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: HIV ScreeningFHIR

Official URL: https://madie.cms.gov/Measure/HIVScreeningFHIR Version: 0.2.000
Draft as of 2024-07-09 ​ Responsible: Centers for Disease Control and Prevention (CDC) Computable Name: HIVScreeningFHIR
Other Identifiers: Short Name (use: usual, ), UUID:40b617bf-3054-4663-bf9c-a15417c9a7dc (use: official, ), UUID:7623bac7-cdd6-43d3-bb92-41208ef65b87 (use: official, ), Publisher (use: official, )

Copyright/Legal: 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. Mathematica disclaims all liability for use or accuracy of any third party codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2023 World Health Organization. All Rights Reserved.

Percentage of patients aged 15-65 at the start of the measurement period who were between 15-65 years old when tested for human immunodeficiency virus (HIV).

UNKNOWN

Title: HIV ScreeningFHIR
Id: HIVScreeningFHIR
Version: 0.2.000
Url: HIV ScreeningFHIR
short-name identifier:

CMS349FHIR

version-independent identifier:

urn:uuid:40b617bf-3054-4663-bf9c-a15417c9a7dc

version-specific identifier:

urn:uuid:7623bac7-cdd6-43d3-bb92-41208ef65b87

publisher (CMS) identifier:

349FHIR

Effective Period: 2025-01-01..2025-12-31
Status: draft
Publisher: Centers for Disease Control and Prevention (CDC)
Author: Mathematica
Description:

Percentage of patients aged 15-65 at the start of the measurement period who were between 15-65 years old when tested for human immunodeficiency virus (HIV).
Purpose:

UNKNOWN
Copyright:

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. Mathematica disclaims all liability for use or accuracy of any third party codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2023 World Health Organization. All Rights Reserved.
Disclaimer:

The performance measure is not a clinical guideline and does not establish a standard of medical care, and has 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].
Scoring:

Proportion

Rationale:

Human immunodeficiency virus (HIV) is a communicable infection that leads to a progressive disease with a long asymptomatic period. There were an estimated 32,100 new HIV infections in the United States in 2021 (Centers for Disease Control and Prevention, 2023a). Without treatment, most persons develop acquired immunodeficiency syndrome (AIDS) within 10 years of HIV infection. Antiretroviral therapy (ART) delays this progression and increases the length of survival, but it is most effective when initiated during the asymptomatic phase. Persons living with HIV who use ART and achieve viral suppression can have a nearly normal life expectancy (Samji et al., 2013). DHHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents recommends immediate antiretroviral therapy for all HIV-infected individuals, regardless of CD4 count at diagnosis, to reduce the risk of disease progression (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2019).

CDC estimates that, in 2021, approximately 13% of the 1.2 million adults and adolescents living with HIV infection in the United States were unaware of their infection (CDC, 2023a). Among persons diagnosed with HIV in 2021, approximately 21% were diagnosed with Stage 3 HIV (AIDS) at the time of HIV diagnosis (CDC, 2023b), which is when there is a CD4 lymphocyte count of less than 200 cells/mm3 or a CD4 percentage of total lymphocytes of less than 14 or documentation of AIDS-defining condition at diagnosis (CDC, 2023b). HIV screening identifies infected persons who were previously unaware of their infection, which enables them to seek medical and social services that can improve their health and the quality and length of their lives. Additionally, using ART with high levels of medication adherence has been shown to substantially reduce the risk of HIV transmission (Panel on Antiretroviral Guidelines for Adults and Adolescents, 2019).

Based on the Behavioral Risk Factor Surveillance System (BRFSS), the percentage of ever tested for HIV increased from 42.9% in 2011 to 45.9% in 2017. Despite this increase, less than half of US adults have ever been tested for HIV over ten years after CDC's recommendations (Patel et al., 2019).
Clinical recommendation statement:

The US Preventive Services Task Force recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened (A Recommendation) (Owens, et al., 2019).

Since 2006, the CDC has recommended routine opt-out HIV screening (i.e., patient is notified that testing will be performed unless the patient declines) in healthcare facilities of adolescents and adults 13-64 years of age and HIV diagnostic testing of adolescents and adults with clinical signs or symptoms consistent with HIV infection (Centers for Disease Control and Prevention, 2006).
Guidance (Usage): This measure evaluates the proportion of patients aged 15 to 65 at the start of the measurement period who have documentation of having received an HIV test at least once on or after their 15th birthday and before their 66th birthday. In order to satisfy the measure, the reporting provider must have documentation of the administration of the laboratory test present in the patient's medical record. In cases where the HIV test was performed elsewhere, providers cannot rely on patient attestation or self-report to meet the measure requirements, as previous research has shown that patient self-report is an unreliable indicator of previous HIV testing history. Rather, providers must request documentation of those test results. If such documentation is not available, the patient should be considered still eligible for HIV screening. If such documentation is available, but cannot be provided in a standardized, structured format (such that the lab test and results can be readily incorporated as structured data within the EHR), providers should enter the information into their EHR as a laboratory test in a manner consistent with the EHR in use. If the specific Human Immunodeficiency Virus (HIV) Laboratory Test LOINC code of the test is not known, the entry should use the more generic code LOINC panel code [75622-1]. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS349v7. 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:
6633d9196c1d307ea36e749d
Initial Population: Patients 15 to 65 years of age at the start of the measurement period AND who had at least one outpatient visit during the day of the measurement period
Denominator: Equals Initial Population
Denominator Exclusion: Patients diagnosed with HIV prior to the start of the day of the measurement period
Numerator: Patients with documentation of an HIV test performed on or after their 15th birthday and before their 66th birthday
Supplemental Data Elements:

SDE Ethnicity

SDE Payer

SDE Race

SDE Sex
Supplemental Data Guidance : For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity SDE Payer SDE Race SDE Sex
Libraries:
HIVScreeningFHIR
Terminology and Other Dependencies:
  • Library/SupplementalDataElements|3.5.000
  • Library/FHIRHelpers|4.4.000
  • Library/QICoreCommon|2.1.000
  • AdministrativeGender
  • Logical Observation Identifiers, Names and Codes (LOINC)
  • ConditionVerificationStatus
  • Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag)
  • Preventive Care Services, Initial Office Visit, 0 to 17
  • Preventive Care Services-Initial Office Visit, 18 and Up
  • Preventive Care, Established Office Visit, 0 to 17
  • Preventive Care Services - Established Office Visit, 18 and Up
  • Office Visit
  • Payer
  • HIV
    		•
    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
    Denominator Exclusions Out 0 1 boolean
    SDE Race Out 0 1 Resource
    DataRequirements:
    Resource Type Resource Elements Valueset Name Valueset
    Patient(QICorePatient) ethnicity race
    Observation(QICoreObservation) code value effective status status.value Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag) Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag)
    Observation(QICoreObservation) code value effective status status.value
    Encounter(QICoreEncounter) type period status status.value Preventive Care Services, Initial Office Visit, 0 to 17 Preventive Care Services, Initial Office Visit, 0 to 17
    Encounter(QICoreEncounter) type period status status.value Preventive Care Services-Initial Office Visit, 18 and Up Preventive Care Services-Initial Office Visit, 18 and Up
    Encounter(QICoreEncounter) type period status status.value Preventive Care, Established Office Visit, 0 to 17 Preventive Care, Established Office Visit, 0 to 17
    Encounter(QICoreEncounter) type period status status.value Preventive Care Services - Established Office Visit, 18 and Up Preventive Care Services - Established Office Visit, 18 and Up
    Encounter(QICoreEncounter) type period status status.value Office Visit Office Visit
    Coverage(QICoreCoverage) type period Payer Type Payer
    Condition(QICoreCondition) code verificationStatus HIV HIV
    Direct Reference Codes:
    display code system
    Male M http://hl7.org/fhir/administrative-gender
    Female F http://hl7.org/fhir/administrative-gender
    HIV 1 and 2 tests - Meaningful Use set 75622-1 http://loinc.org
    refuted http://terminology.hl7.org/CodeSystem/condition-ver-status
    Logic Definitions:
    Group Scoring Population Criteria Expression
    6633d9196c1d307ea36e749d Group scoring: proportion Measure scoring:

    Proportion

    Type:

    Process

    Rate Aggregation: None
    Improvement Notation:

    increase

    Initial Population 
    define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") in Interval[15, 65]
    and exists "Qualifying Encounters"
    Denominator 
    define "Denominator":
  "Initial Population"
    Denominator Exclusion 
    define "Denominator Exclusions":
  exists ( ["Condition": "HIV"] ) HIV
    where HIV.prevalenceInterval ( ) starts before day of start of "Measurement Period"
      and HIV.verificationStatus !~ "refuted"
    Numerator 
    define "Numerator":
  ( "Has HIV Test Performed" )
    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
    HIVScreeningFHIR SDE Sex 
    define "SDE Sex":
  SDE."SDE Sex"
    Library Name Name
    HIVScreeningFHIR Has HIV Test Performed 
    define "Has HIV Test Performed":
  exists ( ["Observation": "Human Immunodeficiency Virus (HIV) Laboratory Test Codes (Ab and Ag)"]
    union ["Observation": "HIV 1 and 2 tests - Meaningful Use set"] ) HIVTest
    where HIVTest.value is not null
      and AgeInYearsAt(date from start of HIVTest.effective.toInterval()) in Interval[15, 65]
      and HIVTest.effective.toInterval ( ) starts before end of "Measurement Period"
      and ( HIVTest.status = 'final'
          or HIVTest.status = 'amended'
          or HIVTest.status = 'corrected'
      )
    Library Name Name
    HIVScreeningFHIR Numerator 
    define "Numerator":
  ( "Has HIV Test Performed" )
    Library Name Name
    HIVScreeningFHIR Qualifying Encounters 
    define "Qualifying Encounters":
  ( ["Encounter": "Preventive Care Services, Initial Office Visit, 0 to 17"]
    union ["Encounter": "Preventive Care Services-Initial Office Visit, 18 and Up"]
    union ["Encounter": "Preventive Care, Established Office Visit, 0 to 17"]
    union ["Encounter": "Preventive Care Services - Established Office Visit, 18 and Up"]
    union ["Encounter": "Office Visit"] ) Encounter
    where Encounter.period during day of "Measurement Period"
      and Encounter.status = 'finished'
    Library Name Name
    HIVScreeningFHIR Initial Population 
    define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") in Interval[15, 65]
    and exists "Qualifying Encounters"
    Library Name Name
    HIVScreeningFHIR 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
    HIVScreeningFHIR 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
    HIVScreeningFHIR SDE Ethnicity 
    define "SDE Ethnicity":
  SDE."SDE Ethnicity"
    Library Name Name
    HIVScreeningFHIR Denominator Exclusions 
    define "Denominator Exclusions":
  exists ( ["Condition": "HIV"] ) HIV
    where HIV.prevalenceInterval ( ) starts before day of start of "Measurement Period"
      and HIV.verificationStatus !~ "refuted"
    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
    HIVScreeningFHIR SDE Race 
    define "SDE Race":
  SDE."SDE Race"
    Library Name Name
    FHIRHelpers ToString 
    define function ToString(value uri): value.value
    Library Name Name
    FHIRHelpers ToCode 
    /*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }
    Library Name Name
    QICoreCommon prevalenceInterval 
    /*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting 
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
    (end of condition.abatementInterval()) abatementDate
    return if abatementDate is null then
      Interval[start of condition.onset.toInterval(), abatementDate)
    else
      Interval[start of condition.onset.toInterval(), abatementDate]