eCQM QICore Content Implementation Guide
2024.0.0 - CI Build

eCQM QICore Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2024.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/ecqm-content-qicore-2024/ and changes regularly. See the Directory of published versions

Measure: Sexually Transmitted Infection (STI) Testing for People with HIVFHIR

Percentage of patients 13 years of age and older with a diagnosis of HIV who had tests for syphilis, gonorrhea, and chlamydia performed within the measurement period

UNKNOWN

Official URL: https://madie.cms.gov/Measure/HIVSTITestingFHIR Version: 0.2.000
Draft as of 2024-07-09 Responsible: Health Resources & Services Administration/a> Computable Name: HIVSTITestingFHIR
Other Identifiers: Short Name (use: usual, ), UUID:6f66ca77-1a2c-489c-b0d8-730da6e5a763 (use: official, ), UUID:ca1ad24d-a2c3-4f64-8de5-e319c5e85ae4 (use: official, ), Publisher (use: official, )

Copyright/Legal: This measure was developed by the Health Resources & Services Administration (HRSA) of the U.S. Department of Health & Human Services (HHS). 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].

Title: Sexually Transmitted Infection (STI) Testing for People with HIVFHIR
Id: HIVSTITestingFHIR
Version: 0.2.000
Url: Sexually Transmitted Infection (STI) Testing for People with HIVFHIR
short-name identifier:

CMS1188FHIR

version-independent identifier:

urn:uuid:6f66ca77-1a2c-489c-b0d8-730da6e5a763

version-specific identifier:

urn:uuid:ca1ad24d-a2c3-4f64-8de5-e319c5e85ae4

publisher (CMS) identifier:

1188FHIR

Effective Period: 2025-01-01..2025-12-31
Status: draft
Publisher: Health Resources & Services Administration
Author: Health Resources & Services Administration
Description:

Percentage of patients 13 years of age and older with a diagnosis of HIV who had tests for syphilis, gonorrhea, and chlamydia performed within the measurement period

Purpose:

UNKNOWN

Copyright:

This measure was developed by the Health Resources & Services Administration (HRSA) of the U.S. Department of Health & Human Services (HHS). 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].

Disclaimer:

These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Rationale:

The rates of syphilis, gonorrhea, and chlamydia cases per 100,000 in the United States have steadily risen over the last decade and increased 11.2 percent, 5.9 percent, and 2.8 percent, respectively, from 2018 to 2019 (DHHS, 2021). People with HIV are at an increased risk of bacterial sexually transmitted infections (STIs), including chlamydia, gonorrhea, and syphilis (Centers for Disease Control and Prevention [CDC], 2004). However, early detection and treatment of bacterial STIs in people with HIV can lead to a reduction in HIV transmission (CDC, 2004). Despite guidelines for at least annual screening among sexually active persons with HIV, only an estimated 55 percent received a syphilis test in the past year, 23 percent received a gonorrhea test in the past year, and 24 percent received a chlamydia test in the past year based on a nationally-representative survey of adults with HIV receiving medical care in the United States (Flagg et al., 2015). This measure will help providers focus their attention and quality improvement efforts towards testing and treating sexually transmitted infections in patients with HIV, thus reducing the complications to long-term syphilis infection and reducing STI incidence (Patel et al., 2012).

Clinical recommendation statement:

"Routine serologic screening for syphilis is recommended at least annually for all persons with HIV infection who are sexually active, with more frequent screening (i.e., every 3-6 months) for those who have multiple or anonymous partners" (Panel on Opportunistic Infections in Adults and Adolescents with HIV, 2022, p. Y-3). "Patients undergoing screening or treatment for syphilis also should be evaluated for other sexually transmitted diseases such as chlamydia and gonorrhea at anatomic sites of exposure in men and for chlamydia, gonorrhea, and trichomonas in women" (Panel on Opportunistic Infections in Adults and Adolescents with HIV, 2022, p. Y-3). "The [United States Preventive Services Task Force (USPSTF)] recommends screening for syphilis in persons who are at increased risk for infection. When deciding which persons to screen for syphilis, clinicians should consider the prevalence of infection in the communities they serve, as well as other sociodemographic and behavioral factors that may be associated with increased risk of syphilis infection. For example, prevalence of syphilis is higher in men, men who have sex with men, persons with HIV infection, young adults, and persons with a history of incarceration, sex work, or military service…. Optimal screening frequency for persons who are at increased risk for syphilis infection is not well established. Men who have sex with men or persons with HIV infection may benefit from screening at least annually or more frequently (e.g., every 3 to 6 months) if they continue to be at high risk" (USPSTF, 2022, p. 1244-1246). "At the initial HIV care visit, providers should screen all sexually active persons for syphilis, gonorrhea, and chlamydia, and perform screening for these infections at least annually during the course of HIV care. Specific testing includes syphilis serology and [a nucleic acid amplification test] NAAT for N. gonorrhoeae and C. trachomatis at the anatomic site of exposure" (Workowski et al., 2021, p. 26).

Guidance (Usage): This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS1188v2. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html)
Population Criteria:
64f8f7f7da013638e7b3d9df
Initial Population: All patients 13 years of age and older at the start of the measurement period with an eligible encounter during the measurement period with a diagnosis of HIV before the end of the measurement period
Denominator: Equals Initial Population
Numerator: Patients who were tested for each of the following at least once during the measurement period: chlamydia, gonorrhea, and syphilis
Supplemental Data Elements:

SDE Ethnicity

SDE Payer

SDE Sex

SDE Race

Supplemental Data Guidance : For every patient evaluated by this measure also identify payer, race, ethnicity and sex
Libraries:
HIVSTITestingFHIR
Terminology and Other Dependencies:
  • Library/SupplementalDataElements|3.5.000
  • Library/FHIRHelpers|4.4.000
  • Library/QICoreCommon|2.1.000
  • AdministrativeGender
  • Chlamydia Screening
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1258.1
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1166.117
  • Office Visit
  • Outpatient Consultation
  • Annual Wellness Visit
  • Face-to-Face Interaction
  • Home Healthcare Services
  • Preventive Care Services - Established Office Visit, 18 and Up
  • Preventive Care Services-Initial Office Visit, 18 and Up
  • Preventive Care Services, Initial Office Visit, 0 to 17
  • Preventive Care, Established Office Visit, 0 to 17
  • Telephone Visits
  • Preventive Care Services - Other
  • HIV
  • Payer
  • Parameters:
    name use min max type
    Measurement Period In 0 1 Period
    SDE Sex Out 0 1 Coding
    Numerator Out 0 1 boolean
    Denominator Out 0 1 boolean
    SDE Payer Out 0 * Resource
    Initial Population Out 0 1 boolean
    SDE Ethnicity Out 0 1 Resource
    SDE Race Out 0 1 Resource
    DataRequirements:
    Resource Type Resource Elements Valueset Name Valueset
    Patient(QICorePatient) ethnicity race
    Observation(QICoreObservation) code value status status.value effective Chlamydia Screening Chlamydia Screening
    Observation(QICoreObservation) code value status status.value effective Gonorrhea Screening http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1258.1
    Observation(QICoreObservation) code value status status.value effective Syphilis Tests http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1166.117
    Encounter(QICoreEncounter) type period Office Visit Office Visit
    Encounter(QICoreEncounter) type period Outpatient Consultation Outpatient Consultation
    Encounter(QICoreEncounter) type period Annual Wellness Visit Annual Wellness Visit
    Encounter(QICoreEncounter) type period Face-to-Face Interaction Face-to-Face Interaction
    Encounter(QICoreEncounter) type period Home Healthcare Services Home Healthcare Services
    Encounter(QICoreEncounter) type period Preventive Care Services Established Office Visit, 18 and Up Preventive Care Services - Established Office Visit, 18 and Up
    Encounter(QICoreEncounter) type period Preventive Care Services Initial Office Visit, 18 and Up Preventive Care Services-Initial Office Visit, 18 and Up
    Encounter(QICoreEncounter) type period Preventive Care Services, Initial Office Visit, 0 to 17 Preventive Care Services, Initial Office Visit, 0 to 17
    Encounter(QICoreEncounter) type period Preventive Care, Established Office Visit, 0 to 17 Preventive Care, Established Office Visit, 0 to 17
    Encounter(QICoreEncounter) type period Telephone Visits Telephone Visits
    Encounter(QICoreEncounter) type period Preventive Care Services Other Preventive Care Services - Other
    Condition(QICoreCondition) code HIV HIV
    Coverage(QICoreCoverage) type period Payer Type Payer
    Direct Reference Codes:
    display code system
    Male M http://hl7.org/fhir/administrative-gender
    Female F http://hl7.org/fhir/administrative-gender
    Logic Definitions:
    Group Scoring Population Criteria Expression
    64f8f7f7da013638e7b3d9df Group scoring: proportion
    Type:

    Process

    Rate Aggregation: None
    Improvement Notation:

    increase

    Initial Population
    define "Initial Population":
      AgeInYearsAt(date from start of "Measurement Period") >= 13
        and "Has Qualifying Encounter During Measurement Period"
        and "Has HIV Diagnosis Before End of Measurement Period"
    Denominator
    define "Denominator":
      "Initial Population"
    Numerator
    define "Numerator":
      "Has Chlamydia Testing"
        and "Has Gonorrhea Testing"
        and "Has Syphilis Testing"
    Library Name Name
    SupplementalDataElements SDE Sex
    define "SDE Sex":
      case
        when Patient.gender = 'male' then "M"
        when Patient.gender = 'female' then "F"
        else null
      end
    Library Name Name
    HIVSTITestingFHIR SDE Sex
    define "SDE Sex":
      SDE."SDE Sex"
    Library Name Name
    HIVSTITestingFHIR Has Chlamydia Testing
    define "Has Chlamydia Testing":
      exists ["Observation": "Chlamydia Screening"] ChlamydiaTest
        where ChlamydiaTest.value is not null
          and ChlamydiaTest.status in { 'final', 'amended', 'corrected' }
          and ChlamydiaTest.effective.latest ( ) during day of "Measurement Period"
    Library Name Name
    HIVSTITestingFHIR Has Gonorrhea Testing
    define "Has Gonorrhea Testing":
      exists ["Observation": "Gonorrhea Screening"] GonorrheaTest
        where GonorrheaTest.value is not null
          and GonorrheaTest.status in { 'final', 'amended', 'corrected' }
          and GonorrheaTest.effective.latest ( ) during day of "Measurement Period"
    Library Name Name
    HIVSTITestingFHIR Has Syphilis Testing
    define "Has Syphilis Testing":
      exists ["Observation": "Syphilis Tests"] SyphilisTest
        where SyphilisTest.value is not null
          and SyphilisTest.status in { 'final', 'amended', 'corrected' }
          and SyphilisTest.effective.latest ( ) during day of "Measurement Period"
    Library Name Name
    HIVSTITestingFHIR Numerator
    define "Numerator":
      "Has Chlamydia Testing"
        and "Has Gonorrhea Testing"
        and "Has Syphilis Testing"
    Library Name Name
    HIVSTITestingFHIR Has Qualifying Encounter During Measurement Period
    define "Has Qualifying Encounter During Measurement Period":
    /*Note: applied workaround using value set 'Preventive Care Services Other', as a DRC cannot be used directly from an encounter retrieve; additional info can be found in CQLIT-368*/
      
      exists ( ( ["Encounter": "Office Visit"]
          union ["Encounter": "Outpatient Consultation"]
          union ["Encounter": "Annual Wellness Visit"]
          union ["Encounter": "Face-to-Face Interaction"]
          union ["Encounter": "Home Healthcare Services"]
          union ["Encounter": "Preventive Care Services Established Office Visit, 18 and Up"]
          union ["Encounter": "Preventive Care Services Initial Office Visit, 18 and Up"]
          union ["Encounter": "Preventive Care Services, Initial Office Visit, 0 to 17"]
          union ["Encounter": "Preventive Care, Established Office Visit, 0 to 17"]
          union ["Encounter": "Telephone Visits"]
          union ["Encounter": "Preventive Care Services Other"] ) QualifyingEncounter
          where QualifyingEncounter.period during day of "Measurement Period"
      )
    Library Name Name
    HIVSTITestingFHIR Has HIV Diagnosis Before End of Measurement Period
    define "Has HIV Diagnosis Before End of Measurement Period":
      exists ["Condition": "HIV"] HIVDx
        where HIVDx.prevalenceInterval ( ) starts on or before day of end of "Measurement Period"
    Library Name Name
    HIVSTITestingFHIR Initial Population
    define "Initial Population":
      AgeInYearsAt(date from start of "Measurement Period") >= 13
        and "Has Qualifying Encounter During Measurement Period"
        and "Has HIV Diagnosis Before End of Measurement Period"
    Library Name Name
    HIVSTITestingFHIR Denominator
    define "Denominator":
      "Initial Population"
    Library Name Name
    SupplementalDataElements SDE Payer
    define "SDE Payer":
      [Coverage: type in "Payer Type"] Payer
        return {
          code: Payer.type,
          period: Payer.period
        }
    Library Name Name
    HIVSTITestingFHIR SDE Payer
    define "SDE Payer":
      SDE."SDE Payer"
    Library Name Name
    SupplementalDataElements SDE Ethnicity
    define "SDE Ethnicity":
      Patient.ethnicity E
        return Tuple {
          codes: { E.ombCategory } union E.detailed,
          display: E.text
        }
    Library Name Name
    HIVSTITestingFHIR SDE Ethnicity
    define "SDE Ethnicity":
      SDE."SDE Ethnicity"
    Library Name Name
    SupplementalDataElements SDE Race
    define "SDE Race":
      Patient.race R
        return Tuple {
          codes: R.ombCategory union R.detailed,
          display: R.text
        }
    Library Name Name
    HIVSTITestingFHIR SDE Race
    define "SDE Race":
      SDE."SDE Race"
    Library Name Name
    QICoreCommon latest
    /*
    @description: Given an interval, returns the ending point if the interval has an ending boundary specified,
    otherwise, returns the starting point
    */
    define fluent function latest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
      (choice.toInterval()) period
        return
          if (period."hasEnd"()) then end of period
          else start of period
    Library Name Name
    QICoreCommon prevalenceInterval
    /*
    @description: Returns an interval representing the normalized prevalence period of a given Condition.
    @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
    onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting 
    interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
    */
    define fluent function prevalenceInterval(condition Condition):
    if condition.clinicalStatus ~ "active"
      or condition.clinicalStatus ~ "recurrence"
      or condition.clinicalStatus ~ "relapse" then
      Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
    else
        (end of condition.abatementInterval()) abatementDate
        return if abatementDate is null then
          Interval[start of condition.onset.toInterval(), abatementDate)
        else
          Interval[start of condition.onset.toInterval(), abatementDate]
    Library Name Name
    FHIRHelpers ToString
    define function ToString(value uri): value.value
    Library Name Name
    FHIRHelpers ToCode
    /*
    @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
    */
    define function ToCode(coding FHIR.Coding):
        if coding is null then
            null
        else
            System.Code {
              code: coding.code.value,
              system: coding.system.value,
              version: coding.version.value,
              display: coding.display.value
            }