FHIR IG Statistics: Measure/CMS133FHIRCataracts2040BCVAwithin90Days

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

define "Initial Population":
  "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed
    where AgeInYearsAt(date from start of "Measurement Period") >= 18

define "Initial Population":
  "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed
    where AgeInYearsAt(date from start of "Measurement Period") >= 18

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  "Cataract Surgeries in Patients with Significant Ocular Conditions Impacting the Visual Outcome of Surgery"

define "Numerator":
  "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed
    with ( [ObservationClinicalResult: "Best corrected visual acuity (observable entity)"]
      union [ObservationClinicalResult: "Best Corrected Visual Acuity Exam Using Snellen Chart"] ) VisualAcuityExamPerformed
      such that VisualAcuityExamPerformed.effective.toInterval ( ) 90 days or less after day of end of CataractSurgeryPerformed.performed.toInterval ( )
        and VisualAcuityExamPerformed.status in { 'final', 'amended', 'corrected', 'preliminary' }
        and VisualAcuityExamPerformed.value as Concept in "Visual Acuity 20/40 or Better"

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 "Cataract Surgery Between January and September of Measurement Period":
  [Procedure: "Cataract Surgery"] CataractSurgery
    where CataractSurgery.performed.toInterval ( ) during "Measurement Period"
      and CataractSurgery.performed.toInterval ( ) starts 92 days or more before end of "Measurement Period"
      and CataractSurgery.status = 'completed'

define "Numerator":
  "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed
    with ( [ObservationClinicalResult: "Best corrected visual acuity (observable entity)"]
      union [ObservationClinicalResult: "Best Corrected Visual Acuity Exam Using Snellen Chart"] ) VisualAcuityExamPerformed
      such that VisualAcuityExamPerformed.effective.toInterval ( ) 90 days or less after day of end of CataractSurgeryPerformed.performed.toInterval ( )
        and VisualAcuityExamPerformed.status in { 'final', 'amended', 'corrected', 'preliminary' }
        and VisualAcuityExamPerformed.value as Concept in "Visual Acuity 20/40 or Better"

define "Initial Population":
  "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed
    where AgeInYearsAt(date from start of "Measurement Period") >= 18

define "Denominator":
  "Initial Population"

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

define "Initial Population":
  "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed
    where AgeInYearsAt(date from start of "Measurement Period") >= 18

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

define "Cataract Surgeries in Patients with Significant Ocular Conditions Impacting the Visual Outcome of Surgery":
  "Cataract Surgery Between January and September of Measurement Period" CataractSurgeryPerformed
    with ( ( ["ConditionProblemsHealthConcerns": "Acute and Subacute Iridocyclitis"]
        union ["ConditionEncounterDiagnosis": "Acute and Subacute Iridocyclitis"]
    )
      union ( ["ConditionProblemsHealthConcerns": "Amblyopia"]
          union ["ConditionEncounterDiagnosis": "Amblyopia"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Burn Confined to Eye and Adnexa"]
          union ["ConditionEncounterDiagnosis": "Burn Confined to Eye and Adnexa"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Cataract Secondary to Ocular Disorders"]
          union ["ConditionEncounterDiagnosis": "Cataract Secondary to Ocular Disorders"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Cataract Congenital"]
          union ["ConditionEncounterDiagnosis": "Cataract Congenital"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Cataract Mature or Hypermature"]
          union ["ConditionEncounterDiagnosis": "Cataract Mature or Hypermature"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Cataract Posterior Polar"]
          union ["ConditionEncounterDiagnosis": "Cataract Posterior Polar"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Central Corneal Ulcer"]
          union ["ConditionEncounterDiagnosis": "Central Corneal Ulcer"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Certain Types of Iridocyclitis"]
          union ["ConditionEncounterDiagnosis": "Certain Types of Iridocyclitis"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Choroidal Degenerations"]
          union ["ConditionEncounterDiagnosis": "Choroidal Degenerations"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Choroidal Detachment"]
          union ["ConditionEncounterDiagnosis": "Choroidal Detachment"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Choroidal Hemorrhage and Rupture"]
          union ["ConditionEncounterDiagnosis": "Choroidal Hemorrhage and Rupture"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Chronic Iridocyclitis"]
          union ["ConditionEncounterDiagnosis": "Chronic Iridocyclitis"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Cloudy Cornea"]
          union ["ConditionEncounterDiagnosis": "Cloudy Cornea"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Corneal Edema"]
          union ["ConditionEncounterDiagnosis": "Corneal Edema"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Disorders of Cornea Including Corneal Opacity"]
          union ["ConditionEncounterDiagnosis": "Disorders of Cornea Including Corneal Opacity"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Degeneration of Macula and Posterior Pole"]
          union ["ConditionEncounterDiagnosis": "Degeneration of Macula and Posterior Pole"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Degenerative Disorders of Globe"]
          union ["ConditionEncounterDiagnosis": "Degenerative Disorders of Globe"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Diabetic Macular Edema"]
          union ["ConditionEncounterDiagnosis": "Diabetic Macular Edema"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Diabetic Retinopathy"]
          union ["ConditionEncounterDiagnosis": "Diabetic Retinopathy"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Disorders of Optic Chiasm"]
          union ["ConditionEncounterDiagnosis": "Disorders of Optic Chiasm"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Disorders of Visual Cortex"]
          union ["ConditionEncounterDiagnosis": "Disorders of Visual Cortex"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Disseminated Chorioretinitis and Disseminated Retinochoroiditis"]
          union ["ConditionEncounterDiagnosis": "Disseminated Chorioretinitis and Disseminated Retinochoroiditis"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Focal Chorioretinitis and Focal Retinochoroiditis"]
          union ["ConditionEncounterDiagnosis": "Focal Chorioretinitis and Focal Retinochoroiditis"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Glaucoma"]
          union ["ConditionEncounterDiagnosis": "Glaucoma"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes"]
          union ["ConditionEncounterDiagnosis": "Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Hereditary Choroidal Dystrophies"]
          union ["ConditionEncounterDiagnosis": "Hereditary Choroidal Dystrophies"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Hereditary Corneal Dystrophies"]
          union ["ConditionEncounterDiagnosis": "Hereditary Corneal Dystrophies"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Hereditary Retinal Dystrophies"]
          union ["ConditionEncounterDiagnosis": "Hereditary Retinal Dystrophies"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Hypotony of Eye"]
          union ["ConditionEncounterDiagnosis": "Hypotony of Eye"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Injury to Optic Nerve and Pathways"]
          union ["ConditionEncounterDiagnosis": "Injury to Optic Nerve and Pathways"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Macular Scar of Posterior Polar"]
          union ["ConditionEncounterDiagnosis": "Macular Scar of Posterior Polar"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Morgagnian Cataract"]
          union ["ConditionEncounterDiagnosis": "Morgagnian Cataract"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Nystagmus and Other Irregular Eye Movements"]
          union ["ConditionEncounterDiagnosis": "Nystagmus and Other Irregular Eye Movements"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Open Wound of Eyeball"]
          union ["ConditionEncounterDiagnosis": "Open Wound of Eyeball"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Optic Atrophy"]
          union ["ConditionEncounterDiagnosis": "Optic Atrophy"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Optic Neuritis"]
          union ["ConditionEncounterDiagnosis": "Optic Neuritis"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis"]
          union ["ConditionEncounterDiagnosis": "Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Other Background Retinopathy and Retinal Vascular Changes"]
          union ["ConditionEncounterDiagnosis": "Other Background Retinopathy and Retinal Vascular Changes"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Other Disorders of Optic Nerve"]
          union ["ConditionEncounterDiagnosis": "Other Disorders of Optic Nerve"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Other Endophthalmitis"]
          union ["ConditionEncounterDiagnosis": "Other Endophthalmitis"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Other Proliferative Retinopathy"]
          union ["ConditionEncounterDiagnosis": "Other Proliferative Retinopathy"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Pathologic Myopia"]
          union ["ConditionEncounterDiagnosis": "Pathologic Myopia"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Posterior Lenticonus"]
          union ["ConditionEncounterDiagnosis": "Posterior Lenticonus"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Prior Penetrating Keratoplasty"]
          union ["ConditionEncounterDiagnosis": "Prior Penetrating Keratoplasty"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Purulent Endophthalmitis"]
          union ["ConditionEncounterDiagnosis": "Purulent Endophthalmitis"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Retinal Detachment with Retinal Defect"]
          union ["ConditionEncounterDiagnosis": "Retinal Detachment with Retinal Defect"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Retinal Vascular Occlusion"]
          union ["ConditionEncounterDiagnosis": "Retinal Vascular Occlusion"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Retrolental Fibroplasias"]
          union ["ConditionEncounterDiagnosis": "Retrolental Fibroplasias"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Scleritis"]
          union ["ConditionEncounterDiagnosis": "Scleritis"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Separation of Retinal Layers"]
          union ["ConditionEncounterDiagnosis": "Separation of Retinal Layers"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Traumatic Cataract"]
          union ["ConditionEncounterDiagnosis": "Traumatic Cataract"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Uveitis"]
          union ["ConditionEncounterDiagnosis": "Uveitis"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Vascular Disorders of Iris and Ciliary Body"]
          union ["ConditionEncounterDiagnosis": "Vascular Disorders of Iris and Ciliary Body"]
      )
      union ( ["ConditionProblemsHealthConcerns": "Visual Field Defects"]
          union ["ConditionEncounterDiagnosis": "Visual Field Defects"]
      ) ) ComorbidDiagnosis
      such that ComorbidDiagnosis.prevalenceInterval ( ) overlaps before CataractSurgeryPerformed.performed.toInterval ( )
        and ComorbidDiagnosis.isActive ( )

define "Denominator Exclusions":
  "Cataract Surgeries in Patients with Significant Ocular Conditions Impacting the Visual Outcome of Surgery"

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

/*
@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

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 [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }

Source

{
  "resourceType": "Measure",
  "id": "CMS133FHIRCataracts2040BCVAwithin90Days",
  "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://snomed.info/sct",
            "code": "419775003",
            "display": "Best corrected visual acuity (observable entity)"
          }
        },
        {
          "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": "CMS133FHIRCataracts2040BCVAwithin90Days"
            },
            {
              "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": "CMS133FHIRCataracts2040BCVAwithin90Days"
            },
            {
              "url": "name",
              "valueString": "Cataract Surgery Between January and September of Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"Cataract Surgery Between January and September of Measurement Period\":\n  [Procedure: \"Cataract Surgery\"] CataractSurgery\n    where CataractSurgery.performed.toInterval ( ) during \"Measurement Period\"\n      and CataractSurgery.performed.toInterval ( ) starts 92 days or more before end of \"Measurement Period\"\n      and CataractSurgery.status = 'completed'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS133FHIRCataracts2040BCVAwithin90Days"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n  \"Cataract Surgery Between January and September of Measurement Period\" CataractSurgeryPerformed\n    with ( [ObservationClinicalResult: \"Best corrected visual acuity (observable entity)\"]\n      union [ObservationClinicalResult: \"Best Corrected Visual Acuity Exam Using Snellen Chart\"] ) VisualAcuityExamPerformed\n      such that VisualAcuityExamPerformed.effective.toInterval ( ) 90 days or less after day of end of CataractSurgeryPerformed.performed.toInterval ( )\n        and VisualAcuityExamPerformed.status in { 'final', 'amended', 'corrected', 'preliminary' }\n        and VisualAcuityExamPerformed.value as Concept in \"Visual Acuity 20/40 or Better\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS133FHIRCataracts2040BCVAwithin90Days"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  \"Cataract Surgery Between January and September of Measurement Period\" CataractSurgeryPerformed\n    where AgeInYearsAt(date from start of \"Measurement Period\") >= 18"
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS133FHIRCataracts2040BCVAwithin90Days"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n  \"Initial Population\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "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": "CMS133FHIRCataracts2040BCVAwithin90Days"
            },
            {
              "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": "CMS133FHIRCataracts2040BCVAwithin90Days"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  \"Cataract Surgery Between January and September of Measurement Period\" CataractSurgeryPerformed\n    where AgeInYearsAt(date from start of \"Measurement Period\") >= 18"
            },
            {
              "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": "CMS133FHIRCataracts2040BCVAwithin90Days"
            },
            {
              "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": "CMS133FHIRCataracts2040BCVAwithin90Days"
            },
            {
              "url": "name",
              "valueString": "Cataract Surgeries in Patients with Significant Ocular Conditions Impacting the Visual Outcome of Surgery"
            },
            {
              "url": "statement",
              "valueString": "define \"Cataract Surgeries in Patients with Significant Ocular Conditions Impacting the Visual Outcome of Surgery\":\n  \"Cataract Surgery Between January and September of Measurement Period\" CataractSurgeryPerformed\n    with ( ( [\"ConditionProblemsHealthConcerns\": \"Acute and Subacute Iridocyclitis\"]\n        union [\"ConditionEncounterDiagnosis\": \"Acute and Subacute Iridocyclitis\"]\n    )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Amblyopia\"]\n          union [\"ConditionEncounterDiagnosis\": \"Amblyopia\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Burn Confined to Eye and Adnexa\"]\n          union [\"ConditionEncounterDiagnosis\": \"Burn Confined to Eye and Adnexa\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Cataract Secondary to Ocular Disorders\"]\n          union [\"ConditionEncounterDiagnosis\": \"Cataract Secondary to Ocular Disorders\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Cataract Congenital\"]\n          union [\"ConditionEncounterDiagnosis\": \"Cataract Congenital\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Cataract Mature or Hypermature\"]\n          union [\"ConditionEncounterDiagnosis\": \"Cataract Mature or Hypermature\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Cataract Posterior Polar\"]\n          union [\"ConditionEncounterDiagnosis\": \"Cataract Posterior Polar\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Central Corneal Ulcer\"]\n          union [\"ConditionEncounterDiagnosis\": \"Central Corneal Ulcer\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Certain Types of Iridocyclitis\"]\n          union [\"ConditionEncounterDiagnosis\": \"Certain Types of Iridocyclitis\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Choroidal Degenerations\"]\n          union [\"ConditionEncounterDiagnosis\": \"Choroidal Degenerations\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Choroidal Detachment\"]\n          union [\"ConditionEncounterDiagnosis\": \"Choroidal Detachment\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Choroidal Hemorrhage and Rupture\"]\n          union [\"ConditionEncounterDiagnosis\": \"Choroidal Hemorrhage and Rupture\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Chronic Iridocyclitis\"]\n          union [\"ConditionEncounterDiagnosis\": \"Chronic Iridocyclitis\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Cloudy Cornea\"]\n          union [\"ConditionEncounterDiagnosis\": \"Cloudy Cornea\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Corneal Edema\"]\n          union [\"ConditionEncounterDiagnosis\": \"Corneal Edema\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Disorders of Cornea Including Corneal Opacity\"]\n          union [\"ConditionEncounterDiagnosis\": \"Disorders of Cornea Including Corneal Opacity\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Degeneration of Macula and Posterior Pole\"]\n          union [\"ConditionEncounterDiagnosis\": \"Degeneration of Macula and Posterior Pole\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Degenerative Disorders of Globe\"]\n          union [\"ConditionEncounterDiagnosis\": \"Degenerative Disorders of Globe\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Diabetic Macular Edema\"]\n          union [\"ConditionEncounterDiagnosis\": \"Diabetic Macular Edema\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Diabetic Retinopathy\"]\n          union [\"ConditionEncounterDiagnosis\": \"Diabetic Retinopathy\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Disorders of Optic Chiasm\"]\n          union [\"ConditionEncounterDiagnosis\": \"Disorders of Optic Chiasm\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Disorders of Visual Cortex\"]\n          union [\"ConditionEncounterDiagnosis\": \"Disorders of Visual Cortex\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Disseminated Chorioretinitis and Disseminated Retinochoroiditis\"]\n          union [\"ConditionEncounterDiagnosis\": \"Disseminated Chorioretinitis and Disseminated Retinochoroiditis\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Focal Chorioretinitis and Focal Retinochoroiditis\"]\n          union [\"ConditionEncounterDiagnosis\": \"Focal Chorioretinitis and Focal Retinochoroiditis\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Glaucoma\"]\n          union [\"ConditionEncounterDiagnosis\": \"Glaucoma\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes\"]\n          union [\"ConditionEncounterDiagnosis\": \"Glaucoma Associated with Congenital Anomalies and Dystrophies and Systemic Syndromes\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Hereditary Choroidal Dystrophies\"]\n          union [\"ConditionEncounterDiagnosis\": \"Hereditary Choroidal Dystrophies\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Hereditary Corneal Dystrophies\"]\n          union [\"ConditionEncounterDiagnosis\": \"Hereditary Corneal Dystrophies\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Hereditary Retinal Dystrophies\"]\n          union [\"ConditionEncounterDiagnosis\": \"Hereditary Retinal Dystrophies\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Hypotony of Eye\"]\n          union [\"ConditionEncounterDiagnosis\": \"Hypotony of Eye\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Injury to Optic Nerve and Pathways\"]\n          union [\"ConditionEncounterDiagnosis\": \"Injury to Optic Nerve and Pathways\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Macular Scar of Posterior Polar\"]\n          union [\"ConditionEncounterDiagnosis\": \"Macular Scar of Posterior Polar\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Morgagnian Cataract\"]\n          union [\"ConditionEncounterDiagnosis\": \"Morgagnian Cataract\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Nystagmus and Other Irregular Eye Movements\"]\n          union [\"ConditionEncounterDiagnosis\": \"Nystagmus and Other Irregular Eye Movements\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Open Wound of Eyeball\"]\n          union [\"ConditionEncounterDiagnosis\": \"Open Wound of Eyeball\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Optic Atrophy\"]\n          union [\"ConditionEncounterDiagnosis\": \"Optic Atrophy\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Optic Neuritis\"]\n          union [\"ConditionEncounterDiagnosis\": \"Optic Neuritis\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis\"]\n          union [\"ConditionEncounterDiagnosis\": \"Other and Unspecified Forms of Chorioretinitis and Retinochoroiditis\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Other Background Retinopathy and Retinal Vascular Changes\"]\n          union [\"ConditionEncounterDiagnosis\": \"Other Background Retinopathy and Retinal Vascular Changes\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Other Disorders of Optic Nerve\"]\n          union [\"ConditionEncounterDiagnosis\": \"Other Disorders of Optic Nerve\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Other Endophthalmitis\"]\n          union [\"ConditionEncounterDiagnosis\": \"Other Endophthalmitis\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Other Proliferative Retinopathy\"]\n          union [\"ConditionEncounterDiagnosis\": \"Other Proliferative Retinopathy\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Pathologic Myopia\"]\n          union [\"ConditionEncounterDiagnosis\": \"Pathologic Myopia\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Posterior Lenticonus\"]\n          union [\"ConditionEncounterDiagnosis\": \"Posterior Lenticonus\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Prior Penetrating Keratoplasty\"]\n          union [\"ConditionEncounterDiagnosis\": \"Prior Penetrating Keratoplasty\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Purulent Endophthalmitis\"]\n          union [\"ConditionEncounterDiagnosis\": \"Purulent Endophthalmitis\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Retinal Detachment with Retinal Defect\"]\n          union [\"ConditionEncounterDiagnosis\": \"Retinal Detachment with Retinal Defect\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Retinal Vascular Occlusion\"]\n          union [\"ConditionEncounterDiagnosis\": \"Retinal Vascular Occlusion\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Retrolental Fibroplasias\"]\n          union [\"ConditionEncounterDiagnosis\": \"Retrolental Fibroplasias\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Scleritis\"]\n          union [\"ConditionEncounterDiagnosis\": \"Scleritis\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Separation of Retinal Layers\"]\n          union [\"ConditionEncounterDiagnosis\": \"Separation of Retinal Layers\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Traumatic Cataract\"]\n          union [\"ConditionEncounterDiagnosis\": \"Traumatic Cataract\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Uveitis\"]\n          union [\"ConditionEncounterDiagnosis\": \"Uveitis\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Vascular Disorders of Iris and Ciliary Body\"]\n          union [\"ConditionEncounterDiagnosis\": \"Vascular Disorders of Iris and Ciliary Body\"]\n      )\n      union ( [\"ConditionProblemsHealthConcerns\": \"Visual Field Defects\"]\n          union [\"ConditionEncounterDiagnosis\": \"Visual Field Defects\"]\n      ) ) ComorbidDiagnosis\n      such that ComorbidDiagnosis.prevalenceInterval ( ) overlaps before CataractSurgeryPerformed.performed.toInterval ( )\n        and ComorbidDiagnosis.isActive ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS133FHIRCataracts2040BCVAwithin90Days"
            },
            {
              "url": "name",
              "valueString": "Denominator Exclusions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exclusions\":\n  \"Cataract Surgeries in Patients with Significant Ocular Conditions Impacting the Visual Outcome of Surgery\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "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": 13
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS133FHIRCataracts2040BCVAwithin90Days"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "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": 15
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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": 16
            }
          ],
          "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": 17
            }
          ],
          "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": 18
            }
          ],
          "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": "Code system SNOMEDCT",
          "resource": "http://snomed.info/sct"
        },
        {
          "type": "depends-on",
          "display": "Code system SNOMEDCT",
          "resource": "http://snomed.info/sct"
        },
        {
          "type": "depends-on",
          "display": "Value set Cataract Surgery",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1411"
        },
        {
          "type": "depends-on",
          "display": "Value set Best Corrected Visual Acuity Exam Using Snellen Chart",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1560"
        },
        {
          "type": "depends-on",
          "display": "Value set Visual Acuity 20/40 or Better",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1483"
        },
        {
          "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 Acute and Subacute Iridocyclitis",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1241"
        },
        {
          "type": "depends-on",
          "display": "Value set Amblyopia",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1448"
        },
        {
          "type": "depends-on",
          "display": "Value set Burn Confined to Eye and Adnexa",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1409"
        },
        {
          "type": "depends-on",
          "display": "Value set Cataract Secondary to Ocular Disorders",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1410"
        },
        {
          "type": "depends-on",
          "display": "Value set Cataract Congenital",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1412"
        },
        {
          "type": "depends-on",
          "display": "Value set Cataract Mature or Hypermature",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1413"
        },
        {
          "type": "depends-on",
          "display": "Value set Cataract Posterior Polar",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1414"
        },
        {
          "type": "depends-on",
          "display": "Value set Central Corneal Ulcer",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1428"
        },
        {
          "type": "depends-on",
          "display": "Value set Certain Types of Iridocyclitis",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1415"
        },
        {
          "type": "depends-on",
          "display": "Value set Choroidal Degenerations",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1450"
        },
        {
          "type": "depends-on",
          "display": "Value set Choroidal Detachment",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1451"
        },
        {
          "type": "depends-on",
          "display": "Value set Choroidal Hemorrhage and Rupture",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1452"
        },
        {
          "type": "depends-on",
          "display": "Value set Chronic Iridocyclitis",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1416"
        },
        {
          "type": "depends-on",
          "display": "Value set Cloudy Cornea",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1417"
        },
        {
          "type": "depends-on",
          "display": "Value set Corneal Edema",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1418"
        },
        {
          "type": "depends-on",
          "display": "Value set Disorders of Cornea Including Corneal Opacity",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1419"
        },
        {
          "type": "depends-on",
          "display": "Value set Degeneration of Macula and Posterior Pole",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1453"
        },
        {
          "type": "depends-on",
          "display": "Value set Degenerative Disorders of Globe",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1454"
        },
        {
          "type": "depends-on",
          "display": "Value set Diabetic Macular Edema",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1455"
        },
        {
          "type": "depends-on",
          "display": "Value set Diabetic Retinopathy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.327"
        },
        {
          "type": "depends-on",
          "display": "Value set Disorders of Optic Chiasm",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1457"
        },
        {
          "type": "depends-on",
          "display": "Value set Disorders of Visual Cortex",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1458"
        },
        {
          "type": "depends-on",
          "display": "Value set Disseminated Chorioretinitis and Disseminated Retinochoroiditis",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1459"
        },
        {
          "type": "depends-on",
          "display": "Value set Focal Chorioretinitis and Focal Retinochoroiditis",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1460"
        },
        {
          "type": "depends-on",
          "display": "Value set Glaucoma",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1423"
        },
        {
          "type": "depends-on",
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  "extension": [
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      "id": "supplementalDataGuidance",
      "extension": [
        {
          "url": "guidance",
          "valueString": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Payer \n SDE Ethnicity \n SDE Race \n SDE Sex \n "
        },
        {
          "url": "usage",
          "valueCodeableConcept": {
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          }
        }
      ],
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    },
    {
      "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/CMS133FHIRCataracts2040BCVAwithin90Days",
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    {
      "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": "CMS133FHIR"
    },
    {
      "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:84905817-706b-48a8-a8f8-a05436cd6a0e"
    },
    {
      "use": "official",
      "type": {
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          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "version-specific",
            "display": "Version Specific"
          }
        ]
      },
      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:c3618d15-8202-4d6e-bb63-4797120715dc"
    },
    {
      "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": "133FHIR",
      "assigner": {
        "display": "CMS"
      }
    }
  ],
  "version": "0.2.000",
  "name": "CMS133FHIRCataracts2040BCVAwithin90Days",
  "title": "Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract SurgeryFHIR",
  "status": "active",
  "experimental": false,
  "date": "2025-07-15T13:37:39+00:00",
  "publisher": "American Academy of Ophthalmology",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "www.aao.org"
        }
      ]
    }
  ],
  "description": "Percentage of cataract surgeries for patients aged 18 and older with a diagnosis of uncomplicated cataract and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following the cataract surgery",
  "usage": "This eCQM is an episode-based measure. An episode for this measure is defined as each cataract surgery during the measurement period, including instances where more than one cataract procedure was performed during the measurement period. Every cataract surgery during the measurement period should be counted as a measurable denominator event for the measure calculation.\n \nOnly procedures performed during January 1 - September 30 of the reporting period will be considered for this measure, in order to determine if 20/40 or better visual acuity has been achieved within the 90 days following the cataract procedure. Cataract procedures performed during October 1 - December 31 are excluded from the initial population.\n\nThe measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional or eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality.\n\nThis measure is to be reported by the clinician performing the cataract surgery procedure. Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure.\n\nTelehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible encounter codes.\n\nThis version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",
  "copyright": "Copyright 2025 American Academy of Ophthalmology. All Rights Reserved.",
  "approvalDate": "2023-09-05",
  "lastReviewDate": "2023-09-05",
  "effectivePeriod": {
    "start": "2026-01-01",
    "end": "2026-12-31"
  },
  "author": [
    {
      "name": "American Academy of Ophthalmology",
      "telecom": [
        {
          "system": "url",
          "value": "www.aao.org"
        }
      ]
    },
    {
      "name": "American Medical Association (AMA)",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.ama-assn.org/"
        }
      ]
    }
  ],
  "library": [
    "https://madie.cms.gov/Library/CMS133FHIRCataracts2040BCVAwithin90Days"
  ],
  "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\nThe Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, 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. \n\nCommercial uses of the Measure require a license agreement between the user and the American Academy of Ophthalmology (Academy). Neither the Academy, PCPI, nor the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor their members shall be responsible for any use of the Measure.\n\nThe PCPI’s and AMA’s significant past efforts and contributions to the development and updating of the Measures are acknowledged. The National Committee for Quality Assurance’s significant past efforts and contributions to the development and updating of the Measure is acknowledged. \n\nTHE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.\n\nLimited proprietary coding is contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party’s use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measures. Any other use of CPT or other coding by the third party is strictly prohibited. The Academy, its members, the AMA, and former members of the PCPI disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications. \n\nCPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association. LOINC(R) is 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 is copyright 2024 World Health Organization. All Rights Reserved.\n\nDue to technical limitations, registered trademarks are indicated by (R) or [R].",
  "rationale": "In the United States, cataracts affect more than 24 million adults over 40 years (National Eye Institute, 2019). According to the American Academy of Ophthalmology (2021), cataract surgery has a substantial beneficial impact on visual function and on quality of life.\n\n1. Scientific basis for measuring visual acuity outcomes after cataract surgery\nThe only reason to perform cataract surgery (other than for a limited set of medical indications) is to improve a patient's vision and associated functioning. The use of a 20/40 visual acuity threshold is based on several considerations. First, it is the level for unrestricted operation of a motor vehicle in the US. Second, it has been consistently used by the FDA in its assessment for approval of intraocular lens (IOL) and other vision devices. Third, it is the literature standard to denote success in cataract surgery. Fourth, work by West et al. in the Salisbury Eye Study suggests that 20/40 is a useful threshold for 50th percentile functioning for several vision-related tasks.\n\nMost patients achieve excellent visual acuity after cataract surgery (20/40 or better). This outcome is achieved consistently through careful attention through the accurate measurement of axial length and corneal power and the appropriate selection of an IOL power calculation formula. As such, it reflects the care and diligence with which the surgery is assessed, planned and executed. Failure to achieve this after surgery in eyes without comorbid ocular conditions that would impact the success of the surgery would reflect care that should be assessed for opportunities for improvement.\n\nThe exclusion of patients with other ocular and systemic conditions known to increase the risk of an adverse outcome reflects the findings of the two published prediction rule papers for cataract surgery outcomes, by Mangione et al. (1995) and Steinberg et al. (1994). In both papers, the presence of comorbid glaucoma and macular degeneration negatively impacted the likelihood of successful outcomes of surgery. Further, as noted in the prior indicator, exclusion of eyes with ocular conditions that could impact the success of the surgery would NOT eliminate the large majority of eyes undergoing surgery while also minimizing the potential adverse selection that might otherwise occur relative to those patients with the most complex situations who might benefit the most from having surgery to maximize their remaining vision. \n\n2. Evidence of a gap in care\nCataract surgery successfully restores vision in the majority of people who have the procedure. \n\nData from a study of 368,256 cataract surgeries show that corrected visual acuity (CDVA) of 0.5 (20/40) or better was achieved in 94.3% and CDVA of 1.0 (20/20) or better was achieved in 61.3% of cases (Lundstrom, Barry, Henry, Rosen & Stenevi, 2013).\n\nAdditionally, data from a UK multi-center Cataract National Dataset found a postoperative visual acuity of 6/12 (20/40) or better was achieved for 94.7% of eyes with no co-pathologies and in 79.9% of eyes with one or more co-pathologies (Jaycock et al., 2009).\n \nA rate of 85.5-94.7% of patients achieving a 20/40 or better visual acuity in the context of approximately 3 million cataract surgeries in the US annually would mean that between 160,000 to 435,000 individuals would not achieve a 20/40 or better visual acuity which suggests an opportunity for improvement.",
  "clinicalRecommendationStatement": "This is an outcome measure. As such, there is no statement in the guideline specific to this measurement topic.",
  "guidance": "This eCQM is an episode-based measure. An episode for this measure is defined as each cataract surgery during the measurement period, including instances where more than one cataract procedure was performed during the measurement period. Every cataract surgery during the measurement period should be counted as a measurable denominator event for the measure calculation.\n \nOnly procedures performed during January 1 - September 30 of the reporting period will be considered for this measure, in order to determine if 20/40 or better visual acuity has been achieved within the 90 days following the cataract procedure. Cataract procedures performed during October 1 - December 31 are excluded from the initial population.\n\nThe measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional or eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality.\n\nThis measure is to be reported by the clinician performing the cataract surgery procedure. Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure.\n\nTelehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible encounter codes.\n\nThis version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",
  "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": "Procedure"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-type",
                "code": "outcome",
                "display": "Outcome"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode": "None"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "decrease",
                "display": "increase"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-improvementNotationGuidance",
          "valueMarkdown": "Higher score indicates better quality"
        }
      ],
      "population": [
        {
          "id": "InitialPopulation_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "All cataract surgeries performed between January and September of the measurement period for patients 18 years and older",
          "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": "Cataract surgeries in patients with significant ocular conditions impacting the visual outcome of surgery\n\nSignificant ocular conditions include: amblyopia, burn confined to eye and adnexa, cataracts econdary to ocular disorders, congenital cataract, mature or hypermature cataract, posterior polar cataract, central corneal ulcer, certain types of iridocyclitis, choroidal degenerations, choroidal detachment, choroidal hemorrhage and rupture, cloudy cornea, corneal edema, disorders of cornea including corneal opacity, degeneration of macula and posterior pole, degenerative disorders of globe, diabetic macular edema, diabetic retinopathy disorders of optic chiasm, disorders of visual cortex, disseminated chorioretinitis and disseminated retinochoroiditis, focal chorioretinitis and focal retinochoroiditis, glaucoma, hereditary dystrophies (choroidal, corneal, retinal), hypotony of eye, injury to optic nerve and pathways, macular scare of posterior polar, morgagnian cataract, nystagmus and other irregular eye movements, open wound of eyeball, optic atrophy, optic neuritis, pathologic myopia, posterior lenticonus, prior penetrating keratoplasty, purulent endophthalmitis, retinal detachment with retinal defect, retinal vascular occlusion, retrolental fibroplasias, scleritis, separation of retinal layers, traumatic cataract, uveitis, vascular disorders of iris and ciliary body, and visual field defects",
          "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": "Cataract surgeries with best-corrected visual acuity of 20/40 or better (distance or near) achieved in the operative eye within 90 days following cataract surgery",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        }
      ]
    }
  ],
  "supplementalData": [
    {
      "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-ethnicity",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
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          ]
        }
      ],
      "description": "SDE Ethnicity",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Ethnicity"
      }
    },
    {
      "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"
      }
    }
  ]
}