FHIR IG Statistics: Measure/CMS104FHIRSTKDCAntithrombotic

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Narrative

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

define "Initial Population":
  TJC."Ischemic Stroke Encounter"

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  TJC."Ischemic Stroke Encounters With Discharge Disposition"
    union TJC."Encounter With Comfort Measures During Hospitalization"

define "Numerator":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with ["MedicationRequest": medication in "Antithrombotic Therapy for Ischemic Stroke"] DischargeAntithrombotic
      such that DischargeAntithrombotic.status in { 'active', 'completed' }
        and DischargeAntithrombotic.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and ( DischargeAntithrombotic.isCommunity ( )
            or DischargeAntithrombotic.isDischarge ( )
        )
        and DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period
        and not exists ( ["TaskRejected"] TaskReject
            where TaskReject.focus.references ( DischargeAntithrombotic )
              and TaskReject.code ~ "fulfill"
        )

define "Denominator Exceptions":
  "Encounter With Documented Reason For No Antithrombotic At Discharge"
    union "Encounter With Pharmacological Contraindications For Antithrombotic Therapy At Discharge"

define "Non Elective Inpatient Encounter With Age":
  ["Encounter": "Nonelective Inpatient Encounter"] NonElectiveEncounter
        where AgeInYearsAt(date from start of NonElectiveEncounter.period ) >= 18
         and NonElectiveEncounter.period ends during day of "Measurement Period"

define "Ischemic Stroke Encounter":
  "Non Elective Inpatient Encounter With Age" NonElectiveEncounterWithAge
   where NonElectiveEncounterWithAge.hasPrincipalDiagnosisOf("Ischemic Stroke" )

define "Ischemic Stroke Encounters With Discharge Disposition":
  "Ischemic Stroke Encounter" IschemicStrokeEncounter
  let DischDisp: IschemicStrokeEncounter.hospitalization.dischargeDisposition
  	where  DischDisp in "Discharge To Acute Care Facility"
		or DischDisp in "Left Against Medical Advice"
		or DischDisp in "Patient Expired"
		or DischDisp in "Discharged to Home for Hospice Care"
		or DischDisp in "Discharged to Health Care Facility for Hospice Care"

define "Intervention Comfort Measures":
  ( ["ServiceRequest": code in "Comfort Measures"] SR
    where SR.status in { 'active', 'completed', 'on-hold' }
      and SR.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
      and SR.doNotPerform is not true
  )  
  union ( ["Procedure": "Comfort Measures"] InterventionPerformed
        where InterventionPerformed.status in { 'completed', 'in-progress' }
  )

define "Encounter With Comfort Measures During Hospitalization":
  "Ischemic Stroke Encounter" IschemicStrokeEncounter
    with "Intervention Comfort Measures" ComfortMeasure
     such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during IschemicStrokeEncounter.hospitalizationWithObservation()

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

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

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

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

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

define "Numerator":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with ["MedicationRequest": medication in "Antithrombotic Therapy for Ischemic Stroke"] DischargeAntithrombotic
      such that DischargeAntithrombotic.status in { 'active', 'completed' }
        and DischargeAntithrombotic.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and ( DischargeAntithrombotic.isCommunity ( )
            or DischargeAntithrombotic.isDischarge ( )
        )
        and DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period
        and not exists ( ["TaskRejected"] TaskReject
            where TaskReject.focus.references ( DischargeAntithrombotic )
              and TaskReject.code ~ "fulfill"
        )

define "Initial Population":
  TJC."Ischemic Stroke Encounter"

define "Denominator":
  "Initial Population"

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

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

define "Denominator Exclusions":
  TJC."Ischemic Stroke Encounters With Discharge Disposition"
    union TJC."Encounter With Comfort Measures During Hospitalization"

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

define "Reason For Not Giving Antithrombotic At Discharge":
  ( ["MedicationNotRequested": "Antithrombotic Therapy for Ischemic Stroke"] NoAntithromboticDischarge
      where ( NoAntithromboticDischarge.reasonCode in "Medical Reason For Not Providing Treatment"
          or NoAntithromboticDischarge.reasonCode in "Patient Refusal"
      )
        and ( NoAntithromboticDischarge.isCommunity ( )
            or NoAntithromboticDischarge.isDischarge ( )
        )
        and NoAntithromboticDischarge.status in { 'active', 'completed' }
        and NoAntithromboticDischarge.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
  )
    union ( ["MedicationRequest": "Antithrombotic Therapy for Ischemic Stroke"] MedReqAntithrombotic
        with ["TaskRejected"] TaskReject
          such that TaskReject.focus.references ( MedReqAntithrombotic )
            and ( TaskReject.statusReason in "Medical Reason For Not Providing Treatment"
                or TaskReject.statusReason in "Patient Refusal"
            )
            and MedReqAntithrombotic.status = 'active'
            and TaskReject.code ~ "fulfill"
    )

define "Encounter With Documented Reason For No Antithrombotic At Discharge":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with "Reason For Not Giving Antithrombotic At Discharge" NoDischargeAntithrombotic
      such that NoDischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period

define "Pharmacological Contraindications For Antithrombotic Therapy At Discharge":
  ["MedicationRequest": medication in "Pharmacological Contraindications For Antithrombotic Therapy"] PharmacologicalContraindications
    where ( PharmacologicalContraindications.isCommunity ( )
        or PharmacologicalContraindications.isDischarge ( )
    )
      and PharmacologicalContraindications.status in { 'active', 'completed' }
      and PharmacologicalContraindications.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }

define "Encounter With Pharmacological Contraindications For Antithrombotic Therapy At Discharge":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with "Pharmacological Contraindications For Antithrombotic Therapy At Discharge" DischargePharmacological
      such that DischargePharmacological.authoredOn during IschemicStrokeEncounter.period

define "Denominator Exceptions":
  "Encounter With Documented Reason For No Antithrombotic At Discharge"
    union "Encounter With Pharmacological Contraindications For Antithrombotic Therapy At Discharge"

define function ToString(value uri): value.value

/*
@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]

/*
@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
        }

/*
@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: 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, '/'))

/*
@description: Returns true if the given code is in the given codeList
@comment: Returns true if the `code` is equivalent to any of the codes in the given `codeList`, false otherwise.
*/
define fluent function includesCode(codeList List<Concept>, code Code):
  exists (codeList C where C ~ code)

/*
@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 the given MedicationRequest has a category of Community
*/
define fluent function isCommunity(medicationRequest Choice<MedicationRequest, MedicationNotRequested>):
  exists (medicationRequest.category C
    where C ~ Community
  )

/*
@description: Returns true if the given MedicationRequest has a category of Discharge
*/
define fluent function isDischarge(medicationRequest Choice<MedicationRequest, MedicationNotRequested>):
  exists (medicationRequest.category C
    where C ~ Discharge
  )

/*
@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: Returns the condition that is specified as the principal diagnosis for the encounter and has a code in the given valueSet.
 @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 hasPrincipalDiagnosisOf(encounter Encounter, valueSet ValueSet):
   (encounter.principalDiagnosis()) PD
     return PD.diagnosis in valueSet
       or PD.diagnosis.getCondition().code in valueSet

/*
@description: Returns the claim diagnosis element that is specified as the principal diagnosis for the 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 principalDiagnosis(encounter Encounter):
singleton from (
     (encounter.claimDiagnosis()) CD
       where CD.type.includesCode("Principal Diagnosis")
   )

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

Source

{
  "resourceType": "Measure",
  "id": "CMS104FHIRSTKDCAntithrombotic",
  "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://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://terminology.hl7.org/CodeSystem/ex-diagnosistype",
            "code": "principal",
            "display": "Principal Diagnosis"
          }
        },
        {
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          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
            "code": "community",
            "display": "Community"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
            "code": "discharge",
            "display": "Discharge"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://hl7.org/fhir/CodeSystem/task-code",
            "code": "fulfill"
          }
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        {
          "extension": [
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              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
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            },
            {
              "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"
            },
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            },
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            }
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        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "TJCOverall"
            },
            {
              "url": "name",
              "valueString": "Non Elective Inpatient Encounter With Age"
            },
            {
              "url": "statement",
              "valueString": "define \"Non Elective Inpatient Encounter With Age\":\n  [\"Encounter\": \"Nonelective Inpatient Encounter\"] NonElectiveEncounter\n        where AgeInYearsAt(date from start of NonElectiveEncounter.period ) >= 18\n         and NonElectiveEncounter.period ends during day of \"Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "TJCOverall"
            },
            {
              "url": "name",
              "valueString": "Ischemic Stroke Encounter"
            },
            {
              "url": "statement",
              "valueString": "define \"Ischemic Stroke Encounter\":\n  \"Non Elective Inpatient Encounter With Age\" NonElectiveEncounterWithAge\n   where NonElectiveEncounterWithAge.hasPrincipalDiagnosisOf(\"Ischemic Stroke\" )"
            },
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            }
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          "extension": [
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              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with [\"MedicationRequest\": medication in \"Antithrombotic Therapy for Ischemic Stroke\"] DischargeAntithrombotic\n      such that DischargeAntithrombotic.status in { 'active', 'completed' }\n        and DischargeAntithrombotic.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n        and ( DischargeAntithrombotic.isCommunity ( )\n            or DischargeAntithrombotic.isDischarge ( )\n        )\n        and DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period\n        and not exists ( [\"TaskRejected\"] TaskReject\n            where TaskReject.focus.references ( DischargeAntithrombotic )\n              and TaskReject.code ~ \"fulfill\"\n        )"
            },
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            }
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          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
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              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  TJC.\"Ischemic Stroke Encounter\""
            },
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              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
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          "extension": [
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              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
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        },
        {
          "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": 7
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "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": 9
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "TJCOverall"
            },
            {
              "url": "name",
              "valueString": "Ischemic Stroke Encounters With Discharge Disposition"
            },
            {
              "url": "statement",
              "valueString": "define \"Ischemic Stroke Encounters With Discharge Disposition\":\n  \"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n  let DischDisp: IschemicStrokeEncounter.hospitalization.dischargeDisposition\n  \twhere  DischDisp in \"Discharge To Acute Care Facility\"\n\t\tor DischDisp in \"Left Against Medical Advice\"\n\t\tor DischDisp in \"Patient Expired\"\n\t\tor DischDisp in \"Discharged to Home for Hospice Care\"\n\t\tor DischDisp in \"Discharged to Health Care Facility for Hospice Care\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "TJCOverall"
            },
            {
              "url": "name",
              "valueString": "Intervention Comfort Measures"
            },
            {
              "url": "statement",
              "valueString": "define \"Intervention Comfort Measures\":\n  ( [\"ServiceRequest\": code in \"Comfort Measures\"] SR\n    where SR.status in { 'active', 'completed', 'on-hold' }\n      and SR.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n      and SR.doNotPerform is not true\n  )  \n  union ( [\"Procedure\": \"Comfort Measures\"] InterventionPerformed\n        where InterventionPerformed.status in { 'completed', 'in-progress' }\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "TJCOverall"
            },
            {
              "url": "name",
              "valueString": "Encounter With Comfort Measures During Hospitalization"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Comfort Measures During Hospitalization\":\n  \"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with \"Intervention Comfort Measures\" ComfortMeasure\n     such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during IschemicStrokeEncounter.hospitalizationWithObservation()"
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Denominator Exclusions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exclusions\":\n  TJC.\"Ischemic Stroke Encounters With Discharge Disposition\"\n    union TJC.\"Encounter With Comfort Measures During Hospitalization\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "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": 15
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 16
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Reason For Not Giving Antithrombotic At Discharge"
            },
            {
              "url": "statement",
              "valueString": "define \"Reason For Not Giving Antithrombotic At Discharge\":\n  ( [\"MedicationNotRequested\": \"Antithrombotic Therapy for Ischemic Stroke\"] NoAntithromboticDischarge\n      where ( NoAntithromboticDischarge.reasonCode in \"Medical Reason For Not Providing Treatment\"\n          or NoAntithromboticDischarge.reasonCode in \"Patient Refusal\"\n      )\n        and ( NoAntithromboticDischarge.isCommunity ( )\n            or NoAntithromboticDischarge.isDischarge ( )\n        )\n        and NoAntithromboticDischarge.status in { 'active', 'completed' }\n        and NoAntithromboticDischarge.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n  )\n    union ( [\"MedicationRequest\": \"Antithrombotic Therapy for Ischemic Stroke\"] MedReqAntithrombotic\n        with [\"TaskRejected\"] TaskReject\n          such that TaskReject.focus.references ( MedReqAntithrombotic )\n            and ( TaskReject.statusReason in \"Medical Reason For Not Providing Treatment\"\n                or TaskReject.statusReason in \"Patient Refusal\"\n            )\n            and MedReqAntithrombotic.status = 'active'\n            and TaskReject.code ~ \"fulfill\"\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Encounter With Documented Reason For No Antithrombotic At Discharge"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Documented Reason For No Antithrombotic At Discharge\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with \"Reason For Not Giving Antithrombotic At Discharge\" NoDischargeAntithrombotic\n      such that NoDischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 18
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Pharmacological Contraindications For Antithrombotic Therapy At Discharge"
            },
            {
              "url": "statement",
              "valueString": "define \"Pharmacological Contraindications For Antithrombotic Therapy At Discharge\":\n  [\"MedicationRequest\": medication in \"Pharmacological Contraindications For Antithrombotic Therapy\"] PharmacologicalContraindications\n    where ( PharmacologicalContraindications.isCommunity ( )\n        or PharmacologicalContraindications.isDischarge ( )\n    )\n      and PharmacologicalContraindications.status in { 'active', 'completed' }\n      and PharmacologicalContraindications.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 19
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Encounter With Pharmacological Contraindications For Antithrombotic Therapy At Discharge"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Pharmacological Contraindications For Antithrombotic Therapy At Discharge\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with \"Pharmacological Contraindications For Antithrombotic Therapy At Discharge\" DischargePharmacological\n      such that DischargePharmacological.authoredOn during IschemicStrokeEncounter.period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 20
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Denominator Exceptions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exceptions\":\n  \"Encounter With Documented Reason For No Antithrombotic At Discharge\"\n    union \"Encounter With Pharmacological Contraindications For Antithrombotic Therapy At Discharge\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 21
            }
          ],
          "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": 22
            }
          ],
          "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": 23
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "hasPrincipalDiagnosisOf"
            },
            {
              "url": "statement",
              "valueString": "/*\n @description: Returns the condition that is specified as the principal diagnosis for the encounter and has a code in the given valueSet.\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 hasPrincipalDiagnosisOf(encounter Encounter, valueSet ValueSet):\n   (encounter.principalDiagnosis()) PD\n     return PD.diagnosis in valueSet\n       or PD.diagnosis.getCondition().code in valueSet"
            },
            {
              "url": "displaySequence",
              "valueInteger": 24
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "principalDiagnosis"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns the claim diagnosis element that is specified as the principal diagnosis for the 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 principalDiagnosis(encounter Encounter):\nsingleton from (\n     (encounter.claimDiagnosis()) CD\n       where CD.type.includesCode(\"Principal Diagnosis\")\n   )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 25
            }
          ],
          "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": 26
            }
          ],
          "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": 27
            }
          ],
          "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": 28
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "includesCode"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given code is in the given codeList\n@comment: Returns true if the `code` is equivalent to any of the codes in the given `codeList`, false otherwise.\n*/\ndefine fluent function includesCode(codeList List<Concept>, code Code):\n  exists (codeList C where C ~ code)"
            },
            {
              "url": "displaySequence",
              "valueInteger": 29
            }
          ],
          "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": 30
            }
          ],
          "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": 31
            }
          ],
          "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": 32
            }
          ],
          "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": 33
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "isCommunity"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given MedicationRequest has a category of Community\n*/\ndefine fluent function isCommunity(medicationRequest Choice<MedicationRequest, MedicationNotRequested>):\n  exists (medicationRequest.category C\n    where C ~ Community\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 34
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "isDischarge"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given MedicationRequest has a category of Discharge\n*/\ndefine fluent function isDischarge(medicationRequest Choice<MedicationRequest, MedicationNotRequested>):\n  exists (medicationRequest.category C\n    where C ~ Discharge\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 35
            }
          ],
          "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": 36
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "hospitalizationWithObservation"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter\n*/\ndefine fluent function hospitalizationWithObservation(TheEncounter Encounter ):\n  TheEncounter Visit\n  \t\tlet ObsVisit: Last([Encounter: \"Observation Services\"] LastObs\n  \t\t\t\twhere LastObs.status = 'finished'\n            and LastObs.period ends 1 hour or less on or before start of Visit.period\n  \t\t\t\tsort by end of period\n  \t\t\t),\n  \t\t\tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n  \t\t\tEDVisit: Last([Encounter: \"Emergency Department Visit\"] LastED\n  \t\t\t\twhere LastED.status = 'finished'\n            and LastED.period ends 1 hour or less on or before VisitStart\n  \t\t\t\tsort by end of period\n  \t\t\t)\n  \t\treturn Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 37
            }
          ],
          "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 SDE",
          "resource": "https://madie.cms.gov/Library/SupplementalDataElements|5.1.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "https://madie.cms.gov/Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library TJC",
          "resource": "https://madie.cms.gov/Library/TJCOverall|8.24.000"
        },
        {
          "type": "depends-on",
          "display": "Library CQMCommon",
          "resource": "https://madie.cms.gov/Library/CQMCommon|4.1.000"
        },
        {
          "type": "depends-on",
          "display": "Library QICoreCommon",
          "resource": "https://madie.cms.gov/Library/QICoreCommon|4.0.000"
        },
        {
          "type": "depends-on",
          "display": "Code system SNOMEDCT",
          "resource": "http://snomed.info/sct"
        },
        {
          "type": "depends-on",
          "display": "Code system Diagnosis Type",
          "resource": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"
        },
        {
          "type": "depends-on",
          "display": "Code system MedicationRequestCategory",
          "resource": "http://terminology.hl7.org/CodeSystem/medicationrequest-category"
        },
        {
          "type": "depends-on",
          "display": "Code system TaskCode",
          "resource": "http://hl7.org/fhir/CodeSystem/task-code"
        },
        {
          "type": "depends-on",
          "display": "Value set Nonelective Inpatient Encounter",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
        },
        {
          "type": "depends-on",
          "display": "Value set Ischemic Stroke",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247"
        },
        {
          "type": "depends-on",
          "display": "Value set Antithrombotic Therapy for Ischemic Stroke",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
        },
        {
          "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 Discharge To Acute Care Facility",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87"
        },
        {
          "type": "depends-on",
          "display": "Value set Left Against Medical Advice",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.308"
        },
        {
          "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 Discharged to Home for Hospice Care",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.209"
        },
        {
          "type": "depends-on",
          "display": "Value set Discharged to Health Care Facility for Hospice Care",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.207"
        },
        {
          "type": "depends-on",
          "display": "Value set Comfort Measures",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"
        },
        {
          "type": "depends-on",
          "display": "Value set Observation Services",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"
        },
        {
          "type": "depends-on",
          "display": "Value set Emergency Department Visit",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
        },
        {
          "type": "depends-on",
          "display": "Value set Medical Reason For Not Providing Treatment",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473"
        },
        {
          "type": "depends-on",
          "display": "Value set Patient Refusal",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93"
        },
        {
          "type": "depends-on",
          "display": "Value set Pharmacological Contraindications For Antithrombotic Therapy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52"
        }
      ],
      "parameter": [
        {
          "name": "Measurement Period",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "Period"
        },
        {
          "name": "Numerator",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Denominator",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Initial Population",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Denominator Exclusions",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Denominator Exceptions",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Sex",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Coding"
        },
        {
          "name": "SDE Payer",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Ethnicity",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Resource"
        },
        {
          "name": "SDE Race",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Resource"
        }
      ],
      "dataRequirement": [
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "extension",
            "url",
            "birthDate",
            "birthDate.value"
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "status",
            "status.value",
            "period",
            "diagnosis",
            "diagnosis.code"
          ],
          "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",
            "status",
            "status.value",
            "period",
            "diagnosis",
            "diagnosis.code"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "diagnosis",
            "diagnosis.code",
            "hospitalization",
            "hospitalization.dischargeDisposition"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
            }
          ]
        },
        {
          "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": "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": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
          ],
          "mustSupport": [
            "medication",
            "status",
            "status.value",
            "intent",
            "intent.value",
            "authoredOn",
            "authoredOn.value"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
            }
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
          ],
          "mustSupport": [
            "medication.reference.value",
            "status",
            "status.value"
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
          ],
          "mustSupport": [
            "medication",
            "status",
            "status.value",
            "intent",
            "intent.value",
            "authoredOn",
            "authoredOn.value"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52"
            }
          ]
        },
        {
          "type": "Task",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-taskrejected"
          ],
          "mustSupport": [
            "focus",
            "code",
            "statusReason"
          ]
        },
        {
          "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": "ServiceRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "intent",
            "intent.value",
            "doNotPerform",
            "doNotPerform.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"
            }
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationnotrequested"
          ],
          "mustSupport": [
            "medication",
            "reasonCode",
            "status",
            "status.value",
            "intent",
            "intent.value"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
            }
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationnotrequested"
          ],
          "mustSupport": [
            "medication",
            "reasonCode",
            "status",
            "status.value",
            "intent",
            "intent.value"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
            }
          ]
        },
        {
          "type": "Medication",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"
          ],
          "mustSupport": [
            "id.value",
            "code"
          ]
        }
      ]
    }
  ],
  "extension": [
    {
      "id": "supplementalDataGuidance",
      "extension": [
        {
          "url": "guidance",
          "valueString": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity-Patient's Ethnicity:\nHispanic or Latino\nNot Hispanic or Latino\n \n SDE Payer-Patient's Payer:\nCategories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system\n \n SDE Race-Patient's Race:\nNative Hawaiian or Other Pacific Islander\nAsian\nAmerican Indian or Alaska Native\nOther Race\nWhite\nBlack or African American\n \n SDE Sex-Patient's Sex:\nGender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.\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"
    },
    {
      "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
      "valueReference": {
        "reference": "#effective-data-requirements"
      }
    }
  ],
  "url": "https://madie.cms.gov/Measure/CMS104FHIRSTKDCAntithrombotic",
  "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": "CMS104FHIR"
    },
    {
      "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:4f57e4a2-097b-45f8-9c85-91b35ea92dc1"
    },
    {
      "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:3e24cf04-e7a8-4f7d-b9bc-3c3e3b1b39b6"
    },
    {
      "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": "104FHIR",
      "assigner": {
        "display": "CMS"
      }
    }
  ],
  "version": "0.9.003",
  "name": "CMS104FHIRSTKDCAntithrombotic",
  "title": "Discharged on Antithrombotic TherapyFHIR",
  "status": "active",
  "experimental": false,
  "date": "2025-06-20T21:30:13+00:00",
  "publisher": "The Joint Commission",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "https://www.jointcommission.org/"
        }
      ]
    }
  ],
  "description": "Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge",
  "usage": "The \"Nonelective Inpatient Encounter\" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the \"Inpatient encounter\" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions.\n\nThe \"Medication, Discharge\" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use.\n\nThe denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.\n\nThis dQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS104v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6. (https://hl7.org/fhir/us/qicore/STU6/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/"
        }
      ]
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
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    {
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      "citation": "CITATION - Adams, H. P., Jr., del Zoppo, G., Alberts, M. J., et al. (2007, May). Guidelines for the early management of adults with ischemic stroke: A guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Stroke, 38(5), 1655-1711. \n"
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    {
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    {
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    }
  ],
  "library": [
    "https://madie.cms.gov/Library/CMS104FHIRSTKDCAntithrombotic"
  ],
  "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 effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity if no contraindications exist.\n\n\nFor patients with a stroke due to a cardioembolic source (e.g., atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. In recent years, novel oral anticoagulant agents (NOACs) have been developed and approved by the U.S. Food and Drug Administration (FDA) for stroke prevention and may be considered as an alternative to warfarin for select patients. Anticoagulation therapy is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke\n\n\nAnticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or transient ischemic attack (TIA).",
  "clinicalRecommendationStatement": "Clinical trial results suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity if no contraindications exist",
  "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": "process",
                "display": "Process"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode": "None"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "increase",
                "display": "Increased score indicates improvement"
              }
            ]
          }
        }
      ],
      "description": "Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge",
      "population": [
        {
          "id": "InitialPopulation_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Inpatient hospitalizations (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke, ending 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": "Equals Initial Population",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator"
          }
        },
        {
          "id": "DenominatorExclusion_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator-exclusion",
                "display": "Denominator Exclusion"
              }
            ]
          },
          "description": "- Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations.\n- Inpatient hospitalizations for patients discharged to another hospital\n- Inpatient hospitalizations for patients who left against medical advice\n- Inpatient hospitalizations for patients who expired\n- Inpatient hospitalizations for patients discharged to home for hospice care\n- Inpatient hospitalizations for patients discharged to a health care facility for hospice care\n- Inpatient hospitalizations for patients with comfort measures documented",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator Exclusions"
          }
        },
        {
          "id": "Numerator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator",
                "display": "Numerator"
              }
            ]
          },
          "description": "Inpatient hospitalizations for patients prescribed or continuing to take antithrombotic therapy at hospital discharge",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        },
        {
          "id": "DenominatorException_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator-exception",
                "display": "Denominator Exception"
              }
            ]
          },
          "description": "- Inpatient hospitalizations for patients with a documented reason for not prescribing antithrombotic therapy at discharge\n- Inpatient hospitalizations for patients who receive Prasugrel as an antithrombotic therapy at discharge",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator Exceptions"
          }
        }
      ]
    }
  ],
  "supplementalData": [
    {
      "id": "sde-ethnicity",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Ethnicity",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Ethnicity"
      }
    },
    {
      "id": "sde-payer",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Payer",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Payer"
      }
    },
    {
      "id": "sde-race",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Race",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Race"
      }
    },
    {
      "id": "sde-sex",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Sex",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Sex"
      }
    }
  ]
}