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 2024-12-18 |
<Measure xmlns="http://hl7.org/fhir">
<id value="UseofHighRiskMedicationsintheElderlyFHIR"/>
<meta>
<profile
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<profile
value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"/>
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<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<table class="grid dict">
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">Use of High-Risk Medications in Older AdultsFHIR</td>
</tr>
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">UseofHighRiskMedicationsintheElderlyFHIR</td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">0.2.001</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="Measure-UseofHighRiskMedicationsintheElderlyFHIR.html">Use of High-Risk Medications in Older AdultsFHIR</a></td>
</tr>
<tr>
<th scope="row">
<b>
short-name identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>CMS156FHIR</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
version-independent identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>urn:uuid:fa08c5d7-5345-4e0b-aa2d-d937099db108</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
version-specific identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>urn:uuid:d9904550-61cd-4ea8-b36b-9d808a339278</span>
</p>
</td>
</tr>
<tr>
<th scope="row">
<b>
publisher (CMS) identifier:
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>156FHIR</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Effective Period: </b></th>
<td style="padding-left: 4px;">2025-01-01..2025-12-31</td>
</tr>
<tr>
<th scope="row"><b>Status: </b></th>
<td style="padding-left: 4px;">draft</td>
</tr>
<tr>
<th scope="row"><b>Publisher: </b></th>
<td style="padding-left: 4px;">National Committee for Quality Assurance</td>
</tr>
<tr>
<th scope="row"><b>Author: </b></th>
<td style="padding-left: 4px;">National Committee for Quality Assurance</td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<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>
<ol>
<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>
<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>
<li>Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators).</li>
</ol>
</div></td>
</tr>
<tr>
<th scope="row"><b>Purpose: </b></th>
<td style="padding-left: 4px;"><div><p>UNKNOWN</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Copyright: </b></th>
<td style="padding-left: 4px;"><div><p>This 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>
<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>
<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>
<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>
<p>This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation.</p>
<p>ICD-10 copyright 2024 World Health Organization. All Rights Reserved.</p>
<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>
<p>“HL7” is the registered trademark of Health Level Seven International.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Disclaimer: </b></th>
<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>
<p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Scoring: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>Proportion </span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Rationale: </b></th>
<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>
<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>
<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>
</div></td>
</tr>
<tr>
<th scope="row"><b>Clinical recommendation statement: </b></th>
<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.
NCQA'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>
</div></td>
</tr>
<tr>
<th scope="row"><b>Guidance (Usage): </b></th>
<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.
The 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.
Calculate 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.
This eCQM is a patient-based measure.
This FHIR-based measure has been derived from the QDM-based measure: CMS156v13.
Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).</td>
</tr>
<tr>
<th scope="row"><b>Population Criteria: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>66460d4ef4fc785d8711734b</b></th>
</tr>
<tr>
<td>Initial Population:</td>
<td>Patients 65 years and older at the end of the measurement period who had a visit during the measurement period</td>
</tr>
<tr>
<td>Denominator:</td>
<td>Equals Initial Population</td>
</tr>
<tr>
<td>Denominator Exclusion:</td>
<td>Exclude patients who are in hospice care for any part of the measurement period.
Exclude patients receiving palliative care for any part of the measurement period.</td>
</tr>
<tr>
<td>Numerator:</td>
<td>Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days.
a. At least two orders of high-risk medications from the same drug class.
b. At least two orders of high-risk medications from the same drug class with summed days supply greater than 90 days.
c. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria.</td>
</tr>
</table>
<table class="grid-dict">
<tr>
<th><b>66460d4ef4fc785d8711734c</b></th>
</tr>
<tr>
<td>Initial Population:</td>
<td>Patients 65 years and older at the end of the measurement period who had a visit during the measurement period</td>
</tr>
<tr>
<td>Denominator:</td>
<td>Equals Initial Population</td>
</tr>
<tr>
<td>Denominator Exclusion:</td>
<td>Exclude patients who are in hospice care for any part of the measurement period.
Exclude patients receiving palliative care for any part of the measurement period.</td>
</tr>
<tr>
<td>Numerator:</td>
<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.
a. 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.
b. 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.
</td>
</tr>
</table>
<table class="grid-dict">
<tr>
<th><b>66460d4ef4fc785d8711734d</b></th>
</tr>
<tr>
<td>Initial Population:</td>
<td>Patients 65 years and older at the end of the measurement period who had a visit during the measurement period</td>
</tr>
<tr>
<td>Denominator:</td>
<td>Equals Initial Population</td>
</tr>
<tr>
<td>Denominator Exclusion:</td>
<td>Exclude patients who are in hospice care for any part of the measurement period.
Exclude patients receiving palliative care for any part of the measurement period.</td>
</tr>
<tr>
<td>Numerator:</td>
<td>Total rate (the sum of the two previous numerators, deduplicated).</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Libraries: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td><a href="Library-UseofHighRiskMedicationsintheElderlyFHIR.html">UseofHighRiskMedicationsintheElderlyFHIR</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Terminology and Other Dependencies: </b></th>
<td style="padding-left: 4px;">
<li><code>Library/Status|1.8.000</code></li>
<li><code>Library/CumulativeMedicationDuration|4.1.000</code></li>
<li><code>Library/FHIRHelpers|4.4.000</code></li>
<li><code>Library/QICoreCommon|2.1.000</code></li>
<li><code>Library/CQMCommon|2.2.000</code></li>
<li><code>Library/Hospice|6.12.000</code></li>
<li><code>Library/PalliativeCare|1.11.000</code></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html">RxNorm</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-CPT.html">Current Procedural Terminology (CPT®)</a></li>
<li><a href="http://hl7.org/fhir/R4/codesystem-snomedct.html">SNOMED CT (all versions)</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-observation-category.html">Observation Category Codes</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html">Logical Observation Identifiers, Names and Codes (LOINC)</a></li>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.11.1252/expansion">Guanfacine</a></li>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion">Office Visit</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1285/expansion">Ophthalmological Services</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion">Preventive Care Services - Established Office Visit, 18 and Up</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1013/expansion">Discharge Services - Nursing Facility</a></li>
<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>
<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>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion">Preventive Care Services-Initial Office Visit, 18 and Up</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion">Annual Wellness Visit</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion">Home Healthcare Services</a></li>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion">Telephone Visits</a></li>
<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>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a></li>
<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>
<li><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</a></li>
<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>
<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>
<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>
<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>
</td>
</tr>
<tr>
<th scope="row"><b>Parameters:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>name</b></th>
<th><b>use</b></th>
<th><b>min</b></th>
<th><b>max</b></th>
<th><b>type</b></th>
</tr>
<tr>
<td>Measurement Period</td>
<td>In</td>
<td>0</td>
<td>1</td>
<td>Period</td>
</tr>
<tr>
<td>ErrorLevel</td>
<td>In</td>
<td>0</td>
<td>1</td>
<td>string</td>
</tr>
<tr>
<td>Numerator 3</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
<tr>
<td>Denominator</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
<tr>
<td>Numerator 1</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
<tr>
<td>Numerator 2</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
<tr>
<td>Initial Population</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
<tr>
<td>Denominator Exclusions</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>boolean</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>DataRequirements:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>Resource Type</b></th>
<th><b>Resource Elements</b></th>
<th><b>Valueset Name</b></th>
<th><b>Valueset</b></th>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Potentially Harmful Antipsychotics for Older Adults
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Potentially Harmful Benzodiazepines for Older Adults
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Potentially Harmful Antihistamines for Older Adults
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Potentially Harmful Antiparkinsonian Agents for Older Adults
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Potentially Harmful Gastrointestinal Antispasmodics for Older Adults
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Dipyridamole Medications
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Guanfacine Medications
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.196.11.1252/expansion">Guanfacine</a></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Nifedipine Medications
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Potentially Harmful Antidepressants for Older Adults
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Potentially Harmful Barbiturates for Older Adults
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Meprobamate Medications
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Potentially Harmful Estrogens for Older Adults
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Potentially Harmful Sulfonylureas for Older Adults
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Desiccated Thyroid Medications
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Potentially Harmful Nonbenzodiazepine Hypnotics for Older Adults
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Potentially Harmful Skeletal Muscle Relaxants for Older Adults
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Potentially Harmful Pain Medications for Older Adults
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Megestrol Medications
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Meperidine Medications
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Potentially Harmful Antiinfectives for Older Adults
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Digoxin Medications
</td>
<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>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication.reference
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationrequest.html">QICoreMedicationRequest</a>)</td>
<td>
medication
status
status.value
intent
intent.value
dosageInstruction
dispenseRequest
dispenseRequest.expectedSupplyDuration
dispenseRequest.quantity
dispenseRequest.numberOfRepeatsAllowed
dispenseRequest.numberOfRepeatsAllowed.value
authoredOn
authoredOn.value
dispenseRequest.validityPeriod
</td>
<td>
Doxepin Medications
</td>
<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>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Medication(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html">QICoreMedication</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Schizophrenia
</td>
<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>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Bipolar Disorder
</td>
<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>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Seizure Disorder
</td>
<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>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
REM Sleep Behavior Disorder
</td>
<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>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Benzodiazepine Withdrawal
</td>
<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>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Alcohol Withdrawal
</td>
<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>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Generalized Anxiety Disorder
</td>
<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>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Hospice Diagnosis
</td>
<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>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html">QICoreCondition</a>)</td>
<td>
code
</td>
<td>
Palliative Care Diagnosis
</td>
<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>
</tr>
<tr>
<td>Patient(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html">QICorePatient</a>)</td>
<td>
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
</td>
<td>
Office Visit
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion">Office Visit</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
</td>
<td>
Ophthalmological Services
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1285/expansion">Ophthalmological Services</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
</td>
<td>
Preventive Care Services Established Office Visit, 18 and Up
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion">Preventive Care Services - Established Office Visit, 18 and Up</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
</td>
<td>
Discharge Services Nursing Facility
</td>
<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>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
</td>
<td>
Nursing Facility Visit
</td>
<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>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
</td>
<td>
Care Services in Long Term Residential Facility
</td>
<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>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
</td>
<td>
Preventive Care Services Initial Office Visit, 18 and Up
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion">Preventive Care Services-Initial Office Visit, 18 and Up</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
</td>
<td>
Annual Wellness Visit
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion">Annual Wellness Visit</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
</td>
<td>
Home Healthcare Services
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion">Home Healthcare Services</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
</td>
<td>
Telephone Visits
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1080/expansion">Telephone Visits</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
status
status.value
period
</td>
<td>
Virtual Encounter
</td>
<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>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
hospitalization
hospitalization.dischargeDisposition
period
status
status.value
</td>
<td>
Encounter Inpatient
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
</td>
<td>
Hospice Encounter
</td>
<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>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html">QICoreEncounter</a>)</td>
<td>
type
period
status
status.value
</td>
<td>
Palliative Care Encounter
</td>
<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>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
<td>
code
value
effective
status
status.value
category
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html">QICoreObservation</a>)</td>
<td>
code
effective
status
status.value
category
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>ServiceRequest(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html">QICoreServiceRequest</a>)</td>
<td>
code
authoredOn
authoredOn.value
status
status.value
intent
intent.value
</td>
<td>
Hospice Care Ambulatory
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
performed
status
status.value
</td>
<td>
Hospice Care Ambulatory
</td>
<td><a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1584/expansion">Hospice Care Ambulatory</a></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html">QICoreProcedure</a>)</td>
<td>
code
performed
status
status.value
</td>
<td>
Palliative Care Intervention
</td>
<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>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Direct Reference Codes:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>display</b></th>
<th><b>code</b></th>
<th><b>system</b></th>
</tr>
<tr>
<td>ergoloid mesylates, USP 1 MG Oral Tablet</td>
<td>318179</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>digoxin 0.05 MG/ML Oral Solution</td>
<td>393245</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>digoxin 0.0625 MG Oral Tablet</td>
<td>245273</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>1 ML digoxin 0.1 MG/ML Injection</td>
<td>204504</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>digoxin 0.125 MG Oral Tablet</td>
<td>197604</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>digoxin 0.25 MG Oral Tablet</td>
<td>197606</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>2 ML digoxin 0.25 MG/ML Injection</td>
<td>104208</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin 3 MG Oral Tablet</td>
<td>966787</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin 6 MG Oral Tablet</td>
<td>966793</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin 10 MG Oral Capsule</td>
<td>1000048</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin 10 MG/ML Oral Solution</td>
<td>1000054</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin 25 MG Oral Capsule</td>
<td>1000070</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin 50 MG Oral Capsule</td>
<td>1000076</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin 75 MG Oral Capsule</td>
<td>1000097</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin 100 MG Oral Capsule</td>
<td>1000058</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<td>doxepin 150 MG Oral Capsule</td>
<td>1000064</td>
<td><a href="https://www.nlm.nih.gov/research/umls/rxnorm/index.html">http://www.nlm.nih.gov/research/umls/rxnorm</a></td>
</tr>
<tr>
<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>
<td>99211</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-CPT.html">http://www.ama-assn.org/go/cpt</a></td>
</tr>
<tr>
<td>Discharge to home for hospice care (procedure)</td>
<td>428361000124107</td>
<td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
</tr>
<tr>
<td>Discharge to healthcare facility for hospice care (procedure)</td>
<td>428371000124100</td>
<td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
</tr>
<tr>
<td>survey</td>
<td>survey</td>
<td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-observation-category.html">http://terminology.hl7.org/CodeSystem/observation-category</a></td>
</tr>
<tr>
<td>Yes (qualifier value)</td>
<td>373066001</td>
<td><a href="https://browser.ihtsdotools.org/">http://snomed.info/sct</a></td>
</tr>
<tr>
<td>Hospice care [Minimum Data Set]</td>
<td>45755-6</td>
<td><a href="https://loinc.org/">http://loinc.org</a></td>
</tr>
<tr>
<td>Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)</td>
<td>71007-9</td>
<td><a href="https://loinc.org/">http://loinc.org</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Logic Definitions:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>Group</b></th>
<th><b>Scoring</b></th>
<th><b>Population Criteria</b></th>
<th><b>Expression</b></th>
</tr>
<tr>
<td> 66460d4ef4fc785d8711734b </td>
<td colspan="3" style="padding-left: 4px;">
<b>Group scoring:</b>
<span> proportion </span>
<b>Measure scoring:</b>
<p style="margin-bottom: 5px;">
<span>Proportion</span>
</p>
<tr>
<th scope="row"><b>Type: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>Process </span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Rate Aggregation: </b></th>
<td colspan="3" style="padding-left: 4px;">None</td>
</tr>
<tr>
<th scope="row"><b>Improvement Notation: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>increase </span>
</p>
</td>
</tr>
</td>
<tr>
<td/>
<td/>
<td>Initial Population</td>
<td>
<pre><code class="language-cql">define "Initial Population":
AgeInYearsAt(date from
end of "Measurement Period"
) >= 65
and exists ( "Qualifying Encounters" )</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator</td>
<td>
<pre><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exclusion</td>
<td>
<pre><code class="language-cql">define "Denominator Exclusions":
Hospice."Has Hospice Services"
or PalliativeCare."Has Palliative Care in the Measurement Period"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator</td>
<td>
<pre><code class="language-cql">define "Numerator 1":
exists ( "Same High Risk Medications Ordered on Different Days" )
or ( "Two High Risk Medications with Prolonged Duration" )
or ( "High Risk Medications with Average Daily Dose Criteria" )</code></pre>
</td>
</tr>
<td> 66460d4ef4fc785d8711734c </td>
<td colspan="3" style="padding-left: 4px;">
<b>Group scoring:</b>
<span> proportion </span>
<b>Measure scoring:</b>
<p style="margin-bottom: 5px;">
<span>Proportion</span>
</p>
<tr>
<th scope="row"><b>Type: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>Process </span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Rate Aggregation: </b></th>
<td colspan="3" style="padding-left: 4px;">None</td>
</tr>
<tr>
<th scope="row"><b>Improvement Notation: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>increase </span>
</p>
</td>
</tr>
</td>
<tr>
<td/>
<td/>
<td>Initial Population</td>
<td>
<pre><code class="language-cql">define "Initial Population":
AgeInYearsAt(date from
end of "Measurement Period"
) >= 65
and exists ( "Qualifying Encounters" )</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator</td>
<td>
<pre><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exclusion</td>
<td>
<pre><code class="language-cql">define "Denominator Exclusions":
Hospice."Has Hospice Services"
or PalliativeCare."Has Palliative Care in the Measurement Period"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator</td>
<td>
<pre><code class="language-cql">define "Numerator 2":
( "More than One Antipsychotic Order"
and ( not exists ( ( [Condition: "Schizophrenia"]
union [Condition: "Bipolar Disorder"] ) AntipsychoticTreatedDiagnoses
where AntipsychoticTreatedDiagnoses.prevalenceInterval ( ) overlaps Interval[start of "Measurement Period" - 1 year, "Antipsychotic Index Prescription Start Date"]
)
)
)
or ( "More than One Benzodiazepine Order"
and ( not exists ( ( [Condition: "Seizure Disorder"]
union [Condition: "REM Sleep Behavior Disorder"]
union [Condition: "Benzodiazepine Withdrawal"]
union [Condition: "Alcohol Withdrawal"]
union [Condition: "Generalized Anxiety Disorder"] ) BenzodiazepineTreatedDiagnoses
where BenzodiazepineTreatedDiagnoses.prevalenceInterval ( ) overlaps Interval[start of "Measurement Period" - 1 year, "Benzodiazepine Index Prescription Start Date"]
)
)
)</code></pre>
</td>
</tr>
<td> 66460d4ef4fc785d8711734d </td>
<td colspan="3" style="padding-left: 4px;">
<b>Group scoring:</b>
<span> proportion </span>
<b>Measure scoring:</b>
<p style="margin-bottom: 5px;">
<span>Proportion</span>
</p>
<tr>
<th scope="row"><b>Type: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>Process </span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Rate Aggregation: </b></th>
<td colspan="3" style="padding-left: 4px;">None</td>
</tr>
<tr>
<th scope="row"><b>Improvement Notation: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>increase </span>
</p>
</td>
</tr>
</td>
<tr>
<td/>
<td/>
<td>Initial Population</td>
<td>
<pre><code class="language-cql">define "Initial Population":
AgeInYearsAt(date from
end of "Measurement Period"
) >= 65
and exists ( "Qualifying Encounters" )</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator</td>
<td>
<pre><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exclusion</td>
<td>
<pre><code class="language-cql">define "Denominator Exclusions":
Hospice."Has Hospice Services"
or PalliativeCare."Has Palliative Care in the Measurement Period"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator</td>
<td>
<pre><code class="language-cql">define "Numerator 3":
"Numerator 2"
or ( "Numerator 1"
and not "Numerator 2"
)</code></pre>
</td>
</tr>
</tr>
</table>
<table class="grid-dict">
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>More than One Antipsychotic Order</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "More than One Antipsychotic Order":
exists ( ( [MedicationRequest: "Potentially Harmful Antipsychotics for Older Adults"] ).moreThanOneOrder ( ) )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Antipsychotic Index Prescription Start Date</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Antipsychotic Index Prescription Start Date":
First((([MedicationRequest: "Potentially Harmful Antipsychotics for Older Adults"]).isMedicationOrder()) AntipsychoticMedication
where AntipsychoticMedication.authoredOn during "Measurement Period"
return AntipsychoticMedication.authoredOn
sort asc
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>More than One Benzodiazepine Order</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "More than One Benzodiazepine Order":
exists ( ( [MedicationRequest: "Potentially Harmful Benzodiazepines for Older Adults"] ).moreThanOneOrder ( ) )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Benzodiazepine Index Prescription Start Date</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Benzodiazepine Index Prescription Start Date":
First((([MedicationRequest: "Potentially Harmful Benzodiazepines for Older Adults"]).isMedicationOrder()) BenzodiazepineMedication
where BenzodiazepineMedication.authoredOn during "Measurement Period"
return BenzodiazepineMedication.authoredOn
sort asc
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Numerator 2</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Numerator 2":
( "More than One Antipsychotic Order"
and ( not exists ( ( [Condition: "Schizophrenia"]
union [Condition: "Bipolar Disorder"] ) AntipsychoticTreatedDiagnoses
where AntipsychoticTreatedDiagnoses.prevalenceInterval ( ) overlaps Interval[start of "Measurement Period" - 1 year, "Antipsychotic Index Prescription Start Date"]
)
)
)
or ( "More than One Benzodiazepine Order"
and ( not exists ( ( [Condition: "Seizure Disorder"]
union [Condition: "REM Sleep Behavior Disorder"]
union [Condition: "Benzodiazepine Withdrawal"]
union [Condition: "Alcohol Withdrawal"]
union [Condition: "Generalized Anxiety Disorder"] ) BenzodiazepineTreatedDiagnoses
where BenzodiazepineTreatedDiagnoses.prevalenceInterval ( ) overlaps Interval[start of "Measurement Period" - 1 year, "Benzodiazepine Index Prescription Start Date"]
)
)
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Same High Risk Medications Ordered on Different Days</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Same High Risk Medications Ordered on Different Days":
( [MedicationRequest: "Potentially Harmful Antihistamines for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Antiparkinsonian Agents for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Gastrointestinal Antispasmodics for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Dipyridamole Medications"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Guanfacine Medications"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Nifedipine Medications"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Antidepressants for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Barbiturates for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "ergoloid mesylates, USP 1 MG Oral Tablet"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Meprobamate Medications"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Estrogens for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Sulfonylureas for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Desiccated Thyroid Medications"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Nonbenzodiazepine Hypnotics for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Skeletal Muscle Relaxants for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Pain Medications for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Megestrol Medications"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Meperidine Medications"] ).moreThanOneOrder ( )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Two High Risk Medications with Prolonged Duration</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Two High Risk Medications with Prolonged Duration":
Sum((([MedicationRequest: "Potentially Harmful Antiinfectives for Older Adults"]).moreThanOneOrder()) AntiInfectives
let DaysSupply: AntiInfectives.MedicationRequestPeriodInDays()
return all DaysSupply
) > 90</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>High Risk Medications with Average Daily Dose Criteria</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "High Risk Medications with Average Daily Dose Criteria":
exists ( ( ( [MedicationRequest: "Digoxin Medications"] ).moreThanOneOrder ( ) ) DigoxinOrdered
where ( DigoxinOrdered ).averageDailyDose ( ) > 0.125 'mg/d'
)
or exists ( ( ( [MedicationRequest: "Doxepin Medications"] ).moreThanOneOrder ( ) ) DoxepinOrdered
where ( DoxepinOrdered ).averageDailyDose ( ) > 6 'mg/d'
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Numerator 1</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Numerator 1":
exists ( "Same High Risk Medications Ordered on Different Days" )
or ( "Two High Risk Medications with Prolonged Duration" )
or ( "High Risk Medications with Average Daily Dose Criteria" )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Numerator 3</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Numerator 3":
"Numerator 2"
or ( "Numerator 1"
and not "Numerator 2"
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Qualifying Encounters</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Qualifying Encounters":
( ( [Encounter: "Office Visit"]
union [Encounter: "Ophthalmological Services"]
union [Encounter: "Preventive Care Services Established Office Visit, 18 and Up"]
union [Encounter: "Discharge Services Nursing Facility"]
union [Encounter: "Nursing Facility Visit"]
union [Encounter: "Care Services in Long Term Residential Facility"]
union [Encounter: "Preventive Care Services Initial Office Visit, 18 and Up"]
union [Encounter: "Annual Wellness Visit"]
union [Encounter: "Home Healthcare Services"]
union [Encounter: "Telephone Visits"]
union [Encounter: "Virtual Encounter"]
union ( [Encounter] E
where exists ( ( E.type ) T
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"
)
)
).isEncounterPerformed ( ) ) ValidEncounters
where ValidEncounters.period during "Measurement Period"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Initial Population</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Initial Population":
AgeInYearsAt(date from
end of "Measurement Period"
) >= 65
and exists ( "Qualifying Encounters" )</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Denominator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>Hospice</td>
<td>Has Hospice Services</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Hospice Services":
exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter
where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
)
and InpatientEncounter.period.toInterval() ends during day of "Measurement Period"
)
or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter
where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period"
)
or exists ((([Observation: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment
where HospiceAssessment.value ~ "Yes (qualifier value)"
and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"
)
or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder
where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period"
// and HospiceOrder.doNotPerform is not true
// https://oncprojectracking.healthit.gov/support/browse/CQLIT-447
)
or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed
where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"
)
or exists (([Condition: "Hospice Diagnosis"]) HospiceCareDiagnosis
where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>PalliativeCare</td>
<td>Has Palliative Care in the Measurement Period</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Has Palliative Care in the Measurement Period":
exists ((([Observation: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment
where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period"
)
or exists ([Condition: "Palliative Care Diagnosis"] PalliativeDiagnosis
where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
)
or exists ((([Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter
where PalliativeEncounter.period.toInterval() overlaps day of "Measurement Period"
)
or exists ((([Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention
where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement Period"
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>Denominator Exclusions</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator Exclusions":
Hospice."Has Hospice Services"
or PalliativeCare."Has Palliative Care in the Measurement Period"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>moreThanOneOrder</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function "moreThanOneOrder"(Medication List<MedicationRequest>):
( Medication.isMedicationOrder ( ) ) OrderMedication1
with ( Medication.isMedicationOrder ( ) ) OrderMedication2
such that ( OrderMedication1.authoredOn during "Measurement Period"
and OrderMedication1.dispenseRequest.numberOfRepeatsAllowed >= 1
)
or ( date from OrderMedication1.authoredOn !~ date from OrderMedication2.authoredOn
and OrderMedication1.authoredOn during "Measurement Period"
and OrderMedication2.authoredOn during "Measurement Period"
)
or ( date from OrderMedication1.authoredOn ~ date from OrderMedication2.authoredOn
and OrderMedication1.authoredOn during "Measurement Period"
and date from start of OrderMedication1.medicationRequestPeriod ( ) !~ date from start of OrderMedication2.medicationRequestPeriod ( )
and start of OrderMedication1.medicationRequestPeriod ( ) during "Measurement Period"
and start of OrderMedication2.medicationRequestPeriod ( ) during "Measurement Period"
)
return OrderMedication1</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>Status</td>
<td>isMedicationOrder</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">//Medication, Order: active and completed only
define fluent function isMedicationOrder(MedicationRequest List<MedicationRequest>):
MedicationRequest M
where M.status in { 'active', 'completed' }
and M.intent = 'order'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CumulativeMedicationDuration</td>
<td>medicationRequestPeriod</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function medicationRequestPeriod(Request "MedicationRequest"):
Request R
let
dosage: singleton from R.dosageInstruction,
doseAndRate: singleton from dosage.doseAndRate,
timing: dosage.timing,
frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),
period: Quantity(timing.repeat.period, timing.repeat.periodUnit),
doseRange: doseAndRate.dose,
doseQuantity: doseAndRate.dose,
dose: Coalesce(end of doseRange, doseQuantity),
dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),
boundsPeriod: timing.repeat.bounds as Interval<DateTime>,
daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value,
quantity: R.dispenseRequest.quantity,
refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),
startDate:
Coalesce(
date from start of boundsPeriod,
date from R.authoredOn,
date from start of R.dispenseRequest.validityPeriod
),
totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills)
return
if startDate is not null and totalDaysSupplied is not null then
Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ]
else if startDate is not null and boundsPeriod."high" is not null then
Interval[startDate, date from end of boundsPeriod]
else
null</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CumulativeMedicationDuration</td>
<td>Quantity</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/**********************************************************************/
/* Functions in this region are copied from opioid-mme-r4 */
/**********************************************************************/
define function Quantity(value Decimal, unit String):
if value is not null then
System.Quantity { value: value, unit: unit }
else
null</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CumulativeMedicationDuration</td>
<td>ToDaily</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
Goal is to get to number of days
Two broad approaches to the calculation:
1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered
2) Based on relevant period, determine a covered interval and calculate the length of that interval in days
This topic covers several use cases and illustrates how to calculate Cumulative
Medication Duration for each type of medication resource using the supply and
frequency approach.
*/
/*
For the first approach, we need to get from frequency to a frequency/day
So we define ToDaily
*/
/*
Calculates daily frequency given frequency within a period
*/
define function ToDaily(frequency System.Integer, period System.Quantity):
case period.unit
when 'h' then frequency * (24.0 / period.value)
when 'min' then frequency * (24.0 / period.value) * 60
when 's' then frequency * (24.0 / period.value) * 60 * 60
when 'd' then frequency * (24.0 / period.value) / 24
when 'wk' then frequency * (24.0 / period.value) / (24 * 7)
when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
when 'hour' then frequency * (24.0 / period.value)
when 'minute' then frequency * (24.0 / period.value) * 60
when 'second' then frequency * (24.0 / period.value) * 60 * 60
when 'day' then frequency * (24.0 / period.value) / 24
when 'week' then frequency * (24.0 / period.value) / (24 * 7)
when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
when 'hours' then frequency * (24.0 / period.value)
when 'minutes' then frequency * (24.0 / period.value) * 60
when 'seconds' then frequency * (24.0 / period.value) * 60 * 60
when 'days' then frequency * (24.0 / period.value) / 24
when 'weeks' then frequency * (24.0 / period.value) / (24 * 7)
when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit)
end</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>prevalenceInterval</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
or condition.clinicalStatus ~ "recurrence"
or condition.clinicalStatus ~ "relapse" then
Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
(end of condition.abatementInterval()) abatementDate
return if abatementDate is null then
Interval[start of condition.onset.toInterval(), abatementDate)
else
Interval[start of condition.onset.toInterval(), abatementDate]</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>MedicationRequestPeriodInDays</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function MedicationRequestPeriodInDays(Request "MedicationRequest"):
Request R
let dosage: singleton from R.dosageInstruction,
doseAndRate: singleton from dosage.doseAndRate,
timing: dosage.timing,
frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),
period: CMD."Quantity" ( timing.repeat.period, timing.repeat.periodUnit ),
doseRange: doseAndRate.dose,
doseQuantity: doseAndRate.dose,
dose: Coalesce(
end of doseRange, doseQuantity
),
dosesPerDay: Coalesce((CMD."ToDaily"(frequency, period)), Count(timing.repeat.timeOfDay), 1.0),
boundsPeriod: timing.repeat.bounds as Interval<DateTime>,
daysSupply: ( convert R.dispenseRequest.expectedSupplyDuration to days ).value,
quantity: R.dispenseRequest.quantity,
refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),
startDate: Coalesce(date from start of boundsPeriod, date from R.authoredOn, date from start of R.dispenseRequest.validityPeriod),
totalDaysSupplied: Coalesce(daysSupply, quantity.value /(dose.value * dosesPerDay)) * ( 1 + refills )
return totalDaysSupplied</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>averageDailyDose</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function "averageDailyDose"(MedicationRequest MedicationRequest):
MedicationRequest Order
let MedicationStrength: Order.getMedicationCode ( ).MedicationStrengthPerUnit ( ),
DaysSupplied: Order.MedicationRequestPeriodInDays ( )
return if DaysSupplied is not null
and ( MedicationStrength.unit = 'mg'
or ( MedicationStrength.unit = 'mg/mL'
and Order.dispenseRequest.quantity.unit = 'mL'
)
) then ( ( Order.dispenseRequest.quantity * MedicationStrength ) / Quantity { value: DaysSupplied, unit: 'd' } )
else null</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>UseofHighRiskMedicationsintheElderlyFHIR</td>
<td>MedicationStrengthPerUnit</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define fluent function MedicationStrengthPerUnit(Strength Concept):
case
when Strength ~ "digoxin 0.05 MG/ML Oral Solution" then 0.05 'mg/mL'
when Strength ~ "digoxin 0.0625 MG Oral Tablet" then 0.0625 'mg'
when Strength ~ "1 ML digoxin 0.1 MG/ML Injection" then 0.1 'mg/mL'
when Strength ~ "digoxin 0.125 MG Oral Tablet" then 0.125 'mg'
when Strength ~ "digoxin 0.25 MG Oral Tablet" then 0.25 'mg'
when Strength ~ "2 ML digoxin 0.25 MG/ML Injection" then 0.25 'mg/mL'
when Strength ~ "doxepin 3 MG Oral Tablet" then 3 'mg'
when Strength ~ "doxepin 6 MG Oral Tablet" then 6 'mg'
when Strength ~ "doxepin 10 MG Oral Capsule" then 10 'mg'
when Strength ~ "doxepin 10 MG/ML Oral Solution" then 10 'mg/mL'
when Strength ~ "doxepin 25 MG Oral Capsule" then 25 'mg'
when Strength ~ "doxepin 50 MG Oral Capsule" then 50 'mg'
when Strength ~ "doxepin 75 MG Oral Capsule" then 75 'mg'
when Strength ~ "doxepin 100 MG Oral Capsule" then 100 'mg'
when Strength ~ "doxepin 150 MG Oral Capsule" then 150 'mg'
else null end</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>CQMCommon</td>
<td>getMedicationCode</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Returns the medication code for the given MedicationRequest
*/
define fluent function getMedicationCode(request MedicationRequest ):
if request.medication is Concept then
request.medication as Concept
else
(singleton from ([Medication] M where M.id = (request.medication as Reference).reference.getId())).code</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>Status</td>
<td>isEncounterPerformed</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">//Encounter, Performed
//General usage unless required otherwise by measure intent (e.g., follow-up encounters)
define fluent function isEncounterPerformed(Enc List<Encounter>):
Enc E
where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>FHIRHelpers</td>
<td>ToConcept</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
if concept is null then
null
else
System.Concept {
codes: concept.coding C return ToCode(C),
display: concept.text.value
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>QICoreCommon</td>
<td>toInterval</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If 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
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
case
when choice is DateTime then
Interval[choice as DateTime, choice as DateTime]
when choice is Interval<DateTime> then
choice as Interval<DateTime>
when choice is Quantity then
Interval[Patient.birthDate + (choice as Quantity),
Patient.birthDate + (choice as Quantity) + 1 year)
when choice is Interval<Quantity> then
Interval[Patient.birthDate + (choice.low as Quantity),
Patient.birthDate + (choice.high as Quantity) + 1 year)
when choice is Timing then
Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
else
null as Interval<DateTime>
end</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>Status</td>
<td>isAssessmentPerformed</td>
</tr>
<tr>
<td/>
<td>
<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.
//Assessment, Performed
define fluent function isAssessmentPerformed(Obs List<Observation>):
Obs O
where O.status in { 'final', 'amended', 'corrected' }
and exists ( O.category ObservationCategory
where ( ObservationCategory ) ~ "survey"
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>Status</td>
<td>isInterventionOrder</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">//Intervention, Order: active and completed only
define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):
ServiceRequest S
where S.status in { 'active', 'completed' }
and S.intent = 'order'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>Status</td>
<td>isInterventionPerformed</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">//Intervention, Performed
define fluent function isInterventionPerformed(Proc List<Procedure>):
Proc P
where P.status ~ 'completed'</code></pre>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</text>
<contained>
<Library>
<id value="effective-data-requirements"/>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="318179"/>
<display value="ergoloid mesylates, USP 1 MG Oral Tablet"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="393245"/>
<display value="digoxin 0.05 MG/ML Oral Solution"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="245273"/>
<display value="digoxin 0.0625 MG Oral Tablet"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="204504"/>
<display value="1 ML digoxin 0.1 MG/ML Injection"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="197604"/>
<display value="digoxin 0.125 MG Oral Tablet"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="197606"/>
<display value="digoxin 0.25 MG Oral Tablet"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="104208"/>
<display value="2 ML digoxin 0.25 MG/ML Injection"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="966787"/>
<display value="doxepin 3 MG Oral Tablet"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="966793"/>
<display value="doxepin 6 MG Oral Tablet"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="1000048"/>
<display value="doxepin 10 MG Oral Capsule"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="1000054"/>
<display value="doxepin 10 MG/ML Oral Solution"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="1000070"/>
<display value="doxepin 25 MG Oral Capsule"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="1000076"/>
<display value="doxepin 50 MG Oral Capsule"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="1000097"/>
<display value="doxepin 75 MG Oral Capsule"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="1000058"/>
<display value="doxepin 100 MG Oral Capsule"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
<code value="1000064"/>
<display value="doxepin 150 MG Oral Capsule"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://www.ama-assn.org/go/cpt"/>
<code value="99211"/>
<display
value="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"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="428361000124107"/>
<display value="Discharge to home for hospice care (procedure)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="428371000124100"/>
<display
value="Discharge to healthcare facility for hospice care (procedure)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/observation-category"/>
<code value="survey"/>
<display value="survey"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="373066001"/>
<display value="Yes (qualifier value)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://loinc.org"/>
<code value="45755-6"/>
<display value="Hospice care [Minimum Data Set]"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
<valueCoding>
<system value="http://loinc.org"/>
<code value="71007-9"/>
<display
value="Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="More than One Antipsychotic Order"/>
</extension>
<extension url="statement">
<valueString
value="define "More than One Antipsychotic Order":
exists ( ( [MedicationRequest: "Potentially Harmful Antipsychotics for Older Adults"] ).moreThanOneOrder ( ) )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Antipsychotic Index Prescription Start Date"/>
</extension>
<extension url="statement">
<valueString
value="define "Antipsychotic Index Prescription Start Date":
First((([MedicationRequest: "Potentially Harmful Antipsychotics for Older Adults"]).isMedicationOrder()) AntipsychoticMedication
where AntipsychoticMedication.authoredOn during "Measurement Period"
return AntipsychoticMedication.authoredOn
sort asc
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="More than One Benzodiazepine Order"/>
</extension>
<extension url="statement">
<valueString
value="define "More than One Benzodiazepine Order":
exists ( ( [MedicationRequest: "Potentially Harmful Benzodiazepines for Older Adults"] ).moreThanOneOrder ( ) )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Benzodiazepine Index Prescription Start Date"/>
</extension>
<extension url="statement">
<valueString
value="define "Benzodiazepine Index Prescription Start Date":
First((([MedicationRequest: "Potentially Harmful Benzodiazepines for Older Adults"]).isMedicationOrder()) BenzodiazepineMedication
where BenzodiazepineMedication.authoredOn during "Measurement Period"
return BenzodiazepineMedication.authoredOn
sort asc
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Numerator 2"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator 2":
( "More than One Antipsychotic Order"
and ( not exists ( ( [Condition: "Schizophrenia"]
union [Condition: "Bipolar Disorder"] ) AntipsychoticTreatedDiagnoses
where AntipsychoticTreatedDiagnoses.prevalenceInterval ( ) overlaps Interval[start of "Measurement Period" - 1 year, "Antipsychotic Index Prescription Start Date"]
)
)
)
or ( "More than One Benzodiazepine Order"
and ( not exists ( ( [Condition: "Seizure Disorder"]
union [Condition: "REM Sleep Behavior Disorder"]
union [Condition: "Benzodiazepine Withdrawal"]
union [Condition: "Alcohol Withdrawal"]
union [Condition: "Generalized Anxiety Disorder"] ) BenzodiazepineTreatedDiagnoses
where BenzodiazepineTreatedDiagnoses.prevalenceInterval ( ) overlaps Interval[start of "Measurement Period" - 1 year, "Benzodiazepine Index Prescription Start Date"]
)
)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString
value="Same High Risk Medications Ordered on Different Days"/>
</extension>
<extension url="statement">
<valueString
value="define "Same High Risk Medications Ordered on Different Days":
( [MedicationRequest: "Potentially Harmful Antihistamines for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Antiparkinsonian Agents for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Gastrointestinal Antispasmodics for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Dipyridamole Medications"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Guanfacine Medications"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Nifedipine Medications"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Antidepressants for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Barbiturates for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "ergoloid mesylates, USP 1 MG Oral Tablet"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Meprobamate Medications"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Estrogens for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Sulfonylureas for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Desiccated Thyroid Medications"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Nonbenzodiazepine Hypnotics for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Skeletal Muscle Relaxants for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Potentially Harmful Pain Medications for Older Adults"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Megestrol Medications"] ).moreThanOneOrder ( )
union ( [MedicationRequest: "Meperidine Medications"] ).moreThanOneOrder ( )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString
value="Two High Risk Medications with Prolonged Duration"/>
</extension>
<extension url="statement">
<valueString
value="define "Two High Risk Medications with Prolonged Duration":
Sum((([MedicationRequest: "Potentially Harmful Antiinfectives for Older Adults"]).moreThanOneOrder()) AntiInfectives
let DaysSupply: AntiInfectives.MedicationRequestPeriodInDays()
return all DaysSupply
) > 90"/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString
value="High Risk Medications with Average Daily Dose Criteria"/>
</extension>
<extension url="statement">
<valueString
value="define "High Risk Medications with Average Daily Dose Criteria":
exists ( ( ( [MedicationRequest: "Digoxin Medications"] ).moreThanOneOrder ( ) ) DigoxinOrdered
where ( DigoxinOrdered ).averageDailyDose ( ) > 0.125 'mg/d'
)
or exists ( ( ( [MedicationRequest: "Doxepin Medications"] ).moreThanOneOrder ( ) ) DoxepinOrdered
where ( DoxepinOrdered ).averageDailyDose ( ) > 6 'mg/d'
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Numerator 1"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator 1":
exists ( "Same High Risk Medications Ordered on Different Days" )
or ( "Two High Risk Medications with Prolonged Duration" )
or ( "High Risk Medications with Average Daily Dose Criteria" )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Numerator 3"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator 3":
"Numerator 2"
or ( "Numerator 1"
and not "Numerator 2"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Qualifying Encounters"/>
</extension>
<extension url="statement">
<valueString
value="define "Qualifying Encounters":
( ( [Encounter: "Office Visit"]
union [Encounter: "Ophthalmological Services"]
union [Encounter: "Preventive Care Services Established Office Visit, 18 and Up"]
union [Encounter: "Discharge Services Nursing Facility"]
union [Encounter: "Nursing Facility Visit"]
union [Encounter: "Care Services in Long Term Residential Facility"]
union [Encounter: "Preventive Care Services Initial Office Visit, 18 and Up"]
union [Encounter: "Annual Wellness Visit"]
union [Encounter: "Home Healthcare Services"]
union [Encounter: "Telephone Visits"]
union [Encounter: "Virtual Encounter"]
union ( [Encounter] E
where exists ( ( E.type ) T
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"
)
)
).isEncounterPerformed ( ) ) ValidEncounters
where ValidEncounters.period during "Measurement Period""/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Initial Population"/>
</extension>
<extension url="statement">
<valueString
value="define "Initial Population":
AgeInYearsAt(date from
end of "Measurement Period"
) >= 65
and exists ( "Qualifying Encounters" )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="11"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator":
"Initial Population""/>
</extension>
<extension url="displaySequence">
<valueInteger value="12"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="Hospice"/>
</extension>
<extension url="name">
<valueString value="Has Hospice Services"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Hospice Services":
exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter
where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
)
and InpatientEncounter.period.toInterval() ends during day of "Measurement Period"
)
or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter
where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period"
)
or exists ((([Observation: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment
where HospiceAssessment.value ~ "Yes (qualifier value)"
and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"
)
or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder
where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period"
// and HospiceOrder.doNotPerform is not true
// https://oncprojectracking.healthit.gov/support/browse/CQLIT-447
)
or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed
where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"
)
or exists (([Condition: "Hospice Diagnosis"]) HospiceCareDiagnosis
where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="13"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="PalliativeCare"/>
</extension>
<extension url="name">
<valueString value="Has Palliative Care in the Measurement Period"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Palliative Care in the Measurement Period":
exists ((([Observation: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment
where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period"
)
or exists ([Condition: "Palliative Care Diagnosis"] PalliativeDiagnosis
where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
)
or exists ((([Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter
where PalliativeEncounter.period.toInterval() overlaps day of "Measurement Period"
)
or exists ((([Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention
where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement Period"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator Exclusions"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator Exclusions":
Hospice."Has Hospice Services"
or PalliativeCare."Has Palliative Care in the Measurement Period""/>
</extension>
<extension url="displaySequence">
<valueInteger value="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="moreThanOneOrder"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function "moreThanOneOrder"(Medication List<MedicationRequest>):
( Medication.isMedicationOrder ( ) ) OrderMedication1
with ( Medication.isMedicationOrder ( ) ) OrderMedication2
such that ( OrderMedication1.authoredOn during "Measurement Period"
and OrderMedication1.dispenseRequest.numberOfRepeatsAllowed >= 1
)
or ( date from OrderMedication1.authoredOn !~ date from OrderMedication2.authoredOn
and OrderMedication1.authoredOn during "Measurement Period"
and OrderMedication2.authoredOn during "Measurement Period"
)
or ( date from OrderMedication1.authoredOn ~ date from OrderMedication2.authoredOn
and OrderMedication1.authoredOn during "Measurement Period"
and date from start of OrderMedication1.medicationRequestPeriod ( ) !~ date from start of OrderMedication2.medicationRequestPeriod ( )
and start of OrderMedication1.medicationRequestPeriod ( ) during "Measurement Period"
and start of OrderMedication2.medicationRequestPeriod ( ) during "Measurement Period"
)
return OrderMedication1"/>
</extension>
<extension url="displaySequence">
<valueInteger value="16"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="Status"/>
</extension>
<extension url="name">
<valueString value="isMedicationOrder"/>
</extension>
<extension url="statement">
<valueString
value="//Medication, Order: active and completed only
define fluent function isMedicationOrder(MedicationRequest List<MedicationRequest>):
MedicationRequest M
where M.status in { 'active', 'completed' }
and M.intent = 'order'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CumulativeMedicationDuration"/>
</extension>
<extension url="name">
<valueString value="medicationRequestPeriod"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function medicationRequestPeriod(Request "MedicationRequest"):
Request R
let
dosage: singleton from R.dosageInstruction,
doseAndRate: singleton from dosage.doseAndRate,
timing: dosage.timing,
frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),
period: Quantity(timing.repeat.period, timing.repeat.periodUnit),
doseRange: doseAndRate.dose,
doseQuantity: doseAndRate.dose,
dose: Coalesce(end of doseRange, doseQuantity),
dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),
boundsPeriod: timing.repeat.bounds as Interval<DateTime>,
daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value,
quantity: R.dispenseRequest.quantity,
refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),
startDate:
Coalesce(
date from start of boundsPeriod,
date from R.authoredOn,
date from start of R.dispenseRequest.validityPeriod
),
totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills)
return
if startDate is not null and totalDaysSupplied is not null then
Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ]
else if startDate is not null and boundsPeriod."high" is not null then
Interval[startDate, date from end of boundsPeriod]
else
null"/>
</extension>
<extension url="displaySequence">
<valueInteger value="18"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CumulativeMedicationDuration"/>
</extension>
<extension url="name">
<valueString value="Quantity"/>
</extension>
<extension url="statement">
<valueString
value="/**********************************************************************/
/* Functions in this region are copied from opioid-mme-r4 */
/**********************************************************************/
define function Quantity(value Decimal, unit String):
if value is not null then
System.Quantity { value: value, unit: unit }
else
null"/>
</extension>
<extension url="displaySequence">
<valueInteger value="19"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CumulativeMedicationDuration"/>
</extension>
<extension url="name">
<valueString value="ToDaily"/>
</extension>
<extension url="statement">
<valueString
value="/*
Goal is to get to number of days
Two broad approaches to the calculation:
1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered
2) Based on relevant period, determine a covered interval and calculate the length of that interval in days
This topic covers several use cases and illustrates how to calculate Cumulative
Medication Duration for each type of medication resource using the supply and
frequency approach.
*/
/*
For the first approach, we need to get from frequency to a frequency/day
So we define ToDaily
*/
/*
Calculates daily frequency given frequency within a period
*/
define function ToDaily(frequency System.Integer, period System.Quantity):
case period.unit
when 'h' then frequency * (24.0 / period.value)
when 'min' then frequency * (24.0 / period.value) * 60
when 's' then frequency * (24.0 / period.value) * 60 * 60
when 'd' then frequency * (24.0 / period.value) / 24
when 'wk' then frequency * (24.0 / period.value) / (24 * 7)
when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
when 'hour' then frequency * (24.0 / period.value)
when 'minute' then frequency * (24.0 / period.value) * 60
when 'second' then frequency * (24.0 / period.value) * 60 * 60
when 'day' then frequency * (24.0 / period.value) / 24
when 'week' then frequency * (24.0 / period.value) / (24 * 7)
when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
when 'hours' then frequency * (24.0 / period.value)
when 'minutes' then frequency * (24.0 / period.value) * 60
when 'seconds' then frequency * (24.0 / period.value) * 60 * 60
when 'days' then frequency * (24.0 / period.value) / 24
when 'weeks' then frequency * (24.0 / period.value) / (24 * 7)
when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit)
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="20"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="prevalenceInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
or condition.clinicalStatus ~ "recurrence"
or condition.clinicalStatus ~ "relapse" then
Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
(end of condition.abatementInterval()) abatementDate
return if abatementDate is null then
Interval[start of condition.onset.toInterval(), abatementDate)
else
Interval[start of condition.onset.toInterval(), abatementDate]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="MedicationRequestPeriodInDays"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function MedicationRequestPeriodInDays(Request "MedicationRequest"):
Request R
let dosage: singleton from R.dosageInstruction,
doseAndRate: singleton from dosage.doseAndRate,
timing: dosage.timing,
frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),
period: CMD."Quantity" ( timing.repeat.period, timing.repeat.periodUnit ),
doseRange: doseAndRate.dose,
doseQuantity: doseAndRate.dose,
dose: Coalesce(
end of doseRange, doseQuantity
),
dosesPerDay: Coalesce((CMD."ToDaily"(frequency, period)), Count(timing.repeat.timeOfDay), 1.0),
boundsPeriod: timing.repeat.bounds as Interval<DateTime>,
daysSupply: ( convert R.dispenseRequest.expectedSupplyDuration to days ).value,
quantity: R.dispenseRequest.quantity,
refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),
startDate: Coalesce(date from start of boundsPeriod, date from R.authoredOn, date from start of R.dispenseRequest.validityPeriod),
totalDaysSupplied: Coalesce(daysSupply, quantity.value /(dose.value * dosesPerDay)) * ( 1 + refills )
return totalDaysSupplied"/>
</extension>
<extension url="displaySequence">
<valueInteger value="22"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="averageDailyDose"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function "averageDailyDose"(MedicationRequest MedicationRequest):
MedicationRequest Order
let MedicationStrength: Order.getMedicationCode ( ).MedicationStrengthPerUnit ( ),
DaysSupplied: Order.MedicationRequestPeriodInDays ( )
return if DaysSupplied is not null
and ( MedicationStrength.unit = 'mg'
or ( MedicationStrength.unit = 'mg/mL'
and Order.dispenseRequest.quantity.unit = 'mL'
)
) then ( ( Order.dispenseRequest.quantity * MedicationStrength ) / Quantity { value: DaysSupplied, unit: 'd' } )
else null"/>
</extension>
<extension url="displaySequence">
<valueInteger value="23"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="UseofHighRiskMedicationsintheElderlyFHIR"/>
</extension>
<extension url="name">
<valueString value="MedicationStrengthPerUnit"/>
</extension>
<extension url="statement">
<valueString
value="define fluent function MedicationStrengthPerUnit(Strength Concept):
case
when Strength ~ "digoxin 0.05 MG/ML Oral Solution" then 0.05 'mg/mL'
when Strength ~ "digoxin 0.0625 MG Oral Tablet" then 0.0625 'mg'
when Strength ~ "1 ML digoxin 0.1 MG/ML Injection" then 0.1 'mg/mL'
when Strength ~ "digoxin 0.125 MG Oral Tablet" then 0.125 'mg'
when Strength ~ "digoxin 0.25 MG Oral Tablet" then 0.25 'mg'
when Strength ~ "2 ML digoxin 0.25 MG/ML Injection" then 0.25 'mg/mL'
when Strength ~ "doxepin 3 MG Oral Tablet" then 3 'mg'
when Strength ~ "doxepin 6 MG Oral Tablet" then 6 'mg'
when Strength ~ "doxepin 10 MG Oral Capsule" then 10 'mg'
when Strength ~ "doxepin 10 MG/ML Oral Solution" then 10 'mg/mL'
when Strength ~ "doxepin 25 MG Oral Capsule" then 25 'mg'
when Strength ~ "doxepin 50 MG Oral Capsule" then 50 'mg'
when Strength ~ "doxepin 75 MG Oral Capsule" then 75 'mg'
when Strength ~ "doxepin 100 MG Oral Capsule" then 100 'mg'
when Strength ~ "doxepin 150 MG Oral Capsule" then 150 'mg'
else null end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="24"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="CQMCommon"/>
</extension>
<extension url="name">
<valueString value="getMedicationCode"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the medication code for the given MedicationRequest
*/
define fluent function getMedicationCode(request MedicationRequest ):
if request.medication is Concept then
request.medication as Concept
else
(singleton from ([Medication] M where M.id = (request.medication as Reference).reference.getId())).code"/>
</extension>
<extension url="displaySequence">
<valueInteger value="25"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="Status"/>
</extension>
<extension url="name">
<valueString value="isEncounterPerformed"/>
</extension>
<extension url="statement">
<valueString
value="//Encounter, Performed
//General usage unless required otherwise by measure intent (e.g., follow-up encounters)
define fluent function isEncounterPerformed(Enc List<Encounter>):
Enc E
where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="26"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToConcept"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
if concept is null then
null
else
System.Concept {
codes: concept.coding C return ToCode(C),
display: concept.text.value
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="27"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="QICoreCommon"/>
</extension>
<extension url="name">
<valueString value="toInterval"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If 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
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
case
when choice is DateTime then
Interval[choice as DateTime, choice as DateTime]
when choice is Interval<DateTime> then
choice as Interval<DateTime>
when choice is Quantity then
Interval[Patient.birthDate + (choice as Quantity),
Patient.birthDate + (choice as Quantity) + 1 year)
when choice is Interval<Quantity> then
Interval[Patient.birthDate + (choice.low as Quantity),
Patient.birthDate + (choice.high as Quantity) + 1 year)
when choice is Timing then
Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
else
null as Interval<DateTime>
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="28"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="Status"/>
</extension>
<extension url="name">
<valueString value="isAssessmentPerformed"/>
</extension>
<extension url="statement">
<valueString
value="//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.
//Assessment, Performed
define fluent function isAssessmentPerformed(Obs List<Observation>):
Obs O
where O.status in { 'final', 'amended', 'corrected' }
and exists ( O.category ObservationCategory
where ( ObservationCategory ) ~ "survey"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="29"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="Status"/>
</extension>
<extension url="name">
<valueString value="isInterventionOrder"/>
</extension>
<extension url="statement">
<valueString
value="//Intervention, Order: active and completed only
define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):
ServiceRequest S
where S.status in { 'active', 'completed' }
and S.intent = 'order'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="30"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="Status"/>
</extension>
<extension url="name">
<valueString value="isInterventionPerformed"/>
</extension>
<extension url="statement">
<valueString
value="//Intervention, Performed
define fluent function isInterventionPerformed(Proc List<Procedure>):
Proc P
where P.status ~ 'completed'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="31"/>
</extension>
</extension>
<name value="EffectiveDataRequirements"/>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Status"/>
<resource value="Library/Status|1.8.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library CMD"/>
<resource value="Library/CumulativeMedicationDuration|4.1.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource value="Library/FHIRHelpers|4.4.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library QICoreCommon"/>
<resource value="Library/QICoreCommon|2.1.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library CQMCommon"/>
<resource value="Library/CQMCommon|2.2.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Hospice"/>
<resource value="Library/Hospice|6.12.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library PalliativeCare"/>
<resource value="Library/PalliativeCare|1.11.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system RXNORM"/>
<resource value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system CPT"/>
<resource value="http://www.ama-assn.org/go/cpt"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system SNOMEDCT"/>
<resource value="http://snomed.info/sct"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ObservationCategoryCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/observation-category"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system LOINC"/>
<resource value="http://loinc.org"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Potentially Harmful Antipsychotics for Older Adults"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1523"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Schizophrenia"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1205"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Bipolar Disorder"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.67.1.101.1.128"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Potentially Harmful Benzodiazepines for Older Adults"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1522"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Seizure Disorder"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1206"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set REM Sleep Behavior Disorder"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1207"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Benzodiazepine Withdrawal"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1208"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Alcohol Withdrawal"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1209"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Generalized Anxiety Disorder"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1210"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Potentially Harmful Antihistamines for Older Adults"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1043"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Potentially Harmful Antiparkinsonian Agents for Older Adults"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1049"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Potentially Harmful Gastrointestinal Antispasmodics for Older Adults"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1050"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Dipyridamole Medications"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1051"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Guanfacine Medications"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.11.1252"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Nifedipine Medications"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1053"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Potentially Harmful Antidepressants for Older Adults"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1054"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Potentially Harmful Barbiturates for Older Adults"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1055"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Meprobamate Medications"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1057"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Potentially Harmful Estrogens for Older Adults"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1058"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Potentially Harmful Sulfonylureas for Older Adults"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1059"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Desiccated Thyroid Medications"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1060"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Potentially Harmful Nonbenzodiazepine Hypnotics for Older Adults"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1480"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Potentially Harmful Skeletal Muscle Relaxants for Older Adults"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1062"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Potentially Harmful Pain Medications for Older Adults"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1063"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Megestrol Medications"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1247"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Meperidine Medications"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1248"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Potentially Harmful Antiinfectives for Older Adults"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1481"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Digoxin Medications"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1065"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Doxepin Medications"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1067"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Office Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Ophthalmological Services"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1285"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Preventive Care Services Established Office Visit, 18 and Up"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Discharge Services Nursing Facility"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1013"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Nursing Facility Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Care Services in Long Term Residential Facility"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Preventive Care Services Initial Office Visit, 18 and Up"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Annual Wellness Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Home Healthcare Services"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Telephone Visits"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Virtual Encounter"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Encounter Inpatient"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Hospice Encounter"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Hospice Care Ambulatory"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Hospice Diagnosis"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Palliative Care Diagnosis"/>
<resource
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<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Medication"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
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<mustSupport value="code"/>
<codeFilter>
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</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
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<mustSupport value="code"/>
<codeFilter>
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</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
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<mustSupport value="code"/>
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</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
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<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
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</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
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<mustSupport value="code"/>
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</dataRequirement>
<dataRequirement>
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<mustSupport value="code"/>
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</dataRequirement>
<dataRequirement>
<type value="Condition"/>
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</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
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<mustSupport value="code"/>
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</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile
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<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
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</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Patient"/>
<profile
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</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
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<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
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</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
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<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
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</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
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<mustSupport value="type"/>
<mustSupport value="status"/>
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</codeFilter>
</dataRequirement>
<dataRequirement>
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<profile
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<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
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</codeFilter>
</dataRequirement>
<dataRequirement>
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<mustSupport value="type"/>
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</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
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<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<codeFilter>
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<valueSet
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</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
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value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
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</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
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</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
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<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="period"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="hospitalization"/>
<mustSupport value="hospitalization.dischargeDisposition"/>
<mustSupport value="period"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
<mustSupport value="type"/>
<mustSupport value="period"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile
value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"/>
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<mustSupport value="status"/>
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</dataRequirement>
<dataRequirement>
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<mustSupport value="code"/>
<mustSupport value="value"/>
<mustSupport value="effective"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<mustSupport value="category"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://loinc.org"/>
<code value="45755-6"/>
<display value="Hospice care [Minimum Data Set]"/>
</code>
</codeFilter>
<codeFilter>
<path value="value"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
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<mustSupport value="effective"/>
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<codeFilter>
<path value="code"/>
<code>
<system value="http://loinc.org"/>
<code value="71007-9"/>
<display
value="Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="ServiceRequest"/>
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value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"/>
<mustSupport value="code"/>
<mustSupport value="authoredOn"/>
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<mustSupport value="status"/>
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<mustSupport value="intent"/>
<mustSupport value="intent.value"/>
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</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
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value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
<mustSupport value="code"/>
<mustSupport value="performed"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
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<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
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value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"/>
<mustSupport value="code"/>
<mustSupport value="performed"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
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<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135"/>
</codeFilter>
</dataRequirement>
</Library>
</contained>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem">
<valueReference>
<reference value="Device/cqf-tooling"/>
</valueReference>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements" id="effective-data-requirements">
<valueReference>
<reference value="#effective-data-requirements"/>
</valueReference>
</extension>
<url
value="https://madie.cms.gov/Measure/UseofHighRiskMedicationsintheElderlyFHIR"/>
<identifier>
<use value="usual"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="short-name"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/shortName"/>
<value value="CMS156FHIR"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="version-independent"/>
</coding>
</type>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:fa08c5d7-5345-4e0b-aa2d-d937099db108"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="version-specific"/>
</coding>
</type>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:uuid:d9904550-61cd-4ea8-b36b-9d808a339278"/>
</identifier>
<identifier>
<use value="official"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"/>
<code value="publisher"/>
</coding>
</type>
<system value="https://madie.cms.gov/measure/cmsId"/>
<value value="156FHIR"/>
<assigner>
<display value="CMS"/>
</assigner>
</identifier>
<version value="0.2.001"/>
<name value="UseofHighRiskMedicationsintheElderlyFHIR"/>
<title value="Use of High-Risk Medications in Older AdultsFHIR"/>
<status value="draft"/>
<experimental value="false"/>
<date value="2024-12-18T21:25:49+00:00"/>
<publisher value="National Committee for Quality Assurance"/>
<contact>
<telecom>
<system value="url"/>
<value value="https://www.ncqa.org/"/>
</telecom>
</contact>
<description
value="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.
1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class.
2. 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.
3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators)."/>
<purpose value="UNKNOWN"/>
<usage
value="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.
The 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.
Calculate 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.
This eCQM is a patient-based measure.
This FHIR-based measure has been derived from the QDM-based measure: CMS156v13.
Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html)."/>
<copyright
value="This 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.
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.
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.
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.
This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation.
ICD-10 copyright 2024 World Health Organization. All Rights Reserved.
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.
“HL7” is the registered trademark of Health Level Seven International."/>
<effectivePeriod>
<start value="2025-01-01"/>
<end value="2025-12-31"/>
</effectivePeriod>
<author>
<name value="National Committee for Quality Assurance"/>
<telecom>
<system value="url"/>
<value value="https://www.ncqa.org/"/>
</telecom>
</author>
<library
value="https://madie.cms.gov/Library/UseofHighRiskMedicationsintheElderlyFHIR"/>
<disclaimer
value="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.
Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]."/>
<scoring>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</scoring>
<rationale
value="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).
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).
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)."/>
<clinicalRecommendationStatement
value="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.
NCQA'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."/>
<group id="66460d4ef4fc785d8711734b">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
<valueCode value="boolean"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="process"/>
<display value="Process"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation">
<valueCode value="None"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
<code value="decrease"/>
<display value="increase"/>
</coding>
</valueCodeableConcept>
</extension>
<population id="0A19E9FB-0BAA-4105-8BCA-EC0647E679FB">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</code>
<description
value="Patients 65 years and older at the end of the measurement period who had a visit during the measurement period"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
</criteria>
</population>
<population id="604B904A-A7D3-452F-BFC1-78E825247DAD">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator"/>
<display value="Denominator"/>
</coding>
</code>
<description value="Equals Initial Population"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator"/>
</criteria>
</population>
<population id="D6782756-5656-47E5-991B-8AC5F4F0E7A7">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exclusion"/>
<display value="Denominator Exclusion"/>
</coding>
</code>
<description
value="Exclude patients who are in hospice care for any part of the measurement period.
Exclude patients receiving palliative care for any part of the measurement period."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exclusions"/>
</criteria>
</population>
<population id="5E6EAABC-3AC9-4360-8A4F-4D70EFD8C2B4">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator"/>
<display value="Numerator"/>
</coding>
</code>
<description
value="Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days.
a. At least two orders of high-risk medications from the same drug class.
b. At least two orders of high-risk medications from the same drug class with summed days supply greater than 90 days.
c. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator 1"/>
</criteria>
</population>
</group>
<group id="66460d4ef4fc785d8711734c">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
<valueCode value="boolean"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="process"/>
<display value="Process"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation">
<valueCode value="None"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
<code value="decrease"/>
<display value="increase"/>
</coding>
</valueCodeableConcept>
</extension>
<population id="D09246EA-9FBF-4C80-ABD9-3051DC7CE8FA">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</code>
<description
value="Patients 65 years and older at the end of the measurement period who had a visit during the measurement period"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
</criteria>
</population>
<population id="D76C3A1E-4767-415E-8CEF-C9D54C8D3904">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator"/>
<display value="Denominator"/>
</coding>
</code>
<description value="Equals Initial Population"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator"/>
</criteria>
</population>
<population id="920ADB82-C127-473E-834C-191682317146">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exclusion"/>
<display value="Denominator Exclusion"/>
</coding>
</code>
<description
value="Exclude patients who are in hospice care for any part of the measurement period.
Exclude patients receiving palliative care for any part of the measurement period."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exclusions"/>
</criteria>
</population>
<population id="EDEE8DED-11C6-492B-B371-BF1D5ECB34CB">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator"/>
<display value="Numerator"/>
</coding>
</code>
<description
value="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.
a. 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.
b. 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.
"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator 2"/>
</criteria>
</population>
</group>
<group id="66460d4ef4fc785d8711734d">
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
<valueCode value="boolean"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="process"/>
<display value="Process"/>
</coding>
</valueCodeableConcept>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation">
<valueCode value="None"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
<code value="decrease"/>
<display value="increase"/>
</coding>
</valueCodeableConcept>
</extension>
<population id="B6C3E029-C345-4BB5-96C9-9E5D1C2B63BD">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</code>
<description
value="Patients 65 years and older at the end of the measurement period who had a visit during the measurement period"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
</criteria>
</population>
<population id="DF3CBBB3-1FA3-497D-8287-2FE6AE9745F6">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator"/>
<display value="Denominator"/>
</coding>
</code>
<description value="Equals Initial Population"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator"/>
</criteria>
</population>
<population id="D4EA7568-D2C8-4B9D-818B-FBC488913633">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exclusion"/>
<display value="Denominator Exclusion"/>
</coding>
</code>
<description
value="Exclude patients who are in hospice care for any part of the measurement period.
Exclude patients receiving palliative care for any part of the measurement period."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exclusions"/>
</criteria>
</population>
<population id="36304EB4-9F6F-4657-9457-1E4295106EA8">
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator"/>
<display value="Numerator"/>
</coding>
</code>
<description
value="Total rate (the sum of the two previous numerators, deduplicated)."/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator 3"/>
</criteria>
</population>
</group>
</Measure>
IG © 2023+ cqframework. Package gov.healthit.ecqi.ecqms#2024.0.0 based on FHIR 4.0.1. Generated 2024-12-19
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