eCQM QICore Content Implementation Guide
2024.0.0 - CI Build
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
| Draft as of 2024-07-09 |
{
"resourceType" : "Measure",
"id" : "UseofHighRiskMedicationsintheElderlyFHIR",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"🔗 ,
"http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm"🔗 ,
"http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"
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},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <table class=\"grid dict\">\n \n <tr>\n <th scope=\"row\"><b>Title: </b></th>\n <td style=\"padding-left: 4px;\">Use of High-Risk Medications in Older AdultsFHIR</td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Id: </b></th>\n <td style=\"padding-left: 4px;\">UseofHighRiskMedicationsintheElderlyFHIR</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Version: </b></th>\n <td style=\"padding-left: 4px;\">0.2.001</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Url: </b></th>\n <td style=\"padding-left: 4px;\"><a href=\"Measure-UseofHighRiskMedicationsintheElderlyFHIR.html\">Use of High-Risk Medications in Older AdultsFHIR</a></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\">\n <b>\n \n \n short-name identifier:\n \n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>CMS156FHIR</span>\n </p>\n \n </td>\n </tr>\n \n <tr>\n <th scope=\"row\">\n <b>\n \n \n version-independent identifier:\n \n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>urn:uuid:fa08c5d7-5345-4e0b-aa2d-d937099db108</span>\n </p>\n \n </td>\n </tr>\n \n <tr>\n <th scope=\"row\">\n <b>\n \n \n version-specific identifier:\n \n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>urn:uuid:d9904550-61cd-4ea8-b36b-9d808a339278</span>\n </p>\n \n </td>\n </tr>\n \n <tr>\n <th scope=\"row\">\n <b>\n \n \n publisher (CMS) identifier:\n \n \n </b>\n </th>\n\n <td style=\"padding-left: 4px;\">\n \n <p style=\"margin-bottom: 5px;\">\n <span>156FHIR</span>\n </p>\n \n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Effective Period: </b></th>\n <td style=\"padding-left: 4px;\">2025-01-01..2025-12-31</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Status: </b></th>\n <td style=\"padding-left: 4px;\">draft</td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Publisher: </b></th>\n <td style=\"padding-left: 4px;\">National Committee for Quality Assurance</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Author: </b></th>\n <td style=\"padding-left: 4px;\">National Committee for Quality Assurance</td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Description: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported.</p>\n<ol>\n<li>Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class.</li>\n<li>Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses.</li>\n<li>Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators).</li>\n</ol>\n</div></td>\n </tr>\n \n\n \n\n \n\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Purpose: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>UNKNOWN</p>\n</div></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Copyright: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract HHSM-500-2011-00079C) with the National Committee for Quality Assurance (NCQA) to develop this electronic measure. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications.</p>\n<p>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. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications.</p>\n<p>CPT(R) codes, descriptions and other data are copyright 2024. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use.</p>\n<p>The measure specifications contain coding from LOINC(R) (http://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use.</p>\n<p>This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation.</p>\n<p>ICD-10 copyright 2024 World Health Organization. All Rights Reserved.</p>\n<p>The Measure uses RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the Measure and does not endorse or recommend this or any other product.</p>\n<p>“HL7” is the registered trademark of Health Level Seven International.</p>\n</div></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Disclaimer: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>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 MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.</p>\n<p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>\n</div></td>\n </tr>\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Scoring: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Proportion </span>\n </p>\n \n \n \n </td>\n </tr>\n \n\n \n\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Rationale: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>Certain medications (MacKinnon & Hepler, 2003) are associated with increased risk of harm from drug side-effects and drug toxicity and pose a concern for patient safety. There is clinical consensus that these drugs pose increased risks in older adults (Kaufman, Brodin, & Sarafian, 2005). Potentially inappropriate medication (PIM) use in older adults has been connected to significantly longer hospital stay lengths and increased hospitalization costs (Hagstrom et al., 2015) as well as increased risk of death (Lau et al., 2004). Use of specific high-risk medications such as hypnotics, including benzodiazepine receptor agonists, and nonsteroidal anti-inflammatory drugs (NSAIDS) can result in increased risk of delirium, falls, fractures, gastrointestinal bleeding and acute kidney injury (Merel & Paauw, 2017). Long-term use of benzodiazepines in older adults has been associated with increased risk of dementia (Zhong, Wang, Zhang, & Zhao, 2015; Takada et al., 2016). Additionally, the use of antipsychotics can lead to increased risk of stroke and greater cognitive decline in older adults with dementia (Tampi et al., 2016). Among Medicare beneficiaries it is estimated that the prevalence of PIM use was 77% among long-stay nursing home residents (defined as >101 consecutive days in a nursing home). The most common PIMs were benzodiazepines, antipsychotics, and insulin (Riester et al., 2023).</p>\n<p>Older adults receiving inappropriate medications are more likely to report poorer health status at follow-up, compared to those who receive appropriate medications (Fu, Liu, & Christensen, 2004). A study of the prevalence of potentially inappropriate medication use in older adults found that 40 percent of individuals 65 and older filled at least one prescription for a potentially inappropriate medication and 13 percent filled two or more (Fick et al., 2008). While some adverse drug events (ADEs) are unavoidable, studies estimate that between 30 and 80 percent of ADEs in older adults are preventable (MacKinnon & Hepler, 2003). More recently with the onset of the COVID-19 pandemic, several studies have shown an increase in anxiety, insomnia and depression rates, which could result in an increase in the use of high-risk medications in order to treat these conditions (Agrawal, 2020).</p>\n<p>Reducing the number of inappropriate prescriptions can lead to improved patient safety and significant cost savings. Conservative estimates of extra costs due to potentially inappropriate medications in older adults average $7.2 billion a year (Fu et al., 2007). Medication use by older adults will likely increase further as the U.S. population ages, new drugs are developed, and new therapeutic and preventive uses for medications are discovered (Rothberg et al., 2008). The annual direct costs of preventable ADEs in the Medicare population have been estimated to exceed $800 million (Institute of Medicine, 2007). By the year 2030, nearly one in five U.S. residents is expected to be aged 65 years or older; this age group is projected to more than double from 38.7 million in 2008 to more than 88.5 million in 2050. Likewise, the population aged 85 years or older is expected to increase almost four-fold, from 5.4 million to 19 million between 2008 and 2050. As the older adult population continues to grow, the number of older adults who present with multiple medical conditions for which several medications are prescribed will likely continue to increase, resulting in polypharmacy concerns (Gray & Gardner, 2009).</p>\n</div></td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Clinical recommendation statement: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>The measure is based on recommendations from the American Geriatrics Society Beers Criteria[R] for Potentially Inappropriate Medication Use in Older Adults (2023). The criteria were developed through key clinical expert consensus processes by Beers in 1997, Zhan in 2001, Fick et al. in 2003, 2012, 2015, and 2019 and, most recently the American Geriatrics Society Beers Criteria Update Expert Panel in 2023. The Beers Criteria identifies lists of drugs that are potentially inappropriate for all older adults, except for those with certain conditions for which some high-risk medications may be warranted, and drugs that are potentially inappropriate in older adults based on various high-risk factors such as dosage, days supply and underlying diseases or conditions.\nNCQA's Geriatric Measurement Advisory Panel recommended a subset of drugs that should be used with caution in older adults for inclusion in the measure based upon the recommendations in the Beers Criteria.</p>\n</div></td>\n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Guidance (Usage): </b></th>\n <td style=\"padding-left: 4px;\">The intent of the measure is to assess if the patient has been ordered at least two high-risk medication prescriptions from the same drug class on different days.\n\nThe intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication from the same drug class for them.\n\nCalculate average daily dose for each prescription event. To calculate average daily dose, multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a prescription for the 30-days supply of digoxin containing 15 pills, 0.25 mg each pill, has an average daily dose of 0.125 mg. To calculate average daily dose for elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose.\n\nThis eCQM is a patient-based measure.\n\nThis FHIR-based measure has been derived from the QDM-based measure:\u202f CMS156v13.\n\nPlease refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).</td>\n </tr>\n \n\n \n \n <tr>\n <th scope=\"row\"><b>Population Criteria: </b></th>\n <td style=\"padding-left: 4px;\">\n \n <table class=\"grid-dict\">\n \n <tr>\n <th><b>66460d4ef4fc785d8711734b</b></th>\n </tr>\n \n \n <tr>\n <td>Initial Population:</td>\n\n \n \n <td>Patients 65 years and older at the end of the measurement period who had a visit during the measurement period</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator:</td>\n\n \n \n <td>Equals Initial Population</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator Exclusion:</td>\n\n \n \n <td>Exclude patients who are in hospice care for any part of the measurement period.\n\nExclude patients receiving palliative care for any part of the measurement period.</td>\n \n \n\n </tr>\n \n <tr>\n <td>Numerator:</td>\n\n \n \n <td>Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days.\na. At least two orders of high-risk medications from the same drug class.\nb. At least two orders of high-risk medications from the same drug class with summed days supply greater than 90 days.\nc. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria.</td>\n \n \n\n </tr>\n \n \n </table>\n \n <table class=\"grid-dict\">\n \n <tr>\n <th><b>66460d4ef4fc785d8711734c</b></th>\n </tr>\n \n \n <tr>\n <td>Initial Population:</td>\n\n \n \n <td>Patients 65 years and older at the end of the measurement period who had a visit during the measurement period</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator:</td>\n\n \n \n <td>Equals Initial Population</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator Exclusion:</td>\n\n \n \n <td>Exclude patients who are in hospice care for any part of the measurement period.\n\nExclude patients receiving palliative care for any part of the measurement period.</td>\n \n \n\n </tr>\n \n <tr>\n <td>Numerator:</td>\n\n \n \n <td>Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines) on different days except for appropriate diagnoses.\na. Patients with two or more antipsychotic prescriptions ordered on different days, and who did not have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the IPSD for antipsychotics. \nb. Patients with two or more benzodiazepine prescriptions ordered on different days, and who did not have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines.\n</td>\n \n \n\n </tr>\n \n \n </table>\n \n <table class=\"grid-dict\">\n \n <tr>\n <th><b>66460d4ef4fc785d8711734d</b></th>\n </tr>\n \n \n <tr>\n <td>Initial Population:</td>\n\n \n \n <td>Patients 65 years and older at the end of the measurement period who had a visit during the measurement period</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator:</td>\n\n \n \n <td>Equals Initial Population</td>\n \n \n\n </tr>\n \n <tr>\n <td>Denominator Exclusion:</td>\n\n \n \n <td>Exclude patients who are in hospice care for any part of the measurement period.\n\nExclude patients receiving palliative care for any part of the measurement period.</td>\n \n \n\n </tr>\n \n <tr>\n <td>Numerator:</td>\n\n \n \n <td>Total rate (the sum of the two previous numerators, deduplicated).</td>\n \n \n\n </tr>\n \n \n </table>\n \n </td>\n </tr>\n \n \n\n \n\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Libraries: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n \n <tr>\n <td><a href=\"Library-UseofHighRiskMedicationsintheElderlyFHIR.html\">UseofHighRiskMedicationsintheElderlyFHIR</a></td>\n </tr>\n \n </table>\n </td>\n </tr>\n \n\n \n\n \n \n <tr>\n <th scope=\"row\"><b>Terminology and Other Dependencies: </b></th>\n <td style=\"padding-left: 4px;\">\n \n <li><code>Library/Status|1.8.000</code></li>\n \n <li><code>Library/CumulativeMedicationDuration|4.1.000</code></li>\n \n <li><code>Library/FHIRHelpers|4.4.000</code></li>\n \n <li><code>Library/QICoreCommon|2.1.000</code></li>\n \n <li><code>Library/CQMCommon|2.2.000</code></li>\n \n <li><code>Library/Hospice|6.12.000</code></li>\n \n <li><code>Library/PalliativeCare|1.11.000</code></li>\n \n <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html\">RxNorm</a></li>\n \n <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-CPT.html\">Current Procedural Terminology (CPT®)</a></li>\n \n <li><a href=\"http://hl7.org/fhir/R4/codesystem-snomedct.html\">SNOMED CT (all versions)</a></li>\n \n <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-observation-category.html\">Observation Category Codes</a></li>\n \n <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html\">Logical Observation Identifiers, Names and Codes (LOINC)</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1523/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1523</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1205/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1205</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.67.1.101.1.128/expansion\">Bipolar Disorder</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1522/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1522</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1206/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1206</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1207/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1207</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1208/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1208</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1209/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1209</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1210/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1210</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1043/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1043</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1049/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1049</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1050/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1050</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1051/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1051</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.11.1252/expansion\">Guanfacine</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1053/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1053</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1054/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1054</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1055/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1055</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1057/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1057</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1058/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1058</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1059/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1059</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1060/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1060</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1480/expansion\">Nonbenzodiazepine hypnotics</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1062/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1062</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1063/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1063</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1247/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1247</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1248/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1248</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1481/expansion\">Anti Infectives, other</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1065/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1065</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1067/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1067</a></li>\n \n <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>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1285/expansion\">Ophthalmological Services</a></li>\n \n <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>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1013/expansion\">Discharge Services - Nursing Facility</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1012/expansion\">Nursing Facility Visit</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1014/expansion\">Care Services in Long-Term Residential Facility</a></li>\n \n <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>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion\">Annual Wellness Visit</a></li>\n \n <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>\n \n <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>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1089/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion\">Hospice Care Ambulatory</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1167/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1090/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090</a></li>\n \n <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1135/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135</a></li>\n \n </td>\n </tr>\n <tr>\n <th scope=\"row\"><b>Parameters:</b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr>\n <th><b>name</b></th>\n <th><b>use</b></th>\n <th><b>min</b></th>\n <th><b>max</b></th>\n <th><b>type</b></th>\n </tr>\n \n <tr>\n <td>Measurement Period</td>\n <td>In</td>\n <td>0</td>\n <td>1</td>\n <td>Period</td>\n </tr>\n \n <tr>\n <td>ErrorLevel</td>\n <td>In</td>\n <td>0</td>\n <td>1</td>\n <td>string</td>\n </tr>\n \n <tr>\n <td>Numerator 3</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>boolean</td>\n </tr>\n \n <tr>\n <td>Denominator</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>boolean</td>\n </tr>\n \n <tr>\n <td>Numerator 1</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>boolean</td>\n </tr>\n \n <tr>\n <td>Numerator 2</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>boolean</td>\n </tr>\n \n <tr>\n <td>Initial Population</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>boolean</td>\n </tr>\n \n <tr>\n <td>Denominator Exclusions</td>\n <td>Out</td>\n <td>0</td>\n <td>1</td>\n <td>boolean</td>\n </tr>\n \n </table>\n </td>\n </tr>\n\n <tr>\n <th scope=\"row\"><b>DataRequirements:</b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr>\n <th><b>Resource Type</b></th>\n <th><b>Resource Elements</b></th>\n <th><b>Valueset Name</b></th>\n <th><b>Valueset</b></th>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Potentially Harmful Antipsychotics for Older Adults\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1523/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1523</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Potentially Harmful Benzodiazepines for Older Adults\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1522/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1522</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Potentially Harmful Antihistamines for Older Adults\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1043/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1043</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Potentially Harmful Antiparkinsonian Agents for Older Adults\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1049/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1049</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Potentially Harmful Gastrointestinal Antispasmodics for Older Adults\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1050/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1050</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Dipyridamole Medications\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1051/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1051</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Guanfacine Medications\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.11.1252/expansion\">Guanfacine</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Nifedipine Medications\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1053/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1053</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Potentially Harmful Antidepressants for Older Adults\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1054/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1054</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Potentially Harmful Barbiturates for Older Adults\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1055/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1055</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Meprobamate Medications\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1057/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1057</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Potentially Harmful Estrogens for Older Adults\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1058/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1058</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Potentially Harmful Sulfonylureas for Older Adults\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1059/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1059</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Desiccated Thyroid Medications\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1060/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1060</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Potentially Harmful Nonbenzodiazepine Hypnotics for Older Adults\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1480/expansion\">Nonbenzodiazepine hypnotics</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Potentially Harmful Skeletal Muscle Relaxants for Older Adults\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1062/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1062</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Potentially Harmful Pain Medications for Older Adults\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1063/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1063</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Megestrol Medications\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1247/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1247</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Meperidine Medications\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1248/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1248</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Potentially Harmful Antiinfectives for Older Adults\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.12.1481/expansion\">Anti Infectives, other</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Digoxin Medications\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1065/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1065</a></td>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication.reference\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n <td>\n \n medication\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n dosageInstruction\n \n dispenseRequest\n \n dispenseRequest.expectedSupplyDuration\n \n dispenseRequest.quantity\n \n dispenseRequest.numberOfRepeatsAllowed\n \n dispenseRequest.numberOfRepeatsAllowed.value\n \n authoredOn\n \n authoredOn.value\n \n dispenseRequest.validityPeriod\n \n </td>\n <td>\n \n \n Doxepin Medications\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1067/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1067</a></td>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n <td>\n \n id\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n <td>\n \n code\n \n </td>\n <td>\n \n \n Schizophrenia\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1205/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1205</a></td>\n </tr>\n \n <tr>\n <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n <td>\n \n code\n \n </td>\n <td>\n \n \n Bipolar Disorder\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.67.1.101.1.128/expansion\">Bipolar Disorder</a></td>\n </tr>\n \n <tr>\n <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n <td>\n \n code\n \n </td>\n <td>\n \n \n Seizure Disorder\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1206/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1206</a></td>\n </tr>\n \n <tr>\n <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n <td>\n \n code\n \n </td>\n <td>\n \n \n REM Sleep Behavior Disorder\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1207/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1207</a></td>\n </tr>\n \n <tr>\n <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n <td>\n \n code\n \n </td>\n <td>\n \n \n Benzodiazepine Withdrawal\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1208/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1208</a></td>\n </tr>\n \n <tr>\n <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n <td>\n \n code\n \n </td>\n <td>\n \n \n Alcohol Withdrawal\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1209/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1209</a></td>\n </tr>\n \n <tr>\n <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n <td>\n \n code\n \n </td>\n <td>\n \n \n Generalized Anxiety Disorder\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1210/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1210</a></td>\n </tr>\n \n <tr>\n <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n <td>\n \n code\n \n </td>\n <td>\n \n \n Hospice Diagnosis\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1165/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165</a></td>\n </tr>\n \n <tr>\n <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n <td>\n \n code\n \n </td>\n <td>\n \n \n Palliative Care Diagnosis\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1167/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167</a></td>\n </tr>\n \n <tr>\n <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n <td>\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Office Visit\n \n \n </td>\n <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>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Ophthalmological Services\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1285/expansion\">Ophthalmological Services</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Preventive Care Services Established Office Visit, 18 and Up\n \n \n </td>\n <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>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Discharge Services Nursing Facility\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1013/expansion\">Discharge Services - Nursing Facility</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Nursing Facility Visit\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1012/expansion\">Nursing Facility Visit</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Care Services in Long Term Residential Facility\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1014/expansion\">Care Services in Long-Term Residential Facility</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Preventive Care Services Initial Office Visit, 18 and Up\n \n \n </td>\n <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>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Annual Wellness Visit\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion\">Annual Wellness Visit</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Home Healthcare Services\n \n \n </td>\n <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>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Telephone Visits\n \n \n </td>\n <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>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n status\n \n status.value\n \n period\n \n </td>\n <td>\n \n \n Virtual Encounter\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1089/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n hospitalization\n \n hospitalization.dischargeDisposition\n \n period\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Encounter Inpatient\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n period\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Hospice Encounter\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1003/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003</a></td>\n </tr>\n \n <tr>\n <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n <td>\n \n type\n \n period\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Palliative Care Encounter\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1090/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090</a></td>\n </tr>\n \n <tr>\n <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n <td>\n \n code\n \n value\n \n effective\n \n status\n \n status.value\n \n category\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n <td>\n \n code\n \n effective\n \n status\n \n status.value\n \n category\n \n </td>\n <td>\n \n </td>\n <td/>\n </tr>\n \n <tr>\n <td>ServiceRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html\">QICoreServiceRequest</a>)</td>\n <td>\n \n code\n \n authoredOn\n \n authoredOn.value\n \n status\n \n status.value\n \n intent\n \n intent.value\n \n </td>\n <td>\n \n \n Hospice Care Ambulatory\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion\">Hospice Care Ambulatory</a></td>\n </tr>\n \n <tr>\n <td>Procedure(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html\">QICoreProcedure</a>)</td>\n <td>\n \n code\n \n performed\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Hospice Care Ambulatory\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion\">Hospice Care Ambulatory</a></td>\n </tr>\n \n <tr>\n <td>Procedure(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html\">QICoreProcedure</a>)</td>\n <td>\n \n code\n \n performed\n \n status\n \n status.value\n \n </td>\n <td>\n \n \n Palliative Care Intervention\n \n \n </td>\n <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1135/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135</a></td>\n </tr>\n \n </table>\n </td>\n </tr>\n\n \n <tr>\n <th scope=\"row\"><b>Direct Reference Codes:</b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr>\n <th><b>display</b></th>\n <th><b>code</b></th>\n <th><b>system</b></th>\n </tr>\n \n <tr>\n <td>ergoloid mesylates, USP 1 MG Oral Tablet</td>\n <td>318179</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html\">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>\n </tr>\n \n <tr>\n <td>digoxin 0.05 MG/ML Oral Solution</td>\n <td>393245</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html\">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>\n </tr>\n \n <tr>\n <td>digoxin 0.0625 MG Oral Tablet</td>\n <td>245273</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html\">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>\n </tr>\n \n <tr>\n <td>1 ML digoxin 0.1 MG/ML Injection</td>\n <td>204504</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html\">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>\n </tr>\n \n <tr>\n <td>digoxin 0.125 MG Oral Tablet</td>\n <td>197604</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html\">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>\n </tr>\n \n <tr>\n <td>digoxin 0.25 MG Oral Tablet</td>\n <td>197606</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html\">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>\n </tr>\n \n <tr>\n <td>2 ML digoxin 0.25 MG/ML Injection</td>\n <td>104208</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html\">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>\n </tr>\n \n <tr>\n <td>doxepin 3 MG Oral Tablet</td>\n <td>966787</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html\">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>\n </tr>\n \n <tr>\n <td>doxepin 6 MG Oral Tablet</td>\n <td>966793</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html\">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>\n </tr>\n \n <tr>\n <td>doxepin 10 MG Oral Capsule</td>\n <td>1000048</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html\">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>\n </tr>\n \n <tr>\n <td>doxepin 10 MG/ML Oral Solution</td>\n <td>1000054</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html\">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>\n </tr>\n \n <tr>\n <td>doxepin 25 MG Oral Capsule</td>\n <td>1000070</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html\">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>\n </tr>\n \n <tr>\n <td>doxepin 50 MG Oral Capsule</td>\n <td>1000076</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html\">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>\n </tr>\n \n <tr>\n <td>doxepin 75 MG Oral Capsule</td>\n <td>1000097</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html\">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>\n </tr>\n \n <tr>\n <td>doxepin 100 MG Oral Capsule</td>\n <td>1000058</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html\">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>\n </tr>\n \n <tr>\n <td>doxepin 150 MG Oral Capsule</td>\n <td>1000064</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html\">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>\n </tr>\n \n <tr>\n <td>Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional</td>\n <td>99211</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-CPT.html\">http://www.ama-assn.org/go/cpt</a></td>\n </tr>\n \n <tr>\n <td>Discharge to home for hospice care (procedure)</td>\n <td>428361000124107</td>\n <td><a href=\"http://hl7.org/fhir/R4/codesystem-snomedct.html\">http://snomed.info/sct</a></td>\n </tr>\n \n <tr>\n <td>Discharge to healthcare facility for hospice care (procedure)</td>\n <td>428371000124100</td>\n <td><a href=\"http://hl7.org/fhir/R4/codesystem-snomedct.html\">http://snomed.info/sct</a></td>\n </tr>\n \n <tr>\n <td>survey</td>\n <td>survey</td>\n <td><a href=\"http://hl7.org/fhir/R4/codesystem-observation-category.html\">http://terminology.hl7.org/CodeSystem/observation-category</a></td>\n </tr>\n \n <tr>\n <td>Yes (qualifier value)</td>\n <td>373066001</td>\n <td><a href=\"http://hl7.org/fhir/R4/codesystem-snomedct.html\">http://snomed.info/sct</a></td>\n </tr>\n \n <tr>\n <td>Hospice care [Minimum Data Set]</td>\n <td>45755-6</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html\">http://loinc.org</a></td>\n </tr>\n \n <tr>\n <td>Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)</td>\n <td>71007-9</td>\n <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html\">http://loinc.org</a></td>\n </tr>\n \n </table>\n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Logic Definitions:</b></th>\n <td style=\"padding-left: 4px;\">\n \n <table class=\"grid-dict\">\n <tr>\n <th><b>Group</b></th>\n <th><b>Scoring</b></th>\n <th><b>Population Criteria</b></th>\n <th><b>Expression</b></th>\n </tr>\n <tr>\n \n <td> 66460d4ef4fc785d8711734b </td>\n <td colspan=\"3\" style=\"padding-left: 4px;\">\n \n <b>Group scoring:</b>\n \n <span> proportion </span>\n \n \n\n \n\n \n <b>Measure scoring:</b>\n \n <p style=\"margin-bottom: 5px;\">\n <span>Proportion</span>\n </p>\n \n \n\n \n\n \n <tr>\n \n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Process </span>\n </p>\n \n \n \n </td>\n \n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Rate Aggregation: </b></th>\n <td colspan=\"3\" style=\"padding-left: 4px;\">None</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Improvement Notation: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n \n <p style=\"margin-bottom: 5px;\">\n <span>increase </span>\n </p>\n \n \n \n \n </td>\n </tr>\n \n\n \n\n </td>\n \n <tr>\n <td/>\n <td/>\n <td>Initial Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Initial Population":\n AgeInYearsAt(date from \n end of "Measurement Period"\n ) >= 65\n and exists ( "Qualifying Encounters" )</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Denominator":\n "Initial Population"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator Exclusion</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Denominator Exclusions":\n Hospice."Has Hospice Services"\n or PalliativeCare."Has Palliative Care in the Measurement Period"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Numerator</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Numerator 1":\n exists ( "Same High Risk Medications Ordered on Different Days" )\n or ( "Two High Risk Medications with Prolonged Duration" )\n or ( "High Risk Medications with Average Daily Dose Criteria" )</code></pre>\n \n </td>\n </tr>\n \n \n \n <td> 66460d4ef4fc785d8711734c </td>\n <td colspan=\"3\" style=\"padding-left: 4px;\">\n \n <b>Group scoring:</b>\n \n <span> proportion </span>\n \n \n\n \n\n \n <b>Measure scoring:</b>\n \n <p style=\"margin-bottom: 5px;\">\n <span>Proportion</span>\n </p>\n \n \n\n \n\n \n <tr>\n \n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Process </span>\n </p>\n \n \n \n </td>\n \n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Rate Aggregation: </b></th>\n <td colspan=\"3\" style=\"padding-left: 4px;\">None</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Improvement Notation: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n \n <p style=\"margin-bottom: 5px;\">\n <span>increase </span>\n </p>\n \n \n \n \n </td>\n </tr>\n \n\n \n\n </td>\n \n <tr>\n <td/>\n <td/>\n <td>Initial Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Initial Population":\n AgeInYearsAt(date from \n end of "Measurement Period"\n ) >= 65\n and exists ( "Qualifying Encounters" )</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Denominator":\n "Initial Population"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator Exclusion</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Denominator Exclusions":\n Hospice."Has Hospice Services"\n or PalliativeCare."Has Palliative Care in the Measurement Period"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Numerator</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Numerator 2":\n ( "More than One Antipsychotic Order"\n and ( not exists ( ( [Condition: "Schizophrenia"]\n union [Condition: "Bipolar Disorder"] ) AntipsychoticTreatedDiagnoses\n where AntipsychoticTreatedDiagnoses.prevalenceInterval ( ) overlaps Interval[start of "Measurement Period" - 1 year, "Antipsychotic Index Prescription Start Date"]\n )\n )\n )\n or ( "More than One Benzodiazepine Order"\n and ( not exists ( ( [Condition: "Seizure Disorder"]\n union [Condition: "REM Sleep Behavior Disorder"]\n union [Condition: "Benzodiazepine Withdrawal"]\n union [Condition: "Alcohol Withdrawal"]\n union [Condition: "Generalized Anxiety Disorder"] ) BenzodiazepineTreatedDiagnoses\n where BenzodiazepineTreatedDiagnoses.prevalenceInterval ( ) overlaps Interval[start of "Measurement Period" - 1 year, "Benzodiazepine Index Prescription Start Date"]\n )\n )\n )</code></pre>\n \n </td>\n </tr>\n \n \n \n <td> 66460d4ef4fc785d8711734d </td>\n <td colspan=\"3\" style=\"padding-left: 4px;\">\n \n <b>Group scoring:</b>\n \n <span> proportion </span>\n \n \n\n \n\n \n <b>Measure scoring:</b>\n \n <p style=\"margin-bottom: 5px;\">\n <span>Proportion</span>\n </p>\n \n \n\n \n\n \n <tr>\n \n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <span>Process </span>\n </p>\n \n \n \n </td>\n \n </tr>\n \n\n \n\n \n <tr>\n <th scope=\"row\"><b>Rate Aggregation: </b></th>\n <td colspan=\"3\" style=\"padding-left: 4px;\">None</td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Improvement Notation: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n \n <p style=\"margin-bottom: 5px;\">\n <span>increase </span>\n </p>\n \n \n \n \n </td>\n </tr>\n \n\n \n\n </td>\n \n <tr>\n <td/>\n <td/>\n <td>Initial Population</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Initial Population":\n AgeInYearsAt(date from \n end of "Measurement Period"\n ) >= 65\n and exists ( "Qualifying Encounters" )</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Denominator":\n "Initial Population"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Denominator Exclusion</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Denominator Exclusions":\n Hospice."Has Hospice Services"\n or PalliativeCare."Has Palliative Care in the Measurement Period"</code></pre>\n \n </td>\n </tr>\n \n <tr>\n <td/>\n <td/>\n <td>Numerator</td>\n <td>\n \n <pre><code class=\"language-cql\">define "Numerator 3":\n "Numerator 2"\n or ( "Numerator 1"\n and not "Numerator 2"\n )</code></pre>\n \n </td>\n </tr>\n \n \n \n </tr>\n </table>\n \n\n <table class=\"grid-dict\">\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>More than One Antipsychotic Order</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "More than One Antipsychotic Order":\n exists ( ( [MedicationRequest: "Potentially Harmful Antipsychotics for Older Adults"] ).moreThanOneOrder ( ) )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>Antipsychotic Index Prescription Start Date</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Antipsychotic Index Prescription Start Date":\n First((([MedicationRequest: "Potentially Harmful Antipsychotics for Older Adults"]).isMedicationOrder()) AntipsychoticMedication\n where AntipsychoticMedication.authoredOn during "Measurement Period"\n return AntipsychoticMedication.authoredOn\n sort asc\n )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>More than One Benzodiazepine Order</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "More than One Benzodiazepine Order":\n exists ( ( [MedicationRequest: "Potentially Harmful Benzodiazepines for Older Adults"] ).moreThanOneOrder ( ) )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>Benzodiazepine Index Prescription Start Date</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Benzodiazepine Index Prescription Start Date":\n First((([MedicationRequest: "Potentially Harmful Benzodiazepines for Older Adults"]).isMedicationOrder()) BenzodiazepineMedication\n where BenzodiazepineMedication.authoredOn during "Measurement Period"\n return BenzodiazepineMedication.authoredOn\n sort asc\n )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>Numerator 2</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Numerator 2":\n ( "More than One Antipsychotic Order"\n and ( not exists ( ( [Condition: "Schizophrenia"]\n union [Condition: "Bipolar Disorder"] ) AntipsychoticTreatedDiagnoses\n where AntipsychoticTreatedDiagnoses.prevalenceInterval ( ) overlaps Interval[start of "Measurement Period" - 1 year, "Antipsychotic Index Prescription Start Date"]\n )\n )\n )\n or ( "More than One Benzodiazepine Order"\n and ( not exists ( ( [Condition: "Seizure Disorder"]\n union [Condition: "REM Sleep Behavior Disorder"]\n union [Condition: "Benzodiazepine Withdrawal"]\n union [Condition: "Alcohol Withdrawal"]\n union [Condition: "Generalized Anxiety Disorder"] ) BenzodiazepineTreatedDiagnoses\n where BenzodiazepineTreatedDiagnoses.prevalenceInterval ( ) overlaps Interval[start of "Measurement Period" - 1 year, "Benzodiazepine Index Prescription Start Date"]\n )\n )\n )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>Same High Risk Medications Ordered on Different Days</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Same High Risk Medications Ordered on Different Days":\n ( [MedicationRequest: "Potentially Harmful Antihistamines for Older Adults"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: "Potentially Harmful Antiparkinsonian Agents for Older Adults"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: "Potentially Harmful Gastrointestinal Antispasmodics for Older Adults"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: "Dipyridamole Medications"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: "Guanfacine Medications"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: "Nifedipine Medications"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: "Potentially Harmful Antidepressants for Older Adults"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: "Potentially Harmful Barbiturates for Older Adults"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: "ergoloid mesylates, USP 1 MG Oral Tablet"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: "Meprobamate Medications"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: "Potentially Harmful Estrogens for Older Adults"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: "Potentially Harmful Sulfonylureas for Older Adults"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: "Desiccated Thyroid Medications"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: "Potentially Harmful Nonbenzodiazepine Hypnotics for Older Adults"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: "Potentially Harmful Skeletal Muscle Relaxants for Older Adults"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: "Potentially Harmful Pain Medications for Older Adults"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: "Megestrol Medications"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: "Meperidine Medications"] ).moreThanOneOrder ( )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>Two High Risk Medications with Prolonged Duration</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Two High Risk Medications with Prolonged Duration":\n Sum((([MedicationRequest: "Potentially Harmful Antiinfectives for Older Adults"]).moreThanOneOrder()) AntiInfectives\n let DaysSupply: AntiInfectives.MedicationRequestPeriodInDays()\n return all DaysSupply\n ) > 90</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>High Risk Medications with Average Daily Dose Criteria</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "High Risk Medications with Average Daily Dose Criteria":\n exists ( ( ( [MedicationRequest: "Digoxin Medications"] ).moreThanOneOrder ( ) ) DigoxinOrdered\n where ( DigoxinOrdered ).averageDailyDose ( ) > 0.125 'mg/d'\n )\n or exists ( ( ( [MedicationRequest: "Doxepin Medications"] ).moreThanOneOrder ( ) ) DoxepinOrdered\n where ( DoxepinOrdered ).averageDailyDose ( ) > 6 'mg/d'\n )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>Numerator 1</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Numerator 1":\n exists ( "Same High Risk Medications Ordered on Different Days" )\n or ( "Two High Risk Medications with Prolonged Duration" )\n or ( "High Risk Medications with Average Daily Dose Criteria" )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>Numerator 3</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Numerator 3":\n "Numerator 2"\n or ( "Numerator 1"\n and not "Numerator 2"\n )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>Qualifying Encounters</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Qualifying Encounters":\n ( ( [Encounter: "Office Visit"]\n union [Encounter: "Ophthalmological Services"]\n union [Encounter: "Preventive Care Services Established Office Visit, 18 and Up"]\n union [Encounter: "Discharge Services Nursing Facility"]\n union [Encounter: "Nursing Facility Visit"]\n union [Encounter: "Care Services in Long Term Residential Facility"]\n union [Encounter: "Preventive Care Services Initial Office Visit, 18 and Up"]\n union [Encounter: "Annual Wellness Visit"]\n union [Encounter: "Home Healthcare Services"]\n union [Encounter: "Telephone Visits"]\n union [Encounter: "Virtual Encounter"]\n union ( [Encounter] E\n where exists ( ( E.type ) T\n where T ~ "Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional"\n )\n )\n ).isEncounterPerformed ( ) ) ValidEncounters\n where ValidEncounters.period during "Measurement Period"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>Initial Population</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Initial Population":\n AgeInYearsAt(date from \n end of "Measurement Period"\n ) >= 65\n and exists ( "Qualifying Encounters" )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>Denominator</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Denominator":\n "Initial Population"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>Hospice</td>\n \n \n <td>Has Hospice Services</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Has Hospice Services":\n exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter\n where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"\n or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"\n )\n and InpatientEncounter.period.toInterval() ends during day of "Measurement Period"\n )\n or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter\n where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period"\n )\n or exists ((([Observation: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment\n where HospiceAssessment.value ~ "Yes (qualifier value)"\n and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"\n )\n or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder\n where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period"\n // and HospiceOrder.doNotPerform is not true\n // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447\n )\n or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed\n where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"\n )\n or exists (([Condition: "Hospice Diagnosis"]) HospiceCareDiagnosis\n where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"\n )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>PalliativeCare</td>\n \n \n <td>Has Palliative Care in the Measurement Period</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Has Palliative Care in the Measurement Period":\n exists ((([Observation: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment\n where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period"\n )\n or exists ([Condition: "Palliative Care Diagnosis"] PalliativeDiagnosis\n where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"\n )\n or exists ((([Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter\n where PalliativeEncounter.period.toInterval() overlaps day of "Measurement Period"\n )\n or exists ((([Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention\n where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement Period"\n )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>Denominator Exclusions</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define "Denominator Exclusions":\n Hospice."Has Hospice Services"\n or PalliativeCare."Has Palliative Care in the Measurement Period"</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>moreThanOneOrder</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define fluent function "moreThanOneOrder"(Medication List<MedicationRequest>):\n ( Medication.isMedicationOrder ( ) ) OrderMedication1\n with ( Medication.isMedicationOrder ( ) ) OrderMedication2\n such that ( OrderMedication1.authoredOn during "Measurement Period"\n and OrderMedication1.dispenseRequest.numberOfRepeatsAllowed >= 1\n )\n or ( date from OrderMedication1.authoredOn !~ date from OrderMedication2.authoredOn\n and OrderMedication1.authoredOn during "Measurement Period"\n and OrderMedication2.authoredOn during "Measurement Period"\n )\n or ( date from OrderMedication1.authoredOn ~ date from OrderMedication2.authoredOn\n and OrderMedication1.authoredOn during "Measurement Period"\n and date from start of OrderMedication1.medicationRequestPeriod ( ) !~ date from start of OrderMedication2.medicationRequestPeriod ( )\n and start of OrderMedication1.medicationRequestPeriod ( ) during "Measurement Period"\n and start of OrderMedication2.medicationRequestPeriod ( ) during "Measurement Period"\n )\n return OrderMedication1</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>Status</td>\n \n \n <td>isMedicationOrder</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">//Medication, Order: active and completed only\ndefine fluent function isMedicationOrder(MedicationRequest List<MedicationRequest>):\n MedicationRequest M\n where M.status in { 'active', 'completed' }\n and M.intent = 'order'</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CumulativeMedicationDuration</td>\n \n \n <td>medicationRequestPeriod</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define fluent function medicationRequestPeriod(Request "MedicationRequest"):\n Request R\n let\n dosage: singleton from R.dosageInstruction,\n doseAndRate: singleton from dosage.doseAndRate,\n timing: dosage.timing,\n frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),\n period: Quantity(timing.repeat.period, timing.repeat.periodUnit),\n doseRange: doseAndRate.dose,\n doseQuantity: doseAndRate.dose,\n dose: Coalesce(end of doseRange, doseQuantity),\n dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),\n boundsPeriod: timing.repeat.bounds as Interval<DateTime>,\n daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value,\n quantity: R.dispenseRequest.quantity,\n refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),\n startDate:\n Coalesce(\n date from start of boundsPeriod,\n date from R.authoredOn,\n date from start of R.dispenseRequest.validityPeriod\n ),\n totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills)\n return\n if startDate is not null and totalDaysSupplied is not null then\n Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ]\n else if startDate is not null and boundsPeriod."high" is not null then\n Interval[startDate, date from end of boundsPeriod]\n else\n null</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CumulativeMedicationDuration</td>\n \n \n <td>Quantity</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/**********************************************************************/\n/* Functions in this region are copied from opioid-mme-r4 */\n/**********************************************************************/\n\ndefine function Quantity(value Decimal, unit String):\n if value is not null then\n System.Quantity { value: value, unit: unit }\n else\n null</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CumulativeMedicationDuration</td>\n \n \n <td>ToDaily</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n Goal is to get to number of days\n Two broad approaches to the calculation:\n 1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered\n 2) Based on relevant period, determine a covered interval and calculate the length of that interval in days\nThis topic covers several use cases and illustrates how to calculate Cumulative\nMedication Duration for each type of medication resource using the supply and\nfrequency approach.\n*/\n\n/*\n For the first approach, we need to get from frequency to a frequency/day\n So we define ToDaily\n*/\n\n/*\n Calculates daily frequency given frequency within a period\n*/\ndefine function ToDaily(frequency System.Integer, period System.Quantity):\n case period.unit\n when 'h' then frequency * (24.0 / period.value)\n when 'min' then frequency * (24.0 / period.value) * 60\n when 's' then frequency * (24.0 / period.value) * 60 * 60\n when 'd' then frequency * (24.0 / period.value) / 24\n when 'wk' then frequency * (24.0 / period.value) / (24 * 7)\n when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n when 'hour' then frequency * (24.0 / period.value)\n when 'minute' then frequency * (24.0 / period.value) * 60\n when 'second' then frequency * (24.0 / period.value) * 60 * 60\n when 'day' then frequency * (24.0 / period.value) / 24\n when 'week' then frequency * (24.0 / period.value) / (24 * 7)\n when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n when 'hours' then frequency * (24.0 / period.value)\n when 'minutes' then frequency * (24.0 / period.value) * 60\n when 'seconds' then frequency * (24.0 / period.value) * 60 * 60\n when 'days' then frequency * (24.0 / period.value) / 24\n when 'weeks' then frequency * (24.0 / period.value) / (24 * 7)\n when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit)\n end</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>QICoreCommon</td>\n \n \n <td>prevalenceInterval</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting \ninterval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ "active"\n or condition.clinicalStatus ~ "recurrence"\n or condition.clinicalStatus ~ "relapse" then\n Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n (end of condition.abatementInterval()) abatementDate\n return if abatementDate is null then\n Interval[start of condition.onset.toInterval(), abatementDate)\n else\n Interval[start of condition.onset.toInterval(), abatementDate]</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>MedicationRequestPeriodInDays</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define fluent function MedicationRequestPeriodInDays(Request "MedicationRequest"):\n Request R\n let dosage: singleton from R.dosageInstruction,\n doseAndRate: singleton from dosage.doseAndRate,\n timing: dosage.timing,\n frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),\n period: CMD."Quantity" ( timing.repeat.period, timing.repeat.periodUnit ),\n doseRange: doseAndRate.dose,\n doseQuantity: doseAndRate.dose,\n dose: Coalesce(\n end of doseRange, doseQuantity\n ),\n dosesPerDay: Coalesce((CMD."ToDaily"(frequency, period)), Count(timing.repeat.timeOfDay), 1.0),\n boundsPeriod: timing.repeat.bounds as Interval<DateTime>,\n daysSupply: ( convert R.dispenseRequest.expectedSupplyDuration to days ).value,\n quantity: R.dispenseRequest.quantity,\n refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),\n startDate: Coalesce(date from start of boundsPeriod, date from R.authoredOn, date from start of R.dispenseRequest.validityPeriod),\n totalDaysSupplied: Coalesce(daysSupply, quantity.value /(dose.value * dosesPerDay)) * ( 1 + refills )\n return totalDaysSupplied</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>averageDailyDose</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define fluent function "averageDailyDose"(MedicationRequest MedicationRequest):\n MedicationRequest Order\n let MedicationStrength: Order.getMedicationCode ( ).MedicationStrengthPerUnit ( ),\n DaysSupplied: Order.MedicationRequestPeriodInDays ( )\n return if DaysSupplied is not null\n and ( MedicationStrength.unit = 'mg'\n or ( MedicationStrength.unit = 'mg/mL'\n and Order.dispenseRequest.quantity.unit = 'mL'\n )\n ) then ( ( Order.dispenseRequest.quantity * MedicationStrength ) / Quantity { value: DaysSupplied, unit: 'd' } ) \n else null</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>UseofHighRiskMedicationsintheElderlyFHIR</td>\n \n \n <td>MedicationStrengthPerUnit</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">define fluent function MedicationStrengthPerUnit(Strength Concept):\n case\n when Strength ~ "digoxin 0.05 MG/ML Oral Solution" then 0.05 'mg/mL'\n when Strength ~ "digoxin 0.0625 MG Oral Tablet" then 0.0625 'mg'\n when Strength ~ "1 ML digoxin 0.1 MG/ML Injection" then 0.1 'mg/mL'\n when Strength ~ "digoxin 0.125 MG Oral Tablet" then 0.125 'mg'\n when Strength ~ "digoxin 0.25 MG Oral Tablet" then 0.25 'mg'\n when Strength ~ "2 ML digoxin 0.25 MG/ML Injection" then 0.25 'mg/mL'\n when Strength ~ "doxepin 3 MG Oral Tablet" then 3 'mg'\n when Strength ~ "doxepin 6 MG Oral Tablet" then 6 'mg'\n when Strength ~ "doxepin 10 MG Oral Capsule" then 10 'mg'\n when Strength ~ "doxepin 10 MG/ML Oral Solution" then 10 'mg/mL'\n when Strength ~ "doxepin 25 MG Oral Capsule" then 25 'mg'\n when Strength ~ "doxepin 50 MG Oral Capsule" then 50 'mg'\n when Strength ~ "doxepin 75 MG Oral Capsule" then 75 'mg'\n when Strength ~ "doxepin 100 MG Oral Capsule" then 100 'mg'\n when Strength ~ "doxepin 150 MG Oral Capsule" then 150 'mg' \n else null end</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>CQMCommon</td>\n \n \n <td>getMedicationCode</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns the medication code for the given MedicationRequest\n*/\ndefine fluent function getMedicationCode(request MedicationRequest ):\n if request.medication is Concept then\n \t request.medication as Concept\n \telse\n \t (singleton from ([Medication] M where M.id = (request.medication as Reference).reference.getId())).code</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>Status</td>\n \n \n <td>isEncounterPerformed</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">//Encounter, Performed\n//General usage unless required otherwise by measure intent (e.g., follow-up encounters)\ndefine fluent function isEncounterPerformed(Enc List<Encounter>):\n Enc E\n where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>FHIRHelpers</td>\n \n \n <td>ToConcept</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n if concept is null then\n null\n else\n System.Concept {\n codes: concept.coding C return ToCode(C),\n display: concept.text.value\n }</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>QICoreCommon</td>\n \n \n <td>toInterval</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in QICore, allowing this function to be used across any resource.\nThe input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.\nIf the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,\nand the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.\nIf the input is a DateTime Interval, the result is the input.\nIf the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result\nis a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending\nimmediately before one year later than the date the patient turned the age given as the end of the quantity interval.\nIf the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval\n*/\ndefine fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):\n case\n\t when choice is DateTime then\n \tInterval[choice as DateTime, choice as DateTime]\n\t\twhen choice is Interval<DateTime> then\n \t\tchoice as Interval<DateTime>\n\t\twhen choice is Quantity then\n\t\t Interval[Patient.birthDate + (choice as Quantity),\n\t\t\t Patient.birthDate + (choice as Quantity) + 1 year)\n\t\twhen choice is Interval<Quantity> then\n\t\t Interval[Patient.birthDate + (choice.low as Quantity),\n\t\t\t Patient.birthDate + (choice.high as Quantity) + 1 year)\n\t\twhen choice is Timing then\n Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>\n\t\telse\n\t\t\tnull as Interval<DateTime>\n\tend</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>Status</td>\n \n \n <td>isAssessmentPerformed</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">//This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA.\n\n//Assessment, Performed\ndefine fluent function isAssessmentPerformed(Obs List<Observation>):\n Obs O\n where O.status in { 'final', 'amended', 'corrected' }\n and exists ( O.category ObservationCategory\n where ( ObservationCategory ) ~ "survey"\n )</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>Status</td>\n \n \n <td>isInterventionOrder</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">//Intervention, Order: active and completed only \ndefine fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):\n ServiceRequest S\n where S.status in { 'active', 'completed' }\n and S.intent = 'order'</code></pre>\n </td>\n \n </tr>\n \n <tr>\n <th><b>Library Name</b></th>\n <th><b>Name</b></th>\n </tr>\n <tr>\n \n <td>Status</td>\n \n \n <td>isInterventionPerformed</td>\n \n </tr>\n <tr>\n \n <td/>\n <td>\n <pre class=\"highlight language-cql\"><code class=\"language-cql\">//Intervention, Performed\ndefine fluent function isInterventionPerformed(Proc List<Procedure>):\n Proc P\n where P.status ~ 'completed'</code></pre>\n </td>\n \n </tr>\n \n </table>\n </td>\n </tr>\n \n \n \n\n </table>\n</div>"
},
"contained" : [
{
"resourceType" : "Library",
"id" : "effective-data-requirements",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "318179",
"display" : "ergoloid mesylates, USP 1 MG Oral Tablet"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "393245",
"display" : "digoxin 0.05 MG/ML Oral Solution"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "245273",
"display" : "digoxin 0.0625 MG Oral Tablet"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "204504",
"display" : "1 ML digoxin 0.1 MG/ML Injection"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "197604",
"display" : "digoxin 0.125 MG Oral Tablet"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "197606",
"display" : "digoxin 0.25 MG Oral Tablet"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "104208",
"display" : "2 ML digoxin 0.25 MG/ML Injection"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "966787",
"display" : "doxepin 3 MG Oral Tablet"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "966793",
"display" : "doxepin 6 MG Oral Tablet"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "1000048",
"display" : "doxepin 10 MG Oral Capsule"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "1000054",
"display" : "doxepin 10 MG/ML Oral Solution"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "1000070",
"display" : "doxepin 25 MG Oral Capsule"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "1000076",
"display" : "doxepin 50 MG Oral Capsule"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "1000097",
"display" : "doxepin 75 MG Oral Capsule"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "1000058",
"display" : "doxepin 100 MG Oral Capsule"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "1000064",
"display" : "doxepin 150 MG Oral Capsule"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://www.ama-assn.org/go/cpt",
"code" : "99211",
"display" : "Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "428361000124107",
"display" : "Discharge to home for hospice care (procedure)"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "428371000124100",
"display" : "Discharge to healthcare facility for hospice care (procedure)"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://terminology.hl7.org/CodeSystem/observation-category",
"code" : "survey",
"display" : "survey"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "373066001",
"display" : "Yes (qualifier value)"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "45755-6",
"display" : "Hospice care [Minimum Data Set]"
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "71007-9",
"display" : "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"
}
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "More than One Antipsychotic Order"
},
{
"url" : "statement",
"valueString" : "define \"More than One Antipsychotic Order\":\n exists ( ( [MedicationRequest: \"Potentially Harmful Antipsychotics for Older Adults\"] ).moreThanOneOrder ( ) )"
},
{
"url" : "displaySequence",
"valueInteger" : 0
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "Antipsychotic Index Prescription Start Date"
},
{
"url" : "statement",
"valueString" : "define \"Antipsychotic Index Prescription Start Date\":\n First((([MedicationRequest: \"Potentially Harmful Antipsychotics for Older Adults\"]).isMedicationOrder()) AntipsychoticMedication\n where AntipsychoticMedication.authoredOn during \"Measurement Period\"\n return AntipsychoticMedication.authoredOn\n sort asc\n )"
},
{
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"valueInteger" : 1
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "More than One Benzodiazepine Order"
},
{
"url" : "statement",
"valueString" : "define \"More than One Benzodiazepine Order\":\n exists ( ( [MedicationRequest: \"Potentially Harmful Benzodiazepines for Older Adults\"] ).moreThanOneOrder ( ) )"
},
{
"url" : "displaySequence",
"valueInteger" : 2
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "Benzodiazepine Index Prescription Start Date"
},
{
"url" : "statement",
"valueString" : "define \"Benzodiazepine Index Prescription Start Date\":\n First((([MedicationRequest: \"Potentially Harmful Benzodiazepines for Older Adults\"]).isMedicationOrder()) BenzodiazepineMedication\n where BenzodiazepineMedication.authoredOn during \"Measurement Period\"\n return BenzodiazepineMedication.authoredOn\n sort asc\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 3
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "Numerator 2"
},
{
"url" : "statement",
"valueString" : "define \"Numerator 2\":\n ( \"More than One Antipsychotic Order\"\n and ( not exists ( ( [Condition: \"Schizophrenia\"]\n union [Condition: \"Bipolar Disorder\"] ) AntipsychoticTreatedDiagnoses\n where AntipsychoticTreatedDiagnoses.prevalenceInterval ( ) overlaps Interval[start of \"Measurement Period\" - 1 year, \"Antipsychotic Index Prescription Start Date\"]\n )\n )\n )\n or ( \"More than One Benzodiazepine Order\"\n and ( not exists ( ( [Condition: \"Seizure Disorder\"]\n union [Condition: \"REM Sleep Behavior Disorder\"]\n union [Condition: \"Benzodiazepine Withdrawal\"]\n union [Condition: \"Alcohol Withdrawal\"]\n union [Condition: \"Generalized Anxiety Disorder\"] ) BenzodiazepineTreatedDiagnoses\n where BenzodiazepineTreatedDiagnoses.prevalenceInterval ( ) overlaps Interval[start of \"Measurement Period\" - 1 year, \"Benzodiazepine Index Prescription Start Date\"]\n )\n )\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 4
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "Same High Risk Medications Ordered on Different Days"
},
{
"url" : "statement",
"valueString" : "define \"Same High Risk Medications Ordered on Different Days\":\n ( [MedicationRequest: \"Potentially Harmful Antihistamines for Older Adults\"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: \"Potentially Harmful Antiparkinsonian Agents for Older Adults\"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: \"Potentially Harmful Gastrointestinal Antispasmodics for Older Adults\"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: \"Dipyridamole Medications\"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: \"Guanfacine Medications\"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: \"Nifedipine Medications\"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: \"Potentially Harmful Antidepressants for Older Adults\"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: \"Potentially Harmful Barbiturates for Older Adults\"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: \"ergoloid mesylates, USP 1 MG Oral Tablet\"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: \"Meprobamate Medications\"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: \"Potentially Harmful Estrogens for Older Adults\"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: \"Potentially Harmful Sulfonylureas for Older Adults\"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: \"Desiccated Thyroid Medications\"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: \"Potentially Harmful Nonbenzodiazepine Hypnotics for Older Adults\"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: \"Potentially Harmful Skeletal Muscle Relaxants for Older Adults\"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: \"Potentially Harmful Pain Medications for Older Adults\"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: \"Megestrol Medications\"] ).moreThanOneOrder ( )\n union ( [MedicationRequest: \"Meperidine Medications\"] ).moreThanOneOrder ( )"
},
{
"url" : "displaySequence",
"valueInteger" : 5
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "Two High Risk Medications with Prolonged Duration"
},
{
"url" : "statement",
"valueString" : "define \"Two High Risk Medications with Prolonged Duration\":\n Sum((([MedicationRequest: \"Potentially Harmful Antiinfectives for Older Adults\"]).moreThanOneOrder()) AntiInfectives\n let DaysSupply: AntiInfectives.MedicationRequestPeriodInDays()\n return all DaysSupply\n ) > 90"
},
{
"url" : "displaySequence",
"valueInteger" : 6
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "High Risk Medications with Average Daily Dose Criteria"
},
{
"url" : "statement",
"valueString" : "define \"High Risk Medications with Average Daily Dose Criteria\":\n exists ( ( ( [MedicationRequest: \"Digoxin Medications\"] ).moreThanOneOrder ( ) ) DigoxinOrdered\n where ( DigoxinOrdered ).averageDailyDose ( ) > 0.125 'mg/d'\n )\n or exists ( ( ( [MedicationRequest: \"Doxepin Medications\"] ).moreThanOneOrder ( ) ) DoxepinOrdered\n where ( DoxepinOrdered ).averageDailyDose ( ) > 6 'mg/d'\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 7
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "Numerator 1"
},
{
"url" : "statement",
"valueString" : "define \"Numerator 1\":\n exists ( \"Same High Risk Medications Ordered on Different Days\" )\n or ( \"Two High Risk Medications with Prolonged Duration\" )\n or ( \"High Risk Medications with Average Daily Dose Criteria\" )"
},
{
"url" : "displaySequence",
"valueInteger" : 8
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "Numerator 3"
},
{
"url" : "statement",
"valueString" : "define \"Numerator 3\":\n \"Numerator 2\"\n or ( \"Numerator 1\"\n and not \"Numerator 2\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 9
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "Qualifying Encounters"
},
{
"url" : "statement",
"valueString" : "define \"Qualifying Encounters\":\n ( ( [Encounter: \"Office Visit\"]\n union [Encounter: \"Ophthalmological Services\"]\n union [Encounter: \"Preventive Care Services Established Office Visit, 18 and Up\"]\n union [Encounter: \"Discharge Services Nursing Facility\"]\n union [Encounter: \"Nursing Facility Visit\"]\n union [Encounter: \"Care Services in Long Term Residential Facility\"]\n union [Encounter: \"Preventive Care Services Initial Office Visit, 18 and Up\"]\n union [Encounter: \"Annual Wellness Visit\"]\n union [Encounter: \"Home Healthcare Services\"]\n union [Encounter: \"Telephone Visits\"]\n union [Encounter: \"Virtual Encounter\"]\n union ( [Encounter] E\n where exists ( ( E.type ) T\n where T ~ \"Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional\"\n )\n )\n ).isEncounterPerformed ( ) ) ValidEncounters\n where ValidEncounters.period during \"Measurement Period\""
},
{
"url" : "displaySequence",
"valueInteger" : 10
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "Initial Population"
},
{
"url" : "statement",
"valueString" : "define \"Initial Population\":\n AgeInYearsAt(date from \n end of \"Measurement Period\"\n ) >= 65\n and exists ( \"Qualifying Encounters\" )"
},
{
"url" : "displaySequence",
"valueInteger" : 11
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "Denominator"
},
{
"url" : "statement",
"valueString" : "define \"Denominator\":\n \"Initial Population\""
},
{
"url" : "displaySequence",
"valueInteger" : 12
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "Hospice"
},
{
"url" : "name",
"valueString" : "Has Hospice Services"
},
{
"url" : "statement",
"valueString" : "define \"Has Hospice Services\":\n exists ((([Encounter: \"Encounter Inpatient\"]).isEncounterPerformed()) InpatientEncounter\n where (InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n or InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\"\n )\n and InpatientEncounter.period.toInterval() ends during day of \"Measurement Period\"\n )\n or exists ((([Encounter: \"Hospice Encounter\"]).isEncounterPerformed()) HospiceEncounter\n where HospiceEncounter.period.toInterval() overlaps day of \"Measurement Period\"\n )\n or exists ((([Observation: \"Hospice care [Minimum Data Set]\"]).isAssessmentPerformed()) HospiceAssessment\n where HospiceAssessment.value ~ \"Yes (qualifier value)\"\n and HospiceAssessment.effective.toInterval() overlaps day of \"Measurement Period\"\n )\n or exists ((([ServiceRequest: \"Hospice Care Ambulatory\"]).isInterventionOrder()) HospiceOrder\n where HospiceOrder.authoredOn.toInterval() during day of \"Measurement Period\"\n // and HospiceOrder.doNotPerform is not true\n // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447\n )\n or exists ((([Procedure: \"Hospice Care Ambulatory\"]).isInterventionPerformed()) HospicePerformed\n where HospicePerformed.performed.toInterval() overlaps day of \"Measurement Period\"\n )\n or exists (([Condition: \"Hospice Diagnosis\"]) HospiceCareDiagnosis\n where HospiceCareDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 13
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "PalliativeCare"
},
{
"url" : "name",
"valueString" : "Has Palliative Care in the Measurement Period"
},
{
"url" : "statement",
"valueString" : "define \"Has Palliative Care in the Measurement Period\":\n exists ((([Observation: \"Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)\"]).isAssessmentPerformed()) PalliativeAssessment\n where PalliativeAssessment.effective.toInterval() overlaps day of \"Measurement Period\"\n )\n or exists ([Condition: \"Palliative Care Diagnosis\"] PalliativeDiagnosis\n where PalliativeDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"\n )\n or exists ((([Encounter: \"Palliative Care Encounter\"]).isEncounterPerformed()) PalliativeEncounter\n where PalliativeEncounter.period.toInterval() overlaps day of \"Measurement Period\"\n )\n or exists ((([Procedure: \"Palliative Care Intervention\"]).isInterventionPerformed()) PalliativeIntervention\n where PalliativeIntervention.performed.toInterval() overlaps day of \"Measurement Period\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 14
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "Denominator Exclusions"
},
{
"url" : "statement",
"valueString" : "define \"Denominator Exclusions\":\n Hospice.\"Has Hospice Services\"\n or PalliativeCare.\"Has Palliative Care in the Measurement Period\""
},
{
"url" : "displaySequence",
"valueInteger" : 15
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "moreThanOneOrder"
},
{
"url" : "statement",
"valueString" : "define fluent function \"moreThanOneOrder\"(Medication List<MedicationRequest>):\n ( Medication.isMedicationOrder ( ) ) OrderMedication1\n with ( Medication.isMedicationOrder ( ) ) OrderMedication2\n such that ( OrderMedication1.authoredOn during \"Measurement Period\"\n and OrderMedication1.dispenseRequest.numberOfRepeatsAllowed >= 1\n )\n or ( date from OrderMedication1.authoredOn !~ date from OrderMedication2.authoredOn\n and OrderMedication1.authoredOn during \"Measurement Period\"\n and OrderMedication2.authoredOn during \"Measurement Period\"\n )\n or ( date from OrderMedication1.authoredOn ~ date from OrderMedication2.authoredOn\n and OrderMedication1.authoredOn during \"Measurement Period\"\n and date from start of OrderMedication1.medicationRequestPeriod ( ) !~ date from start of OrderMedication2.medicationRequestPeriod ( )\n and start of OrderMedication1.medicationRequestPeriod ( ) during \"Measurement Period\"\n and start of OrderMedication2.medicationRequestPeriod ( ) during \"Measurement Period\"\n )\n return OrderMedication1"
},
{
"url" : "displaySequence",
"valueInteger" : 16
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "Status"
},
{
"url" : "name",
"valueString" : "isMedicationOrder"
},
{
"url" : "statement",
"valueString" : "//Medication, Order: active and completed only\ndefine fluent function isMedicationOrder(MedicationRequest List<MedicationRequest>):\n MedicationRequest M\n where M.status in { 'active', 'completed' }\n and M.intent = 'order'"
},
{
"url" : "displaySequence",
"valueInteger" : 17
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CumulativeMedicationDuration"
},
{
"url" : "name",
"valueString" : "medicationRequestPeriod"
},
{
"url" : "statement",
"valueString" : "define fluent function medicationRequestPeriod(Request \"MedicationRequest\"):\n Request R\n let\n dosage: singleton from R.dosageInstruction,\n doseAndRate: singleton from dosage.doseAndRate,\n timing: dosage.timing,\n frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),\n period: Quantity(timing.repeat.period, timing.repeat.periodUnit),\n doseRange: doseAndRate.dose,\n doseQuantity: doseAndRate.dose,\n dose: Coalesce(end of doseRange, doseQuantity),\n dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),\n boundsPeriod: timing.repeat.bounds as Interval<DateTime>,\n daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value,\n quantity: R.dispenseRequest.quantity,\n refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),\n startDate:\n Coalesce(\n date from start of boundsPeriod,\n date from R.authoredOn,\n date from start of R.dispenseRequest.validityPeriod\n ),\n totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills)\n return\n if startDate is not null and totalDaysSupplied is not null then\n Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ]\n else if startDate is not null and boundsPeriod.\"high\" is not null then\n Interval[startDate, date from end of boundsPeriod]\n else\n null"
},
{
"url" : "displaySequence",
"valueInteger" : 18
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CumulativeMedicationDuration"
},
{
"url" : "name",
"valueString" : "Quantity"
},
{
"url" : "statement",
"valueString" : "/**********************************************************************/\n/* Functions in this region are copied from opioid-mme-r4 */\n/**********************************************************************/\n\ndefine function Quantity(value Decimal, unit String):\n if value is not null then\n System.Quantity { value: value, unit: unit }\n else\n null"
},
{
"url" : "displaySequence",
"valueInteger" : 19
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CumulativeMedicationDuration"
},
{
"url" : "name",
"valueString" : "ToDaily"
},
{
"url" : "statement",
"valueString" : "/*\n Goal is to get to number of days\n Two broad approaches to the calculation:\n 1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered\n 2) Based on relevant period, determine a covered interval and calculate the length of that interval in days\nThis topic covers several use cases and illustrates how to calculate Cumulative\nMedication Duration for each type of medication resource using the supply and\nfrequency approach.\n*/\n\n/*\n For the first approach, we need to get from frequency to a frequency/day\n So we define ToDaily\n*/\n\n/*\n Calculates daily frequency given frequency within a period\n*/\ndefine function ToDaily(frequency System.Integer, period System.Quantity):\n case period.unit\n when 'h' then frequency * (24.0 / period.value)\n when 'min' then frequency * (24.0 / period.value) * 60\n when 's' then frequency * (24.0 / period.value) * 60 * 60\n when 'd' then frequency * (24.0 / period.value) / 24\n when 'wk' then frequency * (24.0 / period.value) / (24 * 7)\n when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n when 'hour' then frequency * (24.0 / period.value)\n when 'minute' then frequency * (24.0 / period.value) * 60\n when 'second' then frequency * (24.0 / period.value) * 60 * 60\n when 'day' then frequency * (24.0 / period.value) / 24\n when 'week' then frequency * (24.0 / period.value) / (24 * 7)\n when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n when 'hours' then frequency * (24.0 / period.value)\n when 'minutes' then frequency * (24.0 / period.value) * 60\n when 'seconds' then frequency * (24.0 / period.value) * 60 * 60\n when 'days' then frequency * (24.0 / period.value) / 24\n when 'weeks' then frequency * (24.0 / period.value) / (24 * 7)\n when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */\n when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */\n else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit)\n end"
},
{
"url" : "displaySequence",
"valueInteger" : 20
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "QICoreCommon"
},
{
"url" : "name",
"valueString" : "prevalenceInterval"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting \ninterval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ \"active\"\n or condition.clinicalStatus ~ \"recurrence\"\n or condition.clinicalStatus ~ \"relapse\" then\n Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n (end of condition.abatementInterval()) abatementDate\n return if abatementDate is null then\n Interval[start of condition.onset.toInterval(), abatementDate)\n else\n Interval[start of condition.onset.toInterval(), abatementDate]"
},
{
"url" : "displaySequence",
"valueInteger" : 21
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "MedicationRequestPeriodInDays"
},
{
"url" : "statement",
"valueString" : "define fluent function MedicationRequestPeriodInDays(Request \"MedicationRequest\"):\n Request R\n let dosage: singleton from R.dosageInstruction,\n doseAndRate: singleton from dosage.doseAndRate,\n timing: dosage.timing,\n frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),\n period: CMD.\"Quantity\" ( timing.repeat.period, timing.repeat.periodUnit ),\n doseRange: doseAndRate.dose,\n doseQuantity: doseAndRate.dose,\n dose: Coalesce(\n end of doseRange, doseQuantity\n ),\n dosesPerDay: Coalesce((CMD.\"ToDaily\"(frequency, period)), Count(timing.repeat.timeOfDay), 1.0),\n boundsPeriod: timing.repeat.bounds as Interval<DateTime>,\n daysSupply: ( convert R.dispenseRequest.expectedSupplyDuration to days ).value,\n quantity: R.dispenseRequest.quantity,\n refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),\n startDate: Coalesce(date from start of boundsPeriod, date from R.authoredOn, date from start of R.dispenseRequest.validityPeriod),\n totalDaysSupplied: Coalesce(daysSupply, quantity.value /(dose.value * dosesPerDay)) * ( 1 + refills )\n return totalDaysSupplied"
},
{
"url" : "displaySequence",
"valueInteger" : 22
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "averageDailyDose"
},
{
"url" : "statement",
"valueString" : "define fluent function \"averageDailyDose\"(MedicationRequest MedicationRequest):\n MedicationRequest Order\n let MedicationStrength: Order.getMedicationCode ( ).MedicationStrengthPerUnit ( ),\n DaysSupplied: Order.MedicationRequestPeriodInDays ( )\n return if DaysSupplied is not null\n and ( MedicationStrength.unit = 'mg'\n or ( MedicationStrength.unit = 'mg/mL'\n and Order.dispenseRequest.quantity.unit = 'mL'\n )\n ) then ( ( Order.dispenseRequest.quantity * MedicationStrength ) / Quantity { value: DaysSupplied, unit: 'd' } ) \n else null"
},
{
"url" : "displaySequence",
"valueInteger" : 23
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "UseofHighRiskMedicationsintheElderlyFHIR"
},
{
"url" : "name",
"valueString" : "MedicationStrengthPerUnit"
},
{
"url" : "statement",
"valueString" : "define fluent function MedicationStrengthPerUnit(Strength Concept):\n case\n when Strength ~ \"digoxin 0.05 MG/ML Oral Solution\" then 0.05 'mg/mL'\n when Strength ~ \"digoxin 0.0625 MG Oral Tablet\" then 0.0625 'mg'\n when Strength ~ \"1 ML digoxin 0.1 MG/ML Injection\" then 0.1 'mg/mL'\n when Strength ~ \"digoxin 0.125 MG Oral Tablet\" then 0.125 'mg'\n when Strength ~ \"digoxin 0.25 MG Oral Tablet\" then 0.25 'mg'\n when Strength ~ \"2 ML digoxin 0.25 MG/ML Injection\" then 0.25 'mg/mL'\n when Strength ~ \"doxepin 3 MG Oral Tablet\" then 3 'mg'\n when Strength ~ \"doxepin 6 MG Oral Tablet\" then 6 'mg'\n when Strength ~ \"doxepin 10 MG Oral Capsule\" then 10 'mg'\n when Strength ~ \"doxepin 10 MG/ML Oral Solution\" then 10 'mg/mL'\n when Strength ~ \"doxepin 25 MG Oral Capsule\" then 25 'mg'\n when Strength ~ \"doxepin 50 MG Oral Capsule\" then 50 'mg'\n when Strength ~ \"doxepin 75 MG Oral Capsule\" then 75 'mg'\n when Strength ~ \"doxepin 100 MG Oral Capsule\" then 100 'mg'\n when Strength ~ \"doxepin 150 MG Oral Capsule\" then 150 'mg' \n else null end"
},
{
"url" : "displaySequence",
"valueInteger" : 24
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "CQMCommon"
},
{
"url" : "name",
"valueString" : "getMedicationCode"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Returns the medication code for the given MedicationRequest\n*/\ndefine fluent function getMedicationCode(request MedicationRequest ):\n if request.medication is Concept then\n \t request.medication as Concept\n \telse\n \t (singleton from ([Medication] M where M.id = (request.medication as Reference).reference.getId())).code"
},
{
"url" : "displaySequence",
"valueInteger" : 25
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "Status"
},
{
"url" : "name",
"valueString" : "isEncounterPerformed"
},
{
"url" : "statement",
"valueString" : "//Encounter, Performed\n//General usage unless required otherwise by measure intent (e.g., follow-up encounters)\ndefine fluent function isEncounterPerformed(Enc List<Encounter>):\n Enc E\n where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}"
},
{
"url" : "displaySequence",
"valueInteger" : 26
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "FHIRHelpers"
},
{
"url" : "name",
"valueString" : "ToConcept"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n if concept is null then\n null\n else\n System.Concept {\n codes: concept.coding C return ToCode(C),\n display: concept.text.value\n }"
},
{
"url" : "displaySequence",
"valueInteger" : 27
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "QICoreCommon"
},
{
"url" : "name",
"valueString" : "toInterval"
},
{
"url" : "statement",
"valueString" : "/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in QICore, allowing this function to be used across any resource.\nThe input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.\nIf the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,\nand the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.\nIf the input is a DateTime Interval, the result is the input.\nIf the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result\nis a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending\nimmediately before one year later than the date the patient turned the age given as the end of the quantity interval.\nIf the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval\n*/\ndefine fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):\n case\n\t when choice is DateTime then\n \tInterval[choice as DateTime, choice as DateTime]\n\t\twhen choice is Interval<DateTime> then\n \t\tchoice as Interval<DateTime>\n\t\twhen choice is Quantity then\n\t\t Interval[Patient.birthDate + (choice as Quantity),\n\t\t\t Patient.birthDate + (choice as Quantity) + 1 year)\n\t\twhen choice is Interval<Quantity> then\n\t\t Interval[Patient.birthDate + (choice.low as Quantity),\n\t\t\t Patient.birthDate + (choice.high as Quantity) + 1 year)\n\t\twhen choice is Timing then\n Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>\n\t\telse\n\t\t\tnull as Interval<DateTime>\n\tend"
},
{
"url" : "displaySequence",
"valueInteger" : 28
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "Status"
},
{
"url" : "name",
"valueString" : "isAssessmentPerformed"
},
{
"url" : "statement",
"valueString" : "//This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA.\n\n//Assessment, Performed\ndefine fluent function isAssessmentPerformed(Obs List<Observation>):\n Obs O\n where O.status in { 'final', 'amended', 'corrected' }\n and exists ( O.category ObservationCategory\n where ( ObservationCategory ) ~ \"survey\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 29
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "Status"
},
{
"url" : "name",
"valueString" : "isInterventionOrder"
},
{
"url" : "statement",
"valueString" : "//Intervention, Order: active and completed only \ndefine fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):\n ServiceRequest S\n where S.status in { 'active', 'completed' }\n and S.intent = 'order'"
},
{
"url" : "displaySequence",
"valueInteger" : 30
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "Status"
},
{
"url" : "name",
"valueString" : "isInterventionPerformed"
},
{
"url" : "statement",
"valueString" : "//Intervention, Performed\ndefine fluent function isInterventionPerformed(Proc List<Procedure>):\n Proc P\n where P.status ~ 'completed'"
},
{
"url" : "displaySequence",
"valueInteger" : 31
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
}
],
"name" : "EffectiveDataRequirements",
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/library-type",
"code" : "module-definition"
}
]
},
"relatedArtifact" : [
{
"type" : "depends-on",
"display" : "Library Status",
"resource" : "Library/Status|1.8.000"
},
{
"type" : "depends-on",
"display" : "Library CMD",
"resource" : "Library/CumulativeMedicationDuration|4.1.000"
},
{
"type" : "depends-on",
"display" : "Library FHIRHelpers",
"resource" : "Library/FHIRHelpers|4.4.000"
},
{
"type" : "depends-on",
"display" : "Library QICoreCommon",
"resource" : "Library/QICoreCommon|2.1.000"
},
{
"type" : "depends-on",
"display" : "Library CQMCommon",
"resource" : "Library/CQMCommon|2.2.000"
},
{
"type" : "depends-on",
"display" : "Library Hospice",
"resource" : "Library/Hospice|6.12.000"
},
{
"type" : "depends-on",
"display" : "Library PalliativeCare",
"resource" : "Library/PalliativeCare|1.11.000"
},
{
"type" : "depends-on",
"display" : "Code system RXNORM",
"resource" : "http://www.nlm.nih.gov/research/umls/rxnorm"
},
{
"type" : "depends-on",
"display" : "Code system CPT",
"resource" : "http://www.ama-assn.org/go/cpt"
},
{
"type" : "depends-on",
"display" : "Code system SNOMEDCT",
"resource" : "http://snomed.info/sct"
},
{
"type" : "depends-on",
"display" : "Code system ObservationCategoryCodes",
"resource" : "http://terminology.hl7.org/CodeSystem/observation-category"
},
{
"type" : "depends-on",
"display" : "Code system LOINC",
"resource" : "http://loinc.org"
},
{
"type" : "depends-on",
"display" : "Value set Potentially Harmful Antipsychotics for Older Adults",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1523"
},
{
"type" : "depends-on",
"display" : "Value set Schizophrenia",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1205"
},
{
"type" : "depends-on",
"display" : "Value set Bipolar Disorder",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.67.1.101.1.128"
},
{
"type" : "depends-on",
"display" : "Value set Potentially Harmful Benzodiazepines for Older Adults",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1522"
},
{
"type" : "depends-on",
"display" : "Value set Seizure Disorder",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1206"
},
{
"type" : "depends-on",
"display" : "Value set REM Sleep Behavior Disorder",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1207"
},
{
"type" : "depends-on",
"display" : "Value set Benzodiazepine Withdrawal",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1208"
},
{
"type" : "depends-on",
"display" : "Value set Alcohol Withdrawal",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1209"
},
{
"type" : "depends-on",
"display" : "Value set Generalized Anxiety Disorder",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1210"
},
{
"type" : "depends-on",
"display" : "Value set Potentially Harmful Antihistamines for Older Adults",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1043"
},
{
"type" : "depends-on",
"display" : "Value set Potentially Harmful Antiparkinsonian Agents for Older Adults",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1049"
},
{
"type" : "depends-on",
"display" : "Value set Potentially Harmful Gastrointestinal Antispasmodics for Older Adults",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1050"
},
{
"type" : "depends-on",
"display" : "Value set Dipyridamole Medications",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1051"
},
{
"type" : "depends-on",
"display" : "Value set Guanfacine Medications",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.11.1252"
},
{
"type" : "depends-on",
"display" : "Value set Nifedipine Medications",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1053"
},
{
"type" : "depends-on",
"display" : "Value set Potentially Harmful Antidepressants for Older Adults",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1054"
},
{
"type" : "depends-on",
"display" : "Value set Potentially Harmful Barbiturates for Older Adults",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1055"
},
{
"type" : "depends-on",
"display" : "Value set Meprobamate Medications",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1057"
},
{
"type" : "depends-on",
"display" : "Value set Potentially Harmful Estrogens for Older Adults",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1058"
},
{
"type" : "depends-on",
"display" : "Value set Potentially Harmful Sulfonylureas for Older Adults",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1059"
},
{
"type" : "depends-on",
"display" : "Value set Desiccated Thyroid Medications",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1060"
},
{
"type" : "depends-on",
"display" : "Value set Potentially Harmful Nonbenzodiazepine Hypnotics for Older Adults",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1480"
},
{
"type" : "depends-on",
"display" : "Value set Potentially Harmful Skeletal Muscle Relaxants for Older Adults",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1062"
},
{
"type" : "depends-on",
"display" : "Value set Potentially Harmful Pain Medications for Older Adults",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1063"
},
{
"type" : "depends-on",
"display" : "Value set Megestrol Medications",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1247"
},
{
"type" : "depends-on",
"display" : "Value set Meperidine Medications",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1248"
},
{
"type" : "depends-on",
"display" : "Value set Potentially Harmful Antiinfectives for Older Adults",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1481"
},
{
"type" : "depends-on",
"display" : "Value set Digoxin Medications",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1065"
},
{
"type" : "depends-on",
"display" : "Value set Doxepin Medications",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1067"
},
{
"type" : "depends-on",
"display" : "Value set Office Visit",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
},
{
"type" : "depends-on",
"display" : "Value set Ophthalmological Services",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1285"
},
{
"type" : "depends-on",
"display" : "Value set Preventive Care Services Established Office Visit, 18 and Up",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"
},
{
"type" : "depends-on",
"display" : "Value set Discharge Services Nursing Facility",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1013"
},
{
"type" : "depends-on",
"display" : "Value set Nursing Facility Visit",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012"
},
{
"type" : "depends-on",
"display" : "Value set Care Services in Long Term Residential Facility",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014"
},
{
"type" : "depends-on",
"display" : "Value set Preventive Care Services Initial Office Visit, 18 and Up",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"
},
{
"type" : "depends-on",
"display" : "Value set Annual Wellness Visit",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"
},
{
"type" : "depends-on",
"display" : "Value set Home Healthcare Services",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"
},
{
"type" : "depends-on",
"display" : "Value set Telephone Visits",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"
},
{
"type" : "depends-on",
"display" : "Value set Virtual Encounter",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089"
},
{
"type" : "depends-on",
"display" : "Value set Encounter Inpatient",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
},
{
"type" : "depends-on",
"display" : "Value set Hospice Encounter",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003"
},
{
"type" : "depends-on",
"display" : "Value set Hospice Care Ambulatory",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"
},
{
"type" : "depends-on",
"display" : "Value set Hospice Diagnosis",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165"
},
{
"type" : "depends-on",
"display" : "Value set Palliative Care Diagnosis",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167"
},
{
"type" : "depends-on",
"display" : "Value set Palliative Care Encounter",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090"
},
{
"type" : "depends-on",
"display" : "Value set Palliative Care Intervention",
"resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135"
}
],
"parameter" : [
{
"name" : "Measurement Period",
"use" : "in",
"min" : 0,
"max" : "1",
"type" : "Period"
},
{
"name" : "ErrorLevel",
"use" : "in",
"min" : 0,
"max" : "1",
"type" : "string"
},
{
"name" : "Numerator 3",
"use" : "out",
"min" : 0,
"max" : "1",
"type" : "boolean"
},
{
"name" : "Denominator",
"use" : "out",
"min" : 0,
"max" : "1",
"type" : "boolean"
},
{
"name" : "Numerator 1",
"use" : "out",
"min" : 0,
"max" : "1",
"type" : "boolean"
},
{
"name" : "Numerator 2",
"use" : "out",
"min" : 0,
"max" : "1",
"type" : "boolean"
},
{
"name" : "Initial Population",
"use" : "out",
"min" : 0,
"max" : "1",
"type" : "boolean"
},
{
"name" : "Denominator Exclusions",
"use" : "out",
"min" : 0,
"max" : "1",
"type" : "boolean"
}
],
"dataRequirement" : [
{
"type" : "MedicationRequest",
"profile" : [
🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
],
"mustSupport" : [
"medication",
"status",
"status.value",
"intent",
"intent.value",
"dosageInstruction",
"dispenseRequest",
"dispenseRequest.expectedSupplyDuration",
"dispenseRequest.quantity",
"dispenseRequest.numberOfRepeatsAllowed",
"dispenseRequest.numberOfRepeatsAllowed.value",
"authoredOn",
"authoredOn.value",
"dispenseRequest.validityPeriod"
],
"codeFilter" : [
{
"path" : "medication",
"valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1523"
}
]
},
{
"type" : "MedicationRequest",
"profile" : [
🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
],
"mustSupport" : [
"medication",
"status",
"status.value",
"intent",
"intent.value",
"dosageInstruction",
"dispenseRequest",
"dispenseRequest.expectedSupplyDuration",
"dispenseRequest.quantity",
"dispenseRequest.numberOfRepeatsAllowed",
"dispenseRequest.numberOfRepeatsAllowed.value",
"authoredOn",
"authoredOn.value",
"dispenseRequest.validityPeriod"
],
"codeFilter" : [
{
"path" : "medication",
"valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1522"
}
]
},
{
"type" : "MedicationRequest",
"profile" : [
🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
],
"mustSupport" : [
"medication",
"status",
"status.value",
"intent",
"intent.value",
"dosageInstruction",
"dispenseRequest",
"dispenseRequest.expectedSupplyDuration",
"dispenseRequest.quantity",
"dispenseRequest.numberOfRepeatsAllowed",
"dispenseRequest.numberOfRepeatsAllowed.value",
"authoredOn",
"authoredOn.value",
"dispenseRequest.validityPeriod"
],
"codeFilter" : [
{
"path" : "medication",
"valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1043"
}
]
},
{
"type" : "MedicationRequest",
"profile" : [
🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
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"name" : "UseofHighRiskMedicationsintheElderlyFHIR",
"title" : "Use of High-Risk Medications in Older AdultsFHIR",
"status" : "draft",
"experimental" : false,
"date" : "2024-07-09T14:53:57+00:00",
"publisher" : "National Committee for Quality Assurance",
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"description" : "Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported. \n1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class.\n2. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses.\n3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators).",
"purpose" : "UNKNOWN",
"usage" : "The intent of the measure is to assess if the patient has been ordered at least two high-risk medication prescriptions from the same drug class on different days.\n\nThe intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication from the same drug class for them.\n\nCalculate average daily dose for each prescription event. To calculate average daily dose, multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a prescription for the 30-days supply of digoxin containing 15 pills, 0.25 mg each pill, has an average daily dose of 0.125 mg. To calculate average daily dose for elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose.\n\nThis eCQM is a patient-based measure.\n\nThis FHIR-based measure has been derived from the QDM-based measure:\u202f CMS156v13.\n\nPlease 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" : "This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract HHSM-500-2011-00079C) with the National Committee for Quality Assurance (NCQA) to develop this electronic measure. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications.\n\nLimited 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. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications.\n\nCPT(R) codes, descriptions and other data are copyright 2024. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use.\n\nThe measure specifications contain coding from LOINC(R) (http://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use.\n\nThis material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. \n\nICD-10 copyright 2024 World Health Organization. All Rights Reserved.\n\nThe Measure uses RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the Measure and does not endorse or recommend this or any other product.\n\n“HL7” is the registered trademark of Health Level Seven International.",
"effectivePeriod" : {
"start" : "2025-01-01",
"end" : "2025-12-31"
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"author" : [
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],
"library" : [
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"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 MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.\n \nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
"scoring" : {
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"code" : "proportion",
"display" : "Proportion"
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},
"rationale" : "Certain medications (MacKinnon & Hepler, 2003) are associated with increased risk of harm from drug side-effects and drug toxicity and pose a concern for patient safety. There is clinical consensus that these drugs pose increased risks in older adults (Kaufman, Brodin, & Sarafian, 2005). Potentially inappropriate medication (PIM) use in older adults has been connected to significantly longer hospital stay lengths and increased hospitalization costs (Hagstrom et al., 2015) as well as increased risk of death (Lau et al., 2004). Use of specific high-risk medications such as hypnotics, including benzodiazepine receptor agonists, and nonsteroidal anti-inflammatory drugs (NSAIDS) can result in increased risk of delirium, falls, fractures, gastrointestinal bleeding and acute kidney injury (Merel & Paauw, 2017). Long-term use of benzodiazepines in older adults has been associated with increased risk of dementia (Zhong, Wang, Zhang, & Zhao, 2015; Takada et al., 2016). Additionally, the use of antipsychotics can lead to increased risk of stroke and greater cognitive decline in older adults with dementia (Tampi et al., 2016). Among Medicare beneficiaries it is estimated that the prevalence of PIM use was 77% among long-stay nursing home residents (defined as >101 consecutive days in a nursing home). The most common PIMs were benzodiazepines, antipsychotics, and insulin (Riester et al., 2023).\n\nOlder adults receiving inappropriate medications are more likely to report poorer health status at follow-up, compared to those who receive appropriate medications (Fu, Liu, & Christensen, 2004). A study of the prevalence of potentially inappropriate medication use in older adults found that 40 percent of individuals 65 and older filled at least one prescription for a potentially inappropriate medication and 13 percent filled two or more (Fick et al., 2008). While some adverse drug events (ADEs) are unavoidable, studies estimate that between 30 and 80 percent of ADEs in older adults are preventable (MacKinnon & Hepler, 2003). More recently with the onset of the COVID-19 pandemic, several studies have shown an increase in anxiety, insomnia and depression rates, which could result in an increase in the use of high-risk medications in order to treat these conditions (Agrawal, 2020).\n\nReducing the number of inappropriate prescriptions can lead to improved patient safety and significant cost savings. Conservative estimates of extra costs due to potentially inappropriate medications in older adults average $7.2 billion a year (Fu et al., 2007). Medication use by older adults will likely increase further as the U.S. population ages, new drugs are developed, and new therapeutic and preventive uses for medications are discovered (Rothberg et al., 2008). The annual direct costs of preventable ADEs in the Medicare population have been estimated to exceed $800 million (Institute of Medicine, 2007). By the year 2030, nearly one in five U.S. residents is expected to be aged 65 years or older; this age group is projected to more than double from 38.7 million in 2008 to more than 88.5 million in 2050. Likewise, the population aged 85 years or older is expected to increase almost four-fold, from 5.4 million to 19 million between 2008 and 2050. As the older adult population continues to grow, the number of older adults who present with multiple medical conditions for which several medications are prescribed will likely continue to increase, resulting in polypharmacy concerns (Gray & Gardner, 2009).",
"clinicalRecommendationStatement" : "The measure is based on recommendations from the American Geriatrics Society Beers Criteria[R] for Potentially Inappropriate Medication Use in Older Adults (2023). The criteria were developed through key clinical expert consensus processes by Beers in 1997, Zhan in 2001, Fick et al. in 2003, 2012, 2015, and 2019 and, most recently the American Geriatrics Society Beers Criteria Update Expert Panel in 2023. The Beers Criteria identifies lists of drugs that are potentially inappropriate for all older adults, except for those with certain conditions for which some high-risk medications may be warranted, and drugs that are potentially inappropriate in older adults based on various high-risk factors such as dosage, days supply and underlying diseases or conditions. \nNCQA's Geriatric Measurement Advisory Panel recommended a subset of drugs that should be used with caution in older adults for inclusion in the measure based upon the recommendations in the Beers Criteria.",
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]
},
"description" : "Exclude patients who are in hospice care for any part of the measurement period.\n\nExclude patients receiving palliative care for any part of the measurement period.",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Denominator Exclusions"
}
},
{
"id" : "5E6EAABC-3AC9-4360-8A4F-4D70EFD8C2B4",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "numerator",
"display" : "Numerator"
}
]
},
"description" : "Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days.\na. At least two orders of high-risk medications from the same drug class.\nb. At least two orders of high-risk medications from the same drug class with summed days supply greater than 90 days.\nc. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria.",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Numerator 1"
}
}
]
},
{
"id" : "66460d4ef4fc785d8711734c",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
"code" : "proportion",
"display" : "Proportion"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
"valueCode" : "boolean"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-type",
"code" : "process",
"display" : "Process"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
"valueCode" : "None"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
"code" : "decrease",
"display" : "increase"
}
]
}
}
],
"population" : [
{
"id" : "D09246EA-9FBF-4C80-ABD9-3051DC7CE8FA",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "initial-population",
"display" : "Initial Population"
}
]
},
"description" : "Patients 65 years and older at the end of the measurement period who had a visit during the measurement period",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Initial Population"
}
},
{
"id" : "D76C3A1E-4767-415E-8CEF-C9D54C8D3904",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "denominator",
"display" : "Denominator"
}
]
},
"description" : "Equals Initial Population",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Denominator"
}
},
{
"id" : "920ADB82-C127-473E-834C-191682317146",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "denominator-exclusion",
"display" : "Denominator Exclusion"
}
]
},
"description" : "Exclude patients who are in hospice care for any part of the measurement period.\n\nExclude patients receiving palliative care for any part of the measurement period.",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Denominator Exclusions"
}
},
{
"id" : "EDEE8DED-11C6-492B-B371-BF1D5ECB34CB",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "numerator",
"display" : "Numerator"
}
]
},
"description" : "Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines) on different days except for appropriate diagnoses.\na. Patients with two or more antipsychotic prescriptions ordered on different days, and who did not have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the IPSD for antipsychotics. \nb. Patients with two or more benzodiazepine prescriptions ordered on different days, and who did not have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines.\n",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Numerator 2"
}
}
]
},
{
"id" : "66460d4ef4fc785d8711734d",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
"code" : "proportion",
"display" : "Proportion"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
"valueCode" : "boolean"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-type",
"code" : "process",
"display" : "Process"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
"valueCode" : "None"
},
{
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
"code" : "decrease",
"display" : "increase"
}
]
}
}
],
"population" : [
{
"id" : "B6C3E029-C345-4BB5-96C9-9E5D1C2B63BD",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "initial-population",
"display" : "Initial Population"
}
]
},
"description" : "Patients 65 years and older at the end of the measurement period who had a visit during the measurement period",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Initial Population"
}
},
{
"id" : "DF3CBBB3-1FA3-497D-8287-2FE6AE9745F6",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "denominator",
"display" : "Denominator"
}
]
},
"description" : "Equals Initial Population",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Denominator"
}
},
{
"id" : "D4EA7568-D2C8-4B9D-818B-FBC488913633",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "denominator-exclusion",
"display" : "Denominator Exclusion"
}
]
},
"description" : "Exclude patients who are in hospice care for any part of the measurement period.\n\nExclude patients receiving palliative care for any part of the measurement period.",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Denominator Exclusions"
}
},
{
"id" : "36304EB4-9F6F-4657-9457-1E4295106EA8",
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/measure-population",
"code" : "numerator",
"display" : "Numerator"
}
]
},
"description" : "Total rate (the sum of the two previous numerators, deduplicated).",
"criteria" : {
"language" : "text/cql-identifier",
"expression" : "Numerator 3"
}
}
]
}
]
}
IG © 2023+ cqframework. Package gov.healthit.ecqi.ecqms#2024.0.0 based on FHIR 4.0.1. Generated 2024-11-07
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