FHIR IG Statistics: Measure/CMS1028FHIRPCSevereOBComps

Resources that use this resource

No resources found

Resources that this resource uses

No resources found

Narrative

Note: links and images are rebased to the (stated) source

define "Initial Population":
  PCMaternal."Delivery Encounter With Age Range"

define "Denominator":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation"

define "Numerator":
  "Delivery Encounters With Severe Obstetric Complications"

define "Initial Population":
  PCMaternal."Delivery Encounter With Age Range"

define "Denominator":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation"

define "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only":
  "Delivery Encounters With Severe Obstetric Complications"
    intersect "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions"

define "SOC Excluding Blood Transfusions Only With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC":
  ( "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
      where exists ( ( SOCExcludingTransfusion.encounterDiagnosis ( ) ) EncounterDiagnoses
          where EncounterDiagnoses.code in "Placenta Increta or Percreta"
      )
        and ( exists "Delivery Encounters With Blood Transfusion"
            or exists "Delivery Encounters With Hysterectomy"
        )
  )
	
	//The following logic keeps encounter in the numerator if there is an additional SOC besides Blood Transfusion or Hysterectomy
    
    except ( ( "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
          where SOCExcludingTransfusion.isDiagnosisPresentOnAdmission ( "Severe Maternal Morbidity Diagnoses", "Present on Admission is No or Unable To Determine" )
      )
        union "Delivery Encounters With Cardiac Conversion, Tracheostomy Or Ventilation Procedures"
        union "Delivery Encounters With Expiration"
    )

define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }

define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }

define "SDE Sex":
  case
    when Patient.sex = '248153007' then "Male (finding)"
    when Patient.sex = '248152002' then "Female (finding)"
    else null
  end

define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }

define "Encounter With Age Range":
 CQMCommon."Inpatient Encounter" InpatientEncounter
                      where AgeInYearsAt(date from start of InpatientEncounter.period) in Interval[ 8, 65 )

define "Delivery Encounter With Age Range":
  "Encounter With Age Range" EncounterWithAge
                with ["Procedure": "Delivery Procedures"] DeliveryProcedure
                such that DeliveryProcedure.status = 'completed'
                and DeliveryProcedure.performed.toInterval  ( ) starts during EncounterWithAge.hospitalizationWithEDOBTriageObservation ()

define "Variable Calculated Gestational Age":
 "Delivery Encounter With Age Range" DeliveryEncounter
    let CGA: DeliveryEncounter.calculatedGestationalAge()
    return {
      EncounterID: DeliveryEncounter.id,
      CalculatedCGA: CGA
    }

define fluent function hospitalizationWithEDOBTriageObservation (TheEncounter Encounter ):
  /*hospitalizationWithEDOBTriageObservation returns the total interval from the start of any immediately prior emergency department visit or OB Triage visit through the observation visit to the discharge of the given encounter*/
  TheEncounter Visit
    let ObsVisit: Last(["Encounter": "Observation Services"] LastObs
        where LastObs.period ends 1 hour or less on or before start of Visit.period
          and LastObs.status = 'finished'
        sort by 
        end of period
    ),
    VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
    EDOBTriageVisit: Last(["Encounter": "ED Visit and OB Triage"] LastEDOBTriage
        where LastEDOBTriage.period ends 1 hour or less on or before VisitStart
          and LastEDOBTriage.status = 'finished'
        sort by 
        end of period
    )
    return Interval[Coalesce(start of EDOBTriageVisit.period, VisitStart), 
    end of Visit.period]

define fluent function calculatedGestationalAge (TheEncounter Encounter ):
  //Gestational Age = (280 -(Estimated Delivery Date minus Reference Date/Delivery Date))/7
 ( 280 - ( difference in days between TheEncounter.lastTimeOfDelivery () and TheEncounter.lastEstimatedDeliveryDate( )) ) div 7

define fluent function lastTimeOfDelivery (TheEncounter Encounter ):
  Last(["SimpleObservation": "Date and time of obstetric delivery"] TimeOfDelivery
      where TimeOfDelivery.value as DateTime is not null
        and TimeOfDelivery.status in { 'final', 'amended', 'corrected' }
        and TimeOfDelivery.effective.earliest () during TheEncounter.hospitalizationWithEDOBTriageObservation ()
        and TimeOfDelivery.value as DateTime during TheEncounter.hospitalizationWithEDOBTriageObservation()
      sort by effective.earliest()
  ).value as DateTime

define fluent function lastEstimatedDeliveryDate (TheEncounter Encounter ):
  /*This function identifies the last time the EDD was assessed 42 weeks or less prior to or on delivery and stores the result of that assessment.*/
  Last(["SimpleObservation": "Delivery date Estimated"] EstimatedDateOfDelivery
      where EstimatedDateOfDelivery.value as DateTime is not null
        and EstimatedDateOfDelivery.status in { 'final', 'amended', 'corrected' }
        and EstimatedDateOfDelivery.effective.earliest ( ) 42 weeks or less before or on TheEncounter.lastTimeOfDelivery ()
      sort by effective.earliest ( )
  ).value as DateTime

define fluent function lastEstimatedGestationalAge (TheEncounter Encounter ):
  Last(["SimpleObservation": "Estimated Gestational Age at Delivery"] EstimatedGestationalAge
  let EGATiming:  EstimatedGestationalAge.effective.earliest() where 
  (EGATiming 24 hours or less before or on TheEncounter.lastTimeOfDelivery () 
  and EstimatedGestationalAge.value is not null 
  and EstimatedGestationalAge.status in { 'final', 'amended', 'corrected' }) or 
      (EGATiming same day as TheEncounter.lastTimeOfDelivery () 
      and EGATiming during TheEncounter.hospitalizationWithEDOBTriageObservation() 
      and EstimatedGestationalAge.value is not null)
 sort by effective.earliest ())
         .value as Quantity

/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
  case
	  when choice is DateTime then
    	Interval[choice as DateTime, choice as DateTime]
		when choice is Interval<DateTime> then
  		choice as Interval<DateTime>
		when choice is Quantity then
		  Interval[Patient.birthDate + (choice as Quantity),
			  Patient.birthDate + (choice as Quantity) + 1 year)
		when choice is Interval<Quantity> then
		  Interval[Patient.birthDate + (choice.low as Quantity),
			  Patient.birthDate + (choice.high as Quantity) + 1 year)
		when choice is Timing then
      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
		else
			null as Interval<DateTime>
	end

/*
@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

/*
@description: Given an interval, return true if the interval has a starting boundary specified
(i.e. the start of the interval is not null and not the minimum DateTime value)
*/
define fluent function hasStart(period Interval<DateTime> ):
  not ( start of period is null
      or start of period = minimum DateTime
  )

/*
@description: Returns true if the given reference is to the given resourceId
@comment: Returns true if the `resourceId` parameter exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference Reference, resourceId String):
  resourceId = Last(Split(reference.reference, '/'))

/*
@description: Returns true if any of the given references are to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(references List<Reference>, resource Resource):
  exists (references R where R.references(resource))

/*
@description: Returns true if the given reference is to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference Reference, resource Resource):
  resource.id = Last(Split(reference.reference, '/'))

define "Inpatient Encounter":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.status = 'finished'
      and EncounterInpatient.period ends during day of "Measurement Period"

/*  
@description: Returns the Condition resources referenced by the diagnosis element of the Encounter  
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
  Encounter.reasonReference D
    return singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where D.references(C.id))

/*
 @description: Returns true if the given diagnosis is present on admission, based on the given poaValueSet
 @comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information
 */
 define fluent function isDiagnosisPresentOnAdmission(encounter Encounter, diagnosisValueSet ValueSet, poaValueSet ValueSet):
   exists (
     (encounter.claimDiagnosis()) CD
       where CD.onAdmission in poaValueSet
         and (
           CD.diagnosis in diagnosisValueSet
             or CD.diagnosis.getCondition().code in diagnosisValueSet
         )
   )

/*
@description: Returns the claim diagnosis elements for the given encounter
@comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information
*/
define fluent function claimDiagnosis(encounter Encounter):
  encounter E
    let 
      claim: ([Claim] C where C.status = 'active' and C.use = 'claim' and exists (C.item I where I.encounter.references(E))),
      claimItem: (claim.item I where I.encounter.references(E))
    return claim.diagnosis D where D.sequence in claimItem.diagnosisSequence

/*
@description: Returns the Condition resource for the given reference
*/
define fluent function getCondition(reference Reference):
  singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where reference.references(C.id))

/*
@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
value to a CQL DateTime Interval
@comment: If the start value of the given period is unspecified, the starting
boundary of the resulting interval will be open (meaning the start of the interval
is unknown, as opposed to interpreted as the beginning of time).
*/
define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period."start" is null then
            Interval(period."start".value, period."end".value]
        else
            Interval[period."start".value, period."end".value]

define function ToString(value uri): value.value

/*
@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
        }

/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }

define "Delivery Encounters With Calculated Gestational Age Greater Than Or Equal To 20 Weeks":
  PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
    where DeliveryEncounter.calculatedGestationalAge ( ) >= 20

define "Delivery Encounters With Estimated Gestational Age Assessment Greater Than Or Equal To 20 Weeks":
  PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
    where DeliveryEncounter.calculatedGestationalAge ( ) is null
      and ( DeliveryEncounter.lastEstimatedGestationalAge ( ) >= 20 weeks )

define "Delivery Encounters With Gestational Age Greater Than Or Equal To 20 Weeks Based On Coding":
  PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
    let CGA: DeliveryEncounter.calculatedGestationalAge ( ),
    EGA: DeliveryEncounter.lastEstimatedGestationalAge ( )
    where CGA is null
      and EGA is null
      and exists ( ( DeliveryEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
          where EncounterDiagnosis.code in "20 to 42 Plus Weeks Gestation"
      )

define "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation":
  "Delivery Encounters With Calculated Gestational Age Greater Than Or Equal To 20 Weeks"
    union "Delivery Encounters With Estimated Gestational Age Assessment Greater Than Or Equal To 20 Weeks"
    union "Delivery Encounters With Gestational Age Greater Than Or Equal To 20 Weeks Based On Coding"

define "Risk Variable Asthma":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Acute or Persistent Asthma", "Present On Admission is Yes or Exempt" )

define "Risk Variable Placental Accreta Spectrum":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Placenta Accreta", "Present On Admission is Yes or Exempt" )
      or TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Placenta Increta or Percreta", "Present On Admission is Yes or Exempt" )

define "Risk Variable Hypertension":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Hypertension", "Present On Admission is Yes or Exempt" )

define "Risk Variable Preterm Birth":
/*  CGA = Calculated Gestational Age.  EGA = Estimated Gestational Age. */
  
  ( PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
      let CGA: DeliveryEncounter.calculatedGestationalAge ( ),
      EGA: DeliveryEncounter.lastEstimatedGestationalAge ( )
      where CGA in Interval[20, 36]
        or ( CGA is null
            and ( EGA >= 20 weeks
                and EGA <= 36 weeks
            )
        )
  )
    union ( PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
        let CGA: DeliveryEncounter.calculatedGestationalAge ( ),
        EGA: DeliveryEncounter.lastEstimatedGestationalAge ( )
        where CGA is null
          and EGA is null
          and /*DeliveryEncounter.isDiagnosisPresentOnAdmission("Preterm Birth","Present On Admission is Yes or Exempt")*/
                
                /*where DeliveryEncounter.isDiagnosisPresentOnAdmission("Preterm Birth","Present On Admission is Yes or Exempt")*/
          
          exists ( ( DeliveryEncounter.claimDiagnosis ( ) ) D
              where D.onAdmission ~ "POA-Y"
                and ( D.diagnosis in "Preterm Birth"
                    or D.diagnosis.getCondition ( ).code in "Preterm Birth"
                )
          )
    )

define "SDE Payer":
  SDE."SDE Payer"

define "Risk Variable Placental Abruption":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Placental Abruption", "Present On Admission is Yes or Exempt" )

define "Risk Variable Morbid Obesity":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Morbid or Severe Obesity", "Present On Admission is Yes or Exempt" )

define "Risk Variable Preexisting Diabetes":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Preexisting Diabetes", "Present On Admission is Yes or Exempt" )

define "Risk Variable Bariatric Surgery":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Bariatric Surgery", "Present On Admission is Yes or Exempt" )

define "SDE Race":
  SDE."SDE Race"

define "Risk Variable Placenta Previa":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Placenta Previa", "Present On Admission is Yes or Exempt" )

define "SDE Sex":
  SDE."SDE Sex"

define "Risk Variable Bleeding Disorder":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Bleeding Disorder", "Present On Admission is Yes or Exempt" )

//First resulted value 24 hours prior to start of encounter and before time of delivery
 //Report white blood cell count as 10*3/uL



define "Risk Variable First White Blood Cell Count Lab Test":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let FirstWBC: First(["LaboratoryResultObservation": "White blood cells count lab test"] WBC
        where WBC.issued during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery()]
          and WBC.status in { 'final', 'amended', 'corrected' }
          and WBC.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: TwentyWeeksPlusEncounter.id,
      FirstWBCResult: FirstWBC.value as Quantity,
      Timing: FirstWBC.issued
    }

//First resulted value 24 hours prior to start of encounter and before time of delivery
 //Report hematocrit as %



define "Risk Variable First Hematocrit Lab Test":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let FirstHematocrit: First(["LaboratoryResultObservation": "Hematocrit lab test"] Hematocrit
        where Hematocrit.issued during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery()]
          and Hematocrit.status in { 'final', 'amended', 'corrected' }
          and Hematocrit.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: TwentyWeeksPlusEncounter.id,
      FirstHematocritResult: FirstHematocrit.value as Quantity,
      Timing: FirstHematocrit.issued
    }

define "Risk Variable Anemia":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Anemia", "Present On Admission is Yes or Exempt" )

define "Risk Variable Severe Preeclampsia":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Severe Preeclampsia", "Present On Admission is Yes or Exempt" )

define "Risk Variable Cardiac Disease":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Cardiac Disease", "Present On Admission is Yes or Exempt" )

define "Risk Variable Long Term Anticoagulant Use":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Long Term Anticoagulant Use", "Present On Admission is Yes or Exempt" )

define "Delivery Encounters With Severe Obstetric Complications Diagnosis Or Procedure Excluding Blood Transfusion":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Severe Maternal Morbidity Diagnoses", "Present on Admission is No or Unable To Determine" )
      or ( exists ( ["Procedure": "Severe Maternal Morbidity Procedures"] SMMProcedures
            where SMMProcedures.status = 'completed'
              and SMMProcedures.performed.toInterval ( ) starts during TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )
        )
      )

define "Delivery Encounters With Expiration":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.hospitalization.dischargeDisposition in "Patient Expired"

define "Delivery Encounters With Blood Transfusion":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    with ["Procedure": "Blood Transfusion"] BloodTransfusion
      such that BloodTransfusion.status = 'completed'
        and BloodTransfusion.performed.toInterval ( ) starts during TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )

define "Delivery Encounters With Severe Obstetric Complications":
  "Delivery Encounters With Severe Obstetric Complications Diagnosis Or Procedure Excluding Blood Transfusion"
    union "Delivery Encounters With Expiration"
    union "Delivery Encounters With Blood Transfusion"

define "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions":
  "Delivery Encounters With Severe Obstetric Complications Diagnosis Or Procedure Excluding Blood Transfusion"
    union "Delivery Encounters With Expiration"

define "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only":
  "Delivery Encounters With Severe Obstetric Complications"
    intersect "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions"

define "Delivery Encounters With Hysterectomy":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    with ["Procedure": "Hysterectomy"] Hysterectomy
      such that Hysterectomy.status = 'completed'
        and Hysterectomy.performed.toInterval ( ) starts during TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )

define "Cardiac Conversion, Tracheostomy Or Ventilation Procedures":
  ["Procedure": "Conversion of Cardiac Rhythm"]
    union ["Procedure": "Tracheostomy"]
    union ["Procedure": "Ventilation"]

define "Delivery Encounters With Cardiac Conversion, Tracheostomy Or Ventilation Procedures":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    with "Cardiac Conversion, Tracheostomy Or Ventilation Procedures" ConvTrachVentProcedures
      such that ConvTrachVentProcedures.status = 'completed'
        and ConvTrachVentProcedures.performed.toInterval ( ) starts during TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )

define "SOC Excluding Blood Transfusions Only With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC":
  ( "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
      where exists ( ( SOCExcludingTransfusion.encounterDiagnosis ( ) ) EncounterDiagnoses
          where EncounterDiagnoses.code in "Placenta Increta or Percreta"
      )
        and ( exists "Delivery Encounters With Blood Transfusion"
            or exists "Delivery Encounters With Hysterectomy"
        )
  )
	
	//The following logic keeps encounter in the numerator if there is an additional SOC besides Blood Transfusion or Hysterectomy
    
    except ( ( "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
          where SOCExcludingTransfusion.isDiagnosisPresentOnAdmission ( "Severe Maternal Morbidity Diagnoses", "Present on Admission is No or Unable To Determine" )
      )
        union "Delivery Encounters With Cardiac Conversion, Tracheostomy Or Ventilation Procedures"
        union "Delivery Encounters With Expiration"
    )

//First resulted value 24 hours prior to start of encounter and before time of delivery
//Report systolic blood pressure as mm[Hg]
//Systolic blood pressure value cannot be null per QICore profile requirement.




define "Risk Variable Systolic Blood Pressure":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let FirstSystolicBP: First(["USCoreBloodPressureProfile"] BP
        where BP.effective.earliest() during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery()]
          and BP.status in { 'final', 'amended', 'corrected' }
          and BP.component.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: TwentyWeeksPlusEncounter.id,
      FirstSBPResult: FirstSystolicBP.component C
        where C.code ~ "Systolic blood pressure"
        return C.value as Quantity,
      Timing: FirstSystolicBP.effective.earliest ( )
    }

define "SOC With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC":
  ( "Delivery Encounters With Severe Obstetric Complications" SOCEncounter
      where exists ( ( SOCEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
          where EncounterDiagnosis.code in "Placenta Increta or Percreta"
      )
        and ( exists "Delivery Encounters With Blood Transfusion"
            or exists "Delivery Encounters With Hysterectomy"
        )
  )
	//The following logic keeps encounter in the numerator if there is an additional SOC besides Blood Transfusion or Hysterectomy
    
    except ( ( "Delivery Encounters With Severe Obstetric Complications" SOCEncounter
          where SOCEncounter.isDiagnosisPresentOnAdmission ( "Severe Maternal Morbidity Diagnoses", "Present on Admission is No or Unable To Determine" )
      )
        union "Delivery Encounters With Cardiac Conversion, Tracheostomy Or Ventilation Procedures"
        union "Delivery Encounters With Expiration"
    )

define "SDE Delivery Encounters With Severe Obstetric Complication Diagnosis":
  ( "Delivery Encounters With Severe Obstetric Complications"
    except "SOC With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC" ) Encounter
    where Encounter.isDiagnosisPresentOnAdmission ( "Severe Maternal Morbidity Diagnoses", "Present on Admission is No or Unable To Determine" )

define "SDE SOC Diagnoses Detail":
  "SDE Delivery Encounters With Severe Obstetric Complication Diagnosis" Encounter
    let complication: Encounter.pOAIsNoOrUTD ( )
    return {
      id: Encounter.id,
      code: Encounter.type,
      complications: complication C
        where C in "Severe Maternal Morbidity Diagnoses"
          or C.getCondition ( ).code in "Severe Maternal Morbidity Diagnoses"
        return {
          code: C,
          SOCDxCategory: C.sOCDxCategory ( )
        }
    }

define "Risk Variable Substance Abuse":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Substance Abuse", "Present On Admission is Yes or Exempt" )

define "Risk Variable Renal Disease":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Renal Disease", "Present On Admission is Yes or Exempt" )

define "SDE Variable Calculated Gestational Age":
  //This definition establishes a variable of CGA (Calculated Gestational Age).  CGA is a supplemental data element to store the calculated gestational age result from the "CalculatedGestationalAge" function.  The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition. 
  
  PCMaternal."Variable Calculated Gestational Age"

define "Risk Variable Gastrointestinal Disease":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Gastrointestinal Disease", "Present On Admission is Yes or Exempt" )

define "Risk Variable Pulmonary Hypertension":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Pulmonary Hypertension", "Present On Admission is Yes or Exempt" )

define "SDE Delivery Encounters With Severe Obstetric Complication Procedures":
  ( "Delivery Encounters With Severe Obstetric Complications"
    except "SOC With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC" ) Encounter
    where exists ( ["Procedure": "Severe Maternal Morbidity Procedures"]
      union ["Procedure": "Blood Transfusion"] ) SMMProcedures
      where SMMProcedures.status = 'completed'
        and SMMProcedures.performed.toInterval ( ) starts during Encounter.hospitalizationWithEDOBTriageObservation ( )

define "Risk Variable Other Preeclampsia":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Mild or Moderate Preeclampsia", "Present On Admission is Yes or Exempt" )

define "Risk Variable Thyrotoxicosis":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Thyrotoxicosis", "Present On Admission is Yes or Exempt" )

define "Initial Population":
  PCMaternal."Delivery Encounter With Age Range"

define "Risk Variable Neuromuscular Disease":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Neuromuscular Disease", "Present On Admission is Yes or Exempt" )

define "Risk Variable Economic Housing Instability":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Economic Housing Instability", "Present On Admission is Yes or Exempt" )

define "Risk Variable HIV":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "HIV in Pregnancy Childbirth and Puerperium", "Present On Admission is Yes or Exempt" )

define "Risk Variable Maternal Age":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let MaternalAge: AgeInYearsAt(date from start of TwentyWeeksPlusEncounter.period)
    return { TwentyWeeksPlusEncounter, MaternalAge }

//First resulted value 24 hours prior to start of encounter and before time of delivery
 //Report heart rate as beats/min
 //Heart rate value cannot be null per QICore profile requirement.




define "Risk Variable Heart Rate":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let FirstHeartRate: First([USCoreHeartRateProfile] HeartRate
        where HeartRate.effective.earliest() during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery()]
          and HeartRate.status in { 'final', 'amended', 'corrected' }
        sort by effective.earliest()
    )
    return {
      EncounterId: TwentyWeeksPlusEncounter.id,
      FirstHRResult: FirstHeartRate.value as Quantity,
      Timing: FirstHeartRate.effective.earliest ( )
    }

define "Risk Variable Mental Health Disorder":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Mental Health Disorder", "Present On Admission is Yes or Exempt" )

define "Risk Variable Obstetrical VTE":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Venous Thromboembolism in Pregnancy", "Present On Admission is Yes or Exempt" )

define "Risk Variable Autoimmune Disease":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Autoimmune Disease", "Present On Admission is Yes or Exempt" )

define "Risk Variable Previous Cesarean":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Previous Cesarean", "Present On Admission is Yes or Exempt" )

define "Risk Variable Gestational Diabetes":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Gestational Diabetes", "Present On Admission is Yes or Exempt" )

define "SDE SOC Procedure Detail":
  "SDE Delivery Encounters With Severe Obstetric Complication Procedures" Encounter
    let procedure: Encounter.sOCProcedures ( )
    return {
      id: Encounter.id,
      code: Encounter.type,
      procedures: procedure P
        return {
          code: P,
          SOCProcedureCategory: P.sOCProcedureCategory ( )
        }
    }

define "Numerator":
  "Delivery Encounters With Severe Obstetric Complications"

define "Risk Variable Multiple Pregnancy":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Multiple Pregnancy", "Present On Admission is Yes or Exempt" )

define "Denominator":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation"

define "SDE Ethnicity":
  SDE."SDE Ethnicity"

define fluent function pOAIsNoOrUTD(TheEncounter Encounter):
  ( TheEncounter.claimDiagnosis ( ) ) CDiagnoses
    where CDiagnoses.onAdmission in "Present on Admission is No or Unable To Determine"
    return CDiagnoses.diagnosis

define fluent function sOCDxCategory(Dx Concept):
  case
    when Dx in "Acute Heart Failure" then 'Acute Heart Failure'
    when Dx in "Acute Myocardial Infarction" then 'Acute Myocardial Infarction'
    when Dx in "Acute Renal Failure" then 'Acute Renal Failure'
    when Dx in "Acute Respiratory Distress Syndrome" then 'Acute Respiratory Distress Syndrome'
    when Dx in "Air and Thrombotic Embolism" then 'Air and Thrombotic Embolism'
    when Dx in "Amniotic Fluid Embolism" then 'Amniotic Fluid Embolism'
    when Dx in "Aortic Aneurysm" then 'Aortic Aneurysm'
    when Dx in "Cardiac Arrest Ventricular Fibrillation" then 'Cardiac Arrest Ventricular Fibrillation'
    when Dx in "Disseminated Intravascular Coagulation" then 'Disseminated Intravascular Coagulation'
    when Dx in "Eclampsia" then 'Eclampsia'
    when Dx in "Heart Failure Cardiac Arrest Related to Procedure or Surgery" then 'Heart Failure Cardiac Arrest Related to Procedure or Surgery'
    when Dx in "Puerperal Cerebrovascular Disorder" then 'Puerperal Cerebrovascular Disorder'
    when Dx in "Pulmonary Edema" then 'Pulmonary Edema'
    when Dx in "Sepsis" then 'Sepsis'
    when Dx in "Severe Anesthesia Complications" then 'Severe Anesthesia Complications'
    when Dx in "Shock" then 'Shock'
    when Dx in "Sickle Cell Disease with Crisis" then 'Sickle Cell Disease with Crisis' 
    else null end

define fluent function sOCProcedures(TheEncounter Encounter):
  ( ["Procedure": "Severe Maternal Morbidity Procedures"]
    union ["Procedure": "Blood Transfusion"] ) SMMProcedures
    where SMMProcedures.status = 'completed'
      and SMMProcedures.performed.toInterval ( ) starts during TheEncounter.hospitalizationWithEDOBTriageObservation ( )

define fluent function sOCProcedureCategory(TheProcedure Procedure):
  case
    when TheProcedure.code in "Blood Transfusion" then 'Blood Transfusion'
    when TheProcedure.code in "Conversion of Cardiac Rhythm" then 'Conversion of cardiac rhythm'
    when TheProcedure.code in "Hysterectomy" then 'Hysterectomy'
    when TheProcedure.code in "Tracheostomy" then 'Tracheostomy'
    when TheProcedure.code in "Ventilation" then 'Ventilation' 
    else null end

Source

{
  "resourceType": "Measure",
  "id": "CMS1028FHIRPCSevereOBComps",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareablemeasure",
      "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",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cql-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/elm-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "contained": [
    {
      "resourceType": "Library",
      "id": "effective-data-requirements",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "93857-1",
            "display": "Date and time of obstetric delivery"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "11778-8",
            "display": "Delivery date Estimated"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Coding",
            "code": "Y"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "248153007",
            "display": "Male (finding)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "248152002",
            "display": "Female (finding)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic BP"
          }
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "Inpatient Encounter"
            },
            {
              "url": "statement",
              "valueString": "define \"Inpatient Encounter\":\n  [Encounter: \"Encounter Inpatient\"] EncounterInpatient\n    where EncounterInpatient.status = 'finished'\n      and EncounterInpatient.period ends during day of \"Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 0
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "PCMaternal"
            },
            {
              "url": "name",
              "valueString": "Encounter With Age Range"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Age Range\":\n CQMCommon.\"Inpatient Encounter\" InpatientEncounter\n                      where AgeInYearsAt(date from start of InpatientEncounter.period) in Interval[ 8, 65 )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 1
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "PCMaternal"
            },
            {
              "url": "name",
              "valueString": "Delivery Encounter With Age Range"
            },
            {
              "url": "statement",
              "valueString": "define \"Delivery Encounter With Age Range\":\n  \"Encounter With Age Range\" EncounterWithAge\n                with [\"Procedure\": \"Delivery Procedures\"] DeliveryProcedure\n                such that DeliveryProcedure.status = 'completed'\n                and DeliveryProcedure.performed.toInterval  ( ) starts during EncounterWithAge.hospitalizationWithEDOBTriageObservation ()"
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Delivery Encounters With Calculated Gestational Age Greater Than Or Equal To 20 Weeks"
            },
            {
              "url": "statement",
              "valueString": "define \"Delivery Encounters With Calculated Gestational Age Greater Than Or Equal To 20 Weeks\":\n  PCMaternal.\"Delivery Encounter With Age Range\" DeliveryEncounter\n    where DeliveryEncounter.calculatedGestationalAge ( ) >= 20"
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Delivery Encounters With Estimated Gestational Age Assessment Greater Than Or Equal To 20 Weeks"
            },
            {
              "url": "statement",
              "valueString": "define \"Delivery Encounters With Estimated Gestational Age Assessment Greater Than Or Equal To 20 Weeks\":\n  PCMaternal.\"Delivery Encounter With Age Range\" DeliveryEncounter\n    where DeliveryEncounter.calculatedGestationalAge ( ) is null\n      and ( DeliveryEncounter.lastEstimatedGestationalAge ( ) >= 20 weeks )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Delivery Encounters With Gestational Age Greater Than Or Equal To 20 Weeks Based On Coding"
            },
            {
              "url": "statement",
              "valueString": "define \"Delivery Encounters With Gestational Age Greater Than Or Equal To 20 Weeks Based On Coding\":\n  PCMaternal.\"Delivery Encounter With Age Range\" DeliveryEncounter\n    let CGA: DeliveryEncounter.calculatedGestationalAge ( ),\n    EGA: DeliveryEncounter.lastEstimatedGestationalAge ( )\n    where CGA is null\n      and EGA is null\n      and exists ( ( DeliveryEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n          where EncounterDiagnosis.code in \"20 to 42 Plus Weeks Gestation\"\n      )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation"
            },
            {
              "url": "statement",
              "valueString": "define \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\":\n  \"Delivery Encounters With Calculated Gestational Age Greater Than Or Equal To 20 Weeks\"\n    union \"Delivery Encounters With Estimated Gestational Age Assessment Greater Than Or Equal To 20 Weeks\"\n    union \"Delivery Encounters With Gestational Age Greater Than Or Equal To 20 Weeks Based On Coding\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Asthma"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Asthma\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Acute or Persistent Asthma\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Placental Accreta Spectrum"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Placental Accreta Spectrum\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Placenta Accreta\", \"Present On Admission is Yes or Exempt\" )\n      or TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Placenta Increta or Percreta\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Hypertension"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Hypertension\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Hypertension\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Preterm Birth"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Preterm Birth\":\n/*  CGA = Calculated Gestational Age.  EGA = Estimated Gestational Age. */\n  \n  ( PCMaternal.\"Delivery Encounter With Age Range\" DeliveryEncounter\n      let CGA: DeliveryEncounter.calculatedGestationalAge ( ),\n      EGA: DeliveryEncounter.lastEstimatedGestationalAge ( )\n      where CGA in Interval[20, 36]\n        or ( CGA is null\n            and ( EGA >= 20 weeks\n                and EGA <= 36 weeks\n            )\n        )\n  )\n    union ( PCMaternal.\"Delivery Encounter With Age Range\" DeliveryEncounter\n        let CGA: DeliveryEncounter.calculatedGestationalAge ( ),\n        EGA: DeliveryEncounter.lastEstimatedGestationalAge ( )\n        where CGA is null\n          and EGA is null\n          and /*DeliveryEncounter.isDiagnosisPresentOnAdmission(\"Preterm Birth\",\"Present On Admission is Yes or Exempt\")*/\n                \n                /*where DeliveryEncounter.isDiagnosisPresentOnAdmission(\"Preterm Birth\",\"Present On Admission is Yes or Exempt\")*/\n          \n          exists ( ( DeliveryEncounter.claimDiagnosis ( ) ) D\n              where D.onAdmission ~ \"POA-Y\"\n                and ( D.diagnosis in \"Preterm Birth\"\n                    or D.diagnosis.getCondition ( ).code in \"Preterm Birth\"\n                )\n          )\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-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": 11
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Placental Abruption"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Placental Abruption\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Placental Abruption\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Morbid Obesity"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Morbid Obesity\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Morbid or Severe Obesity\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Preexisting Diabetes"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Preexisting Diabetes\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Preexisting Diabetes\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Bariatric Surgery"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Bariatric Surgery\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Bariatric Surgery\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 16
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-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": 17
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 18
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Placenta Previa"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Placenta Previa\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Placenta Previa\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 19
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":\n  case\n    when Patient.sex = '248153007' then \"Male (finding)\"\n    when Patient.sex = '248152002' then \"Female (finding)\"\n    else null\n  end"
            },
            {
              "url": "displaySequence",
              "valueInteger": 20
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 21
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Bleeding Disorder"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Bleeding Disorder\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Bleeding Disorder\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 22
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable First White Blood Cell Count Lab Test"
            },
            {
              "url": "statement",
              "valueString": "//First resulted value 24 hours prior to start of encounter and before time of delivery\n //Report white blood cell count as 10*3/uL\n\n\n\ndefine \"Risk Variable First White Blood Cell Count Lab Test\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    let FirstWBC: First([\"LaboratoryResultObservation\": \"White blood cells count lab test\"] WBC\n        where WBC.issued during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery()]\n          and WBC.status in { 'final', 'amended', 'corrected' }\n          and WBC.value is not null\n        sort by issued.earliest()\n    )\n    return {\n      EncounterId: TwentyWeeksPlusEncounter.id,\n      FirstWBCResult: FirstWBC.value as Quantity,\n      Timing: FirstWBC.issued\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 23
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable First Hematocrit Lab Test"
            },
            {
              "url": "statement",
              "valueString": "//First resulted value 24 hours prior to start of encounter and before time of delivery\n //Report hematocrit as %\n\n\n\ndefine \"Risk Variable First Hematocrit Lab Test\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    let FirstHematocrit: First([\"LaboratoryResultObservation\": \"Hematocrit lab test\"] Hematocrit\n        where Hematocrit.issued during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery()]\n          and Hematocrit.status in { 'final', 'amended', 'corrected' }\n          and Hematocrit.value is not null\n        sort by issued.earliest()\n    )\n    return {\n      EncounterId: TwentyWeeksPlusEncounter.id,\n      FirstHematocritResult: FirstHematocrit.value as Quantity,\n      Timing: FirstHematocrit.issued\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 24
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Anemia"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Anemia\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Anemia\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 25
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Severe Preeclampsia"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Severe Preeclampsia\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Severe Preeclampsia\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 26
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Cardiac Disease"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Cardiac Disease\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Cardiac Disease\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 27
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Long Term Anticoagulant Use"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Long Term Anticoagulant Use\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Long Term Anticoagulant Use\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 28
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Delivery Encounters With Severe Obstetric Complications Diagnosis Or Procedure Excluding Blood Transfusion"
            },
            {
              "url": "statement",
              "valueString": "define \"Delivery Encounters With Severe Obstetric Complications Diagnosis Or Procedure Excluding Blood Transfusion\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Severe Maternal Morbidity Diagnoses\", \"Present on Admission is No or Unable To Determine\" )\n      or ( exists ( [\"Procedure\": \"Severe Maternal Morbidity Procedures\"] SMMProcedures\n            where SMMProcedures.status = 'completed'\n              and SMMProcedures.performed.toInterval ( ) starts during TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )\n        )\n      )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 29
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Delivery Encounters With Expiration"
            },
            {
              "url": "statement",
              "valueString": "define \"Delivery Encounters With Expiration\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.hospitalization.dischargeDisposition in \"Patient Expired\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 30
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Delivery Encounters With Blood Transfusion"
            },
            {
              "url": "statement",
              "valueString": "define \"Delivery Encounters With Blood Transfusion\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    with [\"Procedure\": \"Blood Transfusion\"] BloodTransfusion\n      such that BloodTransfusion.status = 'completed'\n        and BloodTransfusion.performed.toInterval ( ) starts during TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 31
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Delivery Encounters With Severe Obstetric Complications"
            },
            {
              "url": "statement",
              "valueString": "define \"Delivery Encounters With Severe Obstetric Complications\":\n  \"Delivery Encounters With Severe Obstetric Complications Diagnosis Or Procedure Excluding Blood Transfusion\"\n    union \"Delivery Encounters With Expiration\"\n    union \"Delivery Encounters With Blood Transfusion\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 32
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions"
            },
            {
              "url": "statement",
              "valueString": "define \"Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions\":\n  \"Delivery Encounters With Severe Obstetric Complications Diagnosis Or Procedure Excluding Blood Transfusion\"\n    union \"Delivery Encounters With Expiration\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 33
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only"
            },
            {
              "url": "statement",
              "valueString": "define \"Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only\":\n  \"Delivery Encounters With Severe Obstetric Complications\"\n    intersect \"Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 34
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Delivery Encounters With Hysterectomy"
            },
            {
              "url": "statement",
              "valueString": "define \"Delivery Encounters With Hysterectomy\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    with [\"Procedure\": \"Hysterectomy\"] Hysterectomy\n      such that Hysterectomy.status = 'completed'\n        and Hysterectomy.performed.toInterval ( ) starts during TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 35
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Cardiac Conversion, Tracheostomy Or Ventilation Procedures"
            },
            {
              "url": "statement",
              "valueString": "define \"Cardiac Conversion, Tracheostomy Or Ventilation Procedures\":\n  [\"Procedure\": \"Conversion of Cardiac Rhythm\"]\n    union [\"Procedure\": \"Tracheostomy\"]\n    union [\"Procedure\": \"Ventilation\"]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 36
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Delivery Encounters With Cardiac Conversion, Tracheostomy Or Ventilation Procedures"
            },
            {
              "url": "statement",
              "valueString": "define \"Delivery Encounters With Cardiac Conversion, Tracheostomy Or Ventilation Procedures\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    with \"Cardiac Conversion, Tracheostomy Or Ventilation Procedures\" ConvTrachVentProcedures\n      such that ConvTrachVentProcedures.status = 'completed'\n        and ConvTrachVentProcedures.performed.toInterval ( ) starts during TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 37
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "SOC Excluding Blood Transfusions Only With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC"
            },
            {
              "url": "statement",
              "valueString": "define \"SOC Excluding Blood Transfusions Only With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC\":\n  ( \"Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only\" SOCExcludingTransfusion\n      where exists ( ( SOCExcludingTransfusion.encounterDiagnosis ( ) ) EncounterDiagnoses\n          where EncounterDiagnoses.code in \"Placenta Increta or Percreta\"\n      )\n        and ( exists \"Delivery Encounters With Blood Transfusion\"\n            or exists \"Delivery Encounters With Hysterectomy\"\n        )\n  )\n\t\n\t//The following logic keeps encounter in the numerator if there is an additional SOC besides Blood Transfusion or Hysterectomy\n    \n    except ( ( \"Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only\" SOCExcludingTransfusion\n          where SOCExcludingTransfusion.isDiagnosisPresentOnAdmission ( \"Severe Maternal Morbidity Diagnoses\", \"Present on Admission is No or Unable To Determine\" )\n      )\n        union \"Delivery Encounters With Cardiac Conversion, Tracheostomy Or Ventilation Procedures\"\n        union \"Delivery Encounters With Expiration\"\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 38
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Systolic Blood Pressure"
            },
            {
              "url": "statement",
              "valueString": "//First resulted value 24 hours prior to start of encounter and before time of delivery\n//Report systolic blood pressure as mm[Hg]\n//Systolic blood pressure value cannot be null per QICore profile requirement.\n\n\n\n\ndefine \"Risk Variable Systolic Blood Pressure\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    let FirstSystolicBP: First([\"USCoreBloodPressureProfile\"] BP\n        where BP.effective.earliest() during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery()]\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: TwentyWeeksPlusEncounter.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": 39
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "SOC With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC"
            },
            {
              "url": "statement",
              "valueString": "define \"SOC With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC\":\n  ( \"Delivery Encounters With Severe Obstetric Complications\" SOCEncounter\n      where exists ( ( SOCEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n          where EncounterDiagnosis.code in \"Placenta Increta or Percreta\"\n      )\n        and ( exists \"Delivery Encounters With Blood Transfusion\"\n            or exists \"Delivery Encounters With Hysterectomy\"\n        )\n  )\n\t//The following logic keeps encounter in the numerator if there is an additional SOC besides Blood Transfusion or Hysterectomy\n    \n    except ( ( \"Delivery Encounters With Severe Obstetric Complications\" SOCEncounter\n          where SOCEncounter.isDiagnosisPresentOnAdmission ( \"Severe Maternal Morbidity Diagnoses\", \"Present on Admission is No or Unable To Determine\" )\n      )\n        union \"Delivery Encounters With Cardiac Conversion, Tracheostomy Or Ventilation Procedures\"\n        union \"Delivery Encounters With Expiration\"\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 40
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "SDE Delivery Encounters With Severe Obstetric Complication Diagnosis"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Delivery Encounters With Severe Obstetric Complication Diagnosis\":\n  ( \"Delivery Encounters With Severe Obstetric Complications\"\n    except \"SOC With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC\" ) Encounter\n    where Encounter.isDiagnosisPresentOnAdmission ( \"Severe Maternal Morbidity Diagnoses\", \"Present on Admission is No or Unable To Determine\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 41
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "SDE SOC Diagnoses Detail"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE SOC Diagnoses Detail\":\n  \"SDE Delivery Encounters With Severe Obstetric Complication Diagnosis\" Encounter\n    let complication: Encounter.pOAIsNoOrUTD ( )\n    return {\n      id: Encounter.id,\n      code: Encounter.type,\n      complications: complication C\n        where C in \"Severe Maternal Morbidity Diagnoses\"\n          or C.getCondition ( ).code in \"Severe Maternal Morbidity Diagnoses\"\n        return {\n          code: C,\n          SOCDxCategory: C.sOCDxCategory ( )\n        }\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 42
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Substance Abuse"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Substance Abuse\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Substance Abuse\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 43
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Renal Disease"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Renal Disease\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Renal Disease\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 44
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "PCMaternal"
            },
            {
              "url": "name",
              "valueString": "Variable Calculated Gestational Age"
            },
            {
              "url": "statement",
              "valueString": "define \"Variable Calculated Gestational Age\":\n \"Delivery Encounter With Age Range\" DeliveryEncounter\n    let CGA: DeliveryEncounter.calculatedGestationalAge()\n    return {\n      EncounterID: DeliveryEncounter.id,\n      CalculatedCGA: CGA\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 45
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "SDE Variable Calculated Gestational Age"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Variable Calculated Gestational Age\":\n  //This definition establishes a variable of CGA (Calculated Gestational Age).  CGA is a supplemental data element to store the calculated gestational age result from the \"CalculatedGestationalAge\" function.  The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition. \n  \n  PCMaternal.\"Variable Calculated Gestational Age\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 46
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Gastrointestinal Disease"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Gastrointestinal Disease\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Gastrointestinal Disease\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 47
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Pulmonary Hypertension"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Pulmonary Hypertension\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Pulmonary Hypertension\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 48
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "SDE Delivery Encounters With Severe Obstetric Complication Procedures"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Delivery Encounters With Severe Obstetric Complication Procedures\":\n  ( \"Delivery Encounters With Severe Obstetric Complications\"\n    except \"SOC With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC\" ) Encounter\n    where exists ( [\"Procedure\": \"Severe Maternal Morbidity Procedures\"]\n      union [\"Procedure\": \"Blood Transfusion\"] ) SMMProcedures\n      where SMMProcedures.status = 'completed'\n        and SMMProcedures.performed.toInterval ( ) starts during Encounter.hospitalizationWithEDOBTriageObservation ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 49
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Other Preeclampsia"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Other Preeclampsia\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Mild or Moderate Preeclampsia\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 50
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Thyrotoxicosis"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Thyrotoxicosis\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Thyrotoxicosis\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 51
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  PCMaternal.\"Delivery Encounter With Age Range\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 52
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Neuromuscular Disease"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Neuromuscular Disease\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Neuromuscular Disease\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 53
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Economic Housing Instability"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Economic Housing Instability\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Economic Housing Instability\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 54
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable HIV"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable HIV\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"HIV in Pregnancy Childbirth and Puerperium\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 55
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Maternal Age"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Maternal Age\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    let MaternalAge: AgeInYearsAt(date from start of TwentyWeeksPlusEncounter.period)\n    return { TwentyWeeksPlusEncounter, MaternalAge }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 56
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Heart Rate"
            },
            {
              "url": "statement",
              "valueString": "//First resulted value 24 hours prior to start of encounter and before time of delivery\n //Report heart rate as beats/min\n //Heart rate value cannot be null per QICore profile requirement.\n\n\n\n\ndefine \"Risk Variable Heart Rate\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    let FirstHeartRate: First([USCoreHeartRateProfile] HeartRate\n        where HeartRate.effective.earliest() during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery()]\n          and HeartRate.status in { 'final', 'amended', 'corrected' }\n        sort by effective.earliest()\n    )\n    return {\n      EncounterId: TwentyWeeksPlusEncounter.id,\n      FirstHRResult: FirstHeartRate.value as Quantity,\n      Timing: FirstHeartRate.effective.earliest ( )\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 57
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Mental Health Disorder"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Mental Health Disorder\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Mental Health Disorder\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 58
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Obstetrical VTE"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Obstetrical VTE\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Venous Thromboembolism in Pregnancy\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 59
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Autoimmune Disease"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Autoimmune Disease\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Autoimmune Disease\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 60
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Previous Cesarean"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Previous Cesarean\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Previous Cesarean\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 61
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Gestational Diabetes"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Gestational Diabetes\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Gestational Diabetes\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 62
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "SDE SOC Procedure Detail"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE SOC Procedure Detail\":\n  \"SDE Delivery Encounters With Severe Obstetric Complication Procedures\" Encounter\n    let procedure: Encounter.sOCProcedures ( )\n    return {\n      id: Encounter.id,\n      code: Encounter.type,\n      procedures: procedure P\n        return {\n          code: P,\n          SOCProcedureCategory: P.sOCProcedureCategory ( )\n        }\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 63
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n  \"Delivery Encounters With Severe Obstetric Complications\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 64
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Risk Variable Multiple Pregnancy"
            },
            {
              "url": "statement",
              "valueString": "define \"Risk Variable Multiple Pregnancy\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\" TwentyWeeksPlusEncounter\n    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( \"Multiple Pregnancy\", \"Present On Admission is Yes or Exempt\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 65
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n  \"Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 66
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-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": 67
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 68
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)\nvalue to a CQL DateTime Interval\n@comment: If the start value of the given period is unspecified, the starting\nboundary of the resulting interval will be open (meaning the start of the interval\nis unknown, as opposed to interpreted as the beginning of time).\n*/\ndefine function ToInterval(period FHIR.Period):\n    if period is null then\n        null\n    else\n        if period.\"start\" is null then\n            Interval(period.\"start\".value, period.\"end\".value]\n        else\n            Interval[period.\"start\".value, period.\"end\".value]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 69
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "toInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in QICore, allowing this function to be used across any resource.\nThe input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.\nIf the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,\nand the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.\nIf the input is a DateTime Interval, the result is the input.\nIf the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result\nis a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending\nimmediately before one year later than the date the patient turned the age given as the end of the quantity interval.\nIf the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval\n*/\ndefine fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):\n  case\n\t  when choice is DateTime then\n    \tInterval[choice as DateTime, choice as DateTime]\n\t\twhen choice is Interval<DateTime> then\n  \t\tchoice as Interval<DateTime>\n\t\twhen choice is Quantity then\n\t\t  Interval[Patient.birthDate + (choice as Quantity),\n\t\t\t  Patient.birthDate + (choice as Quantity) + 1 year)\n\t\twhen choice is Interval<Quantity> then\n\t\t  Interval[Patient.birthDate + (choice.low as Quantity),\n\t\t\t  Patient.birthDate + (choice.high as Quantity) + 1 year)\n\t\twhen choice is Timing then\n      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>\n\t\telse\n\t\t\tnull as Interval<DateTime>\n\tend"
            },
            {
              "url": "displaySequence",
              "valueInteger": 70
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "PCMaternal"
            },
            {
              "url": "name",
              "valueString": "hospitalizationWithEDOBTriageObservation"
            },
            {
              "url": "statement",
              "valueString": "define fluent function hospitalizationWithEDOBTriageObservation (TheEncounter Encounter ):\n  /*hospitalizationWithEDOBTriageObservation returns the total interval from the start of any immediately prior emergency department visit or OB Triage visit through the observation visit to the discharge of the given encounter*/\n  TheEncounter Visit\n    let ObsVisit: Last([\"Encounter\": \"Observation Services\"] LastObs\n        where LastObs.period ends 1 hour or less on or before start of Visit.period\n          and LastObs.status = 'finished'\n        sort by \n        end of period\n    ),\n    VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n    EDOBTriageVisit: Last([\"Encounter\": \"ED Visit and OB Triage\"] LastEDOBTriage\n        where LastEDOBTriage.period ends 1 hour or less on or before VisitStart\n          and LastEDOBTriage.status = 'finished'\n        sort by \n        end of period\n    )\n    return Interval[Coalesce(start of EDOBTriageVisit.period, VisitStart), \n    end of Visit.period]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 71
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "PCMaternal"
            },
            {
              "url": "name",
              "valueString": "calculatedGestationalAge"
            },
            {
              "url": "statement",
              "valueString": "define fluent function calculatedGestationalAge (TheEncounter Encounter ):\n  //Gestational Age = (280 -(Estimated Delivery Date minus Reference Date/Delivery Date))/7\n ( 280 - ( difference in days between TheEncounter.lastTimeOfDelivery () and TheEncounter.lastEstimatedDeliveryDate( )) ) div 7"
            },
            {
              "url": "displaySequence",
              "valueInteger": 72
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "PCMaternal"
            },
            {
              "url": "name",
              "valueString": "lastTimeOfDelivery"
            },
            {
              "url": "statement",
              "valueString": "define fluent function lastTimeOfDelivery (TheEncounter Encounter ):\n  Last([\"SimpleObservation\": \"Date and time of obstetric delivery\"] TimeOfDelivery\n      where TimeOfDelivery.value as DateTime is not null\n        and TimeOfDelivery.status in { 'final', 'amended', 'corrected' }\n        and TimeOfDelivery.effective.earliest () during TheEncounter.hospitalizationWithEDOBTriageObservation ()\n        and TimeOfDelivery.value as DateTime during TheEncounter.hospitalizationWithEDOBTriageObservation()\n      sort by effective.earliest()\n  ).value as DateTime"
            },
            {
              "url": "displaySequence",
              "valueInteger": 73
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-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": 74
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "hasStart"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Given an interval, return true if the interval has a starting boundary specified\n(i.e. the start of the interval is not null and not the minimum DateTime value)\n*/\ndefine fluent function hasStart(period Interval<DateTime> ):\n  not ( start of period is null\n      or start of period = minimum DateTime\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 75
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "PCMaternal"
            },
            {
              "url": "name",
              "valueString": "lastEstimatedDeliveryDate"
            },
            {
              "url": "statement",
              "valueString": "define fluent function lastEstimatedDeliveryDate (TheEncounter Encounter ):\n  /*This function identifies the last time the EDD was assessed 42 weeks or less prior to or on delivery and stores the result of that assessment.*/\n  Last([\"SimpleObservation\": \"Delivery date Estimated\"] EstimatedDateOfDelivery\n      where EstimatedDateOfDelivery.value as DateTime is not null\n        and EstimatedDateOfDelivery.status in { 'final', 'amended', 'corrected' }\n        and EstimatedDateOfDelivery.effective.earliest ( ) 42 weeks or less before or on TheEncounter.lastTimeOfDelivery ()\n      sort by effective.earliest ( )\n  ).value as DateTime"
            },
            {
              "url": "displaySequence",
              "valueInteger": 76
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "PCMaternal"
            },
            {
              "url": "name",
              "valueString": "lastEstimatedGestationalAge"
            },
            {
              "url": "statement",
              "valueString": "define fluent function lastEstimatedGestationalAge (TheEncounter Encounter ):\n  Last([\"SimpleObservation\": \"Estimated Gestational Age at Delivery\"] EstimatedGestationalAge\n  let EGATiming:  EstimatedGestationalAge.effective.earliest() where \n  (EGATiming 24 hours or less before or on TheEncounter.lastTimeOfDelivery () \n  and EstimatedGestationalAge.value is not null \n  and EstimatedGestationalAge.status in { 'final', 'amended', 'corrected' }) or \n      (EGATiming same day as TheEncounter.lastTimeOfDelivery () \n      and EGATiming during TheEncounter.hospitalizationWithEDOBTriageObservation() \n      and EstimatedGestationalAge.value is not null)\n sort by effective.earliest ())\n         .value as Quantity"
            },
            {
              "url": "displaySequence",
              "valueInteger": 77
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "encounterDiagnosis"
            },
            {
              "url": "statement",
              "valueString": "/*  \n@description: Returns the Condition resources referenced by the diagnosis element of the Encounter  \n*/\ndefine fluent function encounterDiagnosis(Encounter Encounter ):\n  Encounter.reasonReference D\n    return singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where D.references(C.id))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 78
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "references"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given reference is to the given resourceId\n@comment: Returns true if the `resourceId` parameter exactly equals the tail of the given reference.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(reference Reference, resourceId String):\n  resourceId = Last(Split(reference.reference, '/'))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 79
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "isDiagnosisPresentOnAdmission"
            },
            {
              "url": "statement",
              "valueString": "/*\n @description: Returns true if the given diagnosis is present on admission, based on the given poaValueSet\n @comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information\n */\n define fluent function isDiagnosisPresentOnAdmission(encounter Encounter, diagnosisValueSet ValueSet, poaValueSet ValueSet):\n   exists (\n     (encounter.claimDiagnosis()) CD\n       where CD.onAdmission in poaValueSet\n         and (\n           CD.diagnosis in diagnosisValueSet\n             or CD.diagnosis.getCondition().code in diagnosisValueSet\n         )\n   )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 80
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "claimDiagnosis"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns the claim diagnosis elements for the given encounter\n@comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information\n*/\ndefine fluent function claimDiagnosis(encounter Encounter):\n  encounter E\n    let \n      claim: ([Claim] C where C.status = 'active' and C.use = 'claim' and exists (C.item I where I.encounter.references(E))),\n      claimItem: (claim.item I where I.encounter.references(E))\n    return claim.diagnosis D where D.sequence in claimItem.diagnosisSequence"
            },
            {
              "url": "displaySequence",
              "valueInteger": 81
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "references"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if any of the given references are to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(references List<Reference>, resource Resource):\n  exists (references R where R.references(resource))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 82
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "references"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given reference is to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(reference Reference, resource Resource):\n  resource.id = Last(Split(reference.reference, '/'))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 83
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "getCondition"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns the Condition resource for the given reference\n*/\ndefine fluent function getCondition(reference Reference):\n  singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where reference.references(C.id))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 84
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value uri): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 85
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-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": 86
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "pOAIsNoOrUTD"
            },
            {
              "url": "statement",
              "valueString": "define fluent function pOAIsNoOrUTD(TheEncounter Encounter):\n  ( TheEncounter.claimDiagnosis ( ) ) CDiagnoses\n    where CDiagnoses.onAdmission in \"Present on Admission is No or Unable To Determine\"\n    return CDiagnoses.diagnosis"
            },
            {
              "url": "displaySequence",
              "valueInteger": 87
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToConcept"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 88
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "sOCDxCategory"
            },
            {
              "url": "statement",
              "valueString": "define fluent function sOCDxCategory(Dx Concept):\n  case\n    when Dx in \"Acute Heart Failure\" then 'Acute Heart Failure'\n    when Dx in \"Acute Myocardial Infarction\" then 'Acute Myocardial Infarction'\n    when Dx in \"Acute Renal Failure\" then 'Acute Renal Failure'\n    when Dx in \"Acute Respiratory Distress Syndrome\" then 'Acute Respiratory Distress Syndrome'\n    when Dx in \"Air and Thrombotic Embolism\" then 'Air and Thrombotic Embolism'\n    when Dx in \"Amniotic Fluid Embolism\" then 'Amniotic Fluid Embolism'\n    when Dx in \"Aortic Aneurysm\" then 'Aortic Aneurysm'\n    when Dx in \"Cardiac Arrest Ventricular Fibrillation\" then 'Cardiac Arrest Ventricular Fibrillation'\n    when Dx in \"Disseminated Intravascular Coagulation\" then 'Disseminated Intravascular Coagulation'\n    when Dx in \"Eclampsia\" then 'Eclampsia'\n    when Dx in \"Heart Failure Cardiac Arrest Related to Procedure or Surgery\" then 'Heart Failure Cardiac Arrest Related to Procedure or Surgery'\n    when Dx in \"Puerperal Cerebrovascular Disorder\" then 'Puerperal Cerebrovascular Disorder'\n    when Dx in \"Pulmonary Edema\" then 'Pulmonary Edema'\n    when Dx in \"Sepsis\" then 'Sepsis'\n    when Dx in \"Severe Anesthesia Complications\" then 'Severe Anesthesia Complications'\n    when Dx in \"Shock\" then 'Shock'\n    when Dx in \"Sickle Cell Disease with Crisis\" then 'Sickle Cell Disease with Crisis' \n    else null end"
            },
            {
              "url": "displaySequence",
              "valueInteger": 89
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "sOCProcedures"
            },
            {
              "url": "statement",
              "valueString": "define fluent function sOCProcedures(TheEncounter Encounter):\n  ( [\"Procedure\": \"Severe Maternal Morbidity Procedures\"]\n    union [\"Procedure\": \"Blood Transfusion\"] ) SMMProcedures\n    where SMMProcedures.status = 'completed'\n      and SMMProcedures.performed.toInterval ( ) starts during TheEncounter.hospitalizationWithEDOBTriageObservation ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 90
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS1028FHIRPCSevereOBComps"
            },
            {
              "url": "name",
              "valueString": "sOCProcedureCategory"
            },
            {
              "url": "statement",
              "valueString": "define fluent function sOCProcedureCategory(TheProcedure Procedure):\n  case\n    when TheProcedure.code in \"Blood Transfusion\" then 'Blood Transfusion'\n    when TheProcedure.code in \"Conversion of Cardiac Rhythm\" then 'Conversion of cardiac rhythm'\n    when TheProcedure.code in \"Hysterectomy\" then 'Hysterectomy'\n    when TheProcedure.code in \"Tracheostomy\" then 'Tracheostomy'\n    when TheProcedure.code in \"Ventilation\" then 'Ventilation' \n    else null end"
            },
            {
              "url": "displaySequence",
              "valueInteger": 91
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        }
      ],
      "name": "EffectiveDataRequirements",
      "status": "active",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/library-type",
            "code": "module-definition"
          }
        ]
      },
      "relatedArtifact": [
        {
          "type": "depends-on",
          "display": "Library PCMaternal",
          "resource": "https://madie.cms.gov/Library/PCMaternal|5.25.000"
        },
        {
          "type": "depends-on",
          "display": "Library CQMCommon",
          "resource": "https://madie.cms.gov/Library/CQMCommon|4.1.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "https://madie.cms.gov/Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library QICoreCommon",
          "resource": "https://madie.cms.gov/Library/QICoreCommon|4.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library SDE",
          "resource": "https://madie.cms.gov/Library/SupplementalDataElements|5.1.000"
        },
        {
          "type": "depends-on",
          "display": "Code system LOINC",
          "resource": "http://loinc.org"
        },
        {
          "type": "depends-on",
          "display": "Code system Present On Admission Indicators",
          "resource": "https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Coding"
        },
        {
          "type": "depends-on",
          "display": "Code system SNOMEDCT",
          "resource": "http://snomed.info/sct"
        },
        {
          "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 Delivery Procedures",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.59"
        },
        {
          "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 ED Visit and OB Triage",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.369"
        },
        {
          "type": "depends-on",
          "display": "Value set Estimated Gestational Age at Delivery",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.26"
        },
        {
          "type": "depends-on",
          "display": "Value set 20 to 42 Plus Weeks Gestation",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.67"
        },
        {
          "type": "depends-on",
          "display": "Value set Acute or Persistent Asthma",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.271"
        },
        {
          "type": "depends-on",
          "display": "Value set Present On Admission is Yes or Exempt",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.63"
        },
        {
          "type": "depends-on",
          "display": "Value set Placenta Accreta",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.302"
        },
        {
          "type": "depends-on",
          "display": "Value set Placenta Increta or Percreta",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.388"
        },
        {
          "type": "depends-on",
          "display": "Value set Hypertension",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.332"
        },
        {
          "type": "depends-on",
          "display": "Value set Preterm Birth",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.299"
        },
        {
          "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 Placental Abruption",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.305"
        },
        {
          "type": "depends-on",
          "display": "Value set Morbid or Severe Obesity",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.290"
        },
        {
          "type": "depends-on",
          "display": "Value set Preexisting Diabetes",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.275"
        },
        {
          "type": "depends-on",
          "display": "Value set Bariatric Surgery",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.317"
        },
        {
          "type": "depends-on",
          "display": "Value set Placenta Previa",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.78"
        },
        {
          "type": "depends-on",
          "display": "Value set Bleeding Disorder",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.287"
        },
        {
          "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 Anemia",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.323"
        },
        {
          "type": "depends-on",
          "display": "Value set Severe Preeclampsia",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.327"
        },
        {
          "type": "depends-on",
          "display": "Value set Cardiac Disease",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.341"
        },
        {
          "type": "depends-on",
          "display": "Value set Long Term Anticoagulant Use",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.366"
        },
        {
          "type": "depends-on",
          "display": "Value set Severe Maternal Morbidity Diagnoses",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.255"
        },
        {
          "type": "depends-on",
          "display": "Value set Present on Admission is No or Unable To Determine",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.370"
        },
        {
          "type": "depends-on",
          "display": "Value set Severe Maternal Morbidity Procedures",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.256"
        },
        {
          "type": "depends-on",
          "display": "Value set Patient Expired",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309"
        },
        {
          "type": "depends-on",
          "display": "Value set Blood Transfusion",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.213"
        },
        {
          "type": "depends-on",
          "display": "Value set Hysterectomy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.358"
        },
        {
          "type": "depends-on",
          "display": "Value set Conversion of Cardiac Rhythm",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.357"
        },
        {
          "type": "depends-on",
          "display": "Value set Tracheostomy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.359"
        },
        {
          "type": "depends-on",
          "display": "Value set Ventilation",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.360"
        },
        {
          "type": "depends-on",
          "display": "Value set Acute Heart Failure",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.233"
        },
        {
          "type": "depends-on",
          "display": "Value set Acute Myocardial Infarction",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.623"
        },
        {
          "type": "depends-on",
          "display": "Value set Acute Renal Failure",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.53"
        },
        {
          "type": "depends-on",
          "display": "Value set Acute Respiratory Distress Syndrome",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.214"
        },
        {
          "type": "depends-on",
          "display": "Value set Air and Thrombotic Embolism",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.243"
        },
        {
          "type": "depends-on",
          "display": "Value set Amniotic Fluid Embolism",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.217"
        },
        {
          "type": "depends-on",
          "display": "Value set Aortic Aneurysm",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.219"
        },
        {
          "type": "depends-on",
          "display": "Value set Cardiac Arrest Ventricular Fibrillation",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.221"
        },
        {
          "type": "depends-on",
          "display": "Value set Disseminated Intravascular Coagulation",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.223"
        },
        {
          "type": "depends-on",
          "display": "Value set Eclampsia",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.225"
        },
        {
          "type": "depends-on",
          "display": "Value set Heart Failure Cardiac Arrest Related to Procedure or Surgery",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.227"
        },
        {
          "type": "depends-on",
          "display": "Value set Puerperal Cerebrovascular Disorder",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.229"
        },
        {
          "type": "depends-on",
          "display": "Value set Pulmonary Edema",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.231"
        },
        {
          "type": "depends-on",
          "display": "Value set Sepsis",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.237"
        },
        {
          "type": "depends-on",
          "display": "Value set Severe Anesthesia Complications",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.235"
        },
        {
          "type": "depends-on",
          "display": "Value set Shock",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.239"
        },
        {
          "type": "depends-on",
          "display": "Value set Sickle Cell Disease with Crisis",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.241"
        },
        {
          "type": "depends-on",
          "display": "Value set Substance Abuse",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.320"
        },
        {
          "type": "depends-on",
          "display": "Value set Renal Disease",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.335"
        },
        {
          "type": "depends-on",
          "display": "Value set Gastrointestinal Disease",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.338"
        },
        {
          "type": "depends-on",
          "display": "Value set Pulmonary Hypertension",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.281"
        },
        {
          "type": "depends-on",
          "display": "Value set Mild or Moderate Preeclampsia",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.329"
        },
        {
          "type": "depends-on",
          "display": "Value set Thyrotoxicosis",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.296"
        },
        {
          "type": "depends-on",
          "display": "Value set Neuromuscular Disease",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.308"
        },
        {
          "type": "depends-on",
          "display": "Value set Economic Housing Instability",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.292"
        },
        {
          "type": "depends-on",
          "display": "Value set HIV in Pregnancy Childbirth and Puerperium",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.272"
        },
        {
          "type": "depends-on",
          "display": "Value set Mental Health Disorder",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.314"
        },
        {
          "type": "depends-on",
          "display": "Value set Venous Thromboembolism in Pregnancy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.363"
        },
        {
          "type": "depends-on",
          "display": "Value set Autoimmune Disease",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.311"
        },
        {
          "type": "depends-on",
          "display": "Value set Previous Cesarean",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.278"
        },
        {
          "type": "depends-on",
          "display": "Value set Gestational Diabetes",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.269"
        },
        {
          "type": "depends-on",
          "display": "Value set Multiple Pregnancy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.284"
        }
      ],
      "parameter": [
        {
          "name": "Measurement Period",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "Period"
        },
        {
          "name": "SOC Excluding Blood Transfusions Only With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Initial Population",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Numerator",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Denominator",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Payer",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Race",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Resource"
        },
        {
          "name": "SDE Sex",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Coding"
        },
        {
          "name": "SDE SOC Diagnoses Detail",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Variable Calculated Gestational Age",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Delivery Encounters With Severe Obstetric Complication Procedures",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Delivery Encounters With Severe Obstetric Complication Diagnosis",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE SOC Procedure Detail",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Ethnicity",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Asthma",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Placental Accreta Spectrum",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Hypertension",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Preterm Birth",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Placental Abruption",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Morbid Obesity",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Preexisting Diabetes",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Bariatric Surgery",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Placenta Previa",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Bleeding Disorder",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable First White Blood Cell Count Lab Test",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable First Hematocrit Lab Test",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Anemia",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Severe Preeclampsia",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Cardiac Disease",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Long Term Anticoagulant Use",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Systolic Blood Pressure",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Substance Abuse",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Renal Disease",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Gastrointestinal Disease",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Pulmonary Hypertension",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Other Preeclampsia",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Thyrotoxicosis",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Neuromuscular Disease",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Economic Housing Instability",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable HIV",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Maternal Age",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Heart Rate",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Mental Health Disorder",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Obstetrical VTE",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Autoimmune Disease",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Previous Cesarean",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Gestational Diabetes",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Risk Variable Multiple Pregnancy",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        }
      ],
      "dataRequirement": [
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status",
            "status.value",
            "onAdmission",
            "diagnosis",
            "diagnosis.code",
            "id",
            "id.value",
            "hospitalization",
            "hospitalization.dischargeDisposition"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status",
            "status.value",
            "onAdmission",
            "diagnosis",
            "diagnosis.code",
            "id",
            "id.value",
            "hospitalization",
            "hospitalization.dischargeDisposition"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.369"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "status",
            "status.value",
            "period",
            "onAdmission",
            "diagnosis",
            "diagnosis.code",
            "id",
            "id.value",
            "hospitalization",
            "hospitalization.dischargeDisposition"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
            }
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "birthDate",
            "birthDate.value",
            "url",
            "extension"
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "performed"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.59"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "performed"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.358"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "performed"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.357"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "performed"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.359"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "performed"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.360"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "performed"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.256"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "performed"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.213"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "performed"
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-simple-observation"
          ],
          "mustSupport": [
            "code",
            "value",
            "status",
            "status.value",
            "effective"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "93857-1",
                  "display": "Date and time of obstetric delivery"
                }
              ]
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-simple-observation"
          ],
          "mustSupport": [
            "code",
            "value",
            "status",
            "status.value",
            "effective"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "11778-8",
                  "display": "Delivery date Estimated"
                }
              ]
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-simple-observation"
          ],
          "mustSupport": [
            "code",
            "effective",
            "value",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.26"
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-simple-observation"
          ],
          "mustSupport": [
            "value"
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"
          ]
        },
        {
          "type": "Resource",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Resource"
          ],
          "mustSupport": [
            "id",
            "id.value"
          ]
        },
        {
          "type": "Claim",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim"
          ],
          "mustSupport": [
            "status",
            "status.value",
            "use",
            "use.value",
            "item"
          ]
        },
        {
          "type": "Coverage",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab"
          ],
          "mustSupport": [
            "code",
            "issued",
            "issued.value",
            "status",
            "status.value",
            "value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.129"
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab"
          ],
          "mustSupport": [
            "code",
            "issued",
            "issued.value",
            "status",
            "status.value",
            "value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.114"
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure"
          ],
          "mustSupport": [
            "effective",
            "status",
            "status.value",
            "component"
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate"
          ],
          "mustSupport": [
            "effective",
            "status",
            "status.value",
            "value"
          ]
        }
      ]
    }
  ],
  "extension": [
    {
      "id": "supplementalDataGuidance",
      "extension": [
        {
          "url": "guidance",
          "valueString": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex. No additional supplemental data elements are required to be submitted by reporting entities; all other needed data points are calculated following data receipt.\n\n \n "
        },
        {
          "url": "usage",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                "code": "supplemental-data",
                "display": "Supplemental Data"
              }
            ],
            "text": "Supplemental Data Guidance"
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance"
    },
    {
      "id": "riskAdjustmentVariableGuidance",
      "extension": [
        {
          "url": "guidance",
          "valueString": "The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov).\nPre-existing conditions and variables must be present on admission. Please note that present on admission codes may be extracted from billing/claims data that was entered by coding staff (Leonard, Kennedy, Carmichael, Lyell, & Main, 2020; Main, Leonard, & Menard, 2020).\n- Anemia (includes sickle cell disease)\n- Asthma \n- Autoimmune Disease\n- Bariatric Surgery\n- Bleeding Disorder\n- Cardiac Disease\n- Economic Housing Instability\n- Gastrointestinal Disease \n- Gestational Diabetes\n- HIV\n- Hypertension\n- Long-term Anticoagulant Use\n- Maternal Age (derived from birthdate)\n- Mental Health Disorder\n- Morbid Obesity\n- Multiple Pregnancy\t\n- Neuromuscular Disease\n- Obstetric VTE\n- Other Pre-eclampsia\n- Placenta Previa\n- Placental Abruption\n- Placental Accreta Spectrum\n- Pre-existing Diabetes \n- Preterm Birth\n- Previous Cesarean \n- Pulmonary Hypertension\n- Renal Disease \n- Severe Pre-eclampsia\n- Substance Abuse\n- Thyrotoxicosis \n\nLab and Physical Exam Results:\nReport the first resulted value 24 hours prior to start of encounter and before time of delivery in UCUM units specified:\n- Heart rate: {beats}/min\n- Systolic blood pressure: mm[Hg]\n- Hematocrit: %\n- White blood cell count: 10*3/uL \n\n\nNote regarding submission of risk variable data: The risk variable definitions are included in the specifications and risk variable data should be sent with eCQM data in the QRDA I file. Specific risk variable templates are not needed in the QRDA I files."
        },
        {
          "url": "usage",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                "code": "risk-adjustment-factor",
                "display": "Risk Adjustment Factor"
              }
            ],
            "text": "Risk Adjustment Variable Guidance"
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance"
    },
    {
      "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
      "valueReference": {
        "reference": "#effective-data-requirements"
      }
    }
  ],
  "url": "https://madie.cms.gov/Measure/CMS1028FHIRPCSevereOBComps",
  "identifier": [
    {
      "use": "usual",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "short-name",
            "display": "Short Name"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/shortName",
      "value": "CMS1028FHIR"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "version-independent",
            "display": "Version Independent"
          }
        ]
      },
      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:6cf03fe2-b962-4f83-ac37-26d7477183c7"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "version-specific",
            "display": "Version Specific"
          }
        ]
      },
      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:ef521536-8f48-4d2c-9892-745ba88a52fa"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "endorser",
            "display": "Endorser"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/cbeId",
      "value": "3687e",
      "assigner": {
        "display": "CMS Consensus Based Entity"
      }
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "publisher",
            "display": "Publisher"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/cmsId",
      "value": "1028FHIR",
      "assigner": {
        "display": "CMS"
      }
    }
  ],
  "version": "0.3.000",
  "name": "CMS1028FHIRPCSevereOBComps",
  "title": "Severe Obstetric ComplicationsFHIR",
  "status": "active",
  "experimental": false,
  "date": "2025-06-25T19:32:18+00:00",
  "publisher": "The Joint Commission",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "https://www.jointcommission.org/"
        }
      ]
    }
  ],
  "description": "Patients with severe obstetric complications that occur during the inpatient delivery hospitalization",
  "usage": "Note: This measure will be stratified by race/ethnicity and payer after measure submission.\n\nIn the case of multiple births, map the first delivery date/time (Baby A) as the delivery date/time for the encounter. This measure allows for 3 approaches to determine gestational age (GA) in the following order of precedence:\n\n1.  The GA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.*\n2.  When the calculated GA is not available, the GA is obtained from a discrete field in the electronic health record. The intent is to capture the last estimated GA in the interval starting 24 hours or less prior to delivery and ending before midnight on the same day of delivery.\n3.  The GA is based on ICD10 or SNOMED codes indicative of weeks gestation.  This option is only used when results from items #1 and #2 (see above) are not available.\n \n*ACOG ReVITALize Guidelines for Calculating Gestational Age (ACOG, 2014):      \n     \n               Gestational Age = (280-(Estimated Due Date minus Reference Date))/7\n\n--Estimated Due Date (EDD): The best obstetrical EDD is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (e.g., assisted reproductive technology) \n--Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery.   \n\nNote however the calculation may yield a non-whole number, and gestational age should be rounded down to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks.\n\nDefinition:\nFor this measure, specifications are modeled after the nationally available and adopted CDC definition for Severe Maternal Morbidity (SMM) with the addition of maternal mortality. At times, we may refer to the CDC indicators of morbidity as SMM, but the outcome of the measure, which includes morbidity and mortality, is referred to as Severe Obstetric Complications (SOC).\n\nThis eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.\n\nThis FHIR-based measure has been derived from the QDM-based measure CMS1028v4. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).",
  "copyright": "Measure specifications are in the Public Domain.\n\nLOINC(R) copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved.",
  "effectivePeriod": {
    "start": "2026-01-01",
    "end": "2026-12-31"
  },
  "author": [
    {
      "name": "The Joint Commission",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.jointcommission.org/"
        }
      ]
    },
    {
      "name": "Centers for Medicare & Medicaid Services (CMS)",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.cms.gov/"
        }
      ]
    },
    {
      "name": "Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation",
      "telecom": [
        {
          "system": "url",
          "value": "https://medicine.yale.edu/core/"
        }
      ]
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
      "citation": "CITATION - Centers for Disease Control and Prevention. Severe maternal morbidity in the United States. January 31, 2020; https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html\n"
    },
    {
      "type": "citation",
      "citation": "CITATION - Leonard SA, Main EK, Scott KA, Profit J, Carmichael SL. Racial and ethnic disparities in severe maternal morbidity prevalence and trends. Ann Epidemiol. 2019 Feb 28. pii: S1047-2797(18)30899-8.\n"
    },
    {
      "type": "citation",
      "citation": "CITATION - Leonard SA, Main EK, Carmichael SL. The contribution of maternal characteristics and cesarean delivery to an increasing trend of severe maternal morbidity. BMC Pregnancy Childbirth. BMC Pregnancy Childbirth. 2019 Jan 9;19(1):16. doi: 10.1186/s12884-018-2169-3.\n"
    },
    {
      "type": "citation",
      "citation": "CITATION - American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. (2016, September 01). Severe maternal morbidity: Screening and review. American Journal of Obstetrics & Gynecology, 215(3), B17-B22. http://dx.doi.org/https://doi.org/10.1016/j.ajog.2016.07.050\n"
    },
    {
      "type": "citation",
      "citation": "CITATION - Office of Disease Prevention and Health Promotion. (n.d.). Reduce severe maternal complications identified during delivery hospitalization- MICH-05. Retrieved from https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/reduce-severe-maternal-complications-identified-during-delivery-hospitalizations-mich-05\n"
    },
    {
      "type": "citation",
      "citation": "CITATION - Leonard, S. A., Kennedy, C. J., Carmichael, S. L., Lyell, D. J., & Main, E. K. (2020). An Expanded Obstetric Comorbidity Scoring System for Predicting Severe Maternal Morbidity. Obstetrics and gynecology, 136(3), 440-449. https://doi.org/10.1097/AOG.0000000000004022\n"
    },
    {
      "type": "citation",
      "citation": "CITATION - Main, E. K., Leonard, S. A., & Menard, M. K. (2020). Association of Maternal Comorbidity With Severe Maternal Morbidity: A Cohort Study of California Mothers Delivering Between 1997 and 2014. Annals of internal medicine, 173(11 Suppl), S11-S18. https://doi.org/10.7326/M19-3253\n"
    },
    {
      "type": "citation",
      "citation": "CITATION - U.S. Department of Health and Human Services. HHS Outlines New Plans and a Partnership to Reduce U.S. Pregnancy-related Deaths. 2020; https://www.hhs.gov/about/news/2020/12/03/hhs-outlines-new-plans-to-reduce-us-pregnancy-related-deaths.html.\n"
    },
    {
      "type": "citation",
      "citation": "CITATION - Hoyert DL, Miniño AM. Maternal mortality in the United States: changes in coding, publication, and data release, 2018. National Vital Statistics Report, 69(2), 2020.\n"
    }
  ],
  "library": [
    "https://madie.cms.gov/Library/CMS1028FHIRPCSevereOBComps"
  ],
  "disclaimer": "These performance measures 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 without warranty.",
  "rationale": "The United States (US) experiences higher rates of maternal morbidity and mortality than most other developed countries. The Centers for Disease Control and Prevention (CDC) (2021) report that these rates have continued to trend upward in recent decades. Research indicates that the overall rate of severe maternal morbidity (SMM) increased by almost 200% between 1993 and 2014 to 144 per 10,000 delivery hospitalizations (CDC, 2021), with more than 25,000 women per year experiencing obstetric complications (U.S. Department of Health and Human Services, 2020). Recent maternal mortality data from 2018 reveal that 658 women in the US died from maternal causes, resulting in a rate of 17.4 deaths per 100,000 live births, with 77% of the deaths attributed to direct obstetric causes like hemorrhage, preeclampsia, obstetric embolism, and other complications (Hoyert & Minino, 2020). 144 per 10,000 women hospitalized for delivery have experienced SMM, including hemorrhage, embolism, hypertension, stroke, and other serious complications (CDC, 2021). Racial and ethnic disparities exist: Black women and Hispanic women are at a significantly higher risk for developing these complications than are Non-Hispanic White women (Leonard, Main, Scott, Profit, & Carmichael, 2019). Increasing rates of SMM are resulting in increased healthcare costs, longer hospitalization stays and impacts on a woman's health (Callaghan, Creanga, & Kuklina, 2012). \n\nThere is limited national evaluation of hospitals' performance on maternal morbidity and mortality although SMM is widely used at the population level. SMM is linked to maternal mortality, varies significantly among hospitals, and has significant racial/ethnic and urban/rural disparities. SMM is a cost driver for both Medicaid and commercial plans. This measure is important as it will assist in the discovery and understanding of SMM patterns that can lead to improvements in the safety and quality of maternal care necessary to reduce SMM rates.",
  "clinicalRecommendationStatement": "Healthy People 2030 Measure (MICH-05): Reduce severe maternal complications identified during delivery hospitalizations (U.S. Department of Health and Human Services, n.d.).\n\nThe American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine recommend identifying potential cases of severe maternal morbidity for further review, with a focus on outcomes and complications, and consider this an important step toward promoting safe obstetric care (American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Kilpatrick, & Ecker, 2016).",
  "group": [
    {
      "id": "Group_1",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
                "code": "proportion",
                "display": "Proportion"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
          "valueCode": "Encounter"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-type",
                "code": "outcome",
                "display": "Outcome"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode": "Two hospital-level measure scores are calculated as a risk-adjusted proportion reported as a rate per 10,000 delivery hospitalizations:  1. All Severe Obstetric Complications (SOC).      ((Numerator of Population Criteria 1 – Numerator Exclusions of Population Criteria 1) / Denominator) * 10,000  2. SOC excluding encounters where transfusion was the only SOC.      ((Numerator of Population Criteria 2 – Numerator Exclusions of Population Criteria 2) / Denominator) * 10,000  Numerator of Population Criteria 1: Delivery encounters with SOC Numerator of Population Criteria 2: Delivery encounters with SOC excluding encounters where transfusion was the only SOC Numerator Exclusions of Population Criteria 1: Delivery encounters with blood transfusion or hysterectomy with placenta percreta or placenta increta and no additional SOCs Numerator Exclusions of Population Criteria 2: Delivery encounters with SOC excluding encounters where transfusion was the only SOC with a hysterectomy or blood transfusion with a diagnosis of placenta percreta or placenta increta and no additional SOCs  Denominator: Delivery encounters with > or = 20 weeks' gestation completed"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "decrease",
                "display": "Decreased score indicates improvement"
              }
            ]
          }
        }
      ],
      "description": "All Severe Obstetric Complications (SOC)",
      "population": [
        {
          "id": "InitialPopulation_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Population Criteria 1, Initial Population: Inpatient hospitalizations for patients age greater than or equal to 8 years and less than 65 admitted to the hospital for inpatient acute care who undergo a delivery procedure with a discharge date during the measurement period",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "Denominator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator",
                "display": "Denominator"
              }
            ]
          },
          "description": "Population Criteria 1, Denominator: Inpatient hospitalizations for patients delivering stillborn or live birth with greater than or equal to 20 weeks, 0 days gestation completed",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator"
          }
        },
        {
          "id": "Numerator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator",
                "display": "Numerator"
              }
            ]
          },
          "description": "Population Criteria 1, Numerator: All Severe Obstetric Complications (SOC).\n\nInpatient hospitalizations for patients with severe obstetric complications (not present on admission that occur during the current delivery encounter) including the following: \n- Severe maternal morbidity diagnoses (see list below)\n- Severe maternal morbidity procedures (see list below)\n- Discharge disposition of expired\nPlease note that present on admission codes may be extracted from billing/claims data that was entered by coding staff.\n\nSevere Maternal Morbidity Diagnoses:\n-  Cardiac\n\t          Acute heart failure \n\t          Acute myocardial infarction\n\t          Aortic aneurysm\n\t          Cardiac arrest/ventricular fibrillation\n\t          Heart failure/arrest during procedure or surgery\n-  Hemorrhage\n\t          Disseminated intravascular coagulation\n\t          Shock\n-  Renal\n                  Acute renal failure\n-  Respiratory\n\t          Adult respiratory distress syndrome\n\t          Pulmonary edema\n-  Sepsis\n-  Other OB\n\t          Air and thrombotic embolism\n\t          Amniotic fluid embolism\n\t          Eclampsia\n\t          Severe anesthesia complications\n-  Other Medical\n\t          Puerperal cerebrovascular disorder\n\t          Sickle cell disease with crisis\n\nSevere Maternal Morbidity Procedures:\n-  Blood transfusion\n-  Conversion of cardiac rhythm\n-  Hysterectomy\n-  Temporary tracheostomy\n-  Ventilation\n",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        },
        {
          "id": "NumeratorExclusion_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator-exclusion",
                "display": "Numerator Exclusion"
              }
            ]
          },
          "description": "Population Criteria 1, Numerator Exclusion: Inpatient hospitalizations with blood transfusion or hysterectomy with a diagnosis of placenta percreta or placenta increta and no additional severe obstetrical complications",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "SOC with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC"
          }
        }
      ]
    },
    {
      "id": "Group_2",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
                "code": "proportion",
                "display": "Proportion"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
          "valueCode": "Encounter"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-type",
                "code": "outcome",
                "display": "Outcome"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode": "Two hospital-level measure scores are calculated as a risk-adjusted proportion reported as a rate per 10,000 delivery hospitalizations:  1. All Severe Obstetric Complications (SOC).      ((Num1 – NumExcl1) / Den) * 10,000 2. SOC excluding encounters where transfusion was the only SOC.      ((Num2 – NumExcl2) / Den) * 10,000  Num1: Delivery encounters with SOC Num2: Delivery encounters with SOC excluding encounters where transfusion was the only SOC NumExcl1: Delivery encounters with blood transfusion or hysterectomy with placenta percreta or placenta increta and no additional SOCs NumExcl2: Delivery encounters with SOC excluding encounters where transfusion was the only SOC with a hysterectomy or blood transfusion with a diagnosis of placenta percreta or placenta increta and no additional SOCs Den: Delivery encounters with > or = 20 weeks' gestation completed"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "decrease",
                "display": "Decreased score indicates improvement"
              }
            ]
          }
        }
      ],
      "description": "SOC excluding encounters where transfusion was the only SOC",
      "population": [
        {
          "id": "InitialPopulation_2",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Population Criteria 2, Initial Population: Same initial population as Population Criteria 1",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "Denominator_2",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator",
                "display": "Denominator"
              }
            ]
          },
          "description": "Population Criteria 2, Denominator: Same denominator population as Population Criteria 1",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator"
          }
        },
        {
          "id": "Numerator_2",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator",
                "display": "Numerator"
              }
            ]
          },
          "description": "Population Criteria 2, Numerator: Delivery encounters with SOC excluding encounters where transfusion was the only SOC.\n\nInpatient hospitalizations for patients with severe obstetric complications (not present on admission that occur during the current delivery encounter) including severe maternal morbidity diagnoses (see following list), severe maternal morbidity procedures (see following list), and discharge disposition of expired, yet excluding encounters where transfusion was the only SOC. \nPlease note that present on admission codes may be those entered by coding staff, extracted from billing/claims data.\n\nSevere Maternal Morbidity Diagnoses:\n-  Cardiac\n\t          Acute heart failure \n\t          Acute myocardial infarction\n\t          Aortic aneurysm\n\t          Cardiac arrest/ventricular fibrillation\n\t          Heart failure/arrest during procedure or surgery\n-  Hemorrhage\n\t          Disseminated intravascular coagulation\n\t          Shock\n-  Renal\n                  Acute renal failure\n-  Respiratory\n\t          Adult respiratory distress syndrome\n\t          Pulmonary edema\n-  Sepsis\n-  Other OB\n\t          Air and thrombotic embolism\n\t          Amniotic fluid embolism\n\t          Eclampsia\n\t          Severe anesthesia complications\n-  Other Medical\n\t          Puerperal cerebrovascular disorder\n\t          Sickle cell disease with crisis\n\nSevere Maternal Morbidity Procedures:\n-  Blood transfusion\n-  Conversion of cardiac rhythm\n-  Hysterectomy\n-  Temporary tracheostomy\n-  Ventilation",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only"
          }
        },
        {
          "id": "NumeratorExclusion_2",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator-exclusion",
                "display": "Numerator Exclusion"
              }
            ]
          },
          "description": "Population Criteria 2, Numerator Exclusion: Inpatient hospitalizations with SOC excluding encounters where transfusion was the only SOC with a hysterectomy or blood transfusion with a diagnosis of placenta percreta or placenta increta and no additional severe obstetrical complications",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "SOC Excluding Blood Transfusions Only With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC"
          }
        }
      ]
    }
  ],
  "supplementalData": [
    {
      "id": "sde-ethnicity",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "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",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "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",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "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",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Sex",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Sex"
      }
    },
    {
      "id": "sde-delivery-encounters-with-severe-obstetric-complication-diagnosis",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Delivery Encounters With Severe Obstetric Complication Diagnosis",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Delivery Encounters With Severe Obstetric Complication Diagnosis"
      }
    },
    {
      "id": "sde-soc-diagnoses-detail",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE SOC Diagnoses Detail",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE SOC Diagnoses Detail"
      }
    },
    {
      "id": "sde-soc-procedure-detail",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE SOC Procedure Detail",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE SOC Procedure Detail"
      }
    },
    {
      "id": "sde-variable-calculated-gestational-age",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Variable Calculated Gestational Age",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Variable Calculated Gestational Age"
      }
    },
    {
      "id": "sde-delivery-encounters-with-severe-obstetric-complication-procedures",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Delivery Encounters With Severe Obstetric Complication Procedures",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Delivery Encounters With Severe Obstetric Complication Procedures"
      }
    },
    {
      "id": "risk-variable-anemia",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Anemia",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Anemia"
      }
    },
    {
      "id": "risk-variable-asthma",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Asthma",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Asthma"
      }
    },
    {
      "id": "risk-variable-autoimmune-disease",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Autoimmune Disease",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Autoimmune Disease"
      }
    },
    {
      "id": "risk-variable-bariatric-surgery",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Bariatric Surgery",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Bariatric Surgery"
      }
    },
    {
      "id": "risk-variable-bleeding-disorder",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Bleeding Disorder",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Bleeding Disorder"
      }
    },
    {
      "id": "risk-variable-cardiac-disease",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Cardiac Disease",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Cardiac Disease"
      }
    },
    {
      "id": "risk-variable-economic-housing-instability",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Economic Housing Instability",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Economic Housing Instability"
      }
    },
    {
      "id": "risk-variable-gastrointestinal-disease",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Gastrointestinal Disease",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Gastrointestinal Disease"
      }
    },
    {
      "id": "risk-variable-gestational-diabetes",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Gestational Diabetes",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Gestational Diabetes"
      }
    },
    {
      "id": "risk-variable-hiv",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable HIV",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable HIV"
      }
    },
    {
      "id": "risk-variable-hypertension",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Hypertension",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Hypertension"
      }
    },
    {
      "id": "risk-variable-long-term-anticoagulant-use",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Long Term Anticoagulant Use",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Long Term Anticoagulant Use"
      }
    },
    {
      "id": "risk-variable-maternal-age",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Maternal Age",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Maternal Age"
      }
    },
    {
      "id": "risk-variable-mental-health-disorder",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Mental Health Disorder",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Mental Health Disorder"
      }
    },
    {
      "id": "risk-variable-morbid-obesity",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Morbid Obesity",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Morbid Obesity"
      }
    },
    {
      "id": "risk-variable-multiple-pregnancy",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Multiple Pregnancy",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Multiple Pregnancy"
      }
    },
    {
      "id": "risk-variable-obstetrical-vte",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Obstetrical VTE",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Obstetrical VTE"
      }
    },
    {
      "id": "risk-variable-other-preeclampsia",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Other Preeclampsia",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Other Preeclampsia"
      }
    },
    {
      "id": "risk-variable-placenta-previa",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Placenta Previa",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Placenta Previa"
      }
    },
    {
      "id": "risk-variable-placental-abruption",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Placental Abruption",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Placental Abruption"
      }
    },
    {
      "id": "risk-variable-placental-accreta-spectrum",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Placental Accreta Spectrum",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Placental Accreta Spectrum"
      }
    },
    {
      "id": "risk-variable-preexisting-diabetes",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Preexisting Diabetes",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Preexisting Diabetes"
      }
    },
    {
      "id": "risk-variable-previous-cesarean",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Previous Cesarean",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Previous Cesarean"
      }
    },
    {
      "id": "risk-variable-pulmonary-hypertension",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Pulmonary Hypertension",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Pulmonary Hypertension"
      }
    },
    {
      "id": "risk-variable-renal-disease",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Renal Disease",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Renal Disease"
      }
    },
    {
      "id": "risk-variable-severe-preeclampsia",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Severe Preeclampsia",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Severe Preeclampsia"
      }
    },
    {
      "id": "risk-variable-substance-abuse",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Substance Abuse",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Substance Abuse"
      }
    },
    {
      "id": "risk-variable-thyrotoxicosis",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Thyrotoxicosis",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Thyrotoxicosis"
      }
    },
    {
      "id": "risk-variable-preterm-birth",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Preterm Birth",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Preterm Birth"
      }
    },
    {
      "id": "risk-variable-first-hematocrit-lab-test",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable First Hematocrit Lab Test",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable First Hematocrit Lab Test"
      }
    },
    {
      "id": "risk-variable-first-white-blood-cell-count-lab-test",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable First White Blood Cell Count Lab Test",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable First White Blood Cell Count Lab Test"
      }
    },
    {
      "id": "risk-variable-heart-rate",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Heart Rate",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Heart Rate"
      }
    },
    {
      "id": "risk-variable-systolic-blood-pressure",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Systolic Blood Pressure",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Systolic Blood Pressure"
      }
    },
    {
      "id": "risk-variable-neuromuscular-disease",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "Risk Variable Neuromuscular Disease",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Risk Variable Neuromuscular Disease"
      }
    }
  ]
}