HIV&quot;:
  ( ( [&quot;Encounter&quot;: &quot;Office Visit&quot;]
      union [&quot;Encounter&quot;: &quot;Outpatient Consultation&quot;]
      union [&quot;Encounter&quot;: &quot;Annual Wellness Visit&quot;]
      union [&quot;Encounter&quot;: &quot;Face-to-Face Interaction&quot;]
      union [&quot;Encounter&quot;: &quot;Home Healthcare Services&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care Services Established Office Visit, 18 and Up&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care Services Initial Office Visit, 18 and Up&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care Services, Initial Office Visit, 0 to 17&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care, Established Office Visit, 0 to 17&quot;]
      union [&quot;Encounter&quot;: &quot;Telephone Visits&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care Services Other&quot;] ) ValidEncounter
      with [&quot;Condition&quot;: &quot;HIV&quot;] HIVDiagnosis
        such that ValidEncounter.period during day of &quot;Measurement Period&quot;
          and HIVDiagnosis.prevalenceInterval ( ) starts on or before day of ValidEncounter.period
          and HIVDiagnosis.isActive ( )
  )</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>HIVRetentionFHIR</td>
                            
                            
                                <td>Has One Encounter With HIV and One Viral Load Test At Least 90 Days Apart</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Has One Encounter With HIV and One Viral Load Test At Least 90 Days Apart&quot;:
  exists ( &quot;Encounter During Measurement Period With HIV&quot; ) EncounterWithHIV
    with [&quot;Observation&quot;: &quot;HIV Viral Load&quot;] ViralLoadTest
      such that ViralLoadTest.effective.toInterval ( ) during day of &quot;Measurement Period&quot;
        and ( ( ViralLoadTest.effective.toInterval ( ) starts 90 days or more after day of end of EncounterWithHIV.period )
            or ( EncounterWithHIV.period starts 90 days or more after day of end of ViralLoadTest.effective.toInterval ( ) )
        )</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>HIVRetentionFHIR</td>
                            
                            
                                <td>Has Two Encounters With HIV At Least 90 Days Apart</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Two Encounters With HIV At Least 90 Days Apart&quot;:
  exists &quot;Encounter During Measurement Period With HIV&quot; EncounterWithHIV
    with &quot;Encounter During Measurement Period With HIV&quot; AnotherEncounterWithHIV
      such that EncounterWithHIV !~ AnotherEncounterWithHIV
        and AnotherEncounterWithHIV.period starts 90 days or more after day of end of EncounterWithHIV.period</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>HIVRetentionFHIR</td>
                            
                            
                                <td>Numerator</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Numerator&quot;:
  &quot;Has One Encounter With HIV and One Viral Load Test At Least 90 Days Apart&quot;
    or &quot;Has Two Encounters With HIV At Least 90 Days Apart&quot;</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>HIVRetentionFHIR</td>
                            
                            
                                <td>Has Active HIV Diagnosis Starts On or Before First 240 Days of Measurement Period</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Active HIV Diagnosis Starts On or Before First 240 Days of Measurement Period&quot;:
  exists ( [&quot;Condition&quot;: &quot;HIV&quot;] HIVDx
      where HIVDx.prevalenceInterval ( ) starts on or before day of ( start of &quot;Measurement Period&quot; + 240 days )
        and HIVDx.isActive ( )
  )</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>HIVRetentionFHIR</td>
                            
                            
                                <td>Has Qualifying Encounter During First 240 Days of Measurement Period</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Has Qualifying Encounter During First 240 Days of Measurement Period&quot;:
  exists ( [&quot;Encounter&quot;: &quot;Office Visit&quot;]
    union [&quot;Encounter&quot;: &quot;Outpatient Consultation&quot;]
    union [&quot;Encounter&quot;: &quot;Annual Wellness Visit&quot;]
    union [&quot;Encounter&quot;: &quot;Face-to-Face Interaction&quot;]
    union [&quot;Encounter&quot;: &quot;Home Healthcare Services&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care Services Established Office Visit, 18 and Up&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care Services Initial Office Visit, 18 and Up&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care Services, Initial Office Visit, 0 to 17&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care, Established Office Visit, 0 to 17&quot;]
    union [&quot;Encounter&quot;: &quot;Telephone Visits&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care Services Other&quot;] ) QualifyingEncounter
    where QualifyingEncounter.period during day of Interval[start of &quot;Measurement Period&quot;, start of &quot;Measurement Period&quot; + 240 days]</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>HIVRetentionFHIR</td>
                            
                            
                                <td>Initial Population</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Initial Population&quot;:
  &quot;Has Active HIV Diagnosis Starts On or Before First 240 Days of Measurement Period&quot;
    and &quot;Has Qualifying Encounter During First 240 Days of Measurement Period&quot;</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>HIVRetentionFHIR</td>
                            
                            
                                <td>Denominator</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;Denominator&quot;:
  &quot;Initial Population&quot;</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>SupplementalDataElements</td>
                            
                            
                                <td>SDE Payer</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Payer&quot;:
  [Coverage: type in &quot;Payer Type&quot;] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>HIVRetentionFHIR</td>
                            
                            
                                <td>SDE Payer</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Payer&quot;:
  SDE.&quot;SDE Payer&quot;</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>HIVRetentionFHIR</td>
                            
                            
                                <td>SDE Ethnicity</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Ethnicity&quot;:
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory }
        union E.detailed,
      display: E.text
    }</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>HIVRetentionFHIR</td>
                            
                            
                                <td>SDE Race</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define &quot;SDE Race&quot;:
  Patient.race R
    return Tuple {
      codes: R.ombCategory
        union R.detailed,
      display: R.text
    }</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>QICoreCommon</td>
                            
                            
                                <td>isActive</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">/* Candidates for FHIRCommon */

/*
@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse
*/
define fluent function isActive(condition Condition):
  condition.clinicalStatus ~ &quot;active&quot;
    or condition.clinicalStatus ~ &quot;recurrence&quot;
    or condition.clinicalStatus ~ &quot;relapse&quot;</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>QICoreCommon</td>
                            
                            
                                <td>prevalenceInterval</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting 
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ &quot;active&quot;
  or condition.clinicalStatus ~ &quot;recurrence&quot;
  or condition.clinicalStatus ~ &quot;relapse&quot; then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
    (end of condition.abatementInterval()) abatementDate
    return if abatementDate is null then
      Interval[start of condition.onset.toInterval(), abatementDate)
    else
      Interval[start of condition.onset.toInterval(), abatementDate]</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>FHIRHelpers</td>
                            
                            
                                <td>ToString</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">define function ToString(value uri): value.value</code></pre>
                                </td>
                            
                        </tr>
                    
                        <tr>
                            <th><b>Library Name</b></th>
                            <th><b>Name</b></th>
                        </tr>
                        <tr>
                            
                                <td>FHIRHelpers</td>
                            
                            
                                <td>ToCode</td>
                            
                        </tr>
                        <tr>
                            
                                <td/>
                                <td>
                                    <pre class="highlight language-cql"><code class="language-cql">/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }</code></pre>
                                </td>
                            
                        </tr>
                    
                    </table>
                </td>
            </tr>
            
        
    

    </table>
</div>
  </text>
  <contained>
    <Library>
      <id value="effective-data-requirements"/>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system value="http://hl7.org/fhir/administrative-gender"/>
          <code value="M"/>
          <display value="Male"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system value="http://hl7.org/fhir/administrative-gender"/>
          <code value="F"/>
          <display value="Female"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
          <code value="active"/>
          <display value="Active"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
          <code value="recurrence"/>
          <display value="Recurrence"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
        <valueCoding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
          <code value="relapse"/>
          <display value="Relapse"/>
        </valueCoding>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="SupplementalDataElements"/>
        </extension>
        <extension url="name">
          <valueString value="SDE Sex"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;SDE Sex&quot;:
  case
    when Patient.gender = 'male' then &quot;M&quot;
    when Patient.gender = 'female' then &quot;F&quot;
    else null
  end"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="0"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="HIVRetentionFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="SDE Sex"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;SDE Sex&quot;:
  SDE.&quot;SDE Sex&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="1"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="HIVRetentionFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Encounter During Measurement Period With HIV"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Encounter During Measurement Period With HIV&quot;:
  ( ( [&quot;Encounter&quot;: &quot;Office Visit&quot;]
      union [&quot;Encounter&quot;: &quot;Outpatient Consultation&quot;]
      union [&quot;Encounter&quot;: &quot;Annual Wellness Visit&quot;]
      union [&quot;Encounter&quot;: &quot;Face-to-Face Interaction&quot;]
      union [&quot;Encounter&quot;: &quot;Home Healthcare Services&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care Services Established Office Visit, 18 and Up&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care Services Initial Office Visit, 18 and Up&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care Services, Initial Office Visit, 0 to 17&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care, Established Office Visit, 0 to 17&quot;]
      union [&quot;Encounter&quot;: &quot;Telephone Visits&quot;]
      union [&quot;Encounter&quot;: &quot;Preventive Care Services Other&quot;] ) ValidEncounter
      with [&quot;Condition&quot;: &quot;HIV&quot;] HIVDiagnosis
        such that ValidEncounter.period during day of &quot;Measurement Period&quot;
          and HIVDiagnosis.prevalenceInterval ( ) starts on or before day of ValidEncounter.period
          and HIVDiagnosis.isActive ( )
  )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="2"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="HIVRetentionFHIR"/>
        </extension>
        <extension url="name">
          <valueString
                       value="Has One Encounter With HIV and One Viral Load Test At Least 90 Days Apart"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Has One Encounter With HIV and One Viral Load Test At Least 90 Days Apart&quot;:
  exists ( &quot;Encounter During Measurement Period With HIV&quot; ) EncounterWithHIV
    with [&quot;Observation&quot;: &quot;HIV Viral Load&quot;] ViralLoadTest
      such that ViralLoadTest.effective.toInterval ( ) during day of &quot;Measurement Period&quot;
        and ( ( ViralLoadTest.effective.toInterval ( ) starts 90 days or more after day of end of EncounterWithHIV.period )
            or ( EncounterWithHIV.period starts 90 days or more after day of end of ViralLoadTest.effective.toInterval ( ) )
        )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="3"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="HIVRetentionFHIR"/>
        </extension>
        <extension url="name">
          <valueString
                       value="Has Two Encounters With HIV At Least 90 Days Apart"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Has Two Encounters With HIV At Least 90 Days Apart&quot;:
  exists &quot;Encounter During Measurement Period With HIV&quot; EncounterWithHIV
    with &quot;Encounter During Measurement Period With HIV&quot; AnotherEncounterWithHIV
      such that EncounterWithHIV !~ AnotherEncounterWithHIV
        and AnotherEncounterWithHIV.period starts 90 days or more after day of end of EncounterWithHIV.period"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="4"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="HIVRetentionFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Numerator"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Numerator&quot;:
  &quot;Has One Encounter With HIV and One Viral Load Test At Least 90 Days Apart&quot;
    or &quot;Has Two Encounters With HIV At Least 90 Days Apart&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="5"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="HIVRetentionFHIR"/>
        </extension>
        <extension url="name">
          <valueString
                       value="Has Active HIV Diagnosis Starts On or Before First 240 Days of Measurement Period"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Has Active HIV Diagnosis Starts On or Before First 240 Days of Measurement Period&quot;:
  exists ( [&quot;Condition&quot;: &quot;HIV&quot;] HIVDx
      where HIVDx.prevalenceInterval ( ) starts on or before day of ( start of &quot;Measurement Period&quot; + 240 days )
        and HIVDx.isActive ( )
  )"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="6"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="HIVRetentionFHIR"/>
        </extension>
        <extension url="name">
          <valueString
                       value="Has Qualifying Encounter During First 240 Days of Measurement Period"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Has Qualifying Encounter During First 240 Days of Measurement Period&quot;:
  exists ( [&quot;Encounter&quot;: &quot;Office Visit&quot;]
    union [&quot;Encounter&quot;: &quot;Outpatient Consultation&quot;]
    union [&quot;Encounter&quot;: &quot;Annual Wellness Visit&quot;]
    union [&quot;Encounter&quot;: &quot;Face-to-Face Interaction&quot;]
    union [&quot;Encounter&quot;: &quot;Home Healthcare Services&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care Services Established Office Visit, 18 and Up&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care Services Initial Office Visit, 18 and Up&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care Services, Initial Office Visit, 0 to 17&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care, Established Office Visit, 0 to 17&quot;]
    union [&quot;Encounter&quot;: &quot;Telephone Visits&quot;]
    union [&quot;Encounter&quot;: &quot;Preventive Care Services Other&quot;] ) QualifyingEncounter
    where QualifyingEncounter.period during day of Interval[start of &quot;Measurement Period&quot;, start of &quot;Measurement Period&quot; + 240 days]"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="7"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="HIVRetentionFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Initial Population"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Initial Population&quot;:
  &quot;Has Active HIV Diagnosis Starts On or Before First 240 Days of Measurement Period&quot;
    and &quot;Has Qualifying Encounter During First 240 Days of Measurement Period&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="8"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="HIVRetentionFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="Denominator"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;Denominator&quot;:
  &quot;Initial Population&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="9"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="SupplementalDataElements"/>
        </extension>
        <extension url="name">
          <valueString value="SDE Payer"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;SDE Payer&quot;:
  [Coverage: type in &quot;Payer Type&quot;] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="10"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="HIVRetentionFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="SDE Payer"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;SDE Payer&quot;:
  SDE.&quot;SDE Payer&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="11"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="HIVRetentionFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="SDE Ethnicity"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;SDE Ethnicity&quot;:
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory }
        union E.detailed,
      display: E.text
    }"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="12"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="HIVRetentionFHIR"/>
        </extension>
        <extension url="name">
          <valueString value="SDE Race"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define &quot;SDE Race&quot;:
  Patient.race R
    return Tuple {
      codes: R.ombCategory
        union R.detailed,
      display: R.text
    }"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="13"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="QICoreCommon"/>
        </extension>
        <extension url="name">
          <valueString value="isActive"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/* Candidates for FHIRCommon */

/*
@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse
*/
define fluent function isActive(condition Condition):
  condition.clinicalStatus ~ &quot;active&quot;
    or condition.clinicalStatus ~ &quot;recurrence&quot;
    or condition.clinicalStatus ~ &quot;relapse&quot;"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="14"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="QICoreCommon"/>
        </extension>
        <extension url="name">
          <valueString value="prevalenceInterval"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting 
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ &quot;active&quot;
  or condition.clinicalStatus ~ &quot;recurrence&quot;
  or condition.clinicalStatus ~ &quot;relapse&quot; then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
    (end of condition.abatementInterval()) abatementDate
    return if abatementDate is null then
      Interval[start of condition.onset.toInterval(), abatementDate)
    else
      Interval[start of condition.onset.toInterval(), abatementDate]"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="15"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="FHIRHelpers"/>
        </extension>
        <extension url="name">
          <valueString value="ToString"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="define function ToString(value uri): value.value"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="16"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
        <extension url="libraryName">
          <valueString value="FHIRHelpers"/>
        </extension>
        <extension url="name">
          <valueString value="ToCode"/>
        </extension>
        <extension url="statement">
          <valueString
                       value="/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }"/>
        </extension>
        <extension url="displaySequence">
          <valueInteger value="17"/>
        </extension>
      </extension>
      <name value="EffectiveDataRequirements"/>
      <status value="active"/>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/library-type"/>
          <code value="module-definition"/>
        </coding>
      </type>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library SDE"/>
        <resource value="Library/SupplementalDataElements|3.5.000"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library FHIRHelpers"/>
        <resource value="Library/FHIRHelpers|4.4.000"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Library QICoreCommon"/>
        <resource value="Library/QICoreCommon|2.1.000"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Code system AdministrativeGender"/>
        <resource value="http://hl7.org/fhir/administrative-gender"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Code system ConditionClinicalStatusCodes"/>
        <resource
                  value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Office Visit"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Outpatient Consultation"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Annual Wellness Visit"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Face-to-Face Interaction"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1048"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Home Healthcare Services"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Preventive Care Services Established Office Visit, 18 and Up"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Preventive Care Services Initial Office Visit, 18 and Up"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Preventive Care Services, Initial Office Visit, 0 to 17"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display
                 value="Value set Preventive Care, Established Office Visit, 0 to 17"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Telephone Visits"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Preventive Care Services Other"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.11.1150"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set HIV"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set HIV Viral Load"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1002"/>
      </relatedArtifact>
      <relatedArtifact>
        <type value="depends-on"/>
        <display value="Value set Payer Type"/>
        <resource
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
      </relatedArtifact>
      <parameter>
        <name value="Measurement Period"/>
        <use value="in"/>
        <min value="0"/>
        <max value="1"/>
        <type value="Period"/>
      </parameter>
      <parameter>
        <name value="SDE Sex"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="Coding"/>
      </parameter>
      <parameter>
        <name value="Numerator"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <parameter>
        <name value="Denominator"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <parameter>
        <name value="SDE Payer"/>
        <use value="out"/>
        <min value="0"/>
        <max value="*"/>
        <type value="Resource"/>
      </parameter>
      <parameter>
        <name value="Initial Population"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="boolean"/>
      </parameter>
      <parameter>
        <name value="SDE Ethnicity"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="Resource"/>
      </parameter>
      <parameter>
        <name value="SDE Race"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <type value="Resource"/>
      </parameter>
      <dataRequirement>
        <type value="Patient"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"/>
        <mustSupport value="ethnicity"/>
        <mustSupport value="race"/>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1048"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Encounter"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.11.1150"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Condition"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"/>
        <mustSupport value="code"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Observation"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"/>
        <mustSupport value="code"/>
        <mustSupport value="effective"/>
        <codeFilter>
          <path value="code"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1002"/>
        </codeFilter>
      </dataRequirement>
      <dataRequirement>
        <type value="Coverage"/>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"/>
        <mustSupport value="type"/>
        <mustSupport value="period"/>
        <codeFilter>
          <path value="type"/>
          <valueSet
                    value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
        </codeFilter>
      </dataRequirement>
    </Library>
  </contained>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" id="supplementalDataGuidance">
    <extension url="guidance">
      <valueString
                   value="For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity-For every patient evaluated by this measure also identify payer, race, ethnicity and sex   SDE Payer   SDE Race   SDE Sex   "/>
    </extension>
    <extension url="usage">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
          <code value="supplemental-data"/>
          <display value="Supplemental Data"/>
        </coding>
        <text value="Supplemental Data Guidance"/>
      </valueCodeableConcept>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements" id="effective-data-requirements">
    <valueReference>
      <reference value="#effective-data-requirements"/>
    </valueReference>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem">
    <valueReference>
      <reference value="Device/cqf-tooling"/>
    </valueReference>
  </extension>
  <url value="https://madie.cms.gov/Measure/HIVRetentionFHIR"/>
  <identifier>
    <use value="usual"/>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
        <code value="short-name"/>
      </coding>
    </type>
    <system value="https://madie.cms.gov/measure/shortName"/>
    <value value="CMS1157FHIR"/>
  </identifier>
  <identifier>
    <use value="official"/>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
        <code value="version-independent"/>
      </coding>
    </type>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:uuid:03878bb8-1209-4f3f-91f6-52b655092251"/>
  </identifier>
  <identifier>
    <use value="official"/>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
        <code value="version-specific"/>
      </coding>
    </type>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:uuid:0d43cbbd-6020-43b4-bfb2-40d2b4529b97"/>
  </identifier>
  <identifier>
    <use value="official"/>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
        <code value="publisher"/>
      </coding>
    </type>
    <system value="https://madie.cms.gov/measure/cmsId"/>
    <value value="1157FHIR"/>
    <assigner>
      <display value="CMS"/>
    </assigner>
  </identifier>
  <version value="0.1.000"/>
  <name value="HIVRetentionFHIR"/>
  <title value="HIV Annual Retention in CareFHIR"/>
  <status value="draft"/>
  <experimental value="false"/>
  <date value="2024-07-09T14:53:56+00:00"/>
  <publisher value="Health Resources &amp; Services Administration"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value=" https://www.hrsa.gov/"/>
    </telecom>
  </contact>
  <description
               value="Percentage of patients, regardless of age, with a diagnosis of HIV who had at least two eligible encounters or at least one eligible encounter and one HIV viral load test that were at least 90 days apart within the measurement period"/>
  <purpose value="UNKNOWN"/>
  <usage
         value="A patient would be included in the measure numerator if they have either two eligible encounters or one eligible encounter and one viral load test at least 90 days apart from each other. The encounter or encounters that cause a patient to be included in the numerator do not need to include the encounter that caused the patient to be included in the denominator.  This eCQM is a patient-based measure. This measure is to be submitted a minimum of once per measurement period for patients with a diagnosis of HIV during the first eight months of the measurement period.  This FHIR-based measure has been derived from the QDM-based measure: CMS1157v1. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html)."/>
  <copyright
             value="This measure was developed by the Health Resources and Services Administration of the U.S. Department for Health and Human Services. It is in the public domain.   Citation of HRSA as the source of the original measure is appreciated. Any modified versions may not be represented as approved, endorsed, or authorized by HRSA or HHS. 42 U.S.C. Section 1320b-10. Users of modified versions should clearly explain how they deviate from HRSA's original measure.  Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets.   CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) is copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2023 World Health Organization. All Rights Reserved.  Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]."/>
  <effectivePeriod>
    <start value="2025-01-01"/>
    <end value="2025-12-31"/>
  </effectivePeriod>
  <author>
    <name value="Health Resources &amp; Services Administration"/>
    <telecom>
      <system value="url"/>
      <value value=" https://www.hrsa.gov/"/>
    </telecom>
  </author>
  <library value="https://madie.cms.gov/Library/HIVRetentionFHIR"/>
  <disclaimer
              value="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 &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.  Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]."/>
  <rationale
             value="The HIV &quot;continuum of care&quot; is the process of HIV testing, linkage to HIV care, initiation of ART, adherence to treatment, retention in care, and virologic suppression (Gardner et al 2011). Poor retention in care is associated with lower rates of ART use (Giordano et al 2003), delayed viral suppression (Crawford et al 2014), and increased risk of mortality (Giordano et al 2007; Mugavero et al 2009). This measure will help providers direct their attention and quality improvement efforts towards improving retention in care."/>
  <clinicalRecommendationStatement
                                   value="&quot;Retention in care should be routinely monitored. There are various ways to measure retention, including measures based on attended visits over a defined period of time (constancy measures) and measures based on missed visits. Both approaches are valid and independently predict survival. Missed visits and a prolonged time since the last visit are relatively easy to measure and should trigger efforts to retain or re-engage a person in care. Constancy measures (e.g., at least two visits that are at least 90 days apart over 1 year or at least one visit every 6 months over the last 2 years) can be used as clinic quality assurance measures.&quot; (Panel on Antiretroviral Guidelines for Adults and Adolescents, p. L-4)  &quot;Poor retention in HIV care is associated with greater risk of death. Poor retention is more common in people who use substances, have serious mental health problems, have unmet socioeconomic needs (e.g., housing, food, transportation), lack financial resources or health insurance, have schedules that complicate adherence, have been recently incarcerated, or face stigma. At the provider and health system level, low trust in providers and a poor patient-provider relationship have been associated with lower retention, as has lower satisfaction with the clinic experience. Availability of appointments and timeliness of appointments (i.e., long delay from the request for an appointment to the appointment's date) and scheduling convenience are also factors.&quot; (Panel on Antiretroviral Guidelines for Adults and Adolescents, p. L-3)  &quot;Recommendation 2: Systematic monitoring of retention in HIV care is recommended for all patients (II A): Retention in care is associated with improved individual health outcomes, including HIV biomarker and clinical variables, and may reduce community-level viral burden, with implications for secondary prevention. Although monitoring retention is routinely recommended, specific details, such as retention measures to be used and desired visit frequency, vary among jurisdictions and programs and should be in harmony with national and international guidelines. Many retention measures (for example, visit adherence, gaps in care, and visits per interval of time) and data sources (for example, surveillance, medical records, and administrative databases) have been used and may be applied in accordance with local resources and standards of care. As with monitoring of linkage, integration of data sources may enhance monitoring of retention.&quot; (International Association of Physicians in AIDS Care panel, page 4)"/>
  <group id="64f88520da013638e7b3d74c">
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
          <code value="proportion"/>
          <display value="Proportion"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
      <valueCode value="boolean"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
      <valueCodeableConcept>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
          <code value="process"/>
          <display value="Process"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation">
      <valueCode value="None"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
          <code value="decrease"/>
          <display value="increase"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <population id="A6F32311-CB94-45E1-BC45-52EA2A50C0D5">
      <code>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="initial-population"/>
          <display value="Initial Population"/>
        </coding>
      </code>
      <description
                   value="All patients, regardless of age, with a diagnosis of HIV during the first 8 months of the measurement period or before the measurement period who had at least one eligible encounter during the first 8 months of the measurement period"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Initial Population"/>
      </criteria>
    </population>
    <population id="C3B1C330-E711-40DB-A33F-AE3F9A09202E">
      <code>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="denominator"/>
          <display value="Denominator"/>
        </coding>
      </code>
      <description value="Equals Initial Population"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Denominator"/>
      </criteria>
    </population>
    <population id="C0FD2C2B-79B4-4A14-A13B-87703E1D6B3C">
      <code>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="numerator"/>
          <display value="Numerator"/>
        </coding>
      </code>
      <description
                   value="Number of patients who had at least two eligible encounters or at least one eligible encounter and one HIV viral load test at least 90 days apart within a 12-month measurement year"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Numerator"/>
      </criteria>
    </population>
  </group>
  <supplementalData id="sde-ethnicity">
    <usage>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Ethnicity"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Ethnicity"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-payer">
    <usage>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Payer"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Payer"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-race">
    <usage>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Race"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Race"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-sex">
    <usage>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Sex"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Sex"/>
    </criteria>
  </supplementalData>
</Measure>