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Package gov.healthit.ecqi.ecqms
Type Measure
Id Id
FHIR Version R4
Source http://ecqi.healthit.gov/ecqms/https://build.fhir.org/ig/cqframework/ecqm-content-qicore-2024/Measure-CMS1244ECCQHOQRFHIR.html
Url https://madie.cms.gov/Measure/CMS1244ECCQHOQRFHIR
Version 0.2.001
Status active
Date 2025-01-14T15:54:05+00:00
Name CMS1244ECCQHOQRFHIR
Title Emergency Care Capacity and Quality (HOQR) FHIR
Experimental False
Description This measure assesses the variation in capacity and quality of emergency care to support hospital quality improvement for patients requiring emergency care in an emergency department (ED). This measure is designed to align with incentives to promote improved care both in EDs and the broader health system to help identify where patients do not receive appropriate or timely access to emergency care. Emergency care capacity and quality gaps are inclusive of several concepts pertaining to boarding and crowding in an ED, including significantly longer ED wait times, higher left without being seen rates, longer boarding times, and longer total length of stay in the ED.
Purpose UNKNOWN
Copyright Limited proprietary coding is contained in these specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. All rights reserved. ICD-10 copyright 2024 World Health Organization. All Rights Reserved. CPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association.

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Narrative

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Title: Emergency Care Capacity and Quality (HOQR) FHIR
Id: CMS1244ECCQHOQRFHIR
Version: 0.2.001
Url: Emergency Care Capacity and Quality (HOQR) FHIR
Short Name Identifier:

CMS1244FHIR

Version Independent Identifier:

urn:uuid:1d711504-ebec-41de-81b0-d1993115eac2

Version Specific Identifier:

urn:uuid:6f1c6332-2a49-4ab8-8fff-7fb07ce7c9e3

Publisher (CMS) Identifier:

1244FHIR

Effective Period: 2026-01-01..2026-12-31
Publisher: Centers for Medicare & Medicaid Services (CMS)
Author: Acumen, LLC
Description:

This measure assesses the variation in capacity and quality of emergency care to support hospital quality improvement for patients requiring emergency care in an emergency department (ED). This measure is designed to align with incentives to promote improved care both in EDs and the broader health system to help identify where patients do not receive appropriate or timely access to emergency care.

Emergency care capacity and quality gaps are inclusive of several concepts pertaining to boarding and crowding in an ED, including significantly longer ED wait times, higher left without being seen rates, longer boarding times, and longer total length of stay in the ED.
Purpose:

UNKNOWN
Copyright:

Limited proprietary coding is contained in these specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets.

This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. All rights reserved.

ICD-10 copyright 2024 World Health Organization. All Rights Reserved.

CPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association.
Disclaimer:

These performance specifications are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Rationale:

This measure aims to reduce patient harm and improve outcomes for patients requiring emergency care in an ED by addressing the variation in emergency care and measuring the capacity and quality of emergency care. There are long-standing concerns about parameters that impact the quality and timeliness of care in the ED. Currently, there are no national metrics to assess the proportion of patients impacted by the quality of timely ED care.
Clinical recommendation statement:

The goal of this Emergency Care Capacity and Quality (ECCQ) measure is to assess and improve the safety of the 140 million ED visits that patients experience each year (Centers for Disease Control and Prevention [CDC], 2021). Limitations in capacity and quality of emergency care have been shown to be associated with harm, such as increases in mortality, delays in care, preventable errors, poor patient experience, and staff burnout. These capacity and quality limitations are also associated with increased costs of care. This proposed ECCQ measure is intended for use in CMS’s Hospital Outpatient Quality Reporting (HOQR) program. The numerator is comprised of all ED visits with a quality gap in access as defined in the numerator criteria. Challenges related to emergency care access and capacity have been increasing and have prompted public calls for action. Prior efforts to measure components of this proposed measure (for example, ED boarding, through use of the ED-2 measure) were unsuccessful, likely in part due to the construction of the measure score, which was based on median performance that obscured poor performance (eCQI Resource Center, n.d). Implementation of this proposed measure, which captures multiple components of quality and capacity, will help identify facilities where patients do not receive timely access to emergency care as defined in the numerator criteria. This measure, therefore, could positively impact millions of patients who seek treatment in the ED and help address long-standing disparities in emergency care, including for patients with mental health diagnoses.
Guidance (Usage): Measure Score Calculation The measure score is first calculated at the individual ED level as the proportion of ED visits where any one of the four outcomes occurred, as defined by the numerator. Scores will be standardized z-scores by ED case volume strata (defined in ED visit volume bands of 20,000 visits). For CMS Certification Numbers (CCNs) with more than one ED, volume-adjusted z-scores are then combined as a weighted average for that CCN. A z-score of greater than zero means worse performance and less than zero means better performance, compared to like EDs. For the purposes of this measure, a decision to admit can be captured using any of the following: - an evaluation that results in a decision to admit - an order to admit to inpatient - an order for a bed assignment - start of inpatient admission This eCQM is an episode-based measure. An episode is defined as an ED visit that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS1244v1. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html)
Population Criteria: Stratifier Criteria:
6758b74246b6174510cfef2f
Initial Population: All ED visits that end during the measurement period for all patients
Denominator: Equals Initial Population
Numerator: The numerator is comprised of ED visits meeting the denominator criteria and where the patient experiences any of the following quality gaps in access: 1. The patient waited longer than 60 minutes (1 hour) after arrival to the ED to be placed in a treatment room or dedicated treatment area that allows for audiovisual privacy during history-taking and physical examination, or 2. The patient left the ED without being evaluated, or 3. The patient boarded (time from Decision to Admit order to ED departure for admitted patients) in the ED for longer than 240 minutes (4 hours), or 4. The patient had an ED length of stay (LOS) (time from ED arrival to ED departure as defined by the ED departure timestamp indicating when the patient physically left the ED) of longer than 480 minutes (8 hours). ED encounters with ED observation stays are excluded from criteria #3 (boarding) and #4 (ED LOS). To clarify, patients who have a ‘decision to admit’ after an ED observation stay remain excluded from criteria #3 (boarded) calculations.
Stratum: All patients aged less than 18 years seen in the ED who do not have an ED encounter principal diagnosis consistent with mental health diagnosis. Patients who have an ED encounter principal diagnosis consistent with substance use disorders will be included in this stratification.
Stratum: All patients aged 18 years and older seen in the ED who do not have an ED encounter principal diagnosis consistent with mental health diagnosis. Patients who have an ED encounter principal diagnosis consistent with substance use disorders will be included in this stratification.
Stratum: All patients aged less than 18 years seen in the ED who have an ED encounter principal diagnosis consistent with mental health diagnosis.
Stratum: All patients aged 18 years and older seen in the ED who have an ED encounter principal diagnosis consistent with mental health diagnosis.
Supplemental Data Elements:

SDE Ethnicity

SDE Payer

SDE Race

SDE Sex

SDE Address
Supplemental Data Guidance : For every patient evaluated by this measure also identify payer, race, ethnicity and sex
Libraries:
CMS1244ECCQHOQRFHIR
Terminology and Other Dependencies:
  • Library/SupplementalDataElements|3.5.000
  • Library/FHIRHelpers|4.4.000
  • Library/CQMCommon|2.2.000
  • Library/QICoreCommon|2.1.000
  • AdministrativeGender
  • SNOMED CT (all versions)
  • Diagnosis Role
  • Emergency Department Visit
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.279
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.284
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.278
  • Encounter Inpatient
  • Decision to Admit to Hospital Inpatient
  • Emergency Department Evaluation
  • Admit Inpatient
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.22
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.285
  • Payer
    		•
    Parameters:
    name use min max type
    Measurement Period In 0 1 Period
    SDE Sex Out 0 1 Coding
    Numerator Out 0 * Resource
    Stratification 1: Pediatric With No Mental Health Diagnosis Out 0 * Resource
    Denominator Out 0 * Resource
    Stratification 4: Adult With Mental Health Diagnosis Out 0 * Resource
    Stratification 2: Adult With No Mental Health Diagnosis Out 0 * Resource
    SDE Payer Out 0 * Resource
    Initial Population Out 0 * Resource
    Stratification 3: Pediatric With Mental Health Diagnosis Out 0 * Resource
    SDE Ethnicity Out 0 1 Resource
    SDE Race Out 0 1 Resource
    DataRequirements:
    Resource Type Resource Elements Valueset Name Valueset
    Patient(QICorePatient) ethnicity race
    Encounter(QICoreEncounter) type period location location.type status status.value rank rank.value use condition condition.reference condition.reference.value Triage http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.279
    Encounter(QICoreEncounter) type period hospitalization hospitalization.dischargeDisposition location location.type status status.value rank rank.value use condition condition.reference condition.reference.value Triage http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.279
    Encounter(QICoreEncounter) type period status status.value location location.type rank rank.value use condition condition.reference condition.reference.value Emergency Department Evaluation and Management Visit Emergency Department Visit
    Encounter(QICoreEncounter) type status status.value period location location.type rank rank.value use condition condition.reference condition.reference.value Encounter Inpatient Encounter Inpatient
    Encounter(QICoreEncounter) type period status status.value location location.type rank rank.value use condition condition.reference condition.reference.value Emergency Department Observation http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.22
    Location(QICoreLocation) id id.value
    ServiceRequest(QICoreServiceRequest) code authoredOn authoredOn.value Decision to Admit to Hospital Inpatient Decision to Admit to Hospital Inpatient
    ServiceRequest(QICoreServiceRequest) code authoredOn authoredOn.value intent intent.value status status.value Decision to Admit to Hospital Inpatient Decision to Admit to Hospital Inpatient
    ServiceRequest(QICoreServiceRequest) code authoredOn authoredOn.value Encounter Inpatient Encounter Inpatient
    ServiceRequest(QICoreServiceRequest) code authoredOn authoredOn.value
    ServiceRequest(QICoreServiceRequest) code authoredOn authoredOn.value status status.value Emergency Department Observation http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.22
    Observation(QICoreObservation) code Emergency Department Evaluation Emergency Department Evaluation
    Observation(QICoreObservation) code effective value status status.value Emergency Department Evaluation Emergency Department Evaluation
    Condition(QICoreCondition) id id.value
    Coverage(QICoreCoverage) type period Payer Type Payer
    Direct Reference Codes:
    display code system
    Male M http://hl7.org/fhir/administrative-gender
    Female F http://hl7.org/fhir/administrative-gender
    Patient left without being seen (finding) 21541000119102 http://snomed.info/sct
    Patient bed assigned (finding) 5751000175101 http://snomed.info/sct
    Billing billing http://terminology.hl7.org/CodeSystem/diagnosis-role
    Logic Definitions:
    Group Scoring Population Criteria Expression
    6758b74246b6174510cfef2f Group scoring: proportion
    Type:

    Outcome

    Rate Aggregation: None
    Improvement Notation:

    Decreased score indicates improvement

    Initial Population 
    define "Initial Population":
  "ED Encounter"
    union "ED Triage"
    Denominator 
    define "Denominator":
  "Initial Population"
    Numerator 
    define "Numerator":
  "Time to Treatment Room Greater Than 60 Minutes"
    union "ED Arrival Left Without Being Seen"
    union "Boarded Time Greater Than 240 Minutes and No Observation Stay"
    union "ED Length of Stay Greater Than 480 Minutes and No Observation Stay"
    Library Name Name
    SupplementalDataElements SDE Sex 
    define "SDE Sex":
  case
    when Patient.gender = 'male' then "M"
    when Patient.gender = 'female' then "F"
    else null
  end
    Library Name Name
    CMS1244ECCQHOQRFHIR SDE Sex 
    define "SDE Sex":
  SDE."SDE Sex"
    Library Name Name
    CMS1244ECCQHOQRFHIR ED Encounter 
    define "ED Encounter":
  [Encounter: "Emergency Department Evaluation and Management Visit"] EDEncounter
    where EDEncounter.period ends during day of "Measurement Period"
      and EDEncounter.status = 'finished'
    Library Name Name
    CMS1244ECCQHOQRFHIR ED Triage 
    define "ED Triage":
  ( [Encounter: "Triage"] EDTriage
      where EDTriage.period ends during day of "Measurement Period"
  )
    Library Name Name
    CMS1244ECCQHOQRFHIR Initial Population 
    define "Initial Population":
  "ED Encounter"
    union "ED Triage"
    Library Name Name
    CMS1244ECCQHOQRFHIR Denominator 
    define "Denominator":
  "Initial Population"
    Library Name Name
    CMS1244ECCQHOQRFHIR Time to Treatment Room Greater Than 60 Minutes 
    define "Time to Treatment Room Greater Than 60 Minutes":
  "Denominator" EDEncounter
    where "EDArrivalTime"(EDEncounter) 61 minutes or more before "EDTreatmentRoomTimeArrivalTime"(EDEncounter)
    Library Name Name
    CMS1244ECCQHOQRFHIR ED Arrival Left Without Being Seen 
    define "ED Arrival Left Without Being Seen":
  "ED Triage" EDTriage
    where EDTriage.hospitalization.dischargeDisposition ~ "Patient left without being seen (finding)"
    Library Name Name
    CQMCommon Inpatient Encounter 
    define "Inpatient Encounter":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
		where EncounterInpatient.status = 'finished'
		and EncounterInpatient.period ends during day of "Measurement Period"
    Library Name Name
    CMS1244ECCQHOQRFHIR EDtoIPOrder 
    define "EDtoIPOrder":
  [ServiceRequest: code in "Decision to Admit to Hospital Inpatient"]
    Library Name Name
    CMS1244ECCQHOQRFHIR Decision to Admit Encounter Order 
    define "Decision to Admit Encounter Order":
  "Denominator" EDEncounter
    with CQMCommon."Inpatient Encounter" EncounterInpatient
      such that "AdmitDecisionUsingEncounterOrder"(EncounterInpatient) 241 minutes or more before "EDDepartureTime"(EDEncounter)
    Library Name Name
    CMS1244ECCQHOQRFHIR AssessmentInED 
    define "AssessmentInED":
  [Observation: "Emergency Department Evaluation"]
    Library Name Name
    CMS1244ECCQHOQRFHIR Decision to Admit Using Assessment 
    define "Decision to Admit Using Assessment":
  "Denominator" EDEncounter
    with CQMCommon."Inpatient Encounter" EncounterInpatient
      such that "AdmitDecisionUsingAssessment"(EncounterInpatient) 241 minutes or more before "EDDepartureTime"(EDEncounter)
    Library Name Name
    CMS1244ECCQHOQRFHIR InpatientOrBedAssignmentEncounterOrder 
    define "InpatientOrBedAssignmentEncounterOrder":
  [ServiceRequest: code in "Encounter Inpatient"]
    union [ServiceRequest: "Patient bed assigned (finding)"]
    Library Name Name
    CMS1244ECCQHOQRFHIR Time of Admit Order Or Bed Assignment to Departure Greater Than 241 Minutes 
    define "Time of Admit Order Or Bed Assignment to Departure Greater Than 241 Minutes":
  "Denominator" EDEncounter
    with CQMCommon."Inpatient Encounter" InpatientEncounter
      such that "AdmitInpatientOrBedAssignmentOrder"(InpatientEncounter) 241 minutes or more before "EDDepartureTime"(EDEncounter)
    Library Name Name
    CMS1244ECCQHOQRFHIR Admitted to Inpatient 241 Minutes or More Before Departure 
    define "Admitted to Inpatient 241 Minutes or More Before Departure":
  "Denominator" EDEncounter
    with CQMCommon."Inpatient Encounter" Inpatient
      such that "HoldingInEDAfterAdmission"(Inpatient) 241 minutes or more before "EDDepartureTime"(EDEncounter)
    Library Name Name
    CMS1244ECCQHOQRFHIR Boarded Time Greater Than 240 Minutes 
    define "Boarded Time Greater Than 240 Minutes":
  "Decision to Admit Encounter Order"
    union "Decision to Admit Using Assessment"
    union "Time of Admit Order Or Bed Assignment to Departure Greater Than 241 Minutes"
    union "Admitted to Inpatient 241 Minutes or More Before Departure"
    Library Name Name
    CMS1244ECCQHOQRFHIR ED Observation Encounter Status 
    define "ED Observation Encounter Status":
  [Encounter: "Emergency Department Observation"] EDObsEncounter
    with "Denominator" EDEncounter
      such that start of EDObsEncounter.period during EDEncounter.period
        and EDEncounter.status = 'finished'
        and EDObsEncounter.status = 'finished'
    Library Name Name
    CMS1244ECCQHOQRFHIR ED Observation Order Status 
    define "ED Observation Order Status":
  [ServiceRequest: code in "Emergency Department Observation"] EDObsOrder
    with "Denominator" EDEncounter
      such that EDObsOrder.authoredOn during EDEncounter.period
        and EDEncounter.status = 'finished'
        and EDObsOrder.status = 'active'
    Library Name Name
    CMS1244ECCQHOQRFHIR ED Observation Status 
    define "ED Observation Status":
  ( "ED Observation Encounter Status"
    union "ED Observation Order Status" ) EDObservation
    with ( "Denominator" ) EDStay
      such that EDObservation.period during EDStay.period
        or ( EDObservation.authoredOn during EDStay.period )
    Library Name Name
    CMS1244ECCQHOQRFHIR Boarded Time Greater Than 240 Minutes and No Observation Stay 
    define "Boarded Time Greater Than 240 Minutes and No Observation Stay":
  ( "Boarded Time Greater Than 240 Minutes" Boarding
      where not exists ( "ED Observation Status" EDO
          where ( EDO.period starts during Boarding.period
              or EDO.authoredOn during Boarding.period
          )
      )
  )
    Library Name Name
    CMS1244ECCQHOQRFHIR ED Length of Stay Greater Than 480 Minutes 
    define "ED Length of Stay Greater Than 480 Minutes":
  "Denominator" EDEncounter
    where "EDArrivalTime"(EDEncounter) 481 minutes or more before "EDDepartureTime"(EDEncounter)
    Library Name Name
    CMS1244ECCQHOQRFHIR ED Length of Stay Greater Than 480 Minutes and No Observation Stay 
    define "ED Length of Stay Greater Than 480 Minutes and No Observation Stay":
  ( "ED Length of Stay Greater Than 480 Minutes" EDStay
      where not exists ( "ED Observation Status" EDO
          where ( EDO.period starts during EDStay.period
              or EDO.authoredOn during EDStay.period
          )
      )
  )
    Library Name Name
    CMS1244ECCQHOQRFHIR Numerator 
    define "Numerator":
  "Time to Treatment Room Greater Than 60 Minutes"
    union "ED Arrival Left Without Being Seen"
    union "Boarded Time Greater Than 240 Minutes and No Observation Stay"
    union "ED Length of Stay Greater Than 480 Minutes and No Observation Stay"
    Library Name Name
    CMS1244ECCQHOQRFHIR ED Encounter or Triage of Patients Less Than 18 Years 
    define "ED Encounter or Triage of Patients Less Than 18 Years":
  "Denominator" EDEncounter
    where AgeInYearsAt(date from start of "Measurement Period") < 18
    Library Name Name
    CMS1244ECCQHOQRFHIR Stratification 1: Pediatric With No Mental Health Diagnosis 
    define "Stratification 1: Pediatric With No Mental Health Diagnosis":
  ( "ED Encounter or Triage of Patients Less Than 18 Years" EDEncounter
      let ConditionCode: EDEncounter.principalDiagnosis ( ).code
      where not ( ConditionCode in "Mental Health Diagnosis without Substance Use Disorders" )
  )
    Library Name Name
    CMS1244ECCQHOQRFHIR ED Encounter or Triage of Patients 18 Years and Older 
    define "ED Encounter or Triage of Patients 18 Years and Older":
  "Denominator" EDEncounter
    where AgeInYearsAt(date from start of "Measurement Period") >= 18
    Library Name Name
    CMS1244ECCQHOQRFHIR Stratification 4: Adult With Mental Health Diagnosis 
    define "Stratification 4: Adult With Mental Health Diagnosis":
  ( "ED Encounter or Triage of Patients 18 Years and Older" EDEncounter
      let ConditionCode: EDEncounter.principalDiagnosis ( ).code
      where ( ConditionCode in "Mental Health Diagnosis without Substance Use Disorders" )
  )
    Library Name Name
    CMS1244ECCQHOQRFHIR Stratification 2: Adult With No Mental Health Diagnosis 
    define "Stratification 2: Adult With No Mental Health Diagnosis":
  ( "ED Encounter or Triage of Patients 18 Years and Older" EDEncounter
      let ConditionCode: EDEncounter.principalDiagnosis ( ).code
      where not ( ConditionCode in "Mental Health Diagnosis without Substance Use Disorders" )
  )
    Library Name Name
    SupplementalDataElements SDE Payer 
    define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }
    Library Name Name
    CMS1244ECCQHOQRFHIR SDE Payer 
    define "SDE Payer":
  SDE."SDE Payer"
    Library Name Name
    CMS1244ECCQHOQRFHIR Stratification 3: Pediatric With Mental Health Diagnosis 
    define "Stratification 3: Pediatric With Mental Health Diagnosis":
  ( "ED Encounter or Triage of Patients Less Than 18 Years" EDEncounter
      let ConditionCode: EDEncounter.principalDiagnosis ( ).code
      where ( ConditionCode in "Mental Health Diagnosis without Substance Use Disorders" )
  )
    Library Name Name
    SupplementalDataElements SDE Ethnicity 
    define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }
    Library Name Name
    CMS1244ECCQHOQRFHIR SDE Ethnicity 
    define "SDE Ethnicity":
  SDE."SDE Ethnicity"
    Library Name Name
    SupplementalDataElements SDE Race 
    define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }
    Library Name Name
    CMS1244ECCQHOQRFHIR SDE Race 
    define "SDE Race":
  SDE."SDE Race"
    Library Name Name
    CMS1244ECCQHOQRFHIR EDArrivalTime 
    define function "EDArrivalTime"(EDEncounter Encounter):
  Last(EDEncounter.location Location
      where Location.location.getLocation().type in "Emergency Department Location"
        and start of Location.period is not null
      return start of Location.period
      sort ascending
  )
    Library Name Name
    CQMCommon getLocation 
    /*
@description: Returns the Location resource specified by the given reference.
*/
define fluent function getLocation(reference Reference ):
  singleton from (
    [Location] L where L.id = reference.reference.getId()
  )
    Library Name Name
    QICoreCommon getId 
    /*
@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).
@comment: This function can be used to determine the logical id of a given resource. It can be used in
a single-server environment to trace references. However, this function does not attempt to resolve
or distinguish the base of the given url, and so cannot be used safely in multi-server environments.
*/
define fluent function getId(uri String):
  Last(Split(uri, '/'))
    Library Name Name
    FHIRHelpers ToConcept 
    /*
@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
        }
    Library Name Name
    CMS1244ECCQHOQRFHIR EDTreatmentRoomTimeArrivalTime 
    define function "EDTreatmentRoomTimeArrivalTime"(EDEncounter Encounter):
  Last(EDEncounter.location Location
      where Location.location.getLocation().type in "Emergency Department Treatment Location"
        and start of Location.period is not null
      return start of Location.period
      sort ascending
  )
    Library Name Name
    CMS1244ECCQHOQRFHIR AdmitDecisionUsingEncounterOrder 
    define function "AdmitDecisionUsingEncounterOrder"(InpatientEncounter Encounter):
  Last("EDtoIPOrder" AdmitOrder
      let LastEDVisit: "LastEDEncounter"(InpatientEncounter)
      where AdmitOrder.authoredOn during LastEDVisit.period
        and AdmitOrder.intent ~ 'order'
        and AdmitOrder.status in { 'active', 'completed' }
      return AdmitOrder.authoredOn
      sort ascending
  )
    Library Name Name
    CMS1244ECCQHOQRFHIR LastEDEncounter 
    define function "LastEDEncounter"(InpatientEncounter Encounter):
  Last("ED Encounter" EDVisit
      where EDVisit.period starts 1 day or less before or on start of InpatientEncounter.period
        and EDVisit.period starts before start of InpatientEncounter.period
        and EDVisit.period during "Measurement Period"
        and EDVisit.status = 'finished'
      sort by 
      end of period ascending
  )
    Library Name Name
    CMS1244ECCQHOQRFHIR EDDepartureTime 
    define function "EDDepartureTime"(EDEncounter Encounter):
  Last(EDEncounter.location Location
      where Location.location.getLocation().type in "Emergency Department Location"
        and 
        end of Location.period is not null
      return 
      end of Location.period
      sort ascending
  )
    Library Name Name
    CMS1244ECCQHOQRFHIR AdmitDecisionUsingAssessment 
    define function "AdmitDecisionUsingAssessment"(InpatientEncounter Encounter):
  Last("AssessmentInED" EDEvaluation
      let LastEDVisit: "LastEDEncounter"(InpatientEncounter)
      where EDEvaluation.effective.toInterval() starts during LastEDVisit.period
        and EDEvaluation.value as Concept in "Admit Inpatient"
        and EDEvaluation.status in { 'final', 'amended', 'corrected' }
      return start of EDEvaluation.effective.toInterval()
      sort ascending
  )
    Library Name Name
    CMS1244ECCQHOQRFHIR AdmitInpatientOrBedAssignmentOrder 
    define function "AdmitInpatientOrBedAssignmentOrder"(InpatientEncounter Encounter):
  Last(("InpatientOrBedAssignmentEncounterOrder") AdmitInpatientOrder
      let LastEDVisit: "LastEDEncounter"(InpatientEncounter)
      where AdmitInpatientOrder.authoredOn during LastEDVisit.period
      return AdmitInpatientOrder.authoredOn
      sort ascending
  )
    Library Name Name
    CMS1244ECCQHOQRFHIR HoldingInEDAfterAdmission 
    define function "HoldingInEDAfterAdmission"(InpatientEncounter Encounter):
  Last(CQMCommon."Inpatient Encounter" AdmittedInpatient
      let LastEDVisit: "LastEDEncounter"(InpatientEncounter)
      where start of AdmittedInpatient.period during LastEDVisit.period
      return start of AdmittedInpatient.period
      sort ascending
  )
    Library Name Name
    CQMCommon principalDiagnosis 
    /*
@description: Returns the condition that is specified as the principal diagnosis for the encounter
*/
define fluent function principalDiagnosis(Encounter Encounter ):
	singleton from ((Encounter.diagnosis D where D.rank = 1 and D.use ~ "Billing") PD
      return singleton from ([Condition] C where C.id = PD.condition.reference.getId())
	)
    Library Name Name
    FHIRHelpers ToString 
    define function ToString(value uri): value.value
    Library Name Name
    FHIRHelpers ToCode 
    /*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }

    Source

    {
      "resourceType" : "Measure",
      "id" : "CMS1244ECCQHOQRFHIR",
      "meta" : {
        "profile" : [
          "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm",
          "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm",
          "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"
        ]
      },
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n    <table class=\"grid dict\">\n        \n            <tr>\n                <th scope=\"row\"><b>Title: </b></th>\n                <td style=\"padding-left: 4px;\">Emergency Care Capacity and Quality (HOQR) FHIR</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Id: </b></th>\n                <td style=\"padding-left: 4px;\">CMS1244ECCQHOQRFHIR</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Version: </b></th>\n                <td style=\"padding-left: 4px;\">0.2.001</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Url: </b></th>\n                <td style=\"padding-left: 4px;\"><a href=\"Measure-CMS1244ECCQHOQRFHIR.html\">Emergency Care Capacity and Quality (HOQR) FHIR</a></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                Short Name Identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>CMS1244FHIR</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                Version Independent Identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>urn:uuid:1d711504-ebec-41de-81b0-d1993115eac2</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                Version Specific Identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>urn:uuid:6f1c6332-2a49-4ab8-8fff-7fb07ce7c9e3</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                Publisher (CMS) Identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>1244FHIR</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Effective Period: </b></th>\n                <td style=\"padding-left: 4px;\">2026-01-01..2026-12-31</td>\n            </tr>\n        \n\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Publisher: </b></th>\n                <td style=\"padding-left: 4px;\">Centers for Medicare &amp; Medicaid Services (CMS)</td>\n            </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Author: </b></th>\n            <td style=\"padding-left: 4px;\">Acumen, LLC</td>\n        </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Description: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>This measure assesses the variation in capacity and quality of emergency care to support hospital quality improvement for patients requiring emergency care in an emergency department (ED). This measure is designed to align with incentives to promote improved care both in EDs and the broader health system to help identify where patients do not receive appropriate or timely access to emergency care.</p>\n<p>Emergency care capacity and quality gaps are inclusive of several concepts pertaining to boarding and crowding in an ED, including significantly longer ED wait times, higher left without being seen rates, longer boarding times, and longer total length of stay in the ED.</p>\n</div></td>\n            </tr>\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Purpose: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>UNKNOWN</p>\n</div></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Copyright: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>Limited proprietary coding is contained in these specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets.</p>\n<p>This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. All rights reserved.</p>\n<p>ICD-10 copyright 2024 World Health Organization. All Rights Reserved.</p>\n<p>CPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association.</p>\n</div></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Disclaimer: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>These performance specifications are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications.</p>\n<p>THE MEASURES AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.</p>\n<p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>\n</div></td>\n            </tr>\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Rationale: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>This measure aims to reduce patient harm and improve outcomes for patients requiring emergency care in an ED by addressing the variation in emergency care and measuring the capacity and quality of emergency care. There are long-standing concerns about parameters that impact the quality and timeliness of care in the ED. Currently, there are no national metrics to assess the proportion of patients impacted by the quality of timely ED care.</p>\n</div></td>\n        </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Clinical recommendation statement: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>The goal of this Emergency Care Capacity and Quality (ECCQ) measure is to assess and improve the safety of the 140 million ED visits that patients experience each year (Centers for Disease Control and Prevention [CDC], 2021). Limitations in capacity and quality of emergency care have been shown to be associated with harm, such as increases in mortality, delays in care, preventable errors, poor patient experience, and staff burnout. These capacity and quality limitations are also associated with increased costs of care. This proposed ECCQ measure is intended for use in CMS’s Hospital Outpatient Quality Reporting (HOQR) program. The numerator is comprised of all ED visits with a quality gap in access as defined in the numerator criteria. Challenges related to emergency care access and capacity have been increasing and have prompted public calls for action. Prior efforts to measure components of this proposed measure (for example, ED boarding, through use of the ED-2 measure) were unsuccessful, likely in part due to the construction of the measure score, which was based on median performance that obscured poor performance (eCQI Resource Center, n.d). Implementation of this proposed measure, which captures multiple components of quality and capacity, will help identify facilities where patients do not receive timely access to emergency care as defined in the numerator criteria. This measure, therefore, could positively impact millions of patients who seek treatment in the ED and help address long-standing disparities in emergency care, including for patients with mental health diagnoses.</p>\n</div></td>\n        </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Guidance (Usage): </b></th>\n                <td style=\"padding-left: 4px;\">Measure Score Calculation\nThe measure score is first calculated at the individual ED level as the proportion of ED visits where any one of the four outcomes occurred, as defined by the numerator. Scores will be standardized z-scores by ED case volume strata (defined in ED visit volume bands of 20,000 visits). For CMS Certification Numbers (CCNs) with more than one ED, volume-adjusted z-scores are then combined as a weighted average for that CCN. A z-score of greater than zero means worse performance and less than zero means better performance, compared to like EDs.\n\nFor the purposes of this measure, a decision to admit can be captured using any of the following: \n  - an evaluation that results in a decision to admit\n  - an order to admit to inpatient\n  - an order for a bed assignment\n  - start of inpatient admission\n\nThis eCQM is an episode-based measure. An episode is defined as an ED visit that ends during the measurement period. \n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS1244v1. \n\nPlease refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html)</td>\n            </tr>\n        \n\n        \n            \n                <tr>\n                    <th scope=\"row\"><b>Population Criteria: </b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                            <table class=\"grid-dict\">\n                                \n                                    <tr>\n                                        <th><b>6758b74246b6174510cfef2f</b></th>\n                                    </tr>\n                                \n                                \n                                    <tr>\n                                        <td>Initial Population:</td>\n\n                                        \n                                            \n                                                <td>All ED visits that end during the measurement period for all patients</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator:</td>\n\n                                        \n                                            \n                                                <td>Equals Initial Population</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Numerator:</td>\n\n                                        \n                                            \n                                                <td>The numerator is comprised of ED visits meeting the denominator criteria and where the patient experiences any of the following quality gaps in access:\n1. The patient waited longer than 60 minutes (1 hour) after arrival to the ED to be placed in a treatment room or dedicated treatment area that allows for audiovisual privacy during history-taking and physical examination, or \n2. The patient left the ED without being evaluated, or  \n3. The patient boarded (time from Decision to Admit order to ED departure for admitted patients) in the ED for longer than 240 minutes (4 hours), or\n4. The patient had an ED length of stay (LOS) (time from ED arrival to ED departure as defined by the ED departure timestamp indicating when the patient physically left the ED) of longer than 480 minutes (8 hours).\n\nED encounters with ED observation stays are excluded from criteria #3 (boarding) and #4 (ED LOS). To clarify, patients who have a ‘decision to admit’ after an ED observation stay remain excluded from criteria #3 (boarded) calculations. </td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                \n                                  <tr><b>Stratifier Criteria: </b></tr>\n                                    \n                                        <tr>\n                                            \n                                                <td>Stratum:</td>\n                                            \n\n                                            \n                                                <td>All patients aged less than 18 years seen in the ED who do not have an ED encounter principal diagnosis consistent with mental health diagnosis.  Patients who have an ED encounter principal diagnosis consistent with substance use disorders will be included in this stratification.</td>\n                                            \n                                        </tr>\n                                    \n                                        <tr>\n                                            \n                                                <td>Stratum:</td>\n                                            \n\n                                            \n                                                <td>All patients aged 18 years and older seen in the ED who do not have an ED encounter principal diagnosis consistent with mental health diagnosis.  Patients who have an ED encounter principal diagnosis consistent with substance use disorders will be included in this stratification.</td>\n                                            \n                                        </tr>\n                                    \n                                        <tr>\n                                            \n                                                <td>Stratum:</td>\n                                            \n\n                                            \n                                                <td>All patients aged less than 18 years seen in the ED who have an ED encounter principal diagnosis consistent with mental health diagnosis.</td>\n                                            \n                                        </tr>\n                                    \n                                        <tr>\n                                            \n                                                <td>Stratum:</td>\n                                            \n\n                                            \n                                                <td>All patients aged 18 years and older seen in the ED who have an ED encounter principal diagnosis consistent with mental health diagnosis.</td>\n                                            \n                                        </tr>\n                                    \n                                \n                            </table>\n                        \n                    </td>\n                </tr>\n            \n        \n\n        \n            <tr>\n                <th scope=\"row\"><b> Supplemental Data Elements: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    \n                        \n                            \n                                <p>SDE Ethnicity</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>SDE Payer</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>SDE Race</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>SDE Sex</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>SDE Address</p>\n                            \n                        \n                    \n                </td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\">\n                    <b> Supplemental Data Guidance\n                        : </b></th>\n                <td style=\"padding-left: 4px;\"> For every patient evaluated by this measure also identify payer, race, ethnicity and sex </td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Libraries: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    <table class=\"grid-dict\">\n                        \n                            <tr>\n                                <td><a href=\"Library-CMS1244ECCQHOQRFHIR.html\">CMS1244ECCQHOQRFHIR</a></td>\n                            </tr>\n                        \n                    </table>\n                </td>\n            </tr>\n        \n\n        \n\n        \n            \n                <tr>\n                    <th scope=\"row\"><b>Terminology and Other Dependencies: </b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                            <li><code>Library/SupplementalDataElements|3.5.000</code></li>\n                        \n                            <li><code>Library/FHIRHelpers|4.4.000</code></li>\n                        \n                            <li><code>Library/CQMCommon|2.2.000</code></li>\n                        \n                            <li><code>Library/QICoreCommon|2.1.000</code></li>\n                        \n                            <li><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">AdministrativeGender</a></li>\n                        \n                            <li><a href=\"http://hl7.org/fhir/R4/codesystem-snomedct.html\">SNOMED CT (all versions)</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-diagnosis-role.html\">Diagnosis Role</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion\">Emergency Department Visit</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1046.279/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.279</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1046.284/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.284</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1046.278/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.278</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.294/expansion\">Decision to Admit to Hospital Inpatient</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.163/expansion\">Emergency Department Evaluation</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.164/expansion\">Admit Inpatient</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.22/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.22</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1046.285/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.285</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer</a></li>\n                        \n                    </td>\n                </tr>\n                <tr>\n                    <th scope=\"row\"><b>Parameters:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>name</b></th>\n                                <th><b>use</b></th>\n                                <th><b>min</b></th>\n                                <th><b>max</b></th>\n                                <th><b>type</b></th>\n                            </tr>\n                            \n                                <tr>\n                                    <td>Measurement Period</td>\n                                    <td>In</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Period</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Sex</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Coding</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Numerator</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Stratification 1: Pediatric With No Mental Health Diagnosis</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Denominator</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Stratification 4: Adult With Mental Health Diagnosis</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Stratification 2: Adult With No Mental Health Diagnosis</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Payer</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Initial Population</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Stratification 3: Pediatric With Mental Health Diagnosis</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Ethnicity</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Race</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                        </table>\n                    </td>\n                </tr>\n\n                <tr>\n                    <th scope=\"row\"><b>DataRequirements:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>Resource Type</b></th>\n                                <th><b>Resource Elements</b></th>\n                                <th><b>Valueset Name</b></th>\n                                <th><b>Valueset</b></th>\n                            </tr>\n                            \n                                <tr>\n                                    <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n                                    <td>\n                                        \n                                            ethnicity\n                                        \n                                            race\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                            location\n                                        \n                                            location.type\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            rank\n                                        \n                                            rank.value\n                                        \n                                            use\n                                        \n                                            condition\n                                        \n                                            condition.reference\n                                        \n                                            condition.reference.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Triage\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1046.279/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.279</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                            hospitalization\n                                        \n                                            hospitalization.dischargeDisposition\n                                        \n                                            location\n                                        \n                                            location.type\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            rank\n                                        \n                                            rank.value\n                                        \n                                            use\n                                        \n                                            condition\n                                        \n                                            condition.reference\n                                        \n                                            condition.reference.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Triage\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1046.279/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.279</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            location\n                                        \n                                            location.type\n                                        \n                                            rank\n                                        \n                                            rank.value\n                                        \n                                            use\n                                        \n                                            condition\n                                        \n                                            condition.reference\n                                        \n                                            condition.reference.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Emergency Department Evaluation and Management Visit\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion\">Emergency Department Visit</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            period\n                                        \n                                            location\n                                        \n                                            location.type\n                                        \n                                            rank\n                                        \n                                            rank.value\n                                        \n                                            use\n                                        \n                                            condition\n                                        \n                                            condition.reference\n                                        \n                                            condition.reference.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Encounter Inpatient\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            location\n                                        \n                                            location.type\n                                        \n                                            rank\n                                        \n                                            rank.value\n                                        \n                                            use\n                                        \n                                            condition\n                                        \n                                            condition.reference\n                                        \n                                            condition.reference.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Emergency Department Observation\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.22/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.22</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Location(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-location.html\">QICoreLocation</a>)</td>\n                                    <td>\n                                        \n                                            id\n                                        \n                                            id.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>ServiceRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html\">QICoreServiceRequest</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Decision to Admit to Hospital Inpatient\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.294/expansion\">Decision to Admit to Hospital Inpatient</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>ServiceRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html\">QICoreServiceRequest</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                            intent\n                                        \n                                            intent.value\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Decision to Admit to Hospital Inpatient\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.294/expansion\">Decision to Admit to Hospital Inpatient</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>ServiceRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html\">QICoreServiceRequest</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Encounter Inpatient\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>ServiceRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html\">QICoreServiceRequest</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>ServiceRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-servicerequest.html\">QICoreServiceRequest</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Emergency Department Observation\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.22/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.22</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Emergency Department Evaluation\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.163/expansion\">Emergency Department Evaluation</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            effective\n                                        \n                                            value\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Emergency Department Evaluation\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.163/expansion\">Emergency Department Evaluation</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            id\n                                        \n                                            id.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Coverage(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html\">QICoreCoverage</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Payer Type\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer</a></td>\n                                </tr>\n                            \n                        </table>\n                    </td>\n                </tr>\n\n                \n                    <tr>\n                        <th scope=\"row\"><b>Direct Reference Codes:</b></th>\n                        <td style=\"padding-left: 4px;\">\n                            <table class=\"grid-dict\">\n                                <tr>\n                                    <th><b>display</b></th>\n                                    <th><b>code</b></th>\n                                    <th><b>system</b></th>\n                                </tr>\n                                \n                                    <tr>\n                                        <td>Male</td>\n                                        <td>M</td>\n                                        <td><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">http://hl7.org/fhir/administrative-gender</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Female</td>\n                                        <td>F</td>\n                                        <td><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">http://hl7.org/fhir/administrative-gender</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Patient left without being seen (finding)</td>\n                                        <td>21541000119102</td>\n                                        <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Patient bed assigned (finding)</td>\n                                        <td>5751000175101</td>\n                                        <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Billing</td>\n                                        <td>billing</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-diagnosis-role.html\">http://terminology.hl7.org/CodeSystem/diagnosis-role</a></td>\n                                    </tr>\n                                \n                            </table>\n                        </td>\n                    </tr>\n                \n\n                \n                <tr>\n                    <th scope=\"row\"><b>Logic Definitions:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>Group</b></th>\n                                <th><b>Scoring</b></th>\n                                <th><b>Population Criteria</b></th>\n                                <th><b>Expression</b></th>\n                            </tr>\n                            <tr>\n                                \n                                <td> 6758b74246b6174510cfef2f </td>\n                                <td colspan=\"3\" style=\"padding-left: 4px;\">\n                                    \n                                        <b>Group scoring:</b>\n                                        \n                                            <span>  proportion </span>\n                                        \n                                    \n\n                                    \n\n                                    \n\n                                    \n\n                                    \n                                        <tr>\n                                        \n                                            <th scope=\"row\"><b>Type: </b></th>\n                                            <td style=\"padding-left: 4px;\">\n                                                \n                                                    \n                                                        <p style=\"margin-bottom: 5px;\">\n                                                            <span>Outcome </span>\n                                                        </p>\n                                                    \n                                                \n                                                \n                                            </td>\n                                        \n                                        </tr>\n                                    \n\n                                    \n\n                                    \n                                    <tr>\n                                        <th scope=\"row\"><b>Rate Aggregation: </b></th>\n                                        <td colspan=\"3\" style=\"padding-left: 4px;\">None</td>\n                                    </tr>\n                                    \n\n                                    \n                                        <tr>\n                                            <th scope=\"row\"><b>Improvement Notation: </b></th>\n                                            <td style=\"padding-left: 4px;\">\n                                            \n                                                \n                                                    \n                                                        <p style=\"margin-bottom: 5px;\">\n                                                            <span>Decreased score indicates improvement </span>\n                                                        </p>\n                                                    \n                                                \n                                                \n                                            \n                                            </td>\n                                        </tr>\n                                    \n\n                                    \n\n                                </td>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Initial Population</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  &quot;ED Encounter&quot;\n    union &quot;ED Triage&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Denominator&quot;:\n  &quot;Initial Population&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Numerator</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Numerator&quot;:\n  &quot;Time to Treatment Room Greater Than 60 Minutes&quot;\n    union &quot;ED Arrival Left Without Being Seen&quot;\n    union &quot;Boarded Time Greater Than 240 Minutes and No Observation Stay&quot;\n    union &quot;ED Length of Stay Greater Than 480 Minutes and No Observation Stay&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td/>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\"/></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td/>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\"/></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td/>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\"/></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td/>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\"/></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                            \n                            </tr>\n                        </table>\n                \n\n                <table class=\"grid-dict\">\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElements</td>\n                            \n                            \n                                <td>SDE Sex</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Sex&quot;:\n  case\n    when Patient.gender = 'male' then &quot;M&quot;\n    when Patient.gender = 'female' then &quot;F&quot;\n    else null\n  end</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>SDE Sex</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Sex&quot;:\n  SDE.&quot;SDE Sex&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>ED Encounter</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;ED Encounter&quot;:\n  [Encounter: &quot;Emergency Department Evaluation and Management Visit&quot;] EDEncounter\n    where EDEncounter.period ends during day of &quot;Measurement Period&quot;\n      and EDEncounter.status = 'finished'</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>ED Triage</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;ED Triage&quot;:\n  ( [Encounter: &quot;Triage&quot;] EDTriage\n      where EDTriage.period ends during day of &quot;Measurement Period&quot;\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>Initial Population</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  &quot;ED Encounter&quot;\n    union &quot;ED Triage&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>Denominator</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator&quot;:\n  &quot;Initial Population&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>Time to Treatment Room Greater Than 60 Minutes</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Time to Treatment Room Greater Than 60 Minutes&quot;:\n  &quot;Denominator&quot; EDEncounter\n    where &quot;EDArrivalTime&quot;(EDEncounter) 61 minutes or more before &quot;EDTreatmentRoomTimeArrivalTime&quot;(EDEncounter)</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>ED Arrival Left Without Being Seen</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;ED Arrival Left Without Being Seen&quot;:\n  &quot;ED Triage&quot; EDTriage\n    where EDTriage.hospitalization.dischargeDisposition ~ &quot;Patient left without being seen (finding)&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CQMCommon</td>\n                            \n                            \n                                <td>Inpatient Encounter</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Inpatient Encounter&quot;:\n  [Encounter: &quot;Encounter Inpatient&quot;] EncounterInpatient\n\t\twhere EncounterInpatient.status = 'finished'\n\t\tand EncounterInpatient.period ends during day of &quot;Measurement Period&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>EDtoIPOrder</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;EDtoIPOrder&quot;:\n  [ServiceRequest: code in &quot;Decision to Admit to Hospital Inpatient&quot;]</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>Decision to Admit Encounter Order</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Decision to Admit Encounter Order&quot;:\n  &quot;Denominator&quot; EDEncounter\n    with CQMCommon.&quot;Inpatient Encounter&quot; EncounterInpatient\n      such that &quot;AdmitDecisionUsingEncounterOrder&quot;(EncounterInpatient) 241 minutes or more before &quot;EDDepartureTime&quot;(EDEncounter)</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>AssessmentInED</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;AssessmentInED&quot;:\n  [Observation: &quot;Emergency Department Evaluation&quot;]</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>Decision to Admit Using Assessment</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Decision to Admit Using Assessment&quot;:\n  &quot;Denominator&quot; EDEncounter\n    with CQMCommon.&quot;Inpatient Encounter&quot; EncounterInpatient\n      such that &quot;AdmitDecisionUsingAssessment&quot;(EncounterInpatient) 241 minutes or more before &quot;EDDepartureTime&quot;(EDEncounter)</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>InpatientOrBedAssignmentEncounterOrder</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;InpatientOrBedAssignmentEncounterOrder&quot;:\n  [ServiceRequest: code in &quot;Encounter Inpatient&quot;]\n    union [ServiceRequest: &quot;Patient bed assigned (finding)&quot;]</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>Time of Admit Order Or Bed Assignment to Departure Greater Than 241 Minutes</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Time of Admit Order Or Bed Assignment to Departure Greater Than 241 Minutes&quot;:\n  &quot;Denominator&quot; EDEncounter\n    with CQMCommon.&quot;Inpatient Encounter&quot; InpatientEncounter\n      such that &quot;AdmitInpatientOrBedAssignmentOrder&quot;(InpatientEncounter) 241 minutes or more before &quot;EDDepartureTime&quot;(EDEncounter)</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>Admitted to Inpatient 241 Minutes or More Before Departure</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Admitted to Inpatient 241 Minutes or More Before Departure&quot;:\n  &quot;Denominator&quot; EDEncounter\n    with CQMCommon.&quot;Inpatient Encounter&quot; Inpatient\n      such that &quot;HoldingInEDAfterAdmission&quot;(Inpatient) 241 minutes or more before &quot;EDDepartureTime&quot;(EDEncounter)</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>Boarded Time Greater Than 240 Minutes</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Boarded Time Greater Than 240 Minutes&quot;:\n  &quot;Decision to Admit Encounter Order&quot;\n    union &quot;Decision to Admit Using Assessment&quot;\n    union &quot;Time of Admit Order Or Bed Assignment to Departure Greater Than 241 Minutes&quot;\n    union &quot;Admitted to Inpatient 241 Minutes or More Before Departure&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>ED Observation Encounter Status</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;ED Observation Encounter Status&quot;:\n  [Encounter: &quot;Emergency Department Observation&quot;] EDObsEncounter\n    with &quot;Denominator&quot; EDEncounter\n      such that start of EDObsEncounter.period during EDEncounter.period\n        and EDEncounter.status = 'finished'\n        and EDObsEncounter.status = 'finished'</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>ED Observation Order Status</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;ED Observation Order Status&quot;:\n  [ServiceRequest: code in &quot;Emergency Department Observation&quot;] EDObsOrder\n    with &quot;Denominator&quot; EDEncounter\n      such that EDObsOrder.authoredOn during EDEncounter.period\n        and EDEncounter.status = 'finished'\n        and EDObsOrder.status = 'active'</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>ED Observation Status</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;ED Observation Status&quot;:\n  ( &quot;ED Observation Encounter Status&quot;\n    union &quot;ED Observation Order Status&quot; ) EDObservation\n    with ( &quot;Denominator&quot; ) EDStay\n      such that EDObservation.period during EDStay.period\n        or ( EDObservation.authoredOn during EDStay.period )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>Boarded Time Greater Than 240 Minutes and No Observation Stay</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Boarded Time Greater Than 240 Minutes and No Observation Stay&quot;:\n  ( &quot;Boarded Time Greater Than 240 Minutes&quot; Boarding\n      where not exists ( &quot;ED Observation Status&quot; EDO\n          where ( EDO.period starts during Boarding.period\n              or EDO.authoredOn during Boarding.period\n          )\n      )\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>ED Length of Stay Greater Than 480 Minutes</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;ED Length of Stay Greater Than 480 Minutes&quot;:\n  &quot;Denominator&quot; EDEncounter\n    where &quot;EDArrivalTime&quot;(EDEncounter) 481 minutes or more before &quot;EDDepartureTime&quot;(EDEncounter)</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>ED Length of Stay Greater Than 480 Minutes and No Observation Stay</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;ED Length of Stay Greater Than 480 Minutes and No Observation Stay&quot;:\n  ( &quot;ED Length of Stay Greater Than 480 Minutes&quot; EDStay\n      where not exists ( &quot;ED Observation Status&quot; EDO\n          where ( EDO.period starts during EDStay.period\n              or EDO.authoredOn during EDStay.period\n          )\n      )\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>Numerator</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Numerator&quot;:\n  &quot;Time to Treatment Room Greater Than 60 Minutes&quot;\n    union &quot;ED Arrival Left Without Being Seen&quot;\n    union &quot;Boarded Time Greater Than 240 Minutes and No Observation Stay&quot;\n    union &quot;ED Length of Stay Greater Than 480 Minutes and No Observation Stay&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>ED Encounter or Triage of Patients Less Than 18 Years</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;ED Encounter or Triage of Patients Less Than 18 Years&quot;:\n  &quot;Denominator&quot; EDEncounter\n    where AgeInYearsAt(date from start of &quot;Measurement Period&quot;) &lt; 18</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>Stratification 1: Pediatric With No Mental Health Diagnosis</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Stratification 1: Pediatric With No Mental Health Diagnosis&quot;:\n  ( &quot;ED Encounter or Triage of Patients Less Than 18 Years&quot; EDEncounter\n      let ConditionCode: EDEncounter.principalDiagnosis ( ).code\n      where not ( ConditionCode in &quot;Mental Health Diagnosis without Substance Use Disorders&quot; )\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>ED Encounter or Triage of Patients 18 Years and Older</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;ED Encounter or Triage of Patients 18 Years and Older&quot;:\n  &quot;Denominator&quot; EDEncounter\n    where AgeInYearsAt(date from start of &quot;Measurement Period&quot;) &gt;= 18</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>Stratification 4: Adult With Mental Health Diagnosis</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Stratification 4: Adult With Mental Health Diagnosis&quot;:\n  ( &quot;ED Encounter or Triage of Patients 18 Years and Older&quot; EDEncounter\n      let ConditionCode: EDEncounter.principalDiagnosis ( ).code\n      where ( ConditionCode in &quot;Mental Health Diagnosis without Substance Use Disorders&quot; )\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>Stratification 2: Adult With No Mental Health Diagnosis</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Stratification 2: Adult With No Mental Health Diagnosis&quot;:\n  ( &quot;ED Encounter or Triage of Patients 18 Years and Older&quot; EDEncounter\n      let ConditionCode: EDEncounter.principalDiagnosis ( ).code\n      where not ( ConditionCode in &quot;Mental Health Diagnosis without Substance Use Disorders&quot; )\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElements</td>\n                            \n                            \n                                <td>SDE Payer</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Payer&quot;:\n  [Coverage: type in &quot;Payer Type&quot;] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>SDE Payer</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Payer&quot;:\n  SDE.&quot;SDE Payer&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>Stratification 3: Pediatric With Mental Health Diagnosis</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Stratification 3: Pediatric With Mental Health Diagnosis&quot;:\n  ( &quot;ED Encounter or Triage of Patients Less Than 18 Years&quot; EDEncounter\n      let ConditionCode: EDEncounter.principalDiagnosis ( ).code\n      where ( ConditionCode in &quot;Mental Health Diagnosis without Substance Use Disorders&quot; )\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElements</td>\n                            \n                            \n                                <td>SDE Ethnicity</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Ethnicity&quot;:\n  Patient.ethnicity E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>SDE Ethnicity</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Ethnicity&quot;:\n  SDE.&quot;SDE Ethnicity&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElements</td>\n                            \n                            \n                                <td>SDE Race</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Race&quot;:\n  Patient.race R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>SDE Race</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Race&quot;:\n  SDE.&quot;SDE Race&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>EDArrivalTime</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function &quot;EDArrivalTime&quot;(EDEncounter Encounter):\n  Last(EDEncounter.location Location\n      where Location.location.getLocation().type in &quot;Emergency Department Location&quot;\n        and start of Location.period is not null\n      return start of Location.period\n      sort ascending\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CQMCommon</td>\n                            \n                            \n                                <td>getLocation</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns the Location resource specified by the given reference.\n*/\ndefine fluent function getLocation(reference Reference ):\n  singleton from (\n    [Location] L where L.id = reference.reference.getId()\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>QICoreCommon</td>\n                            \n                            \n                                <td>getId</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).\n@comment: This function can be used to determine the logical id of a given resource. It can be used in\na single-server environment to trace references. However, this function does not attempt to resolve\nor distinguish the base of the given url, and so cannot be used safely in multi-server environments.\n*/\ndefine fluent function getId(uri String):\n  Last(Split(uri, '/'))</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>FHIRHelpers</td>\n                            \n                            \n                                <td>ToConcept</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>EDTreatmentRoomTimeArrivalTime</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function &quot;EDTreatmentRoomTimeArrivalTime&quot;(EDEncounter Encounter):\n  Last(EDEncounter.location Location\n      where Location.location.getLocation().type in &quot;Emergency Department Treatment Location&quot;\n        and start of Location.period is not null\n      return start of Location.period\n      sort ascending\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>AdmitDecisionUsingEncounterOrder</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function &quot;AdmitDecisionUsingEncounterOrder&quot;(InpatientEncounter Encounter):\n  Last(&quot;EDtoIPOrder&quot; AdmitOrder\n      let LastEDVisit: &quot;LastEDEncounter&quot;(InpatientEncounter)\n      where AdmitOrder.authoredOn during LastEDVisit.period\n        and AdmitOrder.intent ~ 'order'\n        and AdmitOrder.status in { 'active', 'completed' }\n      return AdmitOrder.authoredOn\n      sort ascending\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>LastEDEncounter</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function &quot;LastEDEncounter&quot;(InpatientEncounter Encounter):\n  Last(&quot;ED Encounter&quot; EDVisit\n      where EDVisit.period starts 1 day or less before or on start of InpatientEncounter.period\n        and EDVisit.period starts before start of InpatientEncounter.period\n        and EDVisit.period during &quot;Measurement Period&quot;\n        and EDVisit.status = 'finished'\n      sort by \n      end of period ascending\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>EDDepartureTime</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function &quot;EDDepartureTime&quot;(EDEncounter Encounter):\n  Last(EDEncounter.location Location\n      where Location.location.getLocation().type in &quot;Emergency Department Location&quot;\n        and \n        end of Location.period is not null\n      return \n      end of Location.period\n      sort ascending\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>AdmitDecisionUsingAssessment</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function &quot;AdmitDecisionUsingAssessment&quot;(InpatientEncounter Encounter):\n  Last(&quot;AssessmentInED&quot; EDEvaluation\n      let LastEDVisit: &quot;LastEDEncounter&quot;(InpatientEncounter)\n      where EDEvaluation.effective.toInterval() starts during LastEDVisit.period\n        and EDEvaluation.value as Concept in &quot;Admit Inpatient&quot;\n        and EDEvaluation.status in { 'final', 'amended', 'corrected' }\n      return start of EDEvaluation.effective.toInterval()\n      sort ascending\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>AdmitInpatientOrBedAssignmentOrder</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function &quot;AdmitInpatientOrBedAssignmentOrder&quot;(InpatientEncounter Encounter):\n  Last((&quot;InpatientOrBedAssignmentEncounterOrder&quot;) AdmitInpatientOrder\n      let LastEDVisit: &quot;LastEDEncounter&quot;(InpatientEncounter)\n      where AdmitInpatientOrder.authoredOn during LastEDVisit.period\n      return AdmitInpatientOrder.authoredOn\n      sort ascending\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMS1244ECCQHOQRFHIR</td>\n                            \n                            \n                                <td>HoldingInEDAfterAdmission</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function &quot;HoldingInEDAfterAdmission&quot;(InpatientEncounter Encounter):\n  Last(CQMCommon.&quot;Inpatient Encounter&quot; AdmittedInpatient\n      let LastEDVisit: &quot;LastEDEncounter&quot;(InpatientEncounter)\n      where start of AdmittedInpatient.period during LastEDVisit.period\n      return start of AdmittedInpatient.period\n      sort ascending\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CQMCommon</td>\n                            \n                            \n                                <td>principalDiagnosis</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns the condition that is specified as the principal diagnosis for the encounter\n*/\ndefine fluent function principalDiagnosis(Encounter Encounter ):\n\tsingleton from ((Encounter.diagnosis D where D.rank = 1 and D.use ~ &quot;Billing&quot;) PD\n      return singleton from ([Condition] C where C.id = PD.condition.reference.getId())\n\t)</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>FHIRHelpers</td>\n                            \n                            \n                                <td>ToString</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function ToString(value uri): value.value</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>FHIRHelpers</td>\n                            \n                            \n                                <td>ToCode</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                    </table>\n                </td>\n            </tr>\n            \n        \n    \n\n    </table>\n</div>"
      },
      "contained" : [
        {
          "resourceType" : "Library",
          "id" : "effective-data-requirements",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://hl7.org/fhir/administrative-gender",
                "code" : "M",
                "display" : "Male"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://hl7.org/fhir/administrative-gender",
                "code" : "F",
                "display" : "Female"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "21541000119102",
                "display" : "Patient left without being seen (finding)"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "5751000175101",
                "display" : "Patient bed assigned (finding)"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/diagnosis-role",
                "code" : "billing",
                "display" : "Billing"
              }
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "SupplementalDataElements"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Sex"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Sex\":\n  case\n    when Patient.gender = 'male' then \"M\"\n    when Patient.gender = 'female' then \"F\"\n    else null\n  end"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 0
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Sex"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 1
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "ED Encounter"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"ED Encounter\":\n  [Encounter: \"Emergency Department Evaluation and Management Visit\"] EDEncounter\n    where EDEncounter.period ends during day of \"Measurement Period\"\n      and EDEncounter.status = 'finished'"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 2
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "ED Triage"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"ED Triage\":\n  ( [Encounter: \"Triage\"] EDTriage\n      where EDTriage.period ends during day of \"Measurement Period\"\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 3
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Initial Population"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Initial Population\":\n  \"ED Encounter\"\n    union \"ED Triage\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 4
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Denominator\":\n  \"Initial Population\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 5
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Time to Treatment Room Greater Than 60 Minutes"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Time to Treatment Room Greater Than 60 Minutes\":\n  \"Denominator\" EDEncounter\n    where \"EDArrivalTime\"(EDEncounter) 61 minutes or more before \"EDTreatmentRoomTimeArrivalTime\"(EDEncounter)"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 6
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "ED Arrival Left Without Being Seen"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"ED Arrival Left Without Being Seen\":\n  \"ED Triage\" EDTriage\n    where EDTriage.hospitalization.dischargeDisposition ~ \"Patient left without being seen (finding)\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 7
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CQMCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "Inpatient Encounter"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Inpatient Encounter\":\n  [Encounter: \"Encounter Inpatient\"] EncounterInpatient\n\t\twhere EncounterInpatient.status = 'finished'\n\t\tand EncounterInpatient.period ends during day of \"Measurement Period\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 8
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "EDtoIPOrder"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"EDtoIPOrder\":\n  [ServiceRequest: code in \"Decision to Admit to Hospital Inpatient\"]"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 9
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Decision to Admit Encounter Order"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Decision to Admit Encounter Order\":\n  \"Denominator\" EDEncounter\n    with CQMCommon.\"Inpatient Encounter\" EncounterInpatient\n      such that \"AdmitDecisionUsingEncounterOrder\"(EncounterInpatient) 241 minutes or more before \"EDDepartureTime\"(EDEncounter)"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 10
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "AssessmentInED"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"AssessmentInED\":\n  [Observation: \"Emergency Department Evaluation\"]"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 11
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Decision to Admit Using Assessment"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Decision to Admit Using Assessment\":\n  \"Denominator\" EDEncounter\n    with CQMCommon.\"Inpatient Encounter\" EncounterInpatient\n      such that \"AdmitDecisionUsingAssessment\"(EncounterInpatient) 241 minutes or more before \"EDDepartureTime\"(EDEncounter)"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 12
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "InpatientOrBedAssignmentEncounterOrder"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"InpatientOrBedAssignmentEncounterOrder\":\n  [ServiceRequest: code in \"Encounter Inpatient\"]\n    union [ServiceRequest: \"Patient bed assigned (finding)\"]"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 13
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Time of Admit Order Or Bed Assignment to Departure Greater Than 241 Minutes"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Time of Admit Order Or Bed Assignment to Departure Greater Than 241 Minutes\":\n  \"Denominator\" EDEncounter\n    with CQMCommon.\"Inpatient Encounter\" InpatientEncounter\n      such that \"AdmitInpatientOrBedAssignmentOrder\"(InpatientEncounter) 241 minutes or more before \"EDDepartureTime\"(EDEncounter)"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 14
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Admitted to Inpatient 241 Minutes or More Before Departure"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Admitted to Inpatient 241 Minutes or More Before Departure\":\n  \"Denominator\" EDEncounter\n    with CQMCommon.\"Inpatient Encounter\" Inpatient\n      such that \"HoldingInEDAfterAdmission\"(Inpatient) 241 minutes or more before \"EDDepartureTime\"(EDEncounter)"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 15
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Boarded Time Greater Than 240 Minutes"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Boarded Time Greater Than 240 Minutes\":\n  \"Decision to Admit Encounter Order\"\n    union \"Decision to Admit Using Assessment\"\n    union \"Time of Admit Order Or Bed Assignment to Departure Greater Than 241 Minutes\"\n    union \"Admitted to Inpatient 241 Minutes or More Before Departure\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 16
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "ED Observation Encounter Status"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"ED Observation Encounter Status\":\n  [Encounter: \"Emergency Department Observation\"] EDObsEncounter\n    with \"Denominator\" EDEncounter\n      such that start of EDObsEncounter.period during EDEncounter.period\n        and EDEncounter.status = 'finished'\n        and EDObsEncounter.status = 'finished'"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 17
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "ED Observation Order Status"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"ED Observation Order Status\":\n  [ServiceRequest: code in \"Emergency Department Observation\"] EDObsOrder\n    with \"Denominator\" EDEncounter\n      such that EDObsOrder.authoredOn during EDEncounter.period\n        and EDEncounter.status = 'finished'\n        and EDObsOrder.status = 'active'"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 18
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "ED Observation Status"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"ED Observation Status\":\n  ( \"ED Observation Encounter Status\"\n    union \"ED Observation Order Status\" ) EDObservation\n    with ( \"Denominator\" ) EDStay\n      such that EDObservation.period during EDStay.period\n        or ( EDObservation.authoredOn during EDStay.period )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 19
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Boarded Time Greater Than 240 Minutes and No Observation Stay"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Boarded Time Greater Than 240 Minutes and No Observation Stay\":\n  ( \"Boarded Time Greater Than 240 Minutes\" Boarding\n      where not exists ( \"ED Observation Status\" EDO\n          where ( EDO.period starts during Boarding.period\n              or EDO.authoredOn during Boarding.period\n          )\n      )\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 20
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "ED Length of Stay Greater Than 480 Minutes"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"ED Length of Stay Greater Than 480 Minutes\":\n  \"Denominator\" EDEncounter\n    where \"EDArrivalTime\"(EDEncounter) 481 minutes or more before \"EDDepartureTime\"(EDEncounter)"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 21
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "ED Length of Stay Greater Than 480 Minutes and No Observation Stay"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"ED Length of Stay Greater Than 480 Minutes and No Observation Stay\":\n  ( \"ED Length of Stay Greater Than 480 Minutes\" EDStay\n      where not exists ( \"ED Observation Status\" EDO\n          where ( EDO.period starts during EDStay.period\n              or EDO.authoredOn during EDStay.period\n          )\n      )\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 22
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Numerator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Numerator\":\n  \"Time to Treatment Room Greater Than 60 Minutes\"\n    union \"ED Arrival Left Without Being Seen\"\n    union \"Boarded Time Greater Than 240 Minutes and No Observation Stay\"\n    union \"ED Length of Stay Greater Than 480 Minutes and No Observation Stay\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 23
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "ED Encounter or Triage of Patients Less Than 18 Years"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"ED Encounter or Triage of Patients Less Than 18 Years\":\n  \"Denominator\" EDEncounter\n    where AgeInYearsAt(date from start of \"Measurement Period\") < 18"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 24
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Stratification 1: Pediatric With No Mental Health Diagnosis"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Stratification 1: Pediatric With No Mental Health Diagnosis\":\n  ( \"ED Encounter or Triage of Patients Less Than 18 Years\" EDEncounter\n      let ConditionCode: EDEncounter.principalDiagnosis ( ).code\n      where not ( ConditionCode in \"Mental Health Diagnosis without Substance Use Disorders\" )\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 25
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "ED Encounter or Triage of Patients 18 Years and Older"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"ED Encounter or Triage of Patients 18 Years and Older\":\n  \"Denominator\" EDEncounter\n    where AgeInYearsAt(date from start of \"Measurement Period\") >= 18"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 26
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Stratification 4: Adult With Mental Health Diagnosis"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Stratification 4: Adult With Mental Health Diagnosis\":\n  ( \"ED Encounter or Triage of Patients 18 Years and Older\" EDEncounter\n      let ConditionCode: EDEncounter.principalDiagnosis ( ).code\n      where ( ConditionCode in \"Mental Health Diagnosis without Substance Use Disorders\" )\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 27
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Stratification 2: Adult With No Mental Health Diagnosis"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Stratification 2: Adult With No Mental Health Diagnosis\":\n  ( \"ED Encounter or Triage of Patients 18 Years and Older\" EDEncounter\n      let ConditionCode: EDEncounter.principalDiagnosis ( ).code\n      where not ( ConditionCode in \"Mental Health Diagnosis without Substance Use Disorders\" )\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 28
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "SupplementalDataElements"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Payer"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Payer\":\n  [Coverage: type in \"Payer Type\"] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 29
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Payer"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 30
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Stratification 3: Pediatric With Mental Health Diagnosis"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Stratification 3: Pediatric With Mental Health Diagnosis\":\n  ( \"ED Encounter or Triage of Patients Less Than 18 Years\" EDEncounter\n      let ConditionCode: EDEncounter.principalDiagnosis ( ).code\n      where ( ConditionCode in \"Mental Health Diagnosis without Substance Use Disorders\" )\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 31
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "SupplementalDataElements"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Ethnicity"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Ethnicity\":\n  Patient.ethnicity E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 32
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Ethnicity"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 33
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "SupplementalDataElements"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Race"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Race\":\n  Patient.race R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 34
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Race"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Race\":\n  SDE.\"SDE Race\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 35
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "EDArrivalTime"
                },
                {
                  "url" : "statement",
                  "valueString" : "define function \"EDArrivalTime\"(EDEncounter Encounter):\n  Last(EDEncounter.location Location\n      where Location.location.getLocation().type in \"Emergency Department Location\"\n        and start of Location.period is not null\n      return start of Location.period\n      sort ascending\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 36
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CQMCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "getLocation"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns the Location resource specified by the given reference.\n*/\ndefine fluent function getLocation(reference Reference ):\n  singleton from (\n    [Location] L where L.id = reference.reference.getId()\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 37
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "getId"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).\n@comment: This function can be used to determine the logical id of a given resource. It can be used in\na single-server environment to trace references. However, this function does not attempt to resolve\nor distinguish the base of the given url, and so cannot be used safely in multi-server environments.\n*/\ndefine fluent function getId(uri String):\n  Last(Split(uri, '/'))"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 38
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToConcept"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 39
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMS1244ECCQHOQRFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "EDTreatmentRoomTimeArrivalTime"
                },
                {
                  "url" : "statement",
                  "valueString" : "define function \"EDTreatmentRoomTimeArrivalTime\"(EDEncounter Encounter):\n  Last(EDEncounter.location Location\n      where Location.location.getLocation().type in \"Emergency Department Treatment Location\"\n        and start of Location.period is not null\n      return start of Location.period\n      sort ascending\n  )"
                },
                {
                  "     "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
                "code" : "publisher",
                "display" : "Publisher"
              }
            ]
          },
          "system" : "https://madie.cms.gov/measure/cmsId",
          "value" : "1244FHIR",
          "assigner" : {
            "display" : "CMS"
          }
        }
      ],
      "version" : "0.2.001",
      "name" : "CMS1244ECCQHOQRFHIR",
      "title" : "Emergency Care Capacity and Quality (HOQR) FHIR",
      "status" : "active",
      "experimental" : false,
      "date" : "2025-01-14T15:54:05+00:00",
      "publisher" : "Centers for Medicare & Medicaid Services (CMS)",
      "contact" : [
        {
          "telecom" : [
            {
              "system" : "url",
              "value" : "https://www.cms.gov/"
            }
          ]
        }
      ],
      "description" : "This measure assesses the variation in capacity and quality of emergency care to support hospital quality improvement for patients requiring emergency care in an emergency department (ED). This measure is designed to align with incentives to promote improved care both in EDs and the broader health system to help identify where patients do not receive appropriate or timely access to emergency care.\n\nEmergency care capacity and quality gaps are inclusive of several concepts pertaining to boarding and crowding in an ED, including significantly longer ED wait times, higher left without being seen rates, longer boarding times, and longer total length of stay in the ED.",
      "purpose" : "UNKNOWN",
      "usage" : "Measure Score Calculation\nThe measure score is first calculated at the individual ED level as the proportion of ED visits where any one of the four outcomes occurred, as defined by the numerator. Scores will be standardized z-scores by ED case volume strata (defined in ED visit volume bands of 20,000 visits). For CMS Certification Numbers (CCNs) with more than one ED, volume-adjusted z-scores are then combined as a weighted average for that CCN. A z-score of greater than zero means worse performance and less than zero means better performance, compared to like EDs.\n\nFor the purposes of this measure, a decision to admit can be captured using any of the following: \n  - an evaluation that results in a decision to admit\n  - an order to admit to inpatient\n  - an order for a bed assignment\n  - start of inpatient admission\n\nThis eCQM is an episode-based measure. An episode is defined as an ED visit that ends during the measurement period. \n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS1244v1. \n\nPlease refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html)",
      "copyright" : "Limited proprietary coding is contained in these specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets.\n\nThis material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. All rights reserved.\n\nICD-10 copyright 2024 World Health Organization. All Rights Reserved.\n\nCPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association.",
      "effectivePeriod" : {
        "start" : "2026-01-01",
        "end" : "2026-12-31"
      },
      "author" : [
        {
          "name" : "Acumen, LLC",
          "telecom" : [
            {
              "system" : "url",
              "value" : "https://www.acumenllc.com/"
            }
          ]
        }
      ],
      "library" : [
        "https://madie.cms.gov/Library/CMS1244ECCQHOQRFHIR"
      ],
      "disclaimer" : "These performance specifications are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications.\n\nTHE MEASURES AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.\n\nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
      "rationale" : "This measure aims to reduce patient harm and improve outcomes for patients requiring emergency care in an ED by addressing the variation in emergency care and measuring the capacity and quality of emergency care. There are long-standing concerns about parameters that impact the quality and timeliness of care in the ED. Currently, there are no national metrics to assess the proportion of patients impacted by the quality of timely ED care.",
      "clinicalRecommendationStatement" : "The goal of this Emergency Care Capacity and Quality (ECCQ) measure is to assess and improve the safety of the 140 million ED visits that patients experience each year (Centers for Disease Control and Prevention [CDC], 2021). Limitations in capacity and quality of emergency care have been shown to be associated with harm, such as increases in mortality, delays in care, preventable errors, poor patient experience, and staff burnout. These capacity and quality limitations are also associated with increased costs of care. This proposed ECCQ measure is intended for use in CMS’s Hospital Outpatient Quality Reporting (HOQR) program. The numerator is comprised of all ED visits with a quality gap in access as defined in the numerator criteria. Challenges related to emergency care access and capacity have been increasing and have prompted public calls for action. Prior efforts to measure components of this proposed measure (for example, ED boarding, through use of the ED-2 measure) were unsuccessful, likely in part due to the construction of the measure score, which was based on median performance that obscured poor performance (eCQI Resource Center, n.d). Implementation of this proposed measure, which captures multiple components of quality and capacity, will help identify facilities where patients do not receive timely access to emergency care as defined in the numerator criteria. This measure, therefore, could positively impact millions of patients who seek treatment in the ED and help address long-standing disparities in emergency care, including for patients with mental health diagnoses.",
      "guidance" : "Measure Score Calculation\nThe measure score is first calculated at the individual ED level as the proportion of ED visits where any one of the four outcomes occurred, as defined by the numerator. Scores will be standardized z-scores by ED case volume strata (defined in ED visit volume bands of 20,000 visits). For CMS Certification Numbers (CCNs) with more than one ED, volume-adjusted z-scores are then combined as a weighted average for that CCN. A z-score of greater than zero means worse performance and less than zero means better performance, compared to like EDs.\n\nFor the purposes of this measure, a decision to admit can be captured using any of the following: \n  - an evaluation that results in a decision to admit\n  - an order to admit to inpatient\n  - an order for a bed assignment\n  - start of inpatient admission\n\nThis eCQM is an episode-based measure. An episode is defined as an ED visit that ends during the measurement period. \n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS1244v1. \n\nPlease refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html)",
      "group" : [
        {
          "id" : "6758b74246b6174510cfef2f",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
                    "code" : "proportion",
                    "display" : "Proportion"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
              "valueCode" : "Encounter"
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-type",
                    "code" : "outcome",
                    "display" : "Outcome"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
              "valueCode" : "None"
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                    "code" : "decrease",
                    "display" : "Decreased score indicates improvement"
                  }
                ]
              }
            }
          ],
          "description" : "All ED visits that end during the measurement period for all patients",
          "population" : [
            {
              "id" : "04becb34-9cb9-4d76-8f49-5ac899733b14",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "initial-population",
                    "display" : "Initial Population"
                  }
                ]
              },
              "description" : "All ED visits that end during the measurement period for all patients",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Initial Population"
              }
            },
            {
              "id" : "172deab2-d282-4e66-a0eb-93403ffeb477",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "denominator",
                    "display" : "Denominator"
                  }
                ]
              },
              "description" : "Equals Initial Population",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Denominator"
              }
            },
            {
              "id" : "685c6eac-07b7-4a43-bd29-66c6c9f66af7",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "numerator",
                    "display" : "Numerator"
                  }
                ]
              },
              "description" : "The numerator is comprised of ED visits meeting the denominator criteria and where the patient experiences any of the following quality gaps in access:\n1. The patient waited longer than 60 minutes (1 hour) after arrival to the ED to be placed in a treatment room or dedicated treatment area that allows for audiovisual privacy during history-taking and physical examination, or \n2. The patient left the ED without being evaluated, or  \n3. The patient boarded (time from Decision to Admit order to ED departure for admitted patients) in the ED for longer than 240 minutes (4 hours), or\n4. The patient had an ED length of stay (LOS) (time from ED arrival to ED departure as defined by the ED departure timestamp indicating when the patient physically left the ED) of longer than 480 minutes (8 hours).\n\nED encounters with ED observation stays are excluded from criteria #3 (boarding) and #4 (ED LOS). To clarify, patients who have a ‘decision to admit’ after an ED observation stay remain excluded from criteria #3 (boarded) calculations. ",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Numerator"
              }
            }
          ],
          "stratifier" : [
            {
              "id" : "47720a33-5446-484b-b13e-1fd8cb336c8a",
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                        "code" : "initial-population",
                        "display" : "Initial Population"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                        "code" : "denominator",
                        "display" : "Denominator"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                        "code" : "numerator",
                        "display" : "Numerator"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                        "code" : "numerator-exclusion",
                        "display" : "Numerator Exclusion"
                      }
                    ]
                  }
                }
              ],
              "description" : "All patients aged less than 18 years seen in the ED who do not have an ED encounter principal diagnosis consistent with mental health diagnosis.  Patients who have an ED encounter principal diagnosis consistent with substance use disorders will be included in this stratification.",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Stratification 1: Pediatric With No Mental Health Diagnosis"
              }
            },
            {
              "id" : "aeb743ee-a595-49f5-94ba-2fd492420b24",
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                        "code" : "initial-population",
                        "display" : "Initial Population"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                        "code" : "denominator",
                        "display" : "Denominator"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                        "code" : "numerator",
                        "display" : "Numerator"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                        "code" : "numerator-exclusion",
                        "display" : "Numerator Exclusion"
                      }
                    ]
                  }
                }
              ],
              "description" : "All patients aged 18 years and older seen in the ED who do not have an ED encounter principal diagnosis consistent with mental health diagnosis.  Patients who have an ED encounter principal diagnosis consistent with substance use disorders will be included in this stratification.",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Stratification 2: Adult With No Mental Health Diagnosis"
              }
            },
            {
              "id" : "15ee4011-7c35-46d0-997f-9b23f15af731",
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                        "code" : "initial-population",
                        "display" : "Initial Population"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                        "code" : "denominator",
                        "display" : "Denominator"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                        "code" : "numerator",
                        "display" : "Numerator"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                        "code" : "numerator-exclusion",
                        "display" : "Numerator Exclusion"
                      }
                    ]
                  }
                }
              ],
              "description" : "All patients aged less than 18 years seen in the ED who have an ED encounter principal diagnosis consistent with mental health diagnosis.",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Stratification 3: Pediatric With Mental Health Diagnosis"
              }
            },
            {
              "id" : "603ae99f-c70e-437c-92e7-f47d69581b23",
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                        "code" : "initial-population",
                        "display" : "Initial Population"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                        "code" : "denominator",
                        "display" : "Denominator"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                        "code" : "numerator",
                        "display" : "Numerator"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                        "code" : "numerator-exclusion",
                        "display" : "Numerator Exclusion"
                      }
                    ]
                  }
                }
              ],
              "description" : "All patients aged 18 years and older seen in the ED who have an ED encounter principal diagnosis consistent with mental health diagnosis.",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Stratification 4: Adult With Mental Health Diagnosis"
              }
            }
          ]
        }
      ],
      "supplementalData" : [
        {
          "id" : "sde-ethnicity",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "SDE Ethnicity",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "SDE Ethnicity"
          }
        },
        {
          "id" : "sde-payer",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "SDE Payer",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "SDE Payer"
          }
        },
        {
          "id" : "sde-race",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "SDE Race",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "SDE Race"
          }
        },
        {
          "id" : "sde-sex",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "SDE Sex",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "SDE Sex"
          }
        },
        {
          "id" : "sde-address",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "SDE Address",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "SDE Address"
          }
        }
      ]
    }

    XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.