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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-CMSFHIR844HybridHospitalWideMortality.html
Url https://madie.cms.gov/Measure/CMSFHIR844HybridHospitalWideMortality
Version 0.1.001
Status active
Date 2025-01-14T15:54:04+00:00
Name CMSFHIR844HybridHospitalWideMortality
Title Core Clinical Data Elements for the Hybrid Hospital Wide All Condition All Procedure Risk Standardized Mortality Measure HWMFHIR
Experimental False
Description This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from hospitalizations for adult Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) patients admitted to acute care hospitals.
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. LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc.

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Narrative

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Title: Core Clinical Data Elements for the Hybrid Hospital Wide All Condition All Procedure Risk Standardized Mortality Measure HWMFHIR
Id: CMSFHIR844HybridHospitalWideMortality
Version: 0.1.001
Url: Core Clinical Data Elements for the Hybrid Hospital Wide All Condition All Procedure Risk Standardized Mortality Measure HWMFHIR
Short Name Identifier:

CMS844FHIR

Version Independent Identifier:

urn:uuid:965255e9-dfeb-42d0-8416-2c4b7ecc5109

Version Specific Identifier:

urn:uuid:bdfb568a-0f3f-4885-be0c-7bc971fe8b65

Endorser (CMS Consensus Based Entity) Identifier:

3502

Publisher (CMS) Identifier:

844FHIR

Effective Period: 2026-07-01..2027-06-30
Publisher: Centers for Medicare & Medicaid Services (CMS)
Author: Lantana Consulting Group, Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation
Description:

This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from hospitalizations for adult Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) patients admitted to acute care hospitals.
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.

LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc.
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:

The intent of this logic is to extract the FIRST valid set of clinical data elements from hospital electronic health records (EHRs) for all qualifying hospitalizations. The data will be linked with administrative claims to risk adjust the Hybrid HWM outcome measure. This work addresses stakeholder concerns that clinical data garnered from patients and used by clinicians to guide diagnostic decisions and treatment, are preferable to administrative claims data when profiling hospitals’ case mix. We are calling the list of data elements for extraction the "HWM-specific core clinical data elements" (CCDE). The CCDEs are the first set of vital signs and basic laboratory tests resulted from hospitalizations for adult Medicare FFS and MA patients, age 65 through 94 years (Initial Population), after they arrive at the hospital to which they are subsequently admitted. For example, this first set of data values are often captured in the emergency department or in the pre-operative area, sometimes hours before a patient is admitted to that same facility.

Hospitalizations over the age of 94 years are not included to avoid holding hospitals responsible for the survival of the oldest elderly patients, who may be less likely to have survival as a primary goal. While we acknowledge that many elderly patients do have survival beyond 30 days as a primary goal for their hospitalization, with input from our Technical Expert Panel and work groups, we decided to only include hospitalizations between 65 and 94 years of age.

These CCDEs were selected because they: 1. reflect patients' clinical status when they first present to the hospital; 2. are clinically and statistically relevant to patient outcomes; 3. are consistently obtained during adult inpatient hospitalizations based on current clinical practice; 4. are captured with a standard definition and recorded in a standard format across providers; and 5. are entered in structured fields that are feasibly retrieved from current EHR systems (YNHHSC/CORE, 2015).

Additional data called Linking Variables are used to link EHR data files with administrative claims data for CMS to calculate results for the Hybrid HWM measure, which are: CMS Certification Number (CCN); Medicare Beneficiary Identifier (MBI); Inpatient Admission Date; and Discharge Date.
Clinical recommendation statement:

The logic is not meant to guide or alter the care patients receive. The purpose of this CCDE logic is to extract clinical data that are already routinely captured in EHRs from hospitalizations for adult patients. It is not intended to require that clinical staff perform additional measurements or tests that are not needed for diagnostic assessment or treatment of patients.
Guidance (Usage): These specifications are for use for data with discharges that occur between July 1, 2026 and June 30, 2027. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2028. This logic guides the user to extract the FIRST valid resulted HWM-specific CCDEs for all Medicare FFS and MA hospitalizations for patients aged 65 through 94 years (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area, such as the emergency department or hospital outpatient location. The logic supports extraction of the FIRST resulted vital signs and laboratory tests, where the result is not null, during the patient encounter or episode of care. This may include values captured after inpatient admission, as well as prior to inpatient admission, for example from the emergency department, pre-operative, or other outpatient areas associated with the hospital, as long as the values fall within the allowed timeframes specified in the measure logic. All clinical systems used in inpatient and outpatient locations associated with the hospital facility should be queried for core clinical data element values related to a patient who is subsequently admitted. Patients who arrive at the hospital on oxygen therapy will be flagged in the logic, and an abnormal value for oxygen therapy will be imputed in the data. Rationale: patients who arrive on oxygen may appear in better condition, that is, having a higher oxygen saturation due to oxygen administration, that is not truly reflective of the patient's status upon arrival. Value sets for the laboratory tests are represented using Logical Observation Identifiers Names and Codes (LOINC) currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements. NOTE: It is recommended hospitals only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. Hospitals may also choose to report ALL values on an encounter during their entire admission; however, only the first resulted values are utilized in the logic for measure calculation. For each CCDE, it is recommended that hospitals report the below Unified Code for Units of Measure (UCUM) units, however, any unit may be submitted. Where the reported unit is not easily converted to the requested UCUM units, the value will be set to missing and multiple imputation will be used to impute a value based on the characteristics of the CCDE reported. CCDE UCUM Unit: Bicarbonate--------------------------------------meq/L mmol/L Creatinine-----------------------------------------mg/dL Heart rate-----------------------------------------{Beats}/min Hematocrit ---------------------------------------% Oxygen saturation (by pulse oximetry)----% Platelet--------------------------------------------10*3/uL Sodium--------------------------------------------meq/L mmol/L Systolic blood pressure-----------------------mm[Hg] Temperature-------------------------------------Cel [degF] White blood cell count -----------------------{Cells}/uL 10*3/uL 10*9/L For each hospitalization please also submit the following Linking Variables: CMS Certification Number (CCN); Medicare Beneficiary Identifier (MBI); Inpatient Admission Date; and Discharge Date. This eCQM is an encounter-based measure. The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This FHIR-based measure has been derived from the QDM-based measure: CMS844v6. 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:
67533db0670f1c0879cef5cb
Initial Population: All Medicare FFS and MA hospitalizations for patients aged 65 through 94 years at the start of an inpatient admission, where the length of stay is less than 365 days, and the hospitalization ends during the measurement period. NOTE: All Medicare FFS and MA hospitalizations meeting the above criteria should be included, regardless of whether Medicare FFS/MA is the primary, secondary, or tertiary payer.
Supplemental Data Elements:

SDE Ethnicity

SDE Payer

SDE Race

SDE Sex

Encounter with First Bicarbonate Lab Test

Encounter with First Body Temperature

Encounter with First Creatinine Lab Test

Encounter with First Heart Rate

Encounter with First Hematocrit Lab Test

Encounter with First Oxygen Saturation

Encounter with First Platelet Lab Test

Encounter with First Sodium Lab Test

Encounter with First White Blood Cells Lab Test

Encounter with First Systolic Blood Pressure
Supplemental Data Guidance : For hospitalizations in the Initial Population, report the FIRST resulted vital signs (physical exams) during current hospitalization. The physical exam CCDEs are as follows: Body Temperature Heart rate Oxygen saturation (by pulse oximetry) Systolic blood pressure For laboratory test results, report the FIRST resulted laboratory tests where result is not null during current hospitalization. The laboratory tests CCDEs are as follows: Bicarbonate (or carbon dioxide, see Bicarbonate Lab Test value set) Creatinine Hematocrit Platelet Sodium White blood cell count First values for the CCDEs may be resulted in the emergency department or other hospital outpatient locations within the hospital facility before a patient is subsequently admitted to the same hospital. First values for these data elements may also be resulted in an inpatient location for directly admitted patients who do not receive care in the emergency department or other hospital outpatient/same day surgery locations before admission. NOTE: Hospitals may choose to submit all, or only report the FIRST resulted value for EACH CCDE collected in the appropriate timeframe, if available. For every patient in the Initial Population, also identify payer, race, ethnicity and sex.
Libraries:
CMSFHIR844HybridHospitalWideMortality
Terminology and Other Dependencies:
  • Library/CQMCommon|2.2.000
  • Library/FHIRHelpers|4.4.000
  • Library/QICoreCommon|2.1.000
  • Library/SupplementalDataElements|3.5.000
  • Logical Observation Identifiers, Names and Codes (LOINC)
  • AdministrativeGender
  • Encounter Inpatient
  • Medicare payer
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.12
  • Observation Services
  • Emergency Department Visit
  • Outpatient Surgery Service
  • Bicarbonate lab test
  • White blood cells count lab test
  • Hematocrit lab test
  • Platelet count lab test
  • Creatinine lab test
  • Payer
  • Oxygen Saturation in Arterial Blood by Pulse Oximetry
  • Sodium lab test
    		•
    Parameters:
    name use min max type
    Measurement Period In 0 1 Period
    Encounter with First Bicarbonate Lab Test Out 0 * Resource
    Encounter with First Heart Rate Out 0 * Resource
    Encounter with First White Blood Cells Lab Test Out 0 * Resource
    Encounter with First Hematocrit Lab Test Out 0 * Resource
    Encounter with First Platelet Lab Test Out 0 * Resource
    SDE Race Out 0 1 Resource
    Encounter with First Systolic Blood Pressure Out 0 * Resource
    SDE Sex Out 0 1 Coding
    Encounter with First Creatinine Lab Test Out 0 * Resource
    Encounter with First Body Temperature Out 0 * Resource
    SDE Payer Out 0 * Resource
    Initial Population Out 0 * Resource
    SDE Ethnicity Out 0 1 Resource
    Encounter with First Oxygen Saturation Out 0 * Resource
    Encounter with First Sodium Lab Test Out 0 * Resource
    DataRequirements:
    Resource Type Resource Elements Valueset Name Valueset
    Encounter(QICoreEncounter) type status status.value period id id.value Observation Services Observation Services
    Encounter(QICoreEncounter) type status status.value period id id.value Emergency Department Visit Emergency Department Visit
    Encounter(QICoreEncounter) type period id id.value Outpatient Surgery Service Outpatient Surgery Service
    Encounter(QICoreEncounter) type status status.value period id id.value Encounter Inpatient Encounter Inpatient
    Patient(QICorePatient) race ethnicity
    Coverage(QICoreCoverage) type Medicare FFS payer Medicare payer
    Coverage(QICoreCoverage) type Medicare Advantage payer http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.12
    Coverage(QICoreCoverage) type period Payer Type Payer
    Observation(US Core Laboratory Result Observation Profile) code effective status status.value value issued issued.value Bicarbonate lab test Bicarbonate lab test
    Observation(US Core Laboratory Result Observation Profile) code effective status status.value value issued issued.value White blood cells count lab test White blood cells count lab test
    Observation(US Core Laboratory Result Observation Profile) code effective status status.value value issued issued.value Hematocrit lab test Hematocrit lab test
    Observation(US Core Laboratory Result Observation Profile) code effective status status.value value issued issued.value Platelet count lab test Platelet count lab test
    Observation(US Core Laboratory Result Observation Profile) code effective status status.value value issued issued.value Creatinine lab test Creatinine lab test
    Observation(US Core Laboratory Result Observation Profile) code effective status status.value value issued issued.value Sodium lab test Sodium lab test
    Observation(Observation Heart Rate Profile) effective status status.value value
    Observation(Observation Blood Pressure Profile) effective status status.value component
    Observation(Observation Body Temperature Profile) effective status status.value value
    Observation(QICoreObservation) code effective status status.value value Oxygen Saturation by Pulse Oximetry Oxygen Saturation in Arterial Blood by Pulse Oximetry
    Direct Reference Codes:
    display code system
    Systolic BP 8480-6 http://loinc.org
    Male M http://hl7.org/fhir/administrative-gender
    Female F http://hl7.org/fhir/administrative-gender
    Logic Definitions:
    Group Scoring Population Criteria Expression
    67533db0670f1c0879cef5cb Group scoring: cohort
    Type:

    Outcome

    Rate Aggregation: None
    Improvement Notation:

    decrease

    Initial Population 
    define "Initial Population":
  "Inpatient Encounters"
    Library Name Name
    CMSFHIR844HybridHospitalWideMortality Inpatient Encounters 
    define "Inpatient Encounters":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    with ( [Coverage: "Medicare FFS payer"]
      union [Coverage: "Medicare Advantage payer"] ) MedicarePayer
      such that ( EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService ( ).lengthInDays ( ) ) < 365
        and EncounterInpatient.status = 'finished'
        and AgeInYearsAt(date from start of EncounterInpatient.period) in Interval[65, 94]
        and EncounterInpatient.period ends during day of "Measurement Period"
    Library Name Name
    CMSFHIR844HybridHospitalWideMortality Encounter with First Bicarbonate Lab Test 
    define "Encounter with First Bicarbonate Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstBicarbonateLab: First(["USCoreLaboratoryResultObservationProfile": "Bicarbonate lab test"] BicarbonateLab
        where BicarbonateLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and BicarbonateLab.status in { 'final', 'amended', 'corrected' }
          and BicarbonateLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstBicarbonateResult: FirstBicarbonateLab.value as Quantity,
      Timing: FirstBicarbonateLab.issued
    }
    Library Name Name
    CMSFHIR844HybridHospitalWideMortality Encounter with First Heart Rate 
    define "Encounter with First Heart Rate":
  "Inpatient Encounters" EncounterInpatient
    let FirstHeartRate: First(["observation-heartrate"] HeartRate
        where HeartRate.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and HeartRate.status in { 'final', 'amended', 'corrected' }
          and HeartRate.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstHeartRateResult: FirstHeartRate.value as Quantity,
      Timing: FirstHeartRate.effective.earliest ( )
    }
    Library Name Name
    CMSFHIR844HybridHospitalWideMortality Encounter with First White Blood Cells Lab Test 
    define "Encounter with First White Blood Cells Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstWhiteBloodCellLab: First(["USCoreLaboratoryResultObservationProfile": "White blood cells count lab test"] WhiteBloodCellLab
        where WhiteBloodCellLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and WhiteBloodCellLab.status in { 'final', 'amended', 'corrected' }
          and WhiteBloodCellLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstWhiteBloodCellResult: FirstWhiteBloodCellLab.value as Quantity,
      Timing: FirstWhiteBloodCellLab.issued
    }
    Library Name Name
    CMSFHIR844HybridHospitalWideMortality Encounter with First Hematocrit Lab Test 
    define "Encounter with First Hematocrit Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstHematocritLab: First(["USCoreLaboratoryResultObservationProfile": "Hematocrit lab test"] HematocritLab
        where HematocritLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and HematocritLab.status in { 'final', 'amended', 'corrected' }
          and HematocritLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstHematocritResult: FirstHematocritLab.value as Quantity,
      Timing: FirstHematocritLab.issued
    }
    Library Name Name
    CMSFHIR844HybridHospitalWideMortality Encounter with First Platelet Lab Test 
    define "Encounter with First Platelet Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstPlateletLab: First(["USCoreLaboratoryResultObservationProfile": "Platelet count lab test"] PlateletLab
        where PlateletLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and PlateletLab.status in { 'final', 'amended', 'corrected' }
          and PlateletLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstPlateletResult: FirstPlateletLab.value as Quantity,
      Timing: FirstPlateletLab.issued
    }
    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
    CMSFHIR844HybridHospitalWideMortality SDE Race 
    define "SDE Race":
  SDE."SDE Race"
    Library Name Name
    CMSFHIR844HybridHospitalWideMortality Encounter with First Systolic Blood Pressure 
    define "Encounter with First Systolic Blood Pressure":
  "Inpatient Encounters" EncounterInpatient
    let FirstSystolicBP: First(["observation-bp"] BP
        where BP.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and BP.status in { 'final', 'amended', 'corrected' }
          and BP.component.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstSBPResult: FirstSystolicBP.component C
        where C.code ~ "Systolic blood pressure"
        return C.value as Quantity,
      Timing: FirstSystolicBP.effective.earliest ( )
    }
    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
    CMSFHIR844HybridHospitalWideMortality SDE Sex 
    define "SDE Sex":
  SDE."SDE Sex"
    Library Name Name
    CMSFHIR844HybridHospitalWideMortality Encounter with First Creatinine Lab Test 
    define "Encounter with First Creatinine Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstCreatinineLab: First(["USCoreLaboratoryResultObservationProfile": "Creatinine lab test"] CreatinineLab
        where CreatinineLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and CreatinineLab.status in { 'final', 'amended', 'corrected' }
          and CreatinineLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstCreatinineResult: FirstCreatinineLab.value as Quantity,
      Timing: FirstCreatinineLab.issued
    }
    Library Name Name
    CMSFHIR844HybridHospitalWideMortality Encounter with First Body Temperature 
    define "Encounter with First Body Temperature":
  "Inpatient Encounters" EncounterInpatient
    let FirstTemperature: First(["observation-bodytemp"] temperature
        where temperature.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and temperature.status in { 'final', 'amended', 'corrected' }
          and temperature.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstTemperatureResult: FirstTemperature.value as Quantity,
      Timing: FirstTemperature.effective.earliest ( )
    }
    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
    CMSFHIR844HybridHospitalWideMortality SDE Payer 
    define "SDE Payer":
  SDE."SDE Payer"
    Library Name Name
    CMSFHIR844HybridHospitalWideMortality Initial Population 
    define "Initial Population":
  "Inpatient Encounters"
    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
    CMSFHIR844HybridHospitalWideMortality SDE Ethnicity 
    define "SDE Ethnicity":
  SDE."SDE Ethnicity"
    Library Name Name
    CMSFHIR844HybridHospitalWideMortality Encounter with First Oxygen Saturation 
    define "Encounter with First Oxygen Saturation":
  "Inpatient Encounters" EncounterInpatient
    let FirstOxygenSat: First([Observation: "Oxygen Saturation by Pulse Oximetry"] O2Saturation
        where O2Saturation.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and O2Saturation.status in { 'final', 'amended', 'corrected' }
          and O2Saturation.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstOxygenSatResult: FirstOxygenSat.value as Quantity,
      Timing: FirstOxygenSat.effective.earliest ( )
    }
    Library Name Name
    CMSFHIR844HybridHospitalWideMortality Encounter with First Sodium Lab Test 
    define "Encounter with First Sodium Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstSodiumLab: First(["USCoreLaboratoryResultObservationProfile": "Sodium lab test"] SodiumLab
        where SodiumLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and SodiumLab.status in { 'final', 'amended', 'corrected' }
          and SodiumLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstSodiumResult: FirstSodiumLab.value as Quantity,
      Timing: FirstSodiumLab.issued
    }
    Library Name Name
    CQMCommon lengthInDays 
    /*
@description: Calculates the difference in calendar days between the start and end of the given interval.
*/
define fluent function lengthInDays(Value Interval<DateTime> ):
  difference in days between start of Value and end of Value
    Library Name Name
    CQMCommon hospitalizationWithObservationAndOutpatientSurgeryService 
    /*
@description: Hospitalization with Observation and Outpatient Surgery Service returns the total interval from the start of any immediately prior emergency department visit, outpatient surgery visit or observation visit to the discharge of the given encounter.
*/
define fluent function hospitalizationWithObservationAndOutpatientSurgeryService(TheEncounter "Encounter" ):
  TheEncounter Visit
	  let ObsVisit: Last([Encounter: "Observation Services"] LastObs
		  	where LastObs.status = 'finished'
          and LastObs.period ends 1 hour or less on or before start of Visit.period
			  sort by	end of period
    	),
    	VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
    	EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
			  where LastED.status = 'finished'
          and LastED.period ends 1 hour or less on or before VisitStart
			  sort by	end of period
    	),
    	VisitStartWithED: Coalesce(start of EDVisit.period, VisitStart),
    	OutpatientSurgeryVisit: Last([Encounter: "Outpatient Surgery Service"] LastSurgeryOP
			  where LastSurgeryOP.period ends 1 hour or less on or before VisitStartWithED
			  sort by	end of period
    	)
  	return Interval[Coalesce(start of OutpatientSurgeryVisit.period, VisitStartWithED), end of Visit.period]
    Library Name Name
    QICoreCommon earliest 
    /*
@description: Given an interval, return the starting point if the interval has a starting boundary specified,
otherwise, return the ending point
*/
define fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
  (choice.toInterval()) period
    return
      if (period."hasStart"()) then start of period
      else end of period
    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" : "CMSFHIR844HybridHospitalWideMortality",
      "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;\">Core Clinical Data Elements for the Hybrid Hospital Wide All Condition All Procedure Risk Standardized Mortality Measure HWMFHIR</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Id: </b></th>\n                <td style=\"padding-left: 4px;\">CMSFHIR844HybridHospitalWideMortality</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Version: </b></th>\n                <td style=\"padding-left: 4px;\">0.1.001</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-CMSFHIR844HybridHospitalWideMortality.html\">Core Clinical Data Elements for the Hybrid Hospital Wide All Condition All Procedure Risk Standardized Mortality Measure HWMFHIR</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>CMS844FHIR</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:965255e9-dfeb-42d0-8416-2c4b7ecc5109</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:bdfb568a-0f3f-4885-be0c-7bc971fe8b65</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                Endorser (CMS Consensus Based Entity) Identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>3502</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>844FHIR</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;\">2026-07-01..2027-06-30</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;\">Lantana Consulting Group, Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation</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 logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from hospitalizations for adult Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) patients admitted to acute care hospitals.</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>LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc.</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>The intent of this logic is to extract the FIRST valid set of clinical data elements from hospital electronic health records (EHRs) for all qualifying hospitalizations. The data will be linked with administrative claims to risk adjust the Hybrid HWM outcome measure. This work addresses stakeholder concerns that clinical data garnered from patients and used by clinicians to guide diagnostic decisions and treatment, are preferable to administrative claims data when profiling hospitals’ case mix. We are calling the list of data elements for extraction the &quot;HWM-specific core clinical data elements&quot; (CCDE). The CCDEs are the first set of vital signs and basic laboratory tests resulted from hospitalizations for adult Medicare FFS and MA patients, age 65 through 94 years (Initial Population), after they arrive at the hospital to which they are subsequently admitted. For example, this first set of data values are often captured in the emergency department or in the pre-operative area, sometimes hours before a patient is admitted to that same facility.</p>\n<p>Hospitalizations over the age of 94 years are not included to avoid holding hospitals responsible for the survival of the oldest elderly patients, who may be less likely to have survival as a primary goal. While we acknowledge that many elderly patients do have survival beyond 30 days as a primary goal for their hospitalization, with input from our Technical Expert Panel and work groups, we decided to only include hospitalizations between 65 and 94 years of age.</p>\n<p>These CCDEs were selected because they: 1. reflect patients' clinical status when they first present to the hospital; 2. are clinically and statistically relevant to patient outcomes; 3. are consistently obtained during adult inpatient hospitalizations based on current clinical practice; 4. are captured with a standard definition and recorded in a standard format across providers; and 5. are entered in structured fields that are feasibly retrieved from current EHR systems (YNHHSC/CORE, 2015).</p>\n<p>Additional data called Linking Variables are used to link EHR data files with administrative claims data for CMS to calculate results for the Hybrid HWM measure, which are: CMS Certification Number (CCN); Medicare Beneficiary Identifier (MBI); Inpatient Admission Date; and Discharge Date.</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 logic is not meant to guide or alter the care patients receive. The purpose of this CCDE logic is to extract clinical data that are already routinely captured in EHRs from hospitalizations for adult patients. It is not intended to require that clinical staff perform additional measurements or tests that are not needed for diagnostic assessment or treatment of patients.</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;\">These specifications are for use for data with discharges that occur between July 1, 2026 and June 30, 2027. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2028. \n\nThis logic guides the user to extract the FIRST valid resulted HWM-specific CCDEs for all Medicare FFS and MA hospitalizations for patients aged 65 through 94 years (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area, such as the emergency department or hospital outpatient location.\n\nThe logic supports extraction of the FIRST resulted vital signs and laboratory tests, where the result is not null, during the patient encounter or episode of care. This may include values captured after inpatient admission, as well as prior to inpatient admission, for example from the emergency department, pre-operative, or other outpatient areas associated with the hospital, as long as the values fall within the allowed timeframes specified in the measure logic.  All clinical systems used in inpatient and outpatient locations associated with the hospital facility should be queried for core clinical data element values related to a patient who is subsequently admitted.\n\nPatients who arrive at the hospital on oxygen therapy will be flagged in the logic, and an abnormal value for oxygen therapy will be imputed in the data. Rationale: patients who arrive on oxygen may appear in better condition, that is, having a higher oxygen saturation due to oxygen administration, that is not truly reflective of the patient's status upon arrival.\n\nValue sets for the laboratory tests are represented using Logical Observation Identifiers Names and Codes (LOINC) currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements.\n\nNOTE: It is recommended hospitals only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. Hospitals may also choose to report ALL values on an encounter during their entire admission; however, only the first resulted values are utilized in the logic for measure calculation.\n\nFor each CCDE, it is recommended that hospitals report the below Unified Code for Units of Measure (UCUM) units, however, any unit may be submitted. Where the reported unit is not easily converted to the requested UCUM units, the value will be set to missing and multiple imputation will be used to impute a value based on the characteristics of the CCDE reported.\n\nCCDE                                                    UCUM Unit:\nBicarbonate--------------------------------------meq/L \n                                                                 mmol/L\n\nCreatinine-----------------------------------------mg/dL \n\nHeart rate-----------------------------------------{Beats}/min\n\nHematocrit ---------------------------------------%\n\nOxygen saturation (by pulse oximetry)----%\n\nPlatelet--------------------------------------------10*3/uL\n\nSodium--------------------------------------------meq/L\n                                                                 mmol/L \nSystolic blood pressure-----------------------mm[Hg]\n\nTemperature-------------------------------------Cel\n                                                                [degF]  \n    \nWhite blood cell count -----------------------{Cells}/uL\n                                                                10*3/uL\n                                                                10*9/L \n                                                              \nFor each hospitalization please also submit the following Linking Variables: \nCMS Certification Number (CCN); \nMedicare Beneficiary Identifier (MBI);\nInpatient Admission Date; and\nDischarge Date.\n\n\nThis eCQM is an encounter-based measure. The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. \n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS844v6. \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>67533db0670f1c0879cef5cb</b></th>\n                                    </tr>\n                                \n                                \n                                    <tr>\n                                        <td>Initial Population:</td>\n\n                                        \n                                            \n                                                <td>All Medicare FFS and MA hospitalizations for patients aged 65 through 94 years at the start of an inpatient admission, where the length of stay is less than 365 days, and the hospitalization ends during the measurement period.  \n\nNOTE: All Medicare FFS and MA hospitalizations meeting the above criteria should be included, regardless of whether Medicare FFS/MA is the primary, secondary, or tertiary payer.</td>\n                                            \n                                        \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>Encounter with First Bicarbonate Lab Test</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>Encounter with First Body Temperature</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>Encounter with First Creatinine Lab Test</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>Encounter with First Heart Rate</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>Encounter with First Hematocrit Lab Test</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>Encounter with First Oxygen Saturation</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>Encounter with First Platelet Lab Test</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>Encounter with First Sodium Lab Test</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>Encounter with First White Blood Cells Lab Test</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>Encounter with First Systolic Blood Pressure</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 hospitalizations in the Initial Population, report the FIRST resulted vital signs (physical exams) during current hospitalization. \n\nThe physical exam CCDEs are as follows:\n\nBody Temperature\nHeart rate\nOxygen saturation (by pulse oximetry)\nSystolic blood pressure\n\nFor laboratory test results, report the FIRST resulted laboratory tests where result is not null during current hospitalization.\n\nThe laboratory tests CCDEs are as follows:\n\nBicarbonate (or carbon dioxide, see Bicarbonate Lab Test value set)\nCreatinine \nHematocrit\nPlatelet\nSodium\nWhite blood cell count\n\nFirst values for the CCDEs may be resulted in the emergency department or other hospital outpatient locations within the hospital facility before a patient is subsequently admitted to the same hospital. First values for these data elements may also be resulted in an inpatient location for directly admitted patients who do not receive care in the emergency department or other hospital outpatient/same day surgery locations before admission.\n\n\n\nNOTE: Hospitals may choose to submit all, or only report the FIRST resulted value for EACH CCDE collected in the appropriate timeframe, if available.\n\nFor every patient in the Initial Population, 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-CMSFHIR844HybridHospitalWideMortality.html\">CMSFHIR844HybridHospitalWideMortality</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/CQMCommon|2.2.000</code></li>\n                        \n                            <li><code>Library/FHIRHelpers|4.4.000</code></li>\n                        \n                            <li><code>Library/QICoreCommon|2.1.000</code></li>\n                        \n                            <li><code>Library/SupplementalDataElements|3.5.000</code></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html\">Logical Observation Identifiers, Names and Codes (LOINC)</a></li>\n                        \n                            <li><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">AdministrativeGender</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/2.16.840.1.113762.1.4.1104.10/expansion\">Medicare payer</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1104.12/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.12</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion\">Observation Services</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion\">Emergency Department Visit</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.38/expansion\">Outpatient Surgery Service</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.139/expansion\">Bicarbonate lab test</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.129/expansion\">White blood cells count lab test</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.114/expansion\">Hematocrit lab test</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.127/expansion\">Platelet count lab test</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.2363/expansion\">Creatinine lab test</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                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.151/expansion\">Oxygen Saturation in Arterial Blood by Pulse Oximetry</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.119/expansion\">Sodium lab test</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>Encounter with First Bicarbonate Lab Test</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter with First Heart Rate</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter with First White Blood Cells Lab Test</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter with First Hematocrit Lab Test</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter with First Platelet Lab Test</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</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                                <tr>\n                                    <td>Encounter with First Systolic Blood Pressure</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</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>Encounter with First Creatinine Lab Test</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter with First Body Temperature</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>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>Encounter with First Oxygen Saturation</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter with First Sodium Lab Test</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</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>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                                            id\n                                        \n                                            id.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Observation Services\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion\">Observation Services</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            period\n                                        \n                                            id\n                                        \n                                            id.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Emergency Department Visit\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/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                                            period\n                                        \n                                            id\n                                        \n                                            id.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Outpatient Surgery Service\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.38/expansion\">Outpatient Surgery Service</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                                            id\n                                        \n                                            id.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>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n                                    <td>\n                                        \n                                            race\n                                        \n                                            ethnicity\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                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Medicare FFS payer\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1104.10/expansion\">Medicare payer</a></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                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Medicare Advantage payer\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1104.12/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.12</a></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                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html\">US Core Laboratory Result Observation Profile</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            value\n                                        \n                                            issued\n                                        \n                                            issued.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Bicarbonate lab test\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.139/expansion\">Bicarbonate lab test</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html\">US Core Laboratory Result Observation Profile</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            value\n                                        \n                                            issued\n                                        \n                                            issued.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 White blood cells count lab test\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.129/expansion\">White blood cells count lab test</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html\">US Core Laboratory Result Observation Profile</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            value\n                                        \n                                            issued\n                                        \n                                            issued.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Hematocrit lab test\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.114/expansion\">Hematocrit lab test</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html\">US Core Laboratory Result Observation Profile</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            value\n                                        \n                                            issued\n                                        \n                                            issued.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Platelet count lab test\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.127/expansion\">Platelet count lab test</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html\">US Core Laboratory Result Observation Profile</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            value\n                                        \n                                            issued\n                                        \n                                            issued.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Creatinine lab test\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.2363/expansion\">Creatinine lab test</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/core/STU3.1.1/StructureDefinition-us-core-observation-lab.html\">US Core Laboratory Result Observation Profile</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            value\n                                        \n                                            issued\n                                        \n                                            issued.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Sodium lab test\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.119/expansion\">Sodium lab test</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/R4/heartrate.html\">Observation Heart Rate Profile</a>)</td>\n                                    <td>\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/R4/bp.html\">Observation Blood Pressure Profile</a>)</td>\n                                    <td>\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            component\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/R4/bodytemp.html\">Observation Body Temperature Profile</a>)</td>\n                                    <td>\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Oxygen Saturation by Pulse Oximetry\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1045.151/expansion\">Oxygen Saturation in Arterial Blood by Pulse Oximetry</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>Systolic BP</td>\n                                        <td>8480-6</td>\n                                        <td><a href=\"https://loinc.org/\">http://loinc.org</a></td>\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                            </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> 67533db0670f1c0879cef5cb </td>\n                                <td colspan=\"3\" style=\"padding-left: 4px;\">\n                                    \n                                        <b>Group scoring:</b>\n                                        \n                                            <span>  cohort </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>decrease </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;Inpatient Encounters&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                \n                            \n                            </tr>\n                        </table>\n                \n\n                <table class=\"grid-dict\">\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CMSFHIR844HybridHospitalWideMortality</td>\n                            \n                            \n                                <td>Inpatient Encounters</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Inpatient Encounters&quot;:\n  [Encounter: &quot;Encounter Inpatient&quot;] EncounterInpatient\n    with ( [Coverage: &quot;Medicare FFS payer&quot;]\n      union [Coverage: &quot;Medicare Advantage payer&quot;] ) MedicarePayer\n      such that ( EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService ( ).lengthInDays ( ) ) &lt; 365\n        and EncounterInpatient.status = 'finished'\n        and AgeInYearsAt(date from start of EncounterInpatient.period) in Interval[65, 94]\n        and 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>CMSFHIR844HybridHospitalWideMortality</td>\n                            \n                            \n                                <td>Encounter with First Bicarbonate Lab Test</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Encounter with First Bicarbonate Lab Test&quot;:\n  &quot;Inpatient Encounters&quot; EncounterInpatient\n    let FirstBicarbonateLab: First([&quot;USCoreLaboratoryResultObservationProfile&quot;: &quot;Bicarbonate lab test&quot;] BicarbonateLab\n        where BicarbonateLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and BicarbonateLab.status in { 'final', 'amended', 'corrected' }\n          and BicarbonateLab.value is not null\n        sort by issued.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstBicarbonateResult: FirstBicarbonateLab.value as Quantity,\n      Timing: FirstBicarbonateLab.issued\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>CMSFHIR844HybridHospitalWideMortality</td>\n                            \n                            \n                                <td>Encounter with First Heart Rate</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Encounter with First Heart Rate&quot;:\n  &quot;Inpatient Encounters&quot; EncounterInpatient\n    let FirstHeartRate: First([&quot;observation-heartrate&quot;] HeartRate\n        where HeartRate.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and HeartRate.status in { 'final', 'amended', 'corrected' }\n          and HeartRate.value is not null\n        sort by effective.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstHeartRateResult: FirstHeartRate.value as Quantity,\n      Timing: FirstHeartRate.effective.earliest ( )\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>CMSFHIR844HybridHospitalWideMortality</td>\n                            \n                            \n                                <td>Encounter with First White Blood Cells Lab Test</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Encounter with First White Blood Cells Lab Test&quot;:\n  &quot;Inpatient Encounters&quot; EncounterInpatient\n    let FirstWhiteBloodCellLab: First([&quot;USCoreLaboratoryResultObservationProfile&quot;: &quot;White blood cells count lab test&quot;] WhiteBloodCellLab\n        where WhiteBloodCellLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and WhiteBloodCellLab.status in { 'final', 'amended', 'corrected' }\n          and WhiteBloodCellLab.value is not null\n        sort by issued.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstWhiteBloodCellResult: FirstWhiteBloodCellLab.value as Quantity,\n      Timing: FirstWhiteBloodCellLab.issued\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>CMSFHIR844HybridHospitalWideMortality</td>\n                            \n                            \n                                <td>Encounter with First Hematocrit Lab Test</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Encounter with First Hematocrit Lab Test&quot;:\n  &quot;Inpatient Encounters&quot; EncounterInpatient\n    let FirstHematocritLab: First([&quot;USCoreLaboratoryResultObservationProfile&quot;: &quot;Hematocrit lab test&quot;] HematocritLab\n        where HematocritLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and HematocritLab.status in { 'final', 'amended', 'corrected' }\n          and HematocritLab.value is not null\n        sort by issued.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstHematocritResult: FirstHematocritLab.value as Quantity,\n      Timing: FirstHematocritLab.issued\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>CMSFHIR844HybridHospitalWideMortality</td>\n                            \n                            \n                                <td>Encounter with First Platelet Lab Test</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Encounter with First Platelet Lab Test&quot;:\n  &quot;Inpatient Encounters&quot; EncounterInpatient\n    let FirstPlateletLab: First([&quot;USCoreLaboratoryResultObservationProfile&quot;: &quot;Platelet count lab test&quot;] PlateletLab\n        where PlateletLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and PlateletLab.status in { 'final', 'amended', 'corrected' }\n          and PlateletLab.value is not null\n        sort by issued.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstPlateletResult: FirstPlateletLab.value as Quantity,\n      Timing: FirstPlateletLab.issued\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 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>CMSFHIR844HybridHospitalWideMortality</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>CMSFHIR844HybridHospitalWideMortality</td>\n                            \n                            \n                                <td>Encounter with First Systolic Blood Pressure</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Encounter with First Systolic Blood Pressure&quot;:\n  &quot;Inpatient Encounters&quot; EncounterInpatient\n    let FirstSystolicBP: First([&quot;observation-bp&quot;] BP\n        where BP.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and BP.status in { 'final', 'amended', 'corrected' }\n          and BP.component.value is not null\n        sort by effective.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstSBPResult: FirstSystolicBP.component C\n        where C.code ~ &quot;Systolic blood pressure&quot;\n        return C.value as Quantity,\n      Timing: FirstSystolicBP.effective.earliest ( )\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 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>CMSFHIR844HybridHospitalWideMortality</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>CMSFHIR844HybridHospitalWideMortality</td>\n                            \n                            \n                                <td>Encounter with First Creatinine Lab Test</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Encounter with First Creatinine Lab Test&quot;:\n  &quot;Inpatient Encounters&quot; EncounterInpatient\n    let FirstCreatinineLab: First([&quot;USCoreLaboratoryResultObservationProfile&quot;: &quot;Creatinine lab test&quot;] CreatinineLab\n        where CreatinineLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and CreatinineLab.status in { 'final', 'amended', 'corrected' }\n          and CreatinineLab.value is not null\n        sort by issued.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstCreatinineResult: FirstCreatinineLab.value as Quantity,\n      Timing: FirstCreatinineLab.issued\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>CMSFHIR844HybridHospitalWideMortality</td>\n                            \n                            \n                                <td>Encounter with First Body Temperature</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Encounter with First Body Temperature&quot;:\n  &quot;Inpatient Encounters&quot; EncounterInpatient\n    let FirstTemperature: First([&quot;observation-bodytemp&quot;] temperature\n        where temperature.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and temperature.status in { 'final', 'amended', 'corrected' }\n          and temperature.value is not null\n        sort by effective.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstTemperatureResult: FirstTemperature.value as Quantity,\n      Timing: FirstTemperature.effective.earliest ( )\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>CMSFHIR844HybridHospitalWideMortality</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>CMSFHIR844HybridHospitalWideMortality</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;Inpatient Encounters&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 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>CMSFHIR844HybridHospitalWideMortality</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>CMSFHIR844HybridHospitalWideMortality</td>\n                            \n                            \n                                <td>Encounter with First Oxygen Saturation</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Encounter with First Oxygen Saturation&quot;:\n  &quot;Inpatient Encounters&quot; EncounterInpatient\n    let FirstOxygenSat: First([Observation: &quot;Oxygen Saturation by Pulse Oximetry&quot;] O2Saturation\n        where O2Saturation.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and O2Saturation.status in { 'final', 'amended', 'corrected' }\n          and O2Saturation.value is not null\n        sort by effective.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstOxygenSatResult: FirstOxygenSat.value as Quantity,\n      Timing: FirstOxygenSat.effective.earliest ( )\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>CMSFHIR844HybridHospitalWideMortality</td>\n                            \n                            \n                                <td>Encounter with First Sodium Lab Test</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Encounter with First Sodium Lab Test&quot;:\n  &quot;Inpatient Encounters&quot; EncounterInpatient\n    let FirstSodiumLab: First([&quot;USCoreLaboratoryResultObservationProfile&quot;: &quot;Sodium lab test&quot;] SodiumLab\n        where SodiumLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and SodiumLab.status in { 'final', 'amended', 'corrected' }\n          and SodiumLab.value is not null\n        sort by issued.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstSodiumResult: FirstSodiumLab.value as Quantity,\n      Timing: FirstSodiumLab.issued\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>lengthInDays</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Calculates the difference in calendar days between the start and end of the given interval.\n*/\ndefine fluent function lengthInDays(Value Interval&lt;DateTime&gt; ):\n  difference in days between start of Value and end of 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>CQMCommon</td>\n                            \n                            \n                                <td>hospitalizationWithObservationAndOutpatientSurgeryService</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Hospitalization with Observation and Outpatient Surgery Service returns the total interval from the start of any immediately prior emergency department visit, outpatient surgery visit or observation visit to the discharge of the given encounter.\n*/\ndefine fluent function hospitalizationWithObservationAndOutpatientSurgeryService(TheEncounter &quot;Encounter&quot; ):\n  TheEncounter Visit\n\t  let ObsVisit: Last([Encounter: &quot;Observation Services&quot;] LastObs\n\t\t  \twhere LastObs.status = 'finished'\n          and LastObs.period ends 1 hour or less on or before start of Visit.period\n\t\t\t  sort by\tend of period\n    \t),\n    \tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n    \tEDVisit: Last([Encounter: &quot;Emergency Department Visit&quot;] LastED\n\t\t\t  where LastED.status = 'finished'\n          and LastED.period ends 1 hour or less on or before VisitStart\n\t\t\t  sort by\tend of period\n    \t),\n    \tVisitStartWithED: Coalesce(start of EDVisit.period, VisitStart),\n    \tOutpatientSurgeryVisit: Last([Encounter: &quot;Outpatient Surgery Service&quot;] LastSurgeryOP\n\t\t\t  where LastSurgeryOP.period ends 1 hour or less on or before VisitStartWithED\n\t\t\t  sort by\tend of period\n    \t)\n  \treturn Interval[Coalesce(start of OutpatientSurgeryVisit.period, VisitStartWithED), end of Visit.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>QICoreCommon</td>\n                            \n                            \n                                <td>earliest</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Given an interval, return the starting point if the interval has a starting boundary specified,\notherwise, return the ending point\n*/\ndefine fluent function earliest(choice Choice&lt;DateTime, Quantity, Interval&lt;DateTime&gt;, Interval&lt;Quantity&gt;&gt; ):\n  (choice.toInterval()) period\n    return\n      if (period.&quot;hasStart&quot;()) then start of period\n      else end of 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>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://loinc.org",
                "code" : "8480-6",
                "display" : "Systolic BP"
              }
            },
            {
              "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"
              }
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMSFHIR844HybridHospitalWideMortality"
                },
                {
                  "url" : "name",
                  "valueString" : "Inpatient Encounters"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Inpatient Encounters\":\n  [Encounter: \"Encounter Inpatient\"] EncounterInpatient\n    with ( [Coverage: \"Medicare FFS payer\"]\n      union [Coverage: \"Medicare Advantage payer\"] ) MedicarePayer\n      such that ( EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService ( ).lengthInDays ( ) ) < 365\n        and EncounterInpatient.status = 'finished'\n        and AgeInYearsAt(date from start of EncounterInpatient.period) in Interval[65, 94]\n        and EncounterInpatient.period ends during day of \"Measurement Period\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 0
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMSFHIR844HybridHospitalWideMortality"
                },
                {
                  "url" : "name",
                  "valueString" : "Encounter with First Bicarbonate Lab Test"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Encounter with First Bicarbonate Lab Test\":\n  \"Inpatient Encounters\" EncounterInpatient\n    let FirstBicarbonateLab: First([\"USCoreLaboratoryResultObservationProfile\": \"Bicarbonate lab test\"] BicarbonateLab\n        where BicarbonateLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and BicarbonateLab.status in { 'final', 'amended', 'corrected' }\n          and BicarbonateLab.value is not null\n        sort by issued.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstBicarbonateResult: FirstBicarbonateLab.value as Quantity,\n      Timing: FirstBicarbonateLab.issued\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 1
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMSFHIR844HybridHospitalWideMortality"
                },
                {
                  "url" : "name",
                  "valueString" : "Encounter with First Heart Rate"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Encounter with First Heart Rate\":\n  \"Inpatient Encounters\" EncounterInpatient\n    let FirstHeartRate: First([\"observation-heartrate\"] HeartRate\n        where HeartRate.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and HeartRate.status in { 'final', 'amended', 'corrected' }\n          and HeartRate.value is not null\n        sort by effective.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstHeartRateResult: FirstHeartRate.value as Quantity,\n      Timing: FirstHeartRate.effective.earliest ( )\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 2
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMSFHIR844HybridHospitalWideMortality"
                },
                {
                  "url" : "name",
                  "valueString" : "Encounter with First White Blood Cells Lab Test"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Encounter with First White Blood Cells Lab Test\":\n  \"Inpatient Encounters\" EncounterInpatient\n    let FirstWhiteBloodCellLab: First([\"USCoreLaboratoryResultObservationProfile\": \"White blood cells count lab test\"] WhiteBloodCellLab\n        where WhiteBloodCellLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and WhiteBloodCellLab.status in { 'final', 'amended', 'corrected' }\n          and WhiteBloodCellLab.value is not null\n        sort by issued.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstWhiteBloodCellResult: FirstWhiteBloodCellLab.value as Quantity,\n      Timing: FirstWhiteBloodCellLab.issued\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 3
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMSFHIR844HybridHospitalWideMortality"
                },
                {
                  "url" : "name",
                  "valueString" : "Encounter with First Hematocrit Lab Test"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Encounter with First Hematocrit Lab Test\":\n  \"Inpatient Encounters\" EncounterInpatient\n    let FirstHematocritLab: First([\"USCoreLaboratoryResultObservationProfile\": \"Hematocrit lab test\"] HematocritLab\n        where HematocritLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and HematocritLab.status in { 'final', 'amended', 'corrected' }\n          and HematocritLab.value is not null\n        sort by issued.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstHematocritResult: FirstHematocritLab.value as Quantity,\n      Timing: FirstHematocritLab.issued\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 4
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMSFHIR844HybridHospitalWideMortality"
                },
                {
                  "url" : "name",
                  "valueString" : "Encounter with First Platelet Lab Test"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Encounter with First Platelet Lab Test\":\n  \"Inpatient Encounters\" EncounterInpatient\n    let FirstPlateletLab: First([\"USCoreLaboratoryResultObservationProfile\": \"Platelet count lab test\"] PlateletLab\n        where PlateletLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and PlateletLab.status in { 'final', 'amended', 'corrected' }\n          and PlateletLab.value is not null\n        sort by issued.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstPlateletResult: FirstPlateletLab.value as Quantity,\n      Timing: FirstPlateletLab.issued\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 5
                }
              ],
              "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" : 6
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMSFHIR844HybridHospitalWideMortality"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Race"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Race\":\n  SDE.\"SDE Race\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 7
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMSFHIR844HybridHospitalWideMortality"
                },
                {
                  "url" : "name",
                  "valueString" : "Encounter with First Systolic Blood Pressure"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Encounter with First Systolic Blood Pressure\":\n  \"Inpatient Encounters\" EncounterInpatient\n    let FirstSystolicBP: First([\"observation-bp\"] BP\n        where BP.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and BP.status in { 'final', 'amended', 'corrected' }\n          and BP.component.value is not null\n        sort by effective.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstSBPResult: FirstSystolicBP.component C\n        where C.code ~ \"Systolic blood pressure\"\n        return C.value as Quantity,\n      Timing: FirstSystolicBP.effective.earliest ( )\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 8
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "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" : 9
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMSFHIR844HybridHospitalWideMortality"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Sex"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 10
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMSFHIR844HybridHospitalWideMortality"
                },
                {
                  "url" : "name",
                  "valueString" : "Encounter with First Creatinine Lab Test"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Encounter with First Creatinine Lab Test\":\n  \"Inpatient Encounters\" EncounterInpatient\n    let FirstCreatinineLab: First([\"USCoreLaboratoryResultObservationProfile\": \"Creatinine lab test\"] CreatinineLab\n        where CreatinineLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and CreatinineLab.status in { 'final', 'amended', 'corrected' }\n          and CreatinineLab.value is not null\n        sort by issued.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstCreatinineResult: FirstCreatinineLab.value as Quantity,\n      Timing: FirstCreatinineLab.issued\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 11
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMSFHIR844HybridHospitalWideMortality"
                },
                {
                  "url" : "name",
                  "valueString" : "Encounter with First Body Temperature"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Encounter with First Body Temperature\":\n  \"Inpatient Encounters\" EncounterInpatient\n    let FirstTemperature: First([\"observation-bodytemp\"] temperature\n        where temperature.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and temperature.status in { 'final', 'amended', 'corrected' }\n          and temperature.value is not null\n        sort by effective.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstTemperatureResult: FirstTemperature.value as Quantity,\n      Timing: FirstTemperature.effective.earliest ( )\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 12
                }
              ],
              "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" : 13
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMSFHIR844HybridHospitalWideMortality"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Payer"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 14
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMSFHIR844HybridHospitalWideMortality"
                },
                {
                  "url" : "name",
                  "valueString" : "Initial Population"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Initial Population\":\n  \"Inpatient Encounters\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 15
                }
              ],
              "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" : 16
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMSFHIR844HybridHospitalWideMortality"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Ethnicity"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 17
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMSFHIR844HybridHospitalWideMortality"
                },
                {
                  "url" : "name",
                  "valueString" : "Encounter with First Oxygen Saturation"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Encounter with First Oxygen Saturation\":\n  \"Inpatient Encounters\" EncounterInpatient\n    let FirstOxygenSat: First([Observation: \"Oxygen Saturation by Pulse Oximetry\"] O2Saturation\n        where O2Saturation.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and O2Saturation.status in { 'final', 'amended', 'corrected' }\n          and O2Saturation.value is not null\n        sort by effective.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstOxygenSatResult: FirstOxygenSat.value as Quantity,\n      Timing: FirstOxygenSat.effective.earliest ( )\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 18
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CMSFHIR844HybridHospitalWideMortality"
                },
                {
                  "url" : "name",
                  "valueString" : "Encounter with First Sodium Lab Test"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Encounter with First Sodium Lab Test\":\n  \"Inpatient Encounters\" EncounterInpatient\n    let FirstSodiumLab: First([\"USCoreLaboratoryResultObservationProfile\": \"Sodium lab test\"] SodiumLab\n        where SodiumLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()\n          and SodiumLab.status in { 'final', 'amended', 'corrected' }\n          and SodiumLab.value is not null\n        sort by issued.earliest()\n    )\n    return {\n      EncounterId: EncounterInpatient.id,\n      FirstSodiumResult: FirstSodiumLab.value as Quantity,\n      Timing: FirstSodiumLab.issued\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 19
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CQMCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "lengthInDays"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Calculates the difference in calendar days between the start and end of the given interval.\n*/\ndefine fluent function lengthInDays(Value Interval<DateTime> ):\n  difference in days between start of Value and end of Value"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 20
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CQMCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "hospitalizationWithObservationAndOutpatientSurgeryService"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Hospitalization with Observation and Outpatient Surgery Service returns the total interval from the start of any immediately prior emergency department visit, outpatient surgery visit or observation visit to the discharge of the given encounter.\n*/\ndefine fluent function hospitalizationWithObservationAndOutpatientSurgeryService(TheEncounter \"Encounter\" ):\n  TheEncounter Visit\n\t  let ObsVisit: Last([Encounter: \"Observation Services\"] LastObs\n\t\t  \twhere LastObs.status = 'finished'\n          and LastObs.period ends 1 hour or less on or before start of Visit.period\n\t\t\t  sort by\tend of period\n    \t),\n    \tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n    \tEDVisit: Last([Encounter: \"Emergency Department Visit\"] LastED\n\t\t\t  where LastED.status = 'finished'\n          and LastED.period ends 1 hour or less on or before VisitStart\n\t\t\t  sort by\tend of period\n    \t),\n    \tVisitStartWithED: Coalesce(start of EDVisit.period, VisitStart),\n    \tOutpatientSurgeryVisit: Last([Encounter: \"Outpatient Surgery Service\"] LastSurgeryOP\n\t\t\t  where LastSurgeryOP.period ends 1 hour or less on or before VisitStartWithED\n\t\t\t  sort by\tend of period\n    \t)\n  \treturn Interval[Coalesce(start of OutpatientSurgeryVisit.period, VisitStartWithED), end of Visit.period]"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 21
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "earliest"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Given an interval, return the starting point if the interval has a starting boundary specified,\notherwise, return the ending point\n*/\ndefine fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):\n  (choice.toInterval()) period\n    return\n      if (period.\"hasStart\"()) then start of period\n      else end of period"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 22
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToString"
                },
                {
                  "url" : "statement",
                  "valueString" : "define function ToString(value uri): value.value"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 23
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToCode"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\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        }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 24
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            }
          ],
          "name" : "EffectiveDataRequirements",
          "status" : "active",
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/library-type",
                "code" : "module-definition"
              }
            ]
          },
          "relatedArtifact" : [
            {
              "type" : "depends-on",
              "display" : "Library CQMCommon",
              "resource" : "Library/CQMCommon|2.2.000"
            },
            {
              "type" : "depends-on",
              "display" : "Library FHIRHelpers",
              "resource" : "Library/FHIRHelpers|4.4.000"
            },
            {
              "type" : "depends-on",
              "display" : "Library QICoreCommon",
              "resource" : "Library/QICoreCommon|2.1.000"
            },
            {
              "type" : "depends-on",
              "display" : "Library SDE",
              "resource" : "Library/SupplementalDataElements|3.5.000"
            },
            {
              "type" : "depends-on",
              "display" : "Code system LOINC",
              "resource" : "http://loinc.org"
            },
            {
              "type" : "depends-on",
              "display" : "Code system AdministrativeGender",
              "resource" : "http://hl7.org/fhir/administrative-gender"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Encounter Inpatient",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Medicare FFS payer",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.10"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Medicare Advantage payer",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.12"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Observation Services",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Emergency Department Visit",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Outpatient Surgery Service",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.38"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Bicarbonate lab test",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.139"
            },
            {
              "type" : "depends-on",
              "display" : "Value set White blood cells count lab test",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.129"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Hematocrit lab test",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.114"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Platelet count lab test",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.127"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Creatinine lab test",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.2363"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Payer Type",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Oxygen Saturation by Pulse Oximetry",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.151"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Sodium lab test",
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            {
              "system" : "url",
              "value" : "https://www.cms.gov/"
            }
          ]
        }
      ],
      "description" : "This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from hospitalizations for adult Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) patients admitted to acute care hospitals.",
      "purpose" : "UNKNOWN",
      "usage" : "These specifications are for use for data with discharges that occur between July 1, 2026 and June 30, 2027. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2028. \n\nThis logic guides the user to extract the FIRST valid resulted HWM-specific CCDEs for all Medicare FFS and MA hospitalizations for patients aged 65 through 94 years (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area, such as the emergency department or hospital outpatient location.\n\nThe logic supports extraction of the FIRST resulted vital signs and laboratory tests, where the result is not null, during the patient encounter or episode of care. This may include values captured after inpatient admission, as well as prior to inpatient admission, for example from the emergency department, pre-operative, or other outpatient areas associated with the hospital, as long as the values fall within the allowed timeframes specified in the measure logic.  All clinical systems used in inpatient and outpatient locations associated with the hospital facility should be queried for core clinical data element values related to a patient who is subsequently admitted.\n\nPatients who arrive at the hospital on oxygen therapy will be flagged in the logic, and an abnormal value for oxygen therapy will be imputed in the data. Rationale: patients who arrive on oxygen may appear in better condition, that is, having a higher oxygen saturation due to oxygen administration, that is not truly reflective of the patient's status upon arrival.\n\nValue sets for the laboratory tests are represented using Logical Observation Identifiers Names and Codes (LOINC) currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements.\n\nNOTE: It is recommended hospitals only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. Hospitals may also choose to report ALL values on an encounter during their entire admission; however, only the first resulted values are utilized in the logic for measure calculation.\n\nFor each CCDE, it is recommended that hospitals report the below Unified Code for Units of Measure (UCUM) units, however, any unit may be submitted. Where the reported unit is not easily converted to the requested UCUM units, the value will be set to missing and multiple imputation will be used to impute a value based on the characteristics of the CCDE reported.\n\nCCDE                                                    UCUM Unit:\nBicarbonate--------------------------------------meq/L \n                                                                 mmol/L\n\nCreatinine-----------------------------------------mg/dL \n\nHeart rate-----------------------------------------{Beats}/min\n\nHematocrit ---------------------------------------%\n\nOxygen saturation (by pulse oximetry)----%\n\nPlatelet--------------------------------------------10*3/uL\n\nSodium--------------------------------------------meq/L\n                                                                 mmol/L \nSystolic blood pressure-----------------------mm[Hg]\n\nTemperature-------------------------------------Cel\n                                                                [degF]  \n    \nWhite blood cell count -----------------------{Cells}/uL\n                                                                10*3/uL\n                                                                10*9/L \n                                                              \nFor each hospitalization please also submit the following Linking Variables: \nCMS Certification Number (CCN); \nMedicare Beneficiary Identifier (MBI);\nInpatient Admission Date; and\nDischarge Date.\n\n\nThis eCQM is an encounter-based measure. The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. \n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS844v6. \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\nLOINC(R) copyright 2004-2024 Regenstrief Institute, Inc.",
      "effectivePeriod" : {
        "start" : "2026-07-01",
        "end" : "2027-06-30"
      },
      "author" : [
        {
          "name" : "Lantana Consulting Group",
          "telecom" : [
            {
              "system" : "url",
              "value" : "https://www.lantanagroup.com/"
            }
          ]
        },
        {
          "name" : "Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation",
          "telecom" : [
            {
              "system" : "url",
              "value" : "https://medicine.yale.edu/core/"
            }
          ]
        }
      ],
      "library" : [
        "https://madie.cms.gov/Library/CMSFHIR844HybridHospitalWideMortality"
      ],
      "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" : "The intent of this logic is to extract the FIRST valid set of clinical data elements from hospital electronic health records (EHRs) for all qualifying hospitalizations. The data will be linked with administrative claims to risk adjust the Hybrid HWM outcome measure. This work addresses stakeholder concerns that clinical data garnered from patients and used by clinicians to guide diagnostic decisions and treatment, are preferable to administrative claims data when profiling hospitals’ case mix. We are calling the list of data elements for extraction the \"HWM-specific core clinical data elements\" (CCDE). The CCDEs are the first set of vital signs and basic laboratory tests resulted from hospitalizations for adult Medicare FFS and MA patients, age 65 through 94 years (Initial Population), after they arrive at the hospital to which they are subsequently admitted. For example, this first set of data values are often captured in the emergency department or in the pre-operative area, sometimes hours before a patient is admitted to that same facility. \n\nHospitalizations over the age of 94 years are not included to avoid holding hospitals responsible for the survival of the oldest elderly patients, who may be less likely to have survival as a primary goal. While we acknowledge that many elderly patients do have survival beyond 30 days as a primary goal for their hospitalization, with input from our Technical Expert Panel and work groups, we decided to only include hospitalizations between 65 and 94 years of age.\n\nThese CCDEs were selected because they: 1. reflect patients' clinical status when they first present to the hospital; 2. are clinically and statistically relevant to patient outcomes; 3. are consistently obtained during adult inpatient hospitalizations based on current clinical practice; 4. are captured with a standard definition and recorded in a standard format across providers; and 5. are entered in structured fields that are feasibly retrieved from current EHR systems (YNHHSC/CORE, 2015). \n\nAdditional data called Linking Variables are used to link EHR data files with administrative claims data for CMS to calculate results for the Hybrid HWM measure, which are: CMS Certification Number (CCN); Medicare Beneficiary Identifier (MBI); Inpatient Admission Date; and Discharge Date.",
      "clinicalRecommendationStatement" : "The logic is not meant to guide or alter the care patients receive. The purpose of this CCDE logic is to extract clinical data that are already routinely captured in EHRs from hospitalizations for adult patients. It is not intended to require that clinical staff perform additional measurements or tests that are not needed for diagnostic assessment or treatment of patients.",
      "guidance" : "These specifications are for use for data with discharges that occur between July 1, 2026 and June 30, 2027. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2028. \n\nThis logic guides the user to extract the FIRST valid resulted HWM-specific CCDEs for all Medicare FFS and MA hospitalizations for patients aged 65 through 94 years (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area, such as the emergency department or hospital outpatient location.\n\nThe logic supports extraction of the FIRST resulted vital signs and laboratory tests, where the result is not null, during the patient encounter or episode of care. This may include values captured after inpatient admission, as well as prior to inpatient admission, for example from the emergency department, pre-operative, or other outpatient areas associated with the hospital, as long as the values fall within the allowed timeframes specified in the measure logic.  All clinical systems used in inpatient and outpatient locations associated with the hospital facility should be queried for core clinical data element values related to a patient who is subsequently admitted.\n\nPatients who arrive at the hospital on oxygen therapy will be flagged in the logic, and an abnormal value for oxygen therapy will be imputed in the data. Rationale: patients who arrive on oxygen may appear in better condition, that is, having a higher oxygen saturation due to oxygen administration, that is not truly reflective of the patient's status upon arrival.\n\nValue sets for the laboratory tests are represented using Logical Observation Identifiers Names and Codes (LOINC) currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements.\n\nNOTE: It is recommended hospitals only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. Hospitals may also choose to report ALL values on an encounter during their entire admission; however, only the first resulted values are utilized in the logic for measure calculation.\n\nFor each CCDE, it is recommended that hospitals report the below Unified Code for Units of Measure (UCUM) units, however, any unit may be submitted. Where the reported unit is not easily converted to the requested UCUM units, the value will be set to missing and multiple imputation will be used to impute a value based on the characteristics of the CCDE reported.\n\nCCDE                                                    UCUM Unit:\nBicarbonate--------------------------------------meq/L \n                                                                 mmol/L\n\nCreatinine-----------------------------------------mg/dL \n\nHeart rate-----------------------------------------{Beats}/min\n\nHematocrit ---------------------------------------%\n\nOxygen saturation (by pulse oximetry)----%\n\nPlatelet--------------------------------------------10*3/uL\n\nSodium--------------------------------------------meq/L\n                                                                 mmol/L \nSystolic blood pressure-----------------------mm[Hg]\n\nTemperature-------------------------------------Cel\n                                                                [degF]  \n    \nWhite blood cell count -----------------------{Cells}/uL\n                                                                10*3/uL\n                                                                10*9/L \n                                                              \nFor each hospitalization please also submit the following Linking Variables: \nCMS Certification Number (CCN); \nMedicare Beneficiary Identifier (MBI);\nInpatient Admission Date; and\nDischarge Date.\n\n\nThis eCQM is an encounter-based measure. The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. \n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS844v6. \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" : "67533db0670f1c0879cef5cb",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
                    "code" : "cohort",
                    "display" : "Cohort"
                  }
                ]
              }
            },
            {
              "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" : "decrease"
                  }
                ]
              }
            }
          ],
          "description" : "This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from hospitalizations for adult Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) patients admitted to acute care hospitals.",
          "population" : [
            {
              "id" : "24BB5BA9-820F-4958-B8AA-AA8962E9E398",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "initial-population",
                    "display" : "Initial Population"
                  }
                ]
              },
              "description" : "All Medicare FFS and MA hospitalizations for patients aged 65 through 94 years at the start of an inpatient admission, where the length of stay is less than 365 days, and the hospitalization ends during the measurement period.  \n\nNOTE: All Medicare FFS and MA hospitalizations meeting the above criteria should be included, regardless of whether Medicare FFS/MA is the primary, secondary, or tertiary payer.",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Initial Population"
              }
            }
          ]
        }
      ],
      "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" : "encounter-with-first-bicarbonate-lab-test",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "Encounter with First Bicarbonate Lab Test",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Encounter with First Bicarbonate Lab Test"
          }
        },
        {
          "id" : "encounter-with-first-body-temperature",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "Encounter with First Body Temperature",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Encounter with First Body Temperature"
          }
        },
        {
          "id" : "encounter-with-first-creatinine-lab-test",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "Encounter with First Creatinine Lab Test",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Encounter with First Creatinine Lab Test"
          }
        },
        {
          "id" : "encounter-with-first-heart-rate",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "Encounter with First Heart Rate",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Encounter with First Heart Rate"
          }
        },
        {
          "id" : "encounter-with-first-hematocrit-lab-test",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "Encounter with First Hematocrit Lab Test",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Encounter with First Hematocrit Lab Test"
          }
        },
        {
          "id" : "encounter-with-first-oxygen-saturation",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "Encounter with First Oxygen Saturation",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Encounter with First Oxygen Saturation"
          }
        },
        {
          "id" : "encounter-with-first-platelet-lab-test",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "Encounter with First Platelet Lab Test",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Encounter with First Platelet Lab Test"
          }
        },
        {
          "id" : "encounter-with-first-sodium-lab-test",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "Encounter with First Sodium Lab Test",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Encounter with First Sodium Lab Test"
          }
        },
        {
          "id" : "encounter-with-first-white-blood-cells-lab-test",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "Encounter with First White Blood Cells Lab Test",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Encounter with First White Blood Cells Lab Test"
          }
        },
        {
          "id" : "encounter-with-first-systolic-blood-pressure",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "Encounter with First Systolic Blood Pressure",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Encounter with First Systolic Blood Pressure"
          }
        }
      ]
    }

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