| Package | gov.healthit.ecqi.ecqms |
| Resource Type | Measure |
| Id | CMS1056CTClinicalFHIR |
| FHIR Version | R4 |
| Source | http://ecqi.healthit.gov/ecqms/https://build.fhir.org/ig/cqframework/ecqm-content-qicore-2025/Measure-CMS1056CTClinicalFHIR.html |
| URL | https://madie.cms.gov/Measure/CMS1056CTClinicalFHIR |
| Version | 0.6.000 |
| Status | active |
| Date | 2025-06-26T19:30:10+00:00 |
| Name | CMS1056CTClinicalFHIR |
| Title | Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography in Adults - Clinician FHIR |
| Description | This measure provides a standardized method for monitoring the performance of diagnostic CT to discourage unnecessarily high radiation doses, a risk factor for cancer, while preserving image quality. It is expressed as a % of patients with CT exams that are out-of-range based on having either excessive radiation dose or inadequate image quality relative to evidence-based thresholds based on the clinical indication for the exam. All diagnostic CT exams of specified anatomic sites performed in inpatient, outpatient and ambulatory care settings are eligible. This measure is not telehealth eligible. This eCQM requires the use of additional software to access primary data elements stored within radiology electronic health records and translate them into data elements that can be ingested by this eCQM. Additional details are included in the Guidance field. |
| Copyright | The translation software was written and will be updated and maintained by Alara Imaging and will be accessible by creating a secure account through Alara’s website. Copyright (C) 2024 Alara Imaging, Inc. All Rights Reserved. This Measure and related data specifications are owned by Alara Imaging, Inc. Alara Imaging, Inc. is not responsible for any use of the Measure. Alara Imaging, Inc. makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and Alara Imaging, Inc. has no liability to anyone who relies on such measures or specifications. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by Alara Imaging, Inc. and are subject to a license at the discretion of Alara Imaging, Inc. |
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Note: links and images are rebased to the (stated) source
| Metadata | |
|---|---|
| Title | Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography in Adults - Clinician FHIR |
| Version | 0.6.000 |
| Short Name | CMS1056FHIR |
| GUID (Version Independent) | urn:uuid:e5321c7f-e853-42af-a65a-1957b15bab23 |
| GUID (Version Specific) | urn:uuid:7243a2f7-c1d4-4914-9842-148a2f2c11fd |
| CMS Identifier | 1056FHIR |
| CMS Consensus Based Entity Identifier | 3662e |
| Effective Period | 2026-01-01 through 2026-12-31 |
| Steward (Publisher) | Alara Imaging, Inc. |
| Developer | University of California San Francisco |
| Description | This measure provides a standardized method for monitoring the performance of diagnostic CT to discourage unnecessarily high radiation doses, a risk factor for cancer, while preserving image quality. It is expressed as a % of patients with CT exams that are out-of-range based on having either excessive radiation dose or inadequate image quality relative to evidence-based thresholds based on the clinical indication for the exam. All diagnostic CT exams of specified anatomic sites performed in inpatient, outpatient and ambulatory care settings are eligible. This measure is not telehealth eligible. This eCQM requires the use of additional software to access primary data elements stored within radiology electronic health records and translate them into data elements that can be ingested by this eCQM. Additional details are included in the Guidance field. |
| Copyright | The translation software was written and will be updated and maintained by Alara Imaging and will be accessible by creating a secure account through Alara’s website. Copyright (C) 2024 Alara Imaging, Inc. All Rights Reserved. This Measure and related data specifications are owned by Alara Imaging, Inc. Alara Imaging, Inc. is not responsible for any use of the Measure. Alara Imaging, Inc. makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and Alara Imaging, Inc. has no liability to anyone who relies on such measures or specifications. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by Alara Imaging, Inc. and are subject to a license at the discretion of Alara Imaging, Inc. |
| Disclaimer | The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. Alara Imaging, Inc., the University of California San Francisco, and its members and users shall not be responsible for any use or accuracy of the Measure or any code contained within the Measure. THE MEASURE AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Alara Imaging, Inc. disclaims all liability for use or accuracy of any third-party code contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) is copyright 2004-2023 Regenstrief Institute, Inc. SNOMED Clinical Terms(R) (SNOMED CT[R]) is copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2023 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R]. |
| Rationale | Diagnostic imaging using CT occurs in more than a third of acute care hospitalizations in the U.S. (Vance, 2013) and greater than 90 million scans are performed annually in the U.S. (IMV, 2019). There is marked observed variation in the radiation doses used to perform these exams (Smith-Bindman, 2019). The inconsistency in how CT exams are performed represents a significant, unnecessary, and modifiable iatrogenic health risk, as there is extensive epidemiological and biological evidence that suggests exposure to radiation in the same range as that routinely delivered by CT increases a person's risk of developing cancer (Board of Radiation Effects, 2006; Grant, 2017; Hong, 2019; Sakata, 2019; Sadakane, 2019, references a and b; Bernier, 2019; Meulepas, 2019; Brenner, 2020; Berrington de Gonzalez, 2020; Sugiyama, 2020; Hauptmann, 2020; Huang, 2020; Abalo, 2021; Cao, 2022; Hauptmann, 2023). It is estimated that 2% (37,000) of the 1.8 million cancers diagnosed annually in the U.S. are caused by CT exams (Berrington de Gonzalez, 2009; NCI Cancer Statistics, 2020). The measure focuses on reducing radiation dose in CT, an intermediate outcome directly and proportionally related to cancer prevention. As radiation dose is known to be directly related and proportional to future cancer risk (Board of Radiation Effects, 2006; Berrington de Gonzalez, 2009), any reduction in radiation exposure would be expected to lead to a proportional reduction in cancers. Research suggests that when healthcare organizations and clinicians are provided with a summary of their CT radiation doses, their subsequent doses can be reduced without changing the usefulness of these tests (Smith-Bindman, 2020). On the basis of the current estimated number of CT scans performed annually in the U.S. (IMV, 2019), distribution in scan types and observed doses (Demb, 2017; Smith-Bindman, 2019), modeling of the cancer risk associated with CT at different ages of exposure (Berrington de Gonzalez, 2009), and costs of cancer care (Dieguez, 2017; Mariotto, 2011), an estimated 13,982 cancers could be prevented among Medicare beneficiaries annually, resulting in $1.86 billion to $5.21 billion annual cost savings. These cost calculations were supported by more recent data on cancer survivorship and costs, which yielded an estimated $3.04 billion dollars in annual costs savings to Medicare. (Mariotto, 2020; NCI Office of Cancer Survivorship, 2022). |
| Clinical Recommendation Statement | The measure aligns with numerous evidence- and consensus-based clinical guidelines asking radiologists to track, optimize, and lower CT radiation doses, guidelines that have been written by the American College of Radiology (Kanal, 2017), cardiovascular imaging societies (Hirshfeld, 2018, references a, b and c noted below), Image Gently Alliance, an initiative begun by the American College of Radiology, the Radiological Society of North America, American Society of Radiologic Technologists, the American Association of Physicists in Medicine, and the Society of Pediatric Radiology, which dozens of U.S. and international organizations have joined as recently as 2020 (Image Gently Alliance, 2022), and the US Food and Drug Administration (FDA, 2019). This measure has been strongly supported by a Technical Expert Panel (TEP) comprising a diverse group of clinicians, patient advocates, and leaders of medical specialty societies, payers, and healthcare safety and accrediting organizations, all of whom were engaged through every stage of measure conceptualization, development, and testing. In assessing the face validity of the measure, 100% of TEP members agreed radiation dose and global noise are relevant metrics of CT quality, that size is an appropriate method of risk adjustment, and that performance on this measure of radiation dose and image quality as specified is a representation of quality. |
| Guidance (Usage) | This is an inverse measure; as such the higher the value the worse the performance. The level of aggregation for this eCQM is the clinician. Parallel eCQMs report CT exams performed in inpatient and outpatient hospital settings and is aggregated on the facility level. A single CT exam may be simultaneously measured in both the MIPS and one of the hospital reporting programs (inpatient or outpatient); however, a single exam cannot be measured in both the inpatient and outpatient hospital quality reporting programs. TRANSLATION SOFTWARE As a radiology measure, the measure derives standardized data elements from structured fields within both the electronic health record (EHR) and the radiology electronic clinical data systems, including the Radiology Information System (RIS) and the Picture Archiving and Communication System (PACS). Primary imaging data including Radiation Dose Structured Reports and image pixel data are stored in the PACS in Digital Imaging and Communications in Medicine (DICOM) format, a universally adopted standard for medical imaging information. Because of limitations in their specifications and format, eCQMs cannot currently access and consume elements from these radiology sources in their original DICOM formats. Thus, translation software was developed to transform primary data into a format that the eCQM can consume. This eCQM requires the use of additional software (translation software) to access the primary data elements that are required for measure computation and translate them into data elements that can be ingested by this eCQM. The purpose of this translation software is to access and link these primary data elements with minimal site burden, assess each CT exam for eligibility based on initial population criteria, and generate the three data elements mapped to a clinical terminology for eCQM consumption: CT Dose and Image Quality Category, Calculated CT Size-Adjusted Dose, and Calculated CT Global Noise. The free translation software necessary to use this eCQM is written and maintained by Alara Imaging, Inc. However, any software vendor capable of calculating and reporting this eCQM in accordance with the measure’s specifications, including combining radiology data with electronic health system data, and transforming radiology data into a format compatible with eCQM reporting, may report this measure on behalf of hospitals and clinicians. CODING The translation software will create three variables required for measure computation including the CT Dose and Image Quality Category (LOINC(R) Code 96914-7), the Calculated CT Global Noise (LOINC(R) Code 96912-1) and the Calculated CT Size-Adjusted Dose (LOINC(R) Code 96913-9). These variables are defined in the Definition field above. These transformed data elements can be stored in the EHR. MEASURE CALCULATION The measure will evaluate each included CT exam for a patient based on allowable thresholds that are specified by the CT Dose and Image Quality Category. An exam is considered out of range if either the Calculated CT Global Noise or the Calculated CT Size-Adjusted Dose is out of range for the CT Dose and Image Quality Category. Exams will be evaluated against their corresponding threshold, shown below with the following format: [Category shorthand (=CT Dose and Image Quality Category), threshold for the Calculated CT Global Noise in Hounsfield units, threshold for the Calculated CT Size-Adjusted Dose in dose length product]. [LA31752-1 (=Abdomen and Pelvis, Low Dose), 64, 598]; [LA31753-9 (=Abdomen and Pelvis, Routine Dose), 29, 644]; [LA31754-7 (=Abdomen and Pelvis, High Dose), 29, 1260]; [LA31755-4 (=Cardiac Low Dose), 55, 93]; [LA31756-2 (=Cardiac Routine Dose), 32, 576]; [LA31758-8 (=Chest Low Dose), 55, 377]; [LA31759-6 (=Chest Routine Dose), 49, 377]; [LA31761-2 (=Chest High Dose or Cardiac High Dose), 49, 1282]; [LA31762-0 (=Head Low Dose), 115, 582]; [LA31763-8 (=Head Routine Dose), 115, 1025]; [LA31764-6 (=Head High Dose), 115, 1832]; [LA31765-3 (=Upper or Lower Extremity), 73, 320]; [LA31766-1 (=Neck or Cervical Spine), 25, 1260]; [LA31767-9 (=Thoracic or Lumbar Spine), 25, 1260]; [LA31768-7 (=Combined Chest, Abdomen and Pelvis), 29, 1637]; [LA31851-1 (=Combined Thoracic and Lumbar Spine), 25, 2520]; [LA31769-5 (=Combined Head and Neck, Routine Dose), 25, 2285]; [LA31770-3 (=Combined Head and Neck, High Dose), 25, 3092] EXCLUSIONS CT scans with missing patient age or missing CT Dose and Image Quality Category (LOINC(R) 96914-7) are excluded from the initial population. CT scans with a missing Calculated Global Noise value or a missing Calculated CT Size-Adjusted Dose value are not included in the denominator. Patients that have one or more CT scans assigned a CT Dose and Image Quality Category (LOINC(R) 96914-7) value using the LOINC(R) answer list (LL5824-9) of full body (LA31771-1) during the measurement period are excluded from the denominator. These exams are included in the initial population because they have a non-missing CT Dose and Image Quality Category but are then removed as a Denominator Exclusion in the eCQM because the value is full body, which reflects CT exams that cannot be categorized by anatomical area or by clinical indication, either because they are simultaneous exams of multiple body regions outside of four commonly encountered multiple region groupings, or because there is insufficient data for their classification based on the given diagnosis and procedure codes. This eCQM is a patient-based measure and should report the percentage of patients that had an eligible CT scan performed during the measurement period that had either a size adjusted dose or noise level out of range. Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible encounter codes. This FHIR-based measure has been derived from the QDM-based measure: CMS1056v2. 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). |
| Measure Group (Rate) (ID: Group_1) | |
| Basis | boolean |
| Scoring | Proportion |
| Type | Outcome |
| Rate Aggregation | None |
| Improvement Notation | Increased score indicates improvement |
| Initial Population |
ID: InitialPopulation_1
Description: Patients aged 18 years and older at the start of the measurement period that have an eligible CT scan with Dose and Image Quality Category performed during the measurement period Logic Definition: Initial Population |
| Denominator |
ID: Denominator_1
Description: Equals Initial population where an eligible CT scan has a Calculated Global Noise value and a Calculated CT Size-Adjusted Dose value Logic Definition: Denominator |
| Denominator Exclusion |
ID: DenominatorExclusion_1
Description: Patients with one or more eligible CT scans that has a CT Dose and Image Quality Category = full body Logic Definition: Denominator Exclusion |
| Numerator |
ID: Numerator_1
Description: Patients with one or more eligible CT scans with calculated CT Size-Adjusted Dose greater than or equal to a threshold specific to the CT Dose and Image Quality Category, or Calculated CT Global Noise value greater than or equal to a threshold specific to the CT Dose and Image Quality Category Logic Definition: Numerator |
| Supplemental Data Guidance | For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity SDE Payer SDE Race SDE Sex |
| Supplemental Data Elements | |
| Supplemental Data Element |
ID: sde-ethnicity
Usage Code: Supplemental Data Description: SDE Ethnicity Logic Definition: SDE Ethnicity |
| Supplemental Data Element |
ID: sde-payer
Usage Code: Supplemental Data Description: SDE Payer Logic Definition: SDE Payer |
| Supplemental Data Element |
ID: sde-race
Usage Code: Supplemental Data Description: SDE Race Logic Definition: SDE Race |
| Supplemental Data Element |
ID: sde-sex
Usage Code: Supplemental Data Description: SDE Sex Logic Definition: SDE Sex |
| Measure Logic | |
| Primary Library | CMS1056CTClinicalFHIR |
| Contents |
Population Criteria
Logic Definitions Terminology Dependencies Data Requirements |
| Population Criteria | |
| Measure Group (Rate) (ID: Group_1) | |
| Initial Population | |
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| Denominator | |
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| Denominator Exclusion | |
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| Numerator | |
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| Logic Definitions | |
| Logic Definition | Library Name: SupplementalDataElements |
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| Logic Definition | Library Name: SupplementalDataElements |
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| Logic Definition | Library Name: SupplementalDataElements |
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| Logic Definition | Library Name: SupplementalDataElements |
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| Logic Definition | Library Name: CMS1056CTClinicalFHIR |
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| Logic Definition | Library Name: CMS1056CTClinicalFHIR |
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| Logic Definition | Library Name: CMS1056CTClinicalFHIR |
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| Logic Definition | Library Name: CMS1056CTClinicalFHIR |
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| Logic Definition | Library Name: CMS1056CTClinicalFHIR |
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| Logic Definition | Library Name: CMS1056CTClinicalFHIR |
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| Logic Definition | Library Name: CMS1056CTClinicalFHIR |
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| Logic Definition | Library Name: CMS1056CTClinicalFHIR |
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| Logic Definition | Library Name: CMS1056CTClinicalFHIR |
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| Logic Definition | Library Name: CMS1056CTClinicalFHIR |
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| Logic Definition | Library Name: AlaraCommonFunctions |
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| Logic Definition | Library Name: AlaraCommonFunctions |
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| Logic Definition | Library Name: AlaraCommonFunctions |
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| Logic Definition | Library Name: AlaraCommonFunctions |
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| Logic Definition | Library Name: FHIRHelpers |
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| Logic Definition | Library Name: FHIRHelpers |
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| Logic Definition | Library Name: FHIRHelpers |
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| Terminology | |
| Code System |
Description: Code system SNOMEDCT
Resource: SNOMED CT (all versions) Canonical URL: http://snomed.info/sct |
| Code System |
Description: Code system LOINC
Resource: Logical Observation Identifiers, Names and Codes (LOINC) Canonical URL: http://loinc.org |
| Code System |
Description: Code system LOINC
Resource: Logical Observation Identifiers, Names and Codes (LOINC) Canonical URL: http://loinc.org |
| Value Set |
Description: Value set Payer Type
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 |
| Direct Reference Code |
Display: Male (finding)
Code: 248153007 System: http://snomed.info/sct |
| Direct Reference Code |
Display: Female (finding)
Code: 248152002 System: http://snomed.info/sct |
| Direct Reference Code |
Display: CT dose and image quality category
Code: 96914-7 System: http://loinc.org |
| Direct Reference Code |
Display: Calculated CT global noise
Code: 96912-1 System: http://loinc.org |
| Direct Reference Code |
Display: Calculated CT size-adjusted dose
Code: 96913-9 System: http://loinc.org |
| Direct Reference Code |
Display: Abdomen and Pelvis Low Dose
Code: LA31752-1 System: http://loinc.org |
| Direct Reference Code |
Display: Abdomen and Pelvis Routine Dose
Code: LA31753-9 System: http://loinc.org |
| Direct Reference Code |
Display: Abdomen and Pelvis High Dose
Code: LA31754-7 System: http://loinc.org |
| Direct Reference Code |
Display: Cardiac Low Dose
Code: LA31755-4 System: http://loinc.org |
| Direct Reference Code |
Display: Cardiac Routine Dose
Code: LA31756-2 System: http://loinc.org |
| Direct Reference Code |
Display: Chest Low Dose
Code: LA31758-8 System: http://loinc.org |
| Direct Reference Code |
Display: Chest Routine Dose
Code: LA31759-6 System: http://loinc.org |
| Direct Reference Code |
Display: Cardiac High Dose or Chest High Dose
Code: LA31761-2 System: http://loinc.org |
| Direct Reference Code |
Display: Head Low Dose
Code: LA31762-0 System: http://loinc.org |
| Direct Reference Code |
Display: Head Routine Dose
Code: LA31763-8 System: http://loinc.org |
| Direct Reference Code |
Display: Head High Dose
Code: LA31764-6 System: http://loinc.org |
| Direct Reference Code |
Display: Extremity
Code: LA31765-3 System: http://loinc.org |
| Direct Reference Code |
Display: Neck or Cervical Spine
Code: LA31766-1 System: http://loinc.org |
| Direct Reference Code |
Display: Thoracic or Lumbar Spine
Code: LA31767-9 System: http://loinc.org |
| Direct Reference Code |
Display: Simultaneous Chest and Abdomen and Pelvis
Code: LA31768-7 System: http://loinc.org |
| Direct Reference Code |
Display: Simultaneous Thoracic and Lumbar Spine
Code: LA31851-1 System: http://loinc.org |
| Direct Reference Code |
Display: Simultaneous Head and Neck Routine Dose
Code: LA31769-5 System: http://loinc.org |
| Direct Reference Code |
Display: Simultaneous Head and Neck High Dose
Code: LA31770-3 System: http://loinc.org |
| Direct Reference Code |
Display: Full Body
Code: LA31771-1 System: http://loinc.org |
| Dependencies | |
| Dependency |
Description: Library SDE
Resource: Library/SupplementalDataElements|5.1.000
Canonical URL: Library/SupplementalDataElements|5.1.000 |
| Dependency |
Description: Library FHIRHelpers
Resource: Library/FHIRHelpers|4.4.000
Canonical URL: Library/FHIRHelpers|4.4.000 |
| Dependency |
Description: Library QICoreCommon
Resource: Library/QICoreCommon|4.0.000
Canonical URL: Library/QICoreCommon|4.0.000 |
| Dependency |
Description: Library FHIRHelpers
Resource: Library/FHIRHelpers|4.4.000
Canonical URL: Library/FHIRHelpers|4.4.000 |
| Dependency |
Description: Library AlaraCommon
Resource: Library/AlaraCommonFunctions|1.6.000
Canonical URL: Library/AlaraCommonFunctions|1.6.000 |
| Dependency |
Description: Library FHIRHelpers
Resource: Library/FHIRHelpers|4.4.000
Canonical URL: Library/FHIRHelpers|4.4.000 |
| Data Requirements | |
| Data Requirement |
Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
|
| Data Requirement |
Type: Observation
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab
Must Support Elements: code, effective, value, value.codes Code Filter(s): Path: code Code(s): LOINC 96914-7: CT dose and image quality category |
| Data Requirement |
Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
Must Support Elements: url |
| Data Requirement |
Type: Observation
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab
Must Support Elements: code, effective, value Code Filter(s): Path: code Code(s): LOINC 96914-7: CT dose and image quality category |
| Data Requirement |
Type: Coverage
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage
Must Support Elements: type, period Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
|
| Data Requirement |
Type: Observation
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab
Must Support Elements: code, effective Code Filter(s): Path: code Code(s): LOINC 96914-7: CT dose and image quality category |
| Data Requirement |
Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
Must Support Elements: url, extension |
| Generated using version 0.4.8 of the sample-content-ig Liquid templates | |
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"valueCoding": {
"system": "http://loinc.org",
"code": "LA31755-4",
"display": "Cardiac Low Dose"
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},
{
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"display": "Chest Low Dose"
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},
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding": {
"system": "http://loinc.org",
"code": "LA31759-6",
"display": "Chest Routine Dose"
}
},
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding": {
"system": "http://loinc.org",
"code": "LA31761-2",
"display": "Cardiac High Dose or Chest High Dose"
}
},
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding": {
"system": "http://loinc.org",
"code": "LA31762-0",
"display": "Head Low Dose"
}
},
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding": {
"system": "http://loinc.org",
"code": "LA31763-8",
"display": "Head Routine Dose"
}
},
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding": {
"system": "http://loinc.org",
"code": "LA31764-6",
"display": "Head High Dose"
}
},
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding": {
"system": "http://loinc.org",
"code": "LA31765-3",
"display": "Extremity"
}
},
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding": {
"system": "http://loinc.org",
"code": "LA31766-1",
"display": "Neck or Cervical Spine"
}
},
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding": {
"system": "http://loinc.org",
"code": "LA31767-9",
"display": "Thoracic or Lumbar Spine"
}
},
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding": {
"system": "http://loinc.org",
"code": "LA31768-7",
"display": "Simultaneous Chest and Abdomen and Pelvis"
}
},
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding": {
"system": "http://loinc.org",
"code": "LA31851-1",
"display": "Simultaneous Thoracic and Lumbar Spine"
}
},
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding": {
"system": "http://loinc.org",
"code": "LA31769-5",
"display": "Simultaneous Head and Neck Routine Dose"
}
},
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding": {
"system": "http://loinc.org",
"code": "LA31770-3",
"display": "Simultaneous Head and Neck High Dose"
}
},
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
"valueCoding": {
"system": "http://loinc.org",
"code": "LA31771-1",
"display": "Full Body"
}
},
{
"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": 0
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "CMS1056CTClinicalFHIR"
},
{
"url": "name",
"valueString": "SDE Sex"
},
{
"url": "statement",
"valueString": "define \"SDE Sex\":\n SDE.\"SDE Sex\""
},
{
"url": "displaySequence",
"valueInteger": 1
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "CMS1056CTClinicalFHIR"
},
{
"url": "name",
"valueString": "Patients with Qualifying CTScan"
},
{
"url": "statement",
"valueString": "define \"Patients with Qualifying CTScan\":\n [LaboratoryResultObservation: \"CT dose and image quality category\"] CTScanResult\n where QICoreCommon.ToInterval ( CTScanResult.effective ) ends during day of \"Measurement Period\"\n and ( AgeInYearsAt(start of \"Measurement Period\") >= 18 )"
},
{
"url": "displaySequence",
"valueInteger": 2
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "CMS1056CTClinicalFHIR"
},
{
"url": "name",
"valueString": "Patients with Qualifying CTScan with Values"
},
{
"url": "statement",
"valueString": "define \"Patients with Qualifying CTScan with Values\":\n \"Patients with Qualifying CTScan\" CTScan\n where AlaraCommon.\"Global Noise Value\" ( CTScan ) is not null\n and AlaraCommon.\"Size Adjusted Value\" ( CTScan ) is not null\n and CTScan.value is not null"
},
{
"url": "displaySequence",
"valueInteger": 3
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "CMS1056CTClinicalFHIR"
},
{
"url": "name",
"valueString": "Numerator"
},
{
"url": "statement",
"valueString": "define \"Numerator\":\n exists ( \"Patients with Qualifying CTScan with Values\" CTScan\n where AlaraCommon.\"CT Scan Qualifies\" ( CTScan )\n )"
},
{
"url": "displaySequence",
"valueInteger": 4
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "CMS1056CTClinicalFHIR"
},
{
"url": "name",
"valueString": "Denominator"
},
{
"url": "statement",
"valueString": "define \"Denominator\":\n exists ( \"Patients with Qualifying CTScan with Values\" )"
},
{
"url": "displaySequence",
"valueInteger": 5
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "SupplementalDataElements"
},
{
"url": "name",
"valueString": "SDE Payer"
},
{
"url": "statement",
"valueString": "define \"SDE Payer\":\n [Coverage: type in \"Payer Type\"] Payer\n return {\n code: Payer.type,\n period: Payer.period\n }"
},
{
"url": "displaySequence",
"valueInteger": 6
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "CMS1056CTClinicalFHIR"
},
{
"url": "name",
"valueString": "SDE Payer"
},
{
"url": "statement",
"valueString": "define \"SDE Payer\":\n SDE.\"SDE Payer\""
},
{
"url": "displaySequence",
"valueInteger": 7
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "CMS1056CTClinicalFHIR"
},
{
"url": "name",
"valueString": "Initial Population"
},
{
"url": "statement",
"valueString": "define \"Initial Population\":\n exists ( \"Patients with Qualifying CTScan\" )"
},
{
"url": "displaySequence",
"valueInteger": 8
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "SupplementalDataElements"
},
{
"url": "name",
"valueString": "SDE Ethnicity"
},
{
"url": "statement",
"valueString": "define \"SDE Ethnicity\":\n Patient.ethnicity E\n return Tuple {\n codes: { E.ombCategory } union E.detailed,\n display: E.text\n }"
},
{
"url": "displaySequence",
"valueInteger": 9
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "CMS1056CTClinicalFHIR"
},
{
"url": "name",
"valueString": "SDE Ethnicity"
},
{
"url": "statement",
"valueString": "define \"SDE Ethnicity\":\n SDE.\"SDE Ethnicity\""
},
{
"url": "displaySequence",
"valueInteger": 10
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "CMS1056CTClinicalFHIR"
},
{
"url": "name",
"valueString": "Denominator Exclusion"
},
{
"url": "statement",
"valueString": "define \"Denominator Exclusion\":\n exists ( \"Patients with Qualifying CTScan with Values\" CTScan\n where ( CTScan.value as Concept ).codes contains \"Full Body\"\n )"
},
{
"url": "displaySequence",
"valueInteger": 11
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "SupplementalDataElements"
},
{
"url": "name",
"valueString": "SDE Race"
},
{
"url": "statement",
"valueString": "define \"SDE Race\":\n Patient.race R\n return Tuple {\n codes: R.ombCategory union R.detailed,\n display: R.text\n }"
},
{
"url": "displaySequence",
"valueInteger": 12
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "CMS1056CTClinicalFHIR"
},
{
"url": "name",
"valueString": "SDE Race"
},
{
"url": "statement",
"valueString": "define \"SDE Race\":\n SDE.\"SDE Race\""
},
{
"url": "displaySequence",
"valueInteger": 13
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "FHIRHelpers"
},
{
"url": "name",
"valueString": "ToString"
},
{
"url": "statement",
"valueString": "define function ToString(value uri): value.value"
},
{
"url": "displaySequence",
"valueInteger": 14
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "AlaraCommonFunctions"
},
{
"url": "name",
"valueString": "Global Noise Value"
},
{
"url": "statement",
"valueString": "define function \"Global Noise Value\"(Obs LaboratoryResultObservation ):\n singleton from ( Obs.component C\n where C.code ~ \"Calculated CT global noise\"\n and ( C.value as Quantity ).unit = '[hnsf\\'U]'\n return (C.value as Quantity).value\n )"
},
{
"url": "displaySequence",
"valueInteger": 15
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "AlaraCommonFunctions"
},
{
"url": "name",
"valueString": "Size Adjusted Value"
},
{
"url": "statement",
"valueString": "define function \"Size Adjusted Value\"(Obs LaboratoryResultObservation ):\n singleton from ( Obs.component C\n where C.code ~ \"Calculated CT size-adjusted dose\"\n and ( C.value as Quantity ).unit = 'mGy.cm'\n return (C.value as Quantity).value\n )"
},
{
"url": "displaySequence",
"valueInteger": 16
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "AlaraCommonFunctions"
},
{
"url": "name",
"valueString": "CT Scan Qualifies"
},
{
"url": "statement",
"valueString": "define function \"CT Scan Qualifies\"(Obs LaboratoryResultObservation ):\n \"Qualifies\"(Obs, \"Abdomen and Pelvis Low Dose\", 64, 598)\n or \"Qualifies\"(Obs, \"Abdomen and Pelvis Routine Dose\", 29, 644)\n or \"Qualifies\"(Obs, \"Abdomen and Pelvis High Dose\", 29, 1260)\n or \"Qualifies\"(Obs, \"Cardiac Low Dose\", 55, 93)\n or \"Qualifies\"(Obs, \"Cardiac Routine Dose\", 32, 576)\n or \"Qualifies\"(Obs, \"Chest Low Dose\", 55, 377)\n or \"Qualifies\"(Obs, \"Chest Routine Dose\", 49, 377)\n or \"Qualifies\"(Obs, \"Cardiac High Dose or Chest High Dose\", 49, 1282)\n or \"Qualifies\"(Obs, \"Head Low Dose\", 115, 582)\n or \"Qualifies\"(Obs, \"Head Routine Dose\", 115, 1025)\n or \"Qualifies\"(Obs, \"Head High Dose\", 115, 1832)\n or \"Qualifies\"(Obs, \"Extremity\", 73, 320)\n or \"Qualifies\"(Obs, \"Neck or Cervical Spine\", 25, 1260)\n or \"Qualifies\"(Obs, \"Thoracic or Lumbar Spine\", 25, 1260)\n or \"Qualifies\"(Obs, \"Simultaneous Chest and Abdomen and Pelvis\", 29, 1637)\n or \"Qualifies\"(Obs, \"Simultaneous Thoracic and Lumbar Spine\", 25, 2520)\n or \"Qualifies\"(Obs, \"Simultaneous Head and Neck Routine Dose\", 25, 2285)\n or \"Qualifies\"(Obs, \"Simultaneous Head and Neck High Dose\", 25, 3092)"
},
{
"url": "displaySequence",
"valueInteger": 17
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "AlaraCommonFunctions"
},
{
"url": "name",
"valueString": "Qualifies"
},
{
"url": "statement",
"valueString": "define function \"Qualifies\"(Obs LaboratoryResultObservation, code System.Code, noiseThreshold Decimal, sizeDoseThreshold Decimal ):\n (Obs.value as Concept).codes contains code\n and ( \"Global Noise Value\"(Obs)>= noiseThreshold\n or \"Size Adjusted Value\"(Obs)>= sizeDoseThreshold\n )"
},
{
"url": "displaySequence",
"valueInteger": 18
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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": 19
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "FHIRHelpers"
},
{
"url": "name",
"valueString": "ToCode"
},
{
"url": "statement",
"valueString": "/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n if coding is null then\n null\n else\n System.Code {\n code: coding.code.value,\n system: coding.system.value,\n version: coding.version.value,\n display: coding.display.value\n }"
},
{
"url": "displaySequence",
"valueInteger": 20
}
],
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
}
],
"name": "EffectiveDataRequirements",
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/library-type",
"code": "module-definition"
}
]
},
"relatedArtifact": [
{
"type": "depends-on",
"display": "Library SDE",
"resource": "Library/SupplementalDataElements|5.1.000"
},
{
"type": "depends-on",
"display": "Library FHIRHelpers",
"resource": "Library/FHIRHelpers|4.4.000"
},
{
"type": "depends-on",
"display": "Library QICoreCommon",
"resource": "Library/QICoreCommon|4.0.000"
},
{
"type": "depends-on",
"display": "Library FHIRHelpers",
"resource": "Library/FHIRHelpers|4.4.000"
},
{
"type": "depends-on",
"display": "Library AlaraCommon",
"resource": "Library/AlaraCommonFunctions|1.6.000"
},
{
"type": "depends-on",
"display": "Library FHIRHelpers",
"resource": "Library/FHIRHelpers|4.4.000"
},
{
"type": "depends-on",
"display": "Code system SNOMEDCT",
"resource": "http://snomed.info/sct"
},
{
"type": "depends-on",
"display": "Code system LOINC",
"resource": "http://loinc.org"
},
{
"type": "depends-on",
"display": "Code system LOINC",
"resource": "http://loinc.org"
},
{
"type": "depends-on",
"display": "Value set Payer Type",
"resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
}
],
"parameter": [
{
"name": "Measurement Period",
"use": "in",
"min": 0,
"max": "1",
"type": "Period"
},
{
"name": "SDE Sex",
"use": "out",
"min": 0,
"max": "1",
"type": "Coding"
},
{
"name": "Numerator",
"use": "out",
"min": 0,
"max": "1",
"type": "boolean"
},
{
"name": "Denominator",
"use": "out",
"min": 0,
"max": "1",
"type": "boolean"
},
{
"name": "SDE Payer",
"use": "out",
"min": 0,
"max": "*",
"type": "Resource"
},
{
"name": "Initial Population",
"use": "out",
"min": 0,
"max": "1",
"type": "boolean"
},
{
"name": "SDE Ethnicity",
"use": "out",
"min": 0,
"max": "1",
"type": "Resource"
},
{
"name": "Denominator Exclusion",
"use": "out",
"min": 0,
"max": "1",
"type": "boolean"
},
{
"name": "SDE Race",
"use": "out",
"min": 0,
"max": "1",
"type": "Resource"
}
],
"dataRequirement": [
{
"type": "Patient",
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
]
},
{
"type": "Patient",
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
],
"mustSupport": [
"url",
"value.value"
]
},
{
"type": "Patient",
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
],
"mustSupport": [
"url",
"value.value"
]
},
{
"type": "Patient",
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
]
},
{
"type": "Observation",
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab"
],
"mustSupport": [
"code",
"effective"
],
"codeFilter": [
{
"path": "code",
"code": [
{
"system": "http://loinc.org",
"code": "96914-7",
"display": "CT dose and image quality category"
}
]
}
]
},
{
"type": "Observation",
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab"
],
"mustSupport": [
"code",
"effective",
"value"
],
"codeFilter": [
{
"path": "code",
"code": [
{
"system": "http://loinc.org",
"code": "96914-7",
"display": "CT dose and image quality category"
}
]
}
]
},
{
"type": "Observation",
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab"
],
"mustSupport": [
"code",
"effective",
"value"
],
"codeFilter": [
{
"path": "code",
"code": [
{
"system": "http://loinc.org",
"code": "96914-7",
"display": "CT dose and image quality category"
}
]
}
]
},
{
"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": "Patient",
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
],
"mustSupport": [
"url"
]
},
{
"type": "Patient",
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
],
"mustSupport": [
"url",
"extension"
]
},
{
"type": "Observation",
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab"
],
"mustSupport": [
"code",
"effective",
"value",
"value.codes"
],
"codeFilter": [
{
"path": "code",
"code": [
{
"system": "http://loinc.org",
"code": "96914-7",
"display": "CT dose and image quality category"
}
]
}
]
},
{
"type": "Patient",
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
],
"mustSupport": [
"url"
]
},
{
"type": "Patient",
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
],
"mustSupport": [
"url",
"extension"
]
},
{
"type": "Observation",
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab"
],
"mustSupport": [
"code",
"effective",
"value"
],
"codeFilter": [
{
"path": "code",
"code": [
{
"system": "http://loinc.org",
"code": "96914-7",
"display": "CT dose and image quality category"
}
]
}
]
},
{
"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",
"effective"
],
"codeFilter": [
{
"path": "code",
"code": [
{
"system": "http://loinc.org",
"code": "96914-7",
"display": "CT dose and image quality category"
}
]
}
]
},
{
"type": "Patient",
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
],
"mustSupport": [
"url",
"extension"
]
},
{
"type": "Patient",
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
],
"mustSupport": [
"url",
"extension"
]
}
]
}
],
"extension": [
{
"id": "supplementalDataGuidance",
"extension": [
{
"url": "guidance",
"valueString": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity \n SDE Payer \n SDE Race \n SDE Sex \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",
"valueCanonical": "#effective-data-requirements"
},
{
"id": "effective-data-requirements",
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
"valueReference": {
"reference": "#effective-data-requirements"
}
}
],
"url": "https://madie.cms.gov/Measure/CMS1056CTClinicalFHIR",
"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": "CMS1056FHIR"
},
{
"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:e5321c7f-e853-42af-a65a-1957b15bab23"
},
{
"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:7243a2f7-c1d4-4914-9842-148a2f2c11fd"
},
{
"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": "3662e",
"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": "1056FHIR",
"assigner": {
"display": "CMS"
}
}
],
"version": "0.6.000",
"name": "CMS1056CTClinicalFHIR",
"title": "Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography in Adults - Clinician FHIR",
"status": "active",
"experimental": false,
"date": "2025-06-26T19:30:10+00:00",
"publisher": "Alara Imaging, Inc.",
"contact": [
{
"telecom": [
{
"system": "url",
"value": "https://www.alaracare.com/our-commitment"
}
]
}
],
"description": "This measure provides a standardized method for monitoring the performance of diagnostic CT to discourage unnecessarily high radiation doses, a risk factor for cancer, while preserving image quality. It is expressed as a % of patients with CT exams that are out-of-range based on having either excessive radiation dose or inadequate image quality relative to evidence-based thresholds based on the clinical indication for the exam. All diagnostic CT exams of specified anatomic sites performed in inpatient, outpatient and ambulatory care settings are eligible. This measure is not telehealth eligible. This eCQM requires the use of additional software to access primary data elements stored within radiology electronic health records and translate them into data elements that can be ingested by this eCQM. Additional details are included in the Guidance field.",
"usage": "This is an inverse measure; as such the higher the value the worse the performance. \n\nThe level of aggregation for this eCQM is the clinician. Parallel eCQMs report CT exams performed in inpatient and outpatient hospital settings and is aggregated on the facility level. A single CT exam may be simultaneously measured in both the MIPS and one of the hospital reporting programs (inpatient or outpatient); however, a single exam cannot be measured in both the inpatient and outpatient hospital quality reporting programs. \n\nTRANSLATION SOFTWARE\n\nAs a radiology measure, the measure derives standardized data elements from structured fields within both the electronic health record (EHR) and the radiology electronic clinical data systems, including the Radiology Information System (RIS) and the Picture Archiving and Communication System (PACS). Primary imaging data including Radiation Dose Structured Reports and image pixel data are stored in the PACS in Digital Imaging and Communications in Medicine (DICOM) format, a universally adopted standard for medical imaging information. Because of limitations in their specifications and format, eCQMs cannot currently access and consume elements from these radiology sources in their original DICOM formats. Thus, translation software was developed to transform primary data into a format that the eCQM can consume. This eCQM requires the use of additional software (translation software) to access the primary data elements that are required for measure computation and translate them into data elements that can be ingested by this eCQM. The purpose of this translation software is to access and link these primary data elements with minimal site burden, assess each CT exam for eligibility based on initial population criteria, and generate the three data elements mapped to a clinical terminology for eCQM consumption: CT Dose and Image Quality Category, Calculated CT Size-Adjusted Dose, and Calculated CT Global Noise. The free translation software necessary to use this eCQM is written and maintained by Alara Imaging, Inc. However, any software vendor capable of calculating and reporting this eCQM in accordance with the measure’s specifications, including combining radiology data with electronic health system data, and transforming radiology data into a format compatible with eCQM reporting, may report this measure on behalf of hospitals and clinicians.\n\nCODING\n\nThe translation software will create three variables required for measure computation including the CT Dose and Image Quality Category (LOINC(R) Code 96914-7), the Calculated CT Global Noise (LOINC(R) Code 96912-1) and the Calculated CT Size-Adjusted Dose (LOINC(R) Code 96913-9). These variables are defined in the Definition field above. These transformed data elements can be stored in the EHR. \n\nMEASURE CALCULATION\n\nThe measure will evaluate each included CT exam for a patient based on allowable thresholds that are specified by the CT Dose and Image Quality Category. An exam is considered out of range if either the Calculated CT Global Noise or the Calculated CT Size-Adjusted Dose is out of range for the CT Dose and Image Quality Category. Exams will be evaluated against their corresponding threshold, shown below with the following format: [Category shorthand (=CT Dose and Image Quality Category), threshold for the Calculated CT Global Noise in Hounsfield units, threshold for the Calculated CT Size-Adjusted Dose in dose length product].\n\n[LA31752-1 (=Abdomen and Pelvis, Low Dose), 64, 598];\n[LA31753-9 (=Abdomen and Pelvis, Routine Dose), 29, 644];\n[LA31754-7 (=Abdomen and Pelvis, High Dose), 29, 1260];\n[LA31755-4 (=Cardiac Low Dose), 55, 93];\n[LA31756-2 (=Cardiac Routine Dose), 32, 576];\n[LA31758-8 (=Chest Low Dose), 55, 377];\n[LA31759-6 (=Chest Routine Dose), 49, 377];\n[LA31761-2 (=Chest High Dose or Cardiac High Dose), 49, 1282];\n[LA31762-0 (=Head Low Dose), 115, 582];\n[LA31763-8 (=Head Routine Dose), 115, 1025];\n[LA31764-6 (=Head High Dose), 115, 1832];\n[LA31765-3 (=Upper or Lower Extremity), 73, 320];\n[LA31766-1 (=Neck or Cervical Spine), 25, 1260];\n[LA31767-9 (=Thoracic or Lumbar Spine), 25, 1260];\n[LA31768-7 (=Combined Chest, Abdomen and Pelvis), 29, 1637];\n[LA31851-1 (=Combined Thoracic and Lumbar Spine), 25, 2520];\n[LA31769-5 (=Combined Head and Neck, Routine Dose), 25, 2285];\n[LA31770-3 (=Combined Head and Neck, High Dose), 25, 3092]\n\nEXCLUSIONS\n\nCT scans with missing patient age or missing CT Dose and Image Quality Category (LOINC(R) 96914-7) are excluded from the initial population. \nCT scans with a missing Calculated Global Noise value or a missing Calculated CT Size-Adjusted Dose value are not included in the denominator.\nPatients that have one or more CT scans assigned a CT Dose and Image Quality Category (LOINC(R) 96914-7) value using the LOINC(R) answer list (LL5824-9) of full body (LA31771-1) during the measurement period are excluded from the denominator. These exams are included in the initial population because they have a non-missing CT Dose and Image Quality Category but are then removed as a Denominator Exclusion in the eCQM because the value is full body, which reflects CT exams that cannot be categorized by anatomical area or by clinical indication, either because they are simultaneous exams of multiple body regions outside of four commonly encountered multiple region groupings, or because there is insufficient data for their classification based on the given diagnosis and procedure codes.\n\nThis eCQM is a patient-based measure and should report the percentage of patients that had an eligible CT scan performed during the measurement period that had either a size adjusted dose or noise level out of range.\n\nTelehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible encounter codes.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS1056v2. 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": "The translation software was written and will be updated and maintained by Alara Imaging and will be accessible by creating a secure account through Alara’s website.\n\nCopyright (C) 2024 Alara Imaging, Inc. All Rights Reserved. \n\nThis Measure and related data specifications are owned by Alara Imaging, Inc. Alara Imaging, Inc. is not responsible for any use of the Measure. Alara Imaging, Inc. makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and Alara Imaging, Inc. has no liability to anyone who relies on such measures or specifications.\n\nThe Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by Alara Imaging, Inc. and are subject to a license at the discretion of Alara Imaging, Inc.",
"effectivePeriod": {
"start": "2026-01-01",
"end": "2026-12-31"
},
"author": [
{
"name": "University of California San Francisco",
"telecom": [
{
"system": "url",
"value": "https://www.ucsf.edu/"
}
]
}
],
"library": [
"https://madie.cms.gov/Library/CMS1056CTClinicalFHIR"
],
"disclaimer": "The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.\n\nAlara Imaging, Inc., the University of California San Francisco, and its members and users shall not be responsible for any use or accuracy of the Measure or any code contained within the Measure. THE MEASURE AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.\n\nLimited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Alara Imaging, Inc. disclaims all liability for use or accuracy of any third-party code contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) is copyright 2004-2023 Regenstrief Institute, Inc. SNOMED Clinical Terms(R) (SNOMED CT[R]) is copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2023 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R].",
"rationale": "Diagnostic imaging using CT occurs in more than a third of acute care hospitalizations in the U.S. (Vance, 2013) and greater than 90 million scans are performed annually in the U.S. (IMV, 2019). There is marked observed variation in the radiation doses used to perform these exams (Smith-Bindman, 2019). The inconsistency in how CT exams are performed represents a significant, unnecessary, and modifiable iatrogenic health risk, as there is extensive epidemiological and biological evidence that suggests exposure to radiation in the same range as that routinely delivered by CT increases a person's risk of developing cancer (Board of Radiation Effects, 2006; Grant, 2017; Hong, 2019; Sakata, 2019; Sadakane, 2019, references a and b; Bernier, 2019; Meulepas, 2019; Brenner, 2020; Berrington de Gonzalez, 2020; Sugiyama, 2020; Hauptmann, 2020; Huang, 2020; Abalo, 2021; Cao, 2022; Hauptmann, 2023). It is estimated that 2% (37,000) of the 1.8 million cancers diagnosed annually in the U.S. are caused by CT exams (Berrington de Gonzalez, 2009; NCI Cancer Statistics, 2020).\n\nThe measure focuses on reducing radiation dose in CT, an intermediate outcome directly and proportionally related to cancer prevention. As radiation dose is known to be directly related and proportional to future cancer risk (Board of Radiation Effects, 2006; Berrington de Gonzalez, 2009), any reduction in radiation exposure would be expected to lead to a proportional reduction in cancers. Research suggests that when healthcare organizations and clinicians are provided with a summary of their CT radiation doses, their subsequent doses can be reduced without changing the usefulness of these tests (Smith-Bindman, 2020).\n\nOn the basis of the current estimated number of CT scans performed annually in the U.S. (IMV, 2019), distribution in scan types and observed doses (Demb, 2017; Smith-Bindman, 2019), modeling of the cancer risk associated with CT at different ages of exposure (Berrington de Gonzalez, 2009), and costs of cancer care (Dieguez, 2017; Mariotto, 2011), an estimated 13,982 cancers could be prevented among Medicare beneficiaries annually, resulting in $1.86 billion to $5.21 billion annual cost savings. These cost calculations were supported by more recent data on cancer survivorship and costs, which yielded an estimated $3.04 billion dollars in annual costs savings to Medicare. (Mariotto, 2020; NCI Office of Cancer Survivorship, 2022).",
"clinicalRecommendationStatement": "The measure aligns with numerous evidence- and consensus-based clinical guidelines asking radiologists to track, optimize, and lower CT radiation doses, guidelines that have been written by the American College of Radiology (Kanal, 2017), cardiovascular imaging societies (Hirshfeld, 2018, references a, b and c noted below), Image Gently Alliance, an initiative begun by the American College of Radiology, the Radiological Society of North America, American Society of Radiologic Technologists, the American Association of Physicists in Medicine, and the Society of Pediatric Radiology, which dozens of U.S. and international organizations have joined as recently as 2020 (Image Gently Alliance, 2022), and the US Food and Drug Administration (FDA, 2019).\n\nThis measure has been strongly supported by a Technical Expert Panel (TEP) comprising a diverse group of clinicians, patient advocates, and leaders of medical specialty societies, payers, and healthcare safety and accrediting organizations, all of whom were engaged through every stage of measure conceptualization, development, and testing. In assessing the face validity of the measure, 100% of TEP members agreed radiation dose and global noise are relevant metrics of CT quality, that size is an appropriate method of risk adjustment, and that performance on this measure of radiation dose and image quality as specified is a representation of quality.",
"guidance": "This is an inverse measure; as such the higher the value the worse the performance. \n\nThe level of aggregation for this eCQM is the clinician. Parallel eCQMs report CT exams performed in inpatient and outpatient hospital settings and is aggregated on the facility level. A single CT exam may be simultaneously measured in both the MIPS and one of the hospital reporting programs (inpatient or outpatient); however, a single exam cannot be measured in both the inpatient and outpatient hospital quality reporting programs. \n\nTRANSLATION SOFTWARE\n\nAs a radiology measure, the measure derives standardized data elements from structured fields within both the electronic health record (EHR) and the radiology electronic clinical data systems, including the Radiology Information System (RIS) and the Picture Archiving and Communication System (PACS). Primary imaging data including Radiation Dose Structured Reports and image pixel data are stored in the PACS in Digital Imaging and Communications in Medicine (DICOM) format, a universally adopted standard for medical imaging information. Because of limitations in their specifications and format, eCQMs cannot currently access and consume elements from these radiology sources in their original DICOM formats. Thus, translation software was developed to transform primary data into a format that the eCQM can consume. This eCQM requires the use of additional software (translation software) to access the primary data elements that are required for measure computation and translate them into data elements that can be ingested by this eCQM. The purpose of this translation software is to access and link these primary data elements with minimal site burden, assess each CT exam for eligibility based on initial population criteria, and generate the three data elements mapped to a clinical terminology for eCQM consumption: CT Dose and Image Quality Category, Calculated CT Size-Adjusted Dose, and Calculated CT Global Noise. The free translation software necessary to use this eCQM is written and maintained by Alara Imaging, Inc. However, any software vendor capable of calculating and reporting this eCQM in accordance with the measure’s specifications, including combining radiology data with electronic health system data, and transforming radiology data into a format compatible with eCQM reporting, may report this measure on behalf of hospitals and clinicians.\n\nCODING\n\nThe translation software will create three variables required for measure computation including the CT Dose and Image Quality Category (LOINC(R) Code 96914-7), the Calculated CT Global Noise (LOINC(R) Code 96912-1) and the Calculated CT Size-Adjusted Dose (LOINC(R) Code 96913-9). These variables are defined in the Definition field above. These transformed data elements can be stored in the EHR. \n\nMEASURE CALCULATION\n\nThe measure will evaluate each included CT exam for a patient based on allowable thresholds that are specified by the CT Dose and Image Quality Category. An exam is considered out of range if either the Calculated CT Global Noise or the Calculated CT Size-Adjusted Dose is out of range for the CT Dose and Image Quality Category. Exams will be evaluated against their corresponding threshold, shown below with the following format: [Category shorthand (=CT Dose and Image Quality Category), threshold for the Calculated CT Global Noise in Hounsfield units, threshold for the Calculated CT Size-Adjusted Dose in dose length product].\n\n[LA31752-1 (=Abdomen and Pelvis, Low Dose), 64, 598];\n[LA31753-9 (=Abdomen and Pelvis, Routine Dose), 29, 644];\n[LA31754-7 (=Abdomen and Pelvis, High Dose), 29, 1260];\n[LA31755-4 (=Cardiac Low Dose), 55, 93];\n[LA31756-2 (=Cardiac Routine Dose), 32, 576];\n[LA31758-8 (=Chest Low Dose), 55, 377];\n[LA31759-6 (=Chest Routine Dose), 49, 377];\n[LA31761-2 (=Chest High Dose or Cardiac High Dose), 49, 1282];\n[LA31762-0 (=Head Low Dose), 115, 582];\n[LA31763-8 (=Head Routine Dose), 115, 1025];\n[LA31764-6 (=Head High Dose), 115, 1832];\n[LA31765-3 (=Upper or Lower Extremity), 73, 320];\n[LA31766-1 (=Neck or Cervical Spine), 25, 1260];\n[LA31767-9 (=Thoracic or Lumbar Spine), 25, 1260];\n[LA31768-7 (=Combined Chest, Abdomen and Pelvis), 29, 1637];\n[LA31851-1 (=Combined Thoracic and Lumbar Spine), 25, 2520];\n[LA31769-5 (=Combined Head and Neck, Routine Dose), 25, 2285];\n[LA31770-3 (=Combined Head and Neck, High Dose), 25, 3092]\n\nEXCLUSIONS\n\nCT scans with missing patient age or missing CT Dose and Image Quality Category (LOINC(R) 96914-7) are excluded from the initial population. \nCT scans with a missing Calculated Global Noise value or a missing Calculated CT Size-Adjusted Dose value are not included in the denominator.\nPatients that have one or more CT scans assigned a CT Dose and Image Quality Category (LOINC(R) 96914-7) value using the LOINC(R) answer list (LL5824-9) of full body (LA31771-1) during the measurement period are excluded from the denominator. These exams are included in the initial population because they have a non-missing CT Dose and Image Quality Category but are then removed as a Denominator Exclusion in the eCQM because the value is full body, which reflects CT exams that cannot be categorized by anatomical area or by clinical indication, either because they are simultaneous exams of multiple body regions outside of four commonly encountered multiple region groupings, or because there is insufficient data for their classification based on the given diagnosis and procedure codes.\n\nThis eCQM is a patient-based measure and should report the percentage of patients that had an eligible CT scan performed during the measurement period that had either a size adjusted dose or noise level out of range.\n\nTelehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible encounter codes.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS1056v2. 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).",
"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": "boolean"
},
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-type",
"code": "outcome",
"display": "Outcome"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
"valueCode": "None"
},
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
"code": "increase",
"display": "Increased score indicates improvement"
}
]
}
}
],
"population": [
{
"id": "InitialPopulation_1",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "initial-population",
"display": "Initial Population"
}
]
},
"description": "Patients aged 18 years and older at the start of the measurement period that have an eligible CT scan with Dose and Image Quality Category performed 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 where an eligible CT scan has a Calculated Global Noise value and a Calculated CT Size-Adjusted Dose value",
"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": "Patients with one or more eligible CT scans that has a CT Dose and Image Quality Category = full body",
"criteria": {
"language": "text/cql-identifier",
"expression": "Denominator Exclusion"
}
},
{
"id": "Numerator_1",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "numerator",
"display": "Numerator"
}
]
},
"description": "Patients with one or more eligible CT scans with calculated CT Size-Adjusted Dose greater than or equal to a threshold specific to the CT Dose and Image Quality Category, or Calculated CT Global Noise value greater than or equal to a threshold specific to the CT Dose and Image Quality Category",
"criteria": {
"language": "text/cql-identifier",
"expression": "Numerator"
}
}
]
}
],
"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"
}
}
]
}