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FHIR IG Statistics: Measure/CMS135FHIRHFACEIorARBorARNIforLVSD

Packagegov.healthit.ecqi.ecqms
Resource TypeMeasure
IdCMS135FHIRHFACEIorARBorARNIforLVSD
FHIR VersionR4
Sourcehttp://ecqi.healthit.gov/ecqms/https://build.fhir.org/ig/cqframework/ecqm-content-qicore-2025/Measure-CMS135FHIRHFACEIorARBorARNIforLVSD.html
URLhttps://madie.cms.gov/Measure/CMS135FHIRHFACEIorARBorARNIforLVSD
Version0.4.000
Statusactive
Date2025-07-15T13:37:40+00:00
NameCMS135FHIRHFACEIorARBorARNIforLVSD
TitleHeart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD)FHIR
DescriptionPercentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) <=40% who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period
CopyrightCopyright 2025 American College of Cardiology and American Heart Association. All Rights Reserved.

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Metadata
Title Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD)FHIR
Version 0.4.000
Short Name CMS135FHIR
GUID (Version Independent) urn:uuid:86136d6c-dbe1-4b7f-89f3-406cb90f08d5
GUID (Version Specific) urn:uuid:49f6269e-835d-426c-b2ef-248e1e3e2934
CMS Identifier 135FHIR
CMS Consensus Based Entity Identifier 0081e
Effective Period 2026-01-01 through 2026-12-31
Steward (Publisher) American Heart Association
Developer American Heart Association
Developer American Medical Association (AMA)
Description

Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) <=40% who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period
Copyright

Copyright 2025 American College of Cardiology and American Heart Association. All Rights Reserved.
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.

The 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.

Commercial uses of the Measure require a license agreement between the user and the American College of Cardiology (ACC) or the American Heart Association (AHA). Neither the ACC, nor AHA, nor their members shall be responsible for any use of the Measure.

ACC and AHA encourage use of the Measure by other health care professionals, where appropriate. 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. The ACC and AHA and their members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-20234 American Medical Association. LOINC(R) is copyright 2004-20234 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-20234 International Health Terminology Standards Development Organisation. ICD-10 is copyright 20234 World Health Organization. All Rights Reserved.

The American Medical Association’s and the PCPI(R) Foundation’s significant past efforts and contributions to the performance measure are gratefully acknowledged. Due to technical limitations, registered trademarks are indicated by (R) or [R].
Rationale

Use of ACE inhibitor, ARB, or ARNI therapy has been associated with improved outcomes in patients with reduced LVEF. Long-term therapy with ARBs have also been shown to reduce morbidity and mortality, especially in ACE inhibitor–intolerant patients. More recently, ARNI therapy has also been shown to more significantly improve outcomes, such that the newest guidelines recommend replacement of ACE inhibitors or ARBs with ARNI therapy in eligible patients. However, despite the benefits of these drugs, use of ACE inhibitor, ARB, or ARNI remains suboptimal.
Clinical Recommendation Statement

Clinical Recommendation Statement In patients with Heart Failure with Reduced Ejection Fraction (HFrEF) and New York Heart Association (NYHA) class II to III symptoms, the use of ARNI is recommended to reduce morbidity and mortality (Class I, Level of Evidence A) (Heidenreich et al., 2022).

In patients with previous or current symptoms of chronic HFrEF, the use of angiotension-converting enzyme inhibitors (ACEi) is beneficial to reduce morbidity and mortality when the use of ARNI is not feasible (Class I, Level of Evidence A) (Heidenreich et al., 2022).

In patients with previous or current symptoms of chronic HFrEF who are intolerant to ACEi because of cough or angioedema and when the use of ARNI is not feasible, the use of ARB is recommended to reduce morbidity and mortality. (Class I, Level of Evidence A) (Heidenreich et al., 2022).

In patients with chronic symptomatic HFrEF NYHA class II or III who tolerate an ACEi or ARB, replacement by an ARNI is recommended to further reduce morbidity and mortality (Class I, Level of Evidence B-R) (Heidenreich et al., 2022).

ARNI should not be administered concomitantly with ACEi or within 36 hours of the last dose of an ACEi (Class II: Harm, Level of Evidence B-R) (Heidenreich et al., 2022).

ARNI should not be administered to patients with any history of angioedema (Class III: Harm, Level of Evidence C-LD) (Heidenreich et al., 2022).

ACEi should not be administered to patients with any history of angioedema (Class III: Harm, Level of Evidence C-LD) (Heidenreich et al., 2022).

Drugs Commonly Used for Stage C HFrEF (abbreviated to align with focus of measure to include only ACE inhibitors, ARB and ARNI therapy)

Drug Initial Daily Dose(s) Target Dose(s) Mean Doses Achieved in Clinical Trials

ACEi

Captopril 6.25 mg 3 times 50 mg 3 times 122.7 mg total daily

Enalapril 2.5 mg twice 10 to 20 mg twice 16.6 mg total daily

Fosinopril 5 to 10 mg once 40 mg once N/A

Lisinopril 2.5 to 5 mg once 20 to 40 mg once 32.5 to 35.0 mg total daily

Perindopril 2 mg once 8 to 16 mg once N/A

Quinapril 5 mg twice 20 mg twice N/A

Ramipril 1.25 to 2.5 mg once 10 mg once N/A

Trandolapril 1 mg once 4 mg once N/A

ARB

Candesartan 4 to 8 mg once 32 mg once 24 mg total daily

Losartan 25 to 50 mg once 50 to 150 mg once 129 mg total daily

Valsartan 20 to 40 mg twice 160 mg twice 254 mg total daily

ARNI

Sacubitril- 49/51 mg twice 97/103 mg twice 182/193 mg

valsartan (sacubitril/valsartan) (sacubitril/valsartan) (sacubitril/valsartan) total

daily (therapy may be initiated

                            at 24/26 mg twice)
Guidance (Usage) This eCQM is to be reported as patient-based. To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period. The requirement of two or more visits is used to establish that the eligible clinician has an existing relationship with the patient. A range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than or equal to 40% threshold noted in the denominator logic. A range that is greater than 40% would not meet the measure requirement. In order for the Ejection Fraction result pathway to be recognized as below 40%, the result must be reported as a number with unit of %. A text string of "below 40%" or "ejection fraction between 35 and 40%" will not be recognized through electronic data capture. Although, this criteria can also be met using the Diagnosis pathway if specified as "Moderate or Severe." Eligible clinicians who have given a prescription for or whose patient is already taking an Angiotensin-Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) would meet performance for this measure. Other combination therapies that consist of an ACEI plus diuretic, ARB + neprilysin inhibitor (ARNI), ARB plus diuretic, ACEI plus calcium channel blocker, ARB plus calcium channel blocker, or ARB plus calcium channel blocker plus diuretic would also meet performance for this measure. This 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
Measure Group (Rate) (ID: Group_1)
Basis boolean
Scoring Proportion
Type Process
Rate Aggregation None
Improvement Notation Increased score indicates improvement
Initial Population ID: InitialPopulation_1
Description:

All patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of heart failure on or before at least one qualifying encounter

Logic Definition: Initial Population
Denominator ID: Denominator_1
Description:

Equals Initial Population with a current or prior LVEF <= 40%

Logic Definition: Denominator
Denominator Exclusion ID: DenominatorExclusion_1
Description:

Patients with a history of heart transplant or with a Left Ventricular Assist Device (LVAD) prior to the end of the outpatient encounter with Moderate or Severe LVSD

Logic Definition: Denominator Exclusions
Numerator ID: Numerator_1
Description:

Patients who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period

Logic Definition: Numerator
Denominator Exception ID: DenominatorException_1
Description:

Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., pregnancy, renal failure due to ACEI, allergy, intolerance, other medical reasons). Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., patient declined, other patient reasons).

Logic Definition: Denominator Exceptions
Supplemental Data Guidance For every patient evaluated by this measure also identify payer, race, ethnicity and 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 CMS135FHIRHFACEIorARBorARNIforLVSD
Contents Population Criteria
Logic Definitions
Terminology
Dependencies
Data Requirements
Population Criteria
Measure Group (Rate) (ID: Group_1)
Initial Population 
define "Initial Population":
  AHA."Is Adults With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period"
Initial Population 
define "Initial Population":
  AHA."Is Adults With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period"
Denominator 
define "Denominator":
  "Initial Population"
    and exists AHA."Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD"
Denominator Exclusion 
define "Denominator Exclusions":
  AHA."Has Heart Transplant"
    or AHA."Has Heart Transplant Complications"
    or AHA."Has Left Ventricular Assist Device"
    or AHA."Has Left Ventricular Assist Device Complications"
Numerator 
define "Numerator":
  "Has ACEI or ARB or ARNI Ordered"
    or "Is Currently Taking ACEI or ARB or ARNI"
Denominator Exception 
define "Denominator Exceptions":
  "Has Medical or Patient Reason for Not Ordering ACEI or ARB or ARNI"
    or "Has Allergy or Intolerance to ACEI or ARB or ARNI Ingredient"
    or "Has Diagnosis of Allergy or Intolerance to ACEI or ARB"
    or "Has Diagnosis of Pregnancy"
    or "Has Diagnosis of Renal Failure Due to ACEI"
Logic Definitions
Logic Definition Library Name: SupplementalDataElements 
define "SDE Sex":
  case
    when Patient.sex = '248153007' then "Male (finding)"
    when Patient.sex = '248152002' then "Female (finding)"
    else null
  end
Logic Definition Library Name: SupplementalDataElements 
define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }
Logic Definition Library Name: SupplementalDataElements 
define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }
Logic Definition Library Name: SupplementalDataElements 
define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }
Logic Definition Library Name: CMS135FHIRHFACEIorARBorARNIforLVSD 
define "SDE Sex":
  SDE."SDE Sex"
Logic Definition Library Name: CMS135FHIRHFACEIorARBorARNIforLVSD 
define "Has ACEI or ARB or ARNI Ordered":
  exists ( [MedicationRequest: medication in "ACE Inhibitor or ARB or ARNI"] ACEIOrARBOrARNIOrdered
      where ACEIOrARBOrARNIOrdered.isOrderedDuringHeartFailureOutpatientEncounter ( )
  )
Logic Definition Library Name: CMS135FHIRHFACEIorARBorARNIforLVSD 
define "Is Currently Taking ACEI or ARB or ARNI":
  exists ( [MedicationRequest: medication in "ACE Inhibitor or ARB or ARNI"] ActiveACEIOrARBOrARNI
      where ActiveACEIOrARBOrARNI.overlapsAfterHeartFailureOutpatientEncounter ( )
  )
Logic Definition Library Name: CMS135FHIRHFACEIorARBorARNIforLVSD 
define "Numerator":
  "Has ACEI or ARB or ARNI Ordered"
    or "Is Currently Taking ACEI or ARB or ARNI"
Logic Definition Library Name: CMS135FHIRHFACEIorARBorARNIforLVSD 
define "Initial Population":
  AHA."Is Adults With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period"
Logic Definition Library Name: CMS135FHIRHFACEIorARBorARNIforLVSD 
define "Denominator":
  "Initial Population"
    and exists AHA."Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD"
Logic Definition Library Name: CMS135FHIRHFACEIorARBorARNIforLVSD 
define "SDE Payer":
  SDE."SDE Payer"
Logic Definition Library Name: CMS135FHIRHFACEIorARBorARNIforLVSD 
define "Initial Population":
  AHA."Is Adults With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period"
Logic Definition Library Name: CMS135FHIRHFACEIorARBorARNIforLVSD 
define "SDE Ethnicity":
  SDE."SDE Ethnicity"
Logic Definition Library Name: CMS135FHIRHFACEIorARBorARNIforLVSD 
define "Denominator Exclusions":
  AHA."Has Heart Transplant"
    or AHA."Has Heart Transplant Complications"
    or AHA."Has Left Ventricular Assist Device"
    or AHA."Has Left Ventricular Assist Device Complications"
Logic Definition Library Name: CMS135FHIRHFACEIorARBorARNIforLVSD 
define "SDE Race":
  SDE."SDE Race"
Logic Definition Library Name: CMS135FHIRHFACEIorARBorARNIforLVSD 
// TODO: https://oncprojectracking.healthit.gov/support/projects/MADIE/issues/MADIE-2124
// Expecting 1 failure per population until this translator issue is incorporated into MADiE



define "Has Medical or Patient Reason for Not Ordering ACEI or ARB or ARNI":
  exists ( [MedicationNotRequested: medication in "ACE Inhibitor or ARB or ARNI"] NoACEIOrARBOrARNIOrdered
      where NoACEIOrARBOrARNIOrdered.isOrderedDuringHeartFailureOutpatientEncounter ( )
        and ( NoACEIOrARBOrARNIOrdered.reasonCode in "Medical Reason"
            or NoACEIOrARBOrARNIOrdered.reasonCode in "Patient Reason"
            or NoACEIOrARBOrARNIOrdered.reasonCode in "Patient Reason for ACE Inhibitor or ARB Decline"
        )
  )
Logic Definition Library Name: CMS135FHIRHFACEIorARBorARNIforLVSD 
define "Has Allergy or Intolerance to ACEI or ARB or ARNI Ingredient":
  exists ( ( [AllergyIntolerance: "ACE Inhibitor or ARB or ARNI Ingredient"]
      union [AllergyIntolerance: "Substance with angiotensin-converting enzyme inhibitor mechanism of action (substance)"]
      union [AllergyIntolerance: "Substance with angiotensin II receptor antagonist mechanism of action (substance)"]
      union [AllergyIntolerance: "Substance with neprilysin inhibitor mechanism of action (substance)"] ) ACEIOrARBOrARNIAllergyIntolerance
      where ACEIOrARBOrARNIAllergyIntolerance.overlapsAfterHeartFailureOutpatientEncounter ( )
  )
Logic Definition Library Name: CMS135FHIRHFACEIorARBorARNIforLVSD 
define "Has Diagnosis of Allergy or Intolerance to ACEI or ARB":
  exists ( ( ["ConditionProblemsHealthConcerns": "Allergy to ACE Inhibitor or ARB"]
      union ["ConditionProblemsHealthConcerns": "Intolerance to ACE Inhibitor or ARB"] ) ACEIOrARBAllergyOrIntoleranceDiagnosis
      where ACEIOrARBAllergyOrIntoleranceDiagnosis.overlapsAfterHeartFailureOutpatientEncounter ( )
  )
Logic Definition Library Name: CMS135FHIRHFACEIorARBorARNIforLVSD 
define "Has Diagnosis of Pregnancy":
  exists ( [ConditionProblemsHealthConcerns: "Pregnancy"] PregnancyDiagnosis
      with AHA."Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
        such that PregnancyDiagnosis.prevalenceInterval ( ) starts 9 months or less before or on start of ModerateOrSevereLVSDHFOutpatientEncounter.period
  )
Logic Definition Library Name: CMS135FHIRHFACEIorARBorARNIforLVSD 
define "Has Diagnosis of Renal Failure Due to ACEI":
  exists ( [ConditionEncounterDiagnosis: "Acute renal failure caused by angiotensin-converting-enzyme inhibitor (disorder)"] RenalFailureDueToACEI
      where RenalFailureDueToACEI.overlapsHeartFailureOutpatientEncounter ( )
  )
Logic Definition Library Name: CMS135FHIRHFACEIorARBorARNIforLVSD 
define "Denominator Exceptions":
  "Has Medical or Patient Reason for Not Ordering ACEI or ARB or ARNI"
    or "Has Allergy or Intolerance to ACEI or ARB or ARNI Ingredient"
    or "Has Diagnosis of Allergy or Intolerance to ACEI or ARB"
    or "Has Diagnosis of Pregnancy"
    or "Has Diagnosis of Renal Failure Due to ACEI"
Logic Definition Library Name: FHIRHelpers 
define function ToString(value uri): value.value
Logic Definition Library Name: FHIRHelpers 
/*
@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]
Logic Definition Library Name: FHIRHelpers 
/*
@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
        }
Logic Definition Library Name: FHIRHelpers 
/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }
Logic Definition Library Name: QICoreCommon 
/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting 
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
    (end of condition.abatementInterval()) abatementDate
    return if abatementDate is null then
      Interval[start of condition.onset.toInterval(), abatementDate)
    else
      Interval[start of condition.onset.toInterval(), abatementDate]
Logic Definition Library Name: QICoreCommon 
/*
@description: Returns an interval representing the normalized abatement of a given Condition.
@comment: If the abatement element of the Condition is represented as a DateTime, the result
is an interval beginning and ending on that DateTime.
If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The
result is an interval from the date the patient turned that age to immediately before one year later.
If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during
which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately
before one year later than the date the patient turned the ending age of the quantity interval.
*/
define fluent function abatementInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
	if condition.abatement is DateTime then
	  Interval[condition.abatement as DateTime, condition.abatement as DateTime]
	else if condition.abatement is Quantity then
		Interval[Patient.birthDate + (condition.abatement as Quantity),
			Patient.birthDate + (condition.abatement as Quantity) + 1 year)
	else if condition.abatement is Interval<Quantity> then
	  Interval[Patient.birthDate + (condition.abatement.low as Quantity),
		  Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)
	else if condition.abatement is Interval<DateTime> then
	  Interval[condition.abatement.low, condition.abatement.high)
	else null as Interval<DateTime>
Logic Definition Library Name: QICoreCommon 
/*
@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
Logic Definition Library Name: QICoreCommon 
/* Candidates for FHIRCommon */

/*
@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse
*/
define fluent function isActive(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
  condition.clinicalStatus ~ "active"
    or condition.clinicalStatus ~ "recurrence"
    or condition.clinicalStatus ~ "relapse"
Logic Definition Library Name: AHAOverall 
/*
@description: Returns certain finished encounter types that overlap a Heart Failure condition and are during the measurement period: 
                * care services in long term residential facility (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014)
                * home healthcare services (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016)
                * nursing facility visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012)
                * office visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001)
                * outpatient consolutations (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008)
*/
define "Heart Failure Outpatient Encounter":
  ( [Encounter: type in "Care Services in Long Term Residential Facility"]
      union [Encounter: type in "Home Healthcare Services"]
      union [Encounter: type in "Nursing Facility Visit"]
      union [Encounter: type in "Office Visit"] 
      union [Encounter: type in "Outpatient Consultation"]
     ) QualifyingEncounter
    with ([ConditionProblemsHealthConcerns: "Heart Failure"]
      union [ConditionEncounterDiagnosis: "Heart Failure"]) HeartFailure
      such that HeartFailure.prevalenceInterval() overlaps QualifyingEncounter.period  
        and HeartFailure.isConfirmedActiveDiagnosis()
    where QualifyingEncounter.period during day of "Measurement Period"
      and QualifyingEncounter.isFinished()
Logic Definition Library Name: AHAOverall 
/*
@description: Returns a union  of the following:
                * Observations where the final, amended or correction ejection fraction result is <= 40
                * Moderate or Severe LVSD conditions where the diagnosis has been confirmed as active
*/  
define "Moderate or Severe LVSD Findings":
  ( [ObservationClinicalResult: "Ejection Fraction"] EjectionFraction
      where EjectionFraction.value as Quantity <= 40 '%'
        and EjectionFraction.status in {'final', 'amended', 'corrected'} 
  )
  union 
  ( 
    ( 
      (
        [ConditionProblemsHealthConcerns: "Moderate or Severe LVSD"] 
          union [ConditionEncounterDiagnosis: "Moderate or Severe LVSD"]
      )
      union
      ( 
        (  
          [ConditionProblemsHealthConcerns: "Left ventricular systolic dysfunction (disorder)"]
            union [ConditionEncounterDiagnosis: "Left ventricular systolic dysfunction (disorder)"]
        ) LVSDDiagnosis
          where LVSDDiagnosis.severity in "Moderate or Severe"
      )
    ) ModerateOrSevereLVSD   
      where ModerateOrSevereLVSD.isConfirmedActiveDiagnosis()
  )
Logic Definition Library Name: AHAOverall 
/*
@description: Returns heart failure outpatient encounters that start before the end of a moderate or severe LVSD finding
*/ 
define "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD":
    "Heart Failure Outpatient Encounter" HFOutpatientEncounter
        with "Moderate or Severe LVSD Findings" LVSDFindings
            such that Coalesce(LVSDFindings.prevalenceInterval(), LVSDFindings.effective.toInterval()) starts before end of HFOutpatientEncounter.period
Logic Definition Library Name: AHAOverall 
/*
@description: Returns certain finished encounter types that occurred during the measurement period: 
                * office visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001)
                * outpatient consolutations (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008)
                * nursing facility visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012)
                * care services in long term residential facility (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014)
                * home healthcare services (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016)
                * patient provider interactions (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012) 
*/          
define "Qualifying Outpatient Encounter During Measurement Period":
    ( [Encounter: type in "Office Visit"]
        union [Encounter: type in "Outpatient Consultation"]
        union [Encounter: type in "Nursing Facility Visit"]
        union [Encounter: type in "Care Services in Long Term Residential Facility"]
        union [Encounter: type in "Home Healthcare Services"]
        union [Encounter: type in "Patient Provider Interaction"] ) ValidEncounter
      where ValidEncounter.period during day of "Measurement Period"
        and ValidEncounter.isFinished()
Logic Definition Library Name: AHAOverall 
/*
@description: Returns true if the patient meets the following criteria:
                * 18 years of age or older, has two 
                * Has two Qualifying Outpatient Encounters During Measurement Period
                * Has a Heart Failure Outpatient Encounter
*/           
define "Is Adults With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists ( "Qualifying Outpatient Encounter During Measurement Period" Encounter1
        with "Qualifying Outpatient Encounter During Measurement Period" Encounter2
          such that Encounter2.id !~ Encounter1.id
    )
    and exists "Heart Failure Outpatient Encounter"
Logic Definition Library Name: AHAOverall 
/*
@description: Returns completed heart tansplant procedures that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
*/ 
define "Has Heart Transplant":
  exists (
          [Procedure: "Heart Transplant"] HeartTransplant
            with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
              such that HeartTransplant.performed.toInterval() starts before end of ModerateOrSevereLVSDHFOutpatientEncounter.period
            where HeartTransplant.status = 'completed'
          )
Logic Definition Library Name: AHAOverall 
/*
@description: Returns true if patient has confirmed heart transplant complications that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
*/ 
define "Has Heart Transplant Complications":
  exists ( 
          ([ConditionEncounterDiagnosis: "Heart Transplant Complications"]
            union [ConditionProblemsHealthConcerns: "Heart Transplant Complications"]) HeartTransplantComplications
            let diagnosisStart: Coalesce( HeartTransplantComplications.recordedDate, start of HeartTransplantComplications.prevalenceInterval() )  
            with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
              such that diagnosisStart before end of ModerateOrSevereLVSDHFOutpatientEncounter.period
            where HeartTransplantComplications.isConfirmedActiveDiagnosis()
          )
Logic Definition Library Name: AHAOverall 
/*
@description: Returns true if patient has a completed LVAD placement that starts before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
*/ 
define "Has Left Ventricular Assist Device":
  exists (
            [Procedure: "Left Ventricular Assist Device Placement"] LVADOutpatient
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that LVADOutpatient.performed.toInterval() starts before end of ModerateOrSevereLVSDHFOutpatientEncounter.period
              where LVADOutpatient.status = 'completed'
            )
Logic Definition Library Name: AHAOverall 
/*
@description: Returns true if patient has active LVAD complications that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD
*/ 
define "Has Left Ventricular Assist Device Complications":
  exists (
            ([ConditionEncounterDiagnosis: "Left Ventricular Assist Device Complications"]
              union [ConditionProblemsHealthConcerns: "Left Ventricular Assist Device Complications"]) LVADComplications
              let diagnosisStart: Coalesce( LVADComplications.recordedDate, start of LVADComplications.prevalenceInterval() ) 
              with "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
                such that diagnosisStart before end of ModerateOrSevereLVSDHFOutpatientEncounter.period  
              where LVADComplications.isConfirmedActiveDiagnosis()
          )
Logic Definition Library Name: AHAOverall 
/*
@description: Returns true if the given MedicationRequest is ordered during the heart failure outpatient encounter with history of moderate or severe LVSD at any point
*/
define fluent function isOrderedDuringHeartFailureOutpatientEncounter(MedicationRequest MedicationRequest): 
  exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
            where MedicationRequest.authoredOn during day of ModerateOrSevereLVSDHFOutpatientEncounter.period
              and MedicationRequest.status in {'active', 'completed'}
              and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
              /*Issue: The logic commented out below was added to the logic due to an issue described in the authoring patterns for QI-Core: https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1#medication-ordered. However, when this logic is present, it causes an issue in Coverage calculation for resources that must be QI-Core compliant, because the inverse cannot be tested for a QI-Core MedicationRequest profile instance. This logic was commented out to achieve 100% Coverage. This requirement is really to handle what would happen if a MedicationRequest instance that could be set to 'false' were provided, but this should not happen within a trusted environment where QI-Core profile instances must be provided.*/
              // and MedicationRequest.doNotPerform is not true 
          )
Logic Definition Library Name: AHAOverall 
/*
@description: Returns true if the given Encounter is finished
*/
define fluent function isFinished(Encounter Encounter):
    Encounter.status = 'finished'
Logic Definition Library Name: AHAOverall 
/*
@overloaded
@description: Returns true if the given MedicationRequest overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/                    
define fluent function overlapsAfterHeartFailureOutpatientEncounter(MedicationRequest MedicationRequest): 
  exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
             where First( ( collapse (MedicationRequest.dosageInstruction.timing.repeat.bounds DoseTime
                                        return DoseTime.toInterval()) ) DrugPeriods
                           sort by start of $this ) overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period 
               and MedicationRequest.status in { 'active', 'completed' } 
               and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
               /*Issue: The logic commented out below was added to the logic due to an issue described in the authoring patterns for QI-Core: https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1#medication-ordered. However, when this logic is present, it causes an issue in Coverage calculation for resources that must be QI-Core compliant, because the inverse cannot be tested for a QI-Core MedicationRequest profile instance. This logic was commented out to achieve 100% Coverage. This requirement is really to handle what would happen if a MedicationRequest instance that could be set to 'false' were provided, but this should not happen within a trusted environment where QI-Core profile instances must be provided.*/
               // and Event.doNotPerform is not true 
          )
Logic Definition Library Name: AHAOverall 
/*
@overloaded
@description: Returns true if the given MedicationNotRequested overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/                    
define fluent function isOrderedDuringHeartFailureOutpatientEncounter(MedicationRequest MedicationNotRequested): 
  exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
             where MedicationRequest.authoredOn during day of ModerateOrSevereLVSDHFOutpatientEncounter.period 
               and MedicationRequest.status = 'completed'
               and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
          )
Logic Definition Library Name: AHAOverall 
/*
@overloaded
@description: Returns true if the given AllergyIntolerance overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/                    
define fluent function overlapsAfterHeartFailureOutpatientEncounter(AllergyIntolerance AllergyIntolerance): 
  exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
             where Interval[start of AllergyIntolerance.onset.toInterval(), AllergyIntolerance.lastOccurrence] overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
               and ( /* https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1771 - issue with implies operator tied to a non-supported feature in cql-exectuion
                          ( AllergyIntolerance.clinicalStatus is null implies
                              AllergyIntolerance.clinicalStatus ~ QICoreCommon."allergy-active" )
                              or */ AllergyIntolerance.clinicalStatus ~ QICoreCommon."allergy-active" 
                         )
               and AllergyIntolerance.verificationStatus ~ QICoreCommon."allergy-confirmed" 
          )
Logic Definition Library Name: AHAOverall 
/*
@overloaded
@description: Returns true if the given Condition overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD
*/
define fluent function overlapsAfterHeartFailureOutpatientEncounter(Condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>): 
  exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
             where Condition.prevalenceInterval() overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period
               and Condition.isConfirmedActiveDiagnosis()
          )
Logic Definition Library Name: AHAOverall 
/*
@description: Returns true if the given Condition is confirmed as active
*/
define fluent function isConfirmedActiveDiagnosis(condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>):
    condition.isActive()
        and condition.verificationStatus ~ QICoreCommon."confirmed"
Logic Definition Library Name: AHAOverall 
/*
@description: Returns true if the given Condition overlaps the heart failure outpatient encounter with history of moderate or severe LVSD at any point
*/
define fluent function overlapsHeartFailureOutpatientEncounter(Condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>): 
  exists ( "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
            where Condition.prevalenceInterval() overlaps day of ModerateOrSevereLVSDHFOutpatientEncounter.period
              and Condition.isConfirmedActiveDiagnosis()
          )
Terminology
Code System Description: Code system SNOMEDCT
Resource: SNOMED CT (all versions)
Canonical URL: http://snomed.info/sct
Code System Description: Code system SNOMEDCT
Resource: SNOMED CT (all versions)
Canonical URL: http://snomed.info/sct
Code System Description: Code system ConditionClinicalStatusCodes
Resource: Condition Clinical Status Codes
Canonical URL: http://terminology.hl7.org/CodeSystem/condition-clinical
Code System Description: Code system SNOMEDCT
Resource: SNOMED CT (all versions)
Canonical URL: http://snomed.info/sct
Code System Description: Code system AllergyIntoleranceClinicalStatusCodes
Resource: AllergyIntolerance Clinical Status Codes
Canonical URL: http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
Code System Description: Code system AllergyIntoleranceVerificationStatusCodes
Resource: AllergyIntolerance Verification Status
Canonical URL: http://terminology.hl7.org/CodeSystem/allergyintolerance-verification
Code System Description: Code system ConditionVerificationStatusCodes
Resource: ConditionVerificationStatus
Canonical URL: http://terminology.hl7.org/CodeSystem/condition-ver-status
Value Set Description: Value set ACE Inhibitor or ARB or ARNI
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1139
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1139
Value Set Description: Value set Care Services in Long Term Residential Facility
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014
Value Set Description: Value set Home Healthcare Services
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016
Value Set Description: Value set Nursing Facility Visit
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012
Value Set Description: Value set Office Visit
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
Value Set Description: Value set Outpatient Consultation
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008
Value Set Description: Value set Heart Failure
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376
Value Set Description: Value set Ejection Fraction
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1134
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1134
Value Set Description: Value set Moderate or Severe LVSD
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090
Value Set Description: Value set Moderate or Severe
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1092
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1092
Value Set Description: Value set Patient Provider Interaction
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012
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
Value Set Description: Value set Heart Transplant
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.33
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.33
Value Set Description: Value set Heart Transplant Complications
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.56
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.56
Value Set Description: Value set Left Ventricular Assist Device Placement
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.61
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.61
Value Set Description: Value set Left Ventricular Assist Device Complications
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.58
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.58
Value Set Description: Value set Medical Reason
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007
Value Set Description: Value set Patient Reason
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1008
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1008
Value Set Description: Value set Patient Reason for ACE Inhibitor or ARB Decline
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1140
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1140
Value Set Description: Value set ACE Inhibitor or ARB or ARNI Ingredient
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1489
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1489
Value Set Description: Value set Allergy to ACE Inhibitor or ARB
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1211
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1211
Value Set Description: Value set Intolerance to ACE Inhibitor or ARB
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1212
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1212
Value Set Description: Value set Pregnancy
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.378
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.378
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: Left ventricular systolic dysfunction (disorder)
Code: 134401001
System: http://snomed.info/sct
Direct Reference Code Display: Active
Code: active
System: http://terminology.hl7.org/CodeSystem/condition-clinical
Direct Reference Code Display: Recurrence
Code: recurrence
System: http://terminology.hl7.org/CodeSystem/condition-clinical
Direct Reference Code Display: Relapse
Code: relapse
System: http://terminology.hl7.org/CodeSystem/condition-clinical
Direct Reference Code Display: Substance with angiotensin-converting enzyme inhibitor mechanism of action (substance)
Code: 372733002
System: http://snomed.info/sct
Direct Reference Code Display: Substance with angiotensin II receptor antagonist mechanism of action (substance)
Code: 372913009
System: http://snomed.info/sct
Direct Reference Code Display: Substance with neprilysin inhibitor mechanism of action (substance)
Code: 786886009
System: http://snomed.info/sct
Direct Reference Code Display: Active
Code: active
System: http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
Direct Reference Code Display: Confirmed
Code: confirmed
System: http://terminology.hl7.org/CodeSystem/allergyintolerance-verification
Direct Reference Code Display: Confirmed
Code: confirmed
System: http://terminology.hl7.org/CodeSystem/condition-ver-status
Direct Reference Code Display: Acute renal failure caused by angiotensin-converting-enzyme inhibitor (disorder)
Code: 422593004
System: http://snomed.info/sct
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 AHA
Resource: Library/AHAOverall|3.0.000
Canonical URL: Library/AHAOverall|3.0.000
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 FHIRHelpers
Resource: Library/FHIRHelpers|4.4.000
Canonical URL: Library/FHIRHelpers|4.4.000
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
Data Requirements
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376
Data Requirement Type: Observation
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-clinical-result
Must Support Elements: code, value, status, status.value
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1134
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns
Must Support Elements: code
Code Filter(s):
Path: code
Code(s): SNOMED CT 134401001: Left ventricular systolic dysfunction (disorder)
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
Must Support Elements: code
Code Filter(s):
Path: code
Code(s): SNOMED CT 134401001: Left ventricular systolic dysfunction (disorder)
Data Requirement Type: MedicationRequest
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest
Must Support Elements: medication
Code Filter(s):
Path: medication
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1139
Data Requirement Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012
Data Requirement Type: Procedure
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
Must Support Elements: code, performed, status, status.value
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.33
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.56
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.56
Data Requirement Type: Procedure
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
Must Support Elements: code, performed, status, status.value
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.61
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.58
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.58
Data Requirement Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
Must Support Elements: url
Data Requirement Type: MedicationRequest
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationnotrequested
Must Support Elements: medication, reasonCode
Code Filter(s):
Path: medication
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1139
Data Requirement Type: AllergyIntolerance
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1489
Data Requirement Type: AllergyIntolerance
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance
Must Support Elements: code
Code Filter(s):
Path: code
Code(s): SNOMED CT 372733002: Substance with angiotensin-converting enzyme inhibitor mechanism of action (substance)
Data Requirement Type: AllergyIntolerance
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance
Must Support Elements: code
Code Filter(s):
Path: code
Code(s): SNOMED CT 372913009: Substance with angiotensin II receptor antagonist mechanism of action (substance)
Data Requirement Type: AllergyIntolerance
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance
Must Support Elements: code
Code Filter(s):
Path: code
Code(s): SNOMED CT 786886009: Substance with neprilysin inhibitor mechanism of action (substance)
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1211
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1212
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.378
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
Must Support Elements: code
Code Filter(s):
Path: code
Code(s): SNOMED CT 422593004: Acute renal failure caused by angiotensin-converting-enzyme inhibitor (disorder)
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: 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

Source

{
  "resourceType": "Measure",
  "id": "CMS135FHIRHFACEIorARBorARNIforLVSD",
  "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": "134401001",
            "display": "Left ventricular systolic dysfunction (disorder)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "active",
            "display": "Active"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "recurrence",
            "display": "Recurrence"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "relapse",
            "display": "Relapse"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "372733002",
            "display": "Substance with angiotensin-converting enzyme inhibitor mechanism of action (substance)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "372913009",
            "display": "Substance with angiotensin II receptor antagonist mechanism of action (substance)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "786886009",
            "display": "Substance with neprilysin inhibitor mechanism of action (substance)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
            "code": "active",
            "display": "Active"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
            "code": "confirmed",
            "display": "Confirmed"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
            "code": "confirmed",
            "display": "Confirmed"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "422593004",
            "display": "Acute renal failure caused by angiotensin-converting-enzyme inhibitor (disorder)"
          }
        },
        {
          "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": "CMS135FHIRHFACEIorARBorARNIforLVSD"
            },
            {
              "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": "AHAOverall"
            },
            {
              "url": "name",
              "valueString": "Heart Failure Outpatient Encounter"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns certain finished encounter types that overlap a Heart Failure condition and are during the measurement period: \n                * care services in long term residential facility (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014)\n                * home healthcare services (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016)\n                * nursing facility visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012)\n                * office visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001)\n                * outpatient consolutations (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008)\n*/\ndefine \"Heart Failure Outpatient Encounter\":\n  ( [Encounter: type in \"Care Services in Long Term Residential Facility\"]\n      union [Encounter: type in \"Home Healthcare Services\"]\n      union [Encounter: type in \"Nursing Facility Visit\"]\n      union [Encounter: type in \"Office Visit\"] \n      union [Encounter: type in \"Outpatient Consultation\"]\n     ) QualifyingEncounter\n    with ([ConditionProblemsHealthConcerns: \"Heart Failure\"]\n      union [ConditionEncounterDiagnosis: \"Heart Failure\"]) HeartFailure\n      such that HeartFailure.prevalenceInterval() overlaps QualifyingEncounter.period  \n        and HeartFailure.isConfirmedActiveDiagnosis()\n    where QualifyingEncounter.period during day of \"Measurement Period\"\n      and QualifyingEncounter.isFinished()"
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AHAOverall"
            },
            {
              "url": "name",
              "valueString": "Moderate or Severe LVSD Findings"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns a union  of the following:\n                * Observations where the final, amended or correction ejection fraction result is <= 40\n                * Moderate or Severe LVSD conditions where the diagnosis has been confirmed as active\n*/  \ndefine \"Moderate or Severe LVSD Findings\":\n  ( [ObservationClinicalResult: \"Ejection Fraction\"] EjectionFraction\n      where EjectionFraction.value as Quantity <= 40 '%'\n        and EjectionFraction.status in {'final', 'amended', 'corrected'} \n  )\n  union \n  ( \n    ( \n      (\n        [ConditionProblemsHealthConcerns: \"Moderate or Severe LVSD\"] \n          union [ConditionEncounterDiagnosis: \"Moderate or Severe LVSD\"]\n      )\n      union\n      ( \n        (  \n          [ConditionProblemsHealthConcerns: \"Left ventricular systolic dysfunction (disorder)\"]\n            union [ConditionEncounterDiagnosis: \"Left ventricular systolic dysfunction (disorder)\"]\n        ) LVSDDiagnosis\n          where LVSDDiagnosis.severity in \"Moderate or Severe\"\n      )\n    ) ModerateOrSevereLVSD   \n      where ModerateOrSevereLVSD.isConfirmedActiveDiagnosis()\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AHAOverall"
            },
            {
              "url": "name",
              "valueString": "Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns heart failure outpatient encounters that start before the end of a moderate or severe LVSD finding\n*/ \ndefine \"Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD\":\n    \"Heart Failure Outpatient Encounter\" HFOutpatientEncounter\n        with \"Moderate or Severe LVSD Findings\" LVSDFindings\n            such that Coalesce(LVSDFindings.prevalenceInterval(), LVSDFindings.effective.toInterval()) starts before end of HFOutpatientEncounter.period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS135FHIRHFACEIorARBorARNIforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has ACEI or ARB or ARNI Ordered"
            },
            {
              "url": "statement",
              "valueString": "define \"Has ACEI or ARB or ARNI Ordered\":\n  exists ( [MedicationRequest: medication in \"ACE Inhibitor or ARB or ARNI\"] ACEIOrARBOrARNIOrdered\n      where ACEIOrARBOrARNIOrdered.isOrderedDuringHeartFailureOutpatientEncounter ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS135FHIRHFACEIorARBorARNIforLVSD"
            },
            {
              "url": "name",
              "valueString": "Is Currently Taking ACEI or ARB or ARNI"
            },
            {
              "url": "statement",
              "valueString": "define \"Is Currently Taking ACEI or ARB or ARNI\":\n  exists ( [MedicationRequest: medication in \"ACE Inhibitor or ARB or ARNI\"] ActiveACEIOrARBOrARNI\n      where ActiveACEIOrARBOrARNI.overlapsAfterHeartFailureOutpatientEncounter ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS135FHIRHFACEIorARBorARNIforLVSD"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n  \"Has ACEI or ARB or ARNI Ordered\"\n    or \"Is Currently Taking ACEI or ARB or ARNI\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AHAOverall"
            },
            {
              "url": "name",
              "valueString": "Qualifying Outpatient Encounter During Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns certain finished encounter types that occurred during the measurement period: \n                * office visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001)\n                * outpatient consolutations (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008)\n                * nursing facility visits (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012)\n                * care services in long term residential facility (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014)\n                * home healthcare services (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016)\n                * patient provider interactions (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012) \n*/          \ndefine \"Qualifying Outpatient Encounter During Measurement Period\":\n    ( [Encounter: type in \"Office Visit\"]\n        union [Encounter: type in \"Outpatient Consultation\"]\n        union [Encounter: type in \"Nursing Facility Visit\"]\n        union [Encounter: type in \"Care Services in Long Term Residential Facility\"]\n        union [Encounter: type in \"Home Healthcare Services\"]\n        union [Encounter: type in \"Patient Provider Interaction\"] ) ValidEncounter\n      where ValidEncounter.period during day of \"Measurement Period\"\n        and ValidEncounter.isFinished()"
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AHAOverall"
            },
            {
              "url": "name",
              "valueString": "Is Adults With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the patient meets the following criteria:\n                * 18 years of age or older, has two \n                * Has two Qualifying Outpatient Encounters During Measurement Period\n                * Has a Heart Failure Outpatient Encounter\n*/           \ndefine \"Is Adults With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period\":\n  AgeInYearsAt(date from start of \"Measurement Period\") >= 18\n    and exists ( \"Qualifying Outpatient Encounter During Measurement Period\" Encounter1\n        with \"Qualifying Outpatient Encounter During Measurement Period\" Encounter2\n          such that Encounter2.id !~ Encounter1.id\n    )\n    and exists \"Heart Failure Outpatient Encounter\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS135FHIRHFACEIorARBorARNIforLVSD"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  AHA.\"Is Adults With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS135FHIRHFACEIorARBorARNIforLVSD"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n  \"Initial Population\"\n    and exists AHA.\"Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "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": 12
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS135FHIRHFACEIorARBorARNIforLVSD"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS135FHIRHFACEIorARBorARNIforLVSD"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  AHA.\"Is Adults With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "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": 15
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS135FHIRHFACEIorARBorARNIforLVSD"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 16
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AHAOverall"
            },
            {
              "url": "name",
              "valueString": "Has Heart Transplant"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns completed heart tansplant procedures that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD\n*/ \ndefine \"Has Heart Transplant\":\n  exists (\n          [Procedure: \"Heart Transplant\"] HeartTransplant\n            with \"Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD\" ModerateOrSevereLVSDHFOutpatientEncounter\n              such that HeartTransplant.performed.toInterval() starts before end of ModerateOrSevereLVSDHFOutpatientEncounter.period\n            where HeartTransplant.status = 'completed'\n          )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AHAOverall"
            },
            {
              "url": "name",
              "valueString": "Has Heart Transplant Complications"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if patient has confirmed heart transplant complications that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD\n*/ \ndefine \"Has Heart Transplant Complications\":\n  exists ( \n          ([ConditionEncounterDiagnosis: \"Heart Transplant Complications\"]\n            union [ConditionProblemsHealthConcerns: \"Heart Transplant Complications\"]) HeartTransplantComplications\n            let diagnosisStart: Coalesce( HeartTransplantComplications.recordedDate, start of HeartTransplantComplications.prevalenceInterval() )  \n            with \"Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD\" ModerateOrSevereLVSDHFOutpatientEncounter\n              such that diagnosisStart before end of ModerateOrSevereLVSDHFOutpatientEncounter.period\n            where HeartTransplantComplications.isConfirmedActiveDiagnosis()\n          )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 18
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AHAOverall"
            },
            {
              "url": "name",
              "valueString": "Has Left Ventricular Assist Device"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if patient has a completed LVAD placement that starts before the end of a heart failure outpatient encounter with history of moderate or severe LVSD\n*/ \ndefine \"Has Left Ventricular Assist Device\":\n  exists (\n            [Procedure: \"Left Ventricular Assist Device Placement\"] LVADOutpatient\n              with \"Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD\" ModerateOrSevereLVSDHFOutpatientEncounter\n                such that LVADOutpatient.performed.toInterval() starts before end of ModerateOrSevereLVSDHFOutpatientEncounter.period\n              where LVADOutpatient.status = 'completed'\n            )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 19
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AHAOverall"
            },
            {
              "url": "name",
              "valueString": "Has Left Ventricular Assist Device Complications"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if patient has active LVAD complications that start before the end of a heart failure outpatient encounter with history of moderate or severe LVSD\n*/ \ndefine \"Has Left Ventricular Assist Device Complications\":\n  exists (\n            ([ConditionEncounterDiagnosis: \"Left Ventricular Assist Device Complications\"]\n              union [ConditionProblemsHealthConcerns: \"Left Ventricular Assist Device Complications\"]) LVADComplications\n              let diagnosisStart: Coalesce( LVADComplications.recordedDate, start of LVADComplications.prevalenceInterval() ) \n              with \"Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD\" ModerateOrSevereLVSDHFOutpatientEncounter\n                such that diagnosisStart before end of ModerateOrSevereLVSDHFOutpatientEncounter.period  \n              where LVADComplications.isConfirmedActiveDiagnosis()\n          )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 20
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS135FHIRHFACEIorARBorARNIforLVSD"
            },
            {
              "url": "name",
              "valueString": "Denominator Exclusions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exclusions\":\n  AHA.\"Has Heart Transplant\"\n    or AHA.\"Has Heart Transplant Complications\"\n    or AHA.\"Has Left Ventricular Assist Device\"\n    or AHA.\"Has Left Ventricular Assist Device Complications\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 21
            }
          ],
          "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": 22
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS135FHIRHFACEIorARBorARNIforLVSD"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 23
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS135FHIRHFACEIorARBorARNIforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Medical or Patient Reason for Not Ordering ACEI or ARB or ARNI"
            },
            {
              "url": "statement",
              "valueString": "// TODO: https://oncprojectracking.healthit.gov/support/projects/MADIE/issues/MADIE-2124\n// Expecting 1 failure per population until this translator issue is incorporated into MADiE\n\n\n\ndefine \"Has Medical or Patient Reason for Not Ordering ACEI or ARB or ARNI\":\n  exists ( [MedicationNotRequested: medication in \"ACE Inhibitor or ARB or ARNI\"] NoACEIOrARBOrARNIOrdered\n      where NoACEIOrARBOrARNIOrdered.isOrderedDuringHeartFailureOutpatientEncounter ( )\n        and ( NoACEIOrARBOrARNIOrdered.reasonCode in \"Medical Reason\"\n            or NoACEIOrARBOrARNIOrdered.reasonCode in \"Patient Reason\"\n            or NoACEIOrARBOrARNIOrdered.reasonCode in \"Patient Reason for ACE Inhibitor or ARB Decline\"\n        )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 24
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS135FHIRHFACEIorARBorARNIforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Allergy or Intolerance to ACEI or ARB or ARNI Ingredient"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Allergy or Intolerance to ACEI or ARB or ARNI Ingredient\":\n  exists ( ( [AllergyIntolerance: \"ACE Inhibitor or ARB or ARNI Ingredient\"]\n      union [AllergyIntolerance: \"Substance with angiotensin-converting enzyme inhibitor mechanism of action (substance)\"]\n      union [AllergyIntolerance: \"Substance with angiotensin II receptor antagonist mechanism of action (substance)\"]\n      union [AllergyIntolerance: \"Substance with neprilysin inhibitor mechanism of action (substance)\"] ) ACEIOrARBOrARNIAllergyIntolerance\n      where ACEIOrARBOrARNIAllergyIntolerance.overlapsAfterHeartFailureOutpatientEncounter ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 25
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS135FHIRHFACEIorARBorARNIforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Diagnosis of Allergy or Intolerance to ACEI or ARB"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Diagnosis of Allergy or Intolerance to ACEI or ARB\":\n  exists ( ( [\"ConditionProblemsHealthConcerns\": \"Allergy to ACE Inhibitor or ARB\"]\n      union [\"ConditionProblemsHealthConcerns\": \"Intolerance to ACE Inhibitor or ARB\"] ) ACEIOrARBAllergyOrIntoleranceDiagnosis\n      where ACEIOrARBAllergyOrIntoleranceDiagnosis.overlapsAfterHeartFailureOutpatientEncounter ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 26
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS135FHIRHFACEIorARBorARNIforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Diagnosis of Pregnancy"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Diagnosis of Pregnancy\":\n  exists ( [ConditionProblemsHealthConcerns: \"Pregnancy\"] PregnancyDiagnosis\n      with AHA.\"Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD\" ModerateOrSevereLVSDHFOutpatientEncounter\n        such that PregnancyDiagnosis.prevalenceInterval ( ) starts 9 months or less before or on start of ModerateOrSevereLVSDHFOutpatientEncounter.period\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 27
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS135FHIRHFACEIorARBorARNIforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Diagnosis of Renal Failure Due to ACEI"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Diagnosis of Renal Failure Due to ACEI\":\n  exists ( [ConditionEncounterDiagnosis: \"Acute renal failure caused by angiotensin-converting-enzyme inhibitor (disorder)\"] RenalFailureDueToACEI\n      where RenalFailureDueToACEI.overlapsHeartFailureOutpatientEncounter ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 28
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS135FHIRHFACEIorARBorARNIforLVSD"
            },
            {
              "url": "name",
              "valueString": "Denominator Exceptions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exceptions\":\n  \"Has Medical or Patient Reason for Not Ordering ACEI or ARB or ARNI\"\n    or \"Has Allergy or Intolerance to ACEI or ARB or ARNI Ingredient\"\n    or \"Has Diagnosis of Allergy or Intolerance to ACEI or ARB\"\n    or \"Has Diagnosis of Pregnancy\"\n    or \"Has Diagnosis of Renal Failure Due to ACEI\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 29
            }
          ],
          "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": 30
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AHAOverall"
            },
            {
              "url": "name",
              "valueString": "isOrderedDuringHeartFailureOutpatientEncounter"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given MedicationRequest is ordered during the heart failure outpatient encounter with history of moderate or severe LVSD at any point\n*/\ndefine fluent function isOrderedDuringHeartFailureOutpatientEncounter(MedicationRequest MedicationRequest): \n  exists ( \"Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD\" ModerateOrSevereLVSDHFOutpatientEncounter\n            where MedicationRequest.authoredOn during day of ModerateOrSevereLVSDHFOutpatientEncounter.period\n              and MedicationRequest.status in {'active', 'completed'}\n              and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n              /*Issue: The logic commented out below was added to the logic due to an issue described in the authoring patterns for QI-Core: https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1#medication-ordered. However, when this logic is present, it causes an issue in Coverage calculation for resources that must be QI-Core compliant, because the inverse cannot be tested for a QI-Core MedicationRequest profile instance. This logic was commented out to achieve 100% Coverage. This requirement is really to handle what would happen if a MedicationRequest instance that could be set to 'false' were provided, but this should not happen within a trusted environment where QI-Core profile instances must be provided.*/\n              // and MedicationRequest.doNotPerform is not true \n          )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 31
            }
          ],
          "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": 32
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AHAOverall"
            },
            {
              "url": "name",
              "valueString": "isFinished"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given Encounter is finished\n*/\ndefine fluent function isFinished(Encounter Encounter):\n    Encounter.status = 'finished'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 33
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "prevalenceInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting \ninterval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.\n*/\ndefine fluent function prevalenceInterval(condition Choice<\"ConditionEncounterDiagnosis\", \"ConditionProblemsHealthConcerns\">):\nif condition.clinicalStatus ~ \"active\"\n  or condition.clinicalStatus ~ \"recurrence\"\n  or condition.clinicalStatus ~ \"relapse\" then\n  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n    (end of condition.abatementInterval()) abatementDate\n    return if abatementDate is null then\n      Interval[start of condition.onset.toInterval(), abatementDate)\n    else\n      Interval[start of condition.onset.toInterval(), abatementDate]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 34
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "abatementInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns an interval representing the normalized abatement of a given Condition.\n@comment: If the abatement element of the Condition is represented as a DateTime, the result\nis an interval beginning and ending on that DateTime.\nIf the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The\nresult is an interval from the date the patient turned that age to immediately before one year later.\nIf the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during\nwhich the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately\nbefore one year later than the date the patient turned the ending age of the quantity interval.\n*/\ndefine fluent function abatementInterval(condition Choice<\"ConditionEncounterDiagnosis\", \"ConditionProblemsHealthConcerns\">):\n\tif condition.abatement is DateTime then\n\t  Interval[condition.abatement as DateTime, condition.abatement as DateTime]\n\telse if condition.abatement is Quantity then\n\t\tInterval[Patient.birthDate + (condition.abatement as Quantity),\n\t\t\tPatient.birthDate + (condition.abatement as Quantity) + 1 year)\n\telse if condition.abatement is Interval<Quantity> then\n\t  Interval[Patient.birthDate + (condition.abatement.low as Quantity),\n\t\t  Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)\n\telse if condition.abatement is Interval<DateTime> then\n\t  Interval[condition.abatement.low, condition.abatement.high)\n\telse null as Interval<DateTime>"
            },
            {
              "url": "displaySequence",
              "valueInteger": 35
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AHAOverall"
            },
            {
              "url": "name",
              "valueString": "overlapsAfterHeartFailureOutpatientEncounter"
            },
            {
              "url": "statement",
              "valueString": "/*\n@overloaded\n@description: Returns true if the given MedicationRequest overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD\n*/                    \ndefine fluent function overlapsAfterHeartFailureOutpatientEncounter(MedicationRequest MedicationRequest): \n  exists ( \"Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD\" ModerateOrSevereLVSDHFOutpatientEncounter\n             where First( ( collapse (MedicationRequest.dosageInstruction.timing.repeat.bounds DoseTime\n                                        return DoseTime.toInterval()) ) DrugPeriods\n                           sort by start of $this ) overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period \n               and MedicationRequest.status in { 'active', 'completed' } \n               and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n               /*Issue: The logic commented out below was added to the logic due to an issue described in the authoring patterns for QI-Core: https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1#medication-ordered. However, when this logic is present, it causes an issue in Coverage calculation for resources that must be QI-Core compliant, because the inverse cannot be tested for a QI-Core MedicationRequest profile instance. This logic was commented out to achieve 100% Coverage. This requirement is really to handle what would happen if a MedicationRequest instance that could be set to 'false' were provided, but this should not happen within a trusted environment where QI-Core profile instances must be provided.*/\n               // and Event.doNotPerform is not true \n          )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 36
            }
          ],
          "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": 37
            }
          ],
          "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": 38
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AHAOverall"
            },
            {
              "url": "name",
              "valueString": "isOrderedDuringHeartFailureOutpatientEncounter"
            },
            {
              "url": "statement",
              "valueString": "/*\n@overloaded\n@description: Returns true if the given MedicationNotRequested overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD\n*/                    \ndefine fluent function isOrderedDuringHeartFailureOutpatientEncounter(MedicationRequest MedicationNotRequested): \n  exists ( \"Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD\" ModerateOrSevereLVSDHFOutpatientEncounter\n             where MedicationRequest.authoredOn during day of ModerateOrSevereLVSDHFOutpatientEncounter.period \n               and MedicationRequest.status = 'completed'\n               and MedicationRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n          )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 39
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToConcept"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 40
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AHAOverall"
            },
            {
              "url": "name",
              "valueString": "overlapsAfterHeartFailureOutpatientEncounter"
            },
            {
              "url": "statement",
              "valueString": "/*\n@overloaded\n@description: Returns true if the given AllergyIntolerance overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD\n*/                    \ndefine fluent function overlapsAfterHeartFailureOutpatientEncounter(AllergyIntolerance AllergyIntolerance): \n  exists ( \"Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD\" ModerateOrSevereLVSDHFOutpatientEncounter\n             where Interval[start of AllergyIntolerance.onset.toInterval(), AllergyIntolerance.lastOccurrence] overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period\n               and ( /* https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1771 - issue with implies operator tied to a non-supported feature in cql-exectuion\n                          ( AllergyIntolerance.clinicalStatus is null implies\n                              AllergyIntolerance.clinicalStatus ~ QICoreCommon.\"allergy-active\" )\n                              or */ AllergyIntolerance.clinicalStatus ~ QICoreCommon.\"allergy-active\" \n                         )\n               and AllergyIntolerance.verificationStatus ~ QICoreCommon.\"allergy-confirmed\" \n          )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 41
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AHAOverall"
            },
            {
              "url": "name",
              "valueString": "overlapsAfterHeartFailureOutpatientEncounter"
            },
            {
              "url": "statement",
              "valueString": "/*\n@overloaded\n@description: Returns true if the given Condition overlaps after the day of the heart failure outpatient encounter with history of moderate or severe LVSD\n*/\ndefine fluent function overlapsAfterHeartFailureOutpatientEncounter(Condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>): \n  exists ( \"Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD\" ModerateOrSevereLVSDHFOutpatientEncounter\n             where Condition.prevalenceInterval() overlaps after day of ModerateOrSevereLVSDHFOutpatientEncounter.period\n               and Condition.isConfirmedActiveDiagnosis()\n          )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 42
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AHAOverall"
            },
            {
              "url": "name",
              "valueString": "isConfirmedActiveDiagnosis"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given Condition is confirmed as active\n*/\ndefine fluent function isConfirmedActiveDiagnosis(condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>):\n    condition.isActive()\n        and condition.verificationStatus ~ QICoreCommon.\"confirmed\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 43
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "isActive"
            },
            {
              "url": "statement",
              "valueString": "/* Candidates for FHIRCommon */\n\n/*\n@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse\n*/\ndefine fluent function isActive(condition Choice<\"ConditionEncounterDiagnosis\", \"ConditionProblemsHealthConcerns\">):\n  condition.clinicalStatus ~ \"active\"\n    or condition.clinicalStatus ~ \"recurrence\"\n    or condition.clinicalStatus ~ \"relapse\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 44
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AHAOverall"
            },
            {
              "url": "name",
              "valueString": "overlapsHeartFailureOutpatientEncounter"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given Condition overlaps the heart failure outpatient encounter with history of moderate or severe LVSD at any point\n*/\ndefine fluent function overlapsHeartFailureOutpatientEncounter(Condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>): \n  exists ( \"Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD\" ModerateOrSevereLVSDHFOutpatientEncounter\n            where Condition.prevalenceInterval() overlaps day of ModerateOrSevereLVSDHFOutpatientEncounter.period\n              and Condition.isConfirmedActiveDiagnosis()\n          )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 45
            }
          ],
          "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 AHA",
          "resource": "Library/AHAOverall|3.0.000"
        },
        {
          "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 FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "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": "Code system SNOMEDCT",
          "resource": "http://snomed.info/sct"
        },
        {
          "type": "depends-on",
          "display": "Code system SNOMEDCT",
          "resource": "http://snomed.info/sct"
        },
        {
          "type": "depends-on",
          "display": "Code system ConditionClinicalStatusCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/condition-clinical"
        },
        {
          "type": "depends-on",
          "display": "Code system SNOMEDCT",
          "resource": "http://snomed.info/sct"
        },
        {
          "type": "depends-on",
          "display": "Code system AllergyIntoleranceClinicalStatusCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical"
        },
        {
          "type": "depends-on",
          "display": "Code system AllergyIntoleranceVerificationStatusCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification"
        },
        {
          "type": "depends-on",
          "display": "Code system ConditionVerificationStatusCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/condition-ver-status"
        },
        {
          "type": "depends-on",
          "display": "Value set ACE Inhibitor or ARB or ARNI",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1139"
        },
        {
          "type": "depends-on",
          "display": "Value set Care Services in Long Term Residential Facility",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014"
        },
        {
          "type": "depends-on",
          "display": "Value set Home Healthcare Services",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"
        },
        {
          "type": "depends-on",
          "display": "Value set Nursing Facility Visit",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012"
        },
        {
          "type": "depends-on",
          "display": "Value set Office Visit",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
        },
        {
          "type": "depends-on",
          "display": "Value set Outpatient Consultation",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"
        },
        {
          "type": "depends-on",
          "display": "Value set Heart Failure",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376"
        },
        {
          "type": "depends-on",
          "display": "Value set Ejection Fraction",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1134"
        },
        {
          "type": "depends-on",
          "display": "Value set Moderate or Severe LVSD",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090"
        },
        {
          "type": "depends-on",
          "display": "Value set Moderate or Severe",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1092"
        },
        {
          "type": "depends-on",
          "display": "Value set Patient Provider Interaction",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1012"
        },
        {
          "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 Heart Transplant",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.33"
        },
        {
          "type": "depends-on",
          "display": "Value set Heart Transplant Complications",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.56"
        },
        {
          "type": "depends-on",
          "display": "Value set Left Ventricular Assist Device Placement",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.61"
        },
        {
          "type": "depends-on",
          "display": "Value set Left Ventricular Assist Device Complications",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.58"
        },
        {
          "type": "depends-on",
          "display": "Value set Medical Reason",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007"
        },
        {
          "type": "depends-on",
          "display": "Value set Patient Reason",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1008"
        },
        {
          "type": "depends-on",
          "display": "Value set Patient Reason for ACE Inhibitor or ARB Decline",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1140"
        },
        {
          "type": "depends-on",
          "display": "Value set ACE Inhibitor or ARB or ARNI Ingredient",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1489"
        },
        {
          "type": "depends-on",
          "display": "Value set Allergy to ACE Inhibitor or ARB",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1211"
        },
        {
          "type": "depends-on",
          "display": "Value set Intolerance to ACE Inhibitor or ARB",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1212"
        },
        {
          "type": "depends-on",
          "display": "Value set Pregnancy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.378"
        }
      ],
      "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 Exclusions",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "SDE Race",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Resource"
        },
        {
          "name": "Denominator Exceptions",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        }
      ],
      "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": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"
          ],
          "mustSupport": [
            "code"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"
          ],
          "mustSupport": [
            "code"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.376"
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-clinical-result"
          ],
          "mustSupport": [
            "code",
            "value",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1134"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"
          ],
          "mustSupport": [
            "code"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"
          ],
          "mustSupport": [
            "code"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1090"
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  "url": "https://madie.cms.gov/Measure/CMS135FHIRHFACEIorARBorARNIforLVSD",
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        ]
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      "system": "https://madie.cms.gov/measure/cbeId",
      "value": "0081e",
      "assigner": {
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    },
    {
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      "value": "135FHIR",
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  ],
  "version": "0.4.000",
  "name": "CMS135FHIRHFACEIorARBorARNIforLVSD",
  "title": "Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD)FHIR",
  "status": "active",
  "experimental": false,
  "date": "2025-07-15T13:37:40+00:00",
  "publisher": "American Heart Association",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "https://www.heart.org/"
        }
      ]
    }
  ],
  "description": "Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) <=40% who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period",
  "usage": "This eCQM is to be reported as patient-based. To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period.\n\nThe requirement of two or more visits is used to establish that the eligible clinician has an existing relationship with the patient. \n\nA range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than or equal to 40% threshold noted in the denominator logic. A range that is greater than 40% would not meet the measure requirement. \n\nIn order for the Ejection Fraction result pathway to be recognized as below 40%, the result must be reported as a number with unit of %. A text string of \"below 40%\" or \"ejection fraction between 35 and 40%\" will not be recognized through electronic data capture. Although, this criteria can also be met using the Diagnosis pathway if specified as \"Moderate or Severe.\"\n\nEligible clinicians who have given a prescription for or whose patient is already taking an Angiotensin-Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) would meet performance for this measure. Other combination therapies that consist of an ACEI plus diuretic, ARB + neprilysin inhibitor (ARNI), ARB plus diuretic, ACEI plus calcium channel blocker, ARB plus calcium channel blocker, or ARB plus calcium channel blocker plus diuretic would also meet performance for this measure.\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 College of Cardiology and American Heart Association. All Rights Reserved.",
  "effectivePeriod": {
    "start": "2026-01-01",
    "end": "2026-12-31"
  },
  "author": [
    {
      "name": "American Heart Association",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.heart.org/"
        }
      ]
    },
    {
      "name": "American Medical Association (AMA)",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.ama-assn.org/"
        }
      ]
    }
  ],
  "library": [
    "https://madie.cms.gov/Library/CMS135FHIRHFACEIorARBorARNIforLVSD"
  ],
  "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 College of Cardiology (ACC) or the American Heart Association (AHA). Neither the ACC, nor AHA, nor their members shall be responsible for any use of the Measure.\n\nACC and AHA encourage use of the Measure by other health care professionals, where appropriate.\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. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The ACC and AHA and their members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications.\n\nCPT(R) contained in the Measure specifications is copyright 2004-20234 American Medical Association. LOINC(R) is copyright 2004-20234 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-20234 International Health Terminology Standards Development Organisation. ICD-10 is copyright 20234 World Health Organization. All Rights Reserved.\n\nThe American Medical Association’s and the PCPI(R) Foundation’s significant past efforts and contributions to the performance measure are gratefully acknowledged.\nDue to technical limitations, registered trademarks are indicated by (R) or [R].",
  "rationale": "Use of ACE inhibitor, ARB, or ARNI therapy has been associated with improved outcomes in patients with reduced LVEF. Long-term therapy with ARBs have also been shown to reduce morbidity and mortality, especially in ACE inhibitor–intolerant patients. More recently, ARNI therapy has also been shown to more significantly improve outcomes, such that the newest guidelines recommend replacement of ACE inhibitors or ARBs with ARNI therapy in eligible patients. However, despite the benefits of these drugs, use of ACE inhibitor, ARB, or ARNI remains suboptimal.",
  "clinicalRecommendationStatement": "Clinical Recommendation Statement\tIn patients with Heart Failure with Reduced Ejection Fraction (HFrEF) and New York Heart Association (NYHA) class II to III symptoms, the use of ARNI is recommended to reduce morbidity and mortality (Class I, Level of Evidence A) (Heidenreich et al., 2022). \n\nIn patients with previous or current symptoms of chronic HFrEF, the use of angiotension-converting enzyme inhibitors (ACEi) is beneficial to reduce morbidity and mortality when the use of ARNI is not feasible (Class I, Level of Evidence A) (Heidenreich et al., 2022). \n\nIn patients with previous or current symptoms of chronic HFrEF who are intolerant to ACEi because of cough or angioedema and when the use of ARNI is not feasible, the use of ARB is recommended to reduce morbidity and mortality. (Class I, Level of Evidence A) (Heidenreich et al., 2022). \n\nIn patients with chronic symptomatic HFrEF NYHA class II or III who tolerate an ACEi or ARB, replacement by an ARNI is recommended to further reduce morbidity and mortality (Class I, Level of Evidence B-R) (Heidenreich et al., 2022). \n\nARNI should not be administered concomitantly with ACEi or within 36 hours of the last dose of an ACEi (Class II: Harm, Level of Evidence B-R) (Heidenreich et al., 2022). \n\nARNI should not be administered to patients with any history of angioedema (Class III: Harm, Level of Evidence C-LD) (Heidenreich et al., 2022). \n\nACEi should not be administered to patients with any history of angioedema (Class III: Harm, Level of Evidence C-LD) (Heidenreich et al., 2022).\n\nDrugs Commonly Used for Stage C HFrEF (abbreviated to align with focus of measure to include only ACE inhibitors, ARB and ARNI therapy)\n\n\nDrug                       Initial Daily Dose(s)                    Target Dose(s)                Mean Doses Achieved in Clinical Trials                                                                                                                              \n\nACEi \n\n   Captopril             6.25 mg 3 times                           50 mg 3 times               122.7 mg total daily\n\n   Enalapril              2.5 mg twice                                 10 to 20 mg twice         16.6 mg total daily\n\n   Fosinopril            5 to 10 mg once                            40 mg once                   N/A\n\n   Lisinopril             2.5 to 5 mg once                           20 to 40 mg once         32.5 to 35.0 mg total daily\n\n   Perindopril          2 mg once                                      8 to 16 mg once             N/A\n\n   Quinapril              5 mg twice                                     20 mg twice                   N/A\n\n   Ramipril               1.25 to 2.5 mg once                      10 mg once                     N/A\n\n   Trandolapril         1 mg once                                       4 mg once                       N/A\n\nARB\n\n   Candesartan      4 to 8 mg once                               32 mg once                      24 mg total daily\n\n   Losartan             25 to 50 mg once                           50 to 150 mg once         129 mg total daily\n\n   Valsartan            20 to 40 mg twice                          160 mg twice                   254 mg total daily\n\nARNI\n\n   Sacubitril-           49/51 mg twice                               97/103 mg twice            182/193 mg \n\n   valsartan             (sacubitril/valsartan)                     (sacubitril/valsartan)    (sacubitril/valsartan) total\n\n daily\n                                (therapy may be initiated                                                    \n        \n                                at 24/26 mg twice)",
  "definition": [
    "Definition - Prescribed - prescription given to the patient for ACE inhibitor or ARB or ARNI therapy at one or more visits in the measurement period OR patient already taking ACE inhibitor or ARB or ARNI therapy as documented in current medication list.\n\n\n\nLVEF <=40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction (LVSD). The LVSD may be determined by quantitative or qualitative assessment, which may be current or historical. Examples of a quantitative or qualitative assessment may include an echocardiogram:\n\n1) that provides a numerical value of LVSD or 2) that uses descriptive terms such as moderately or severely depressed left ventricular systolic function. Any current or prior ejection fraction study documenting LVSD can be used to identify patients.\n\n"
  ],
  "guidance": "This eCQM is to be reported as patient-based. To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period.\n\nThe requirement of two or more visits is used to establish that the eligible clinician has an existing relationship with the patient. \n\nA range value should satisfy the logic requirement for 'Ejection Fraction' as long as the ranged observation value clearly meets the less than or equal to 40% threshold noted in the denominator logic. A range that is greater than 40% would not meet the measure requirement. \n\nIn order for the Ejection Fraction result pathway to be recognized as below 40%, the result must be reported as a number with unit of %. A text string of \"below 40%\" or \"ejection fraction between 35 and 40%\" will not be recognized through electronic data capture. Although, this criteria can also be met using the Diagnosis pathway if specified as \"Moderate or Severe.\"\n\nEligible clinicians who have given a prescription for or whose patient is already taking an Angiotensin-Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) would meet performance for this measure. Other combination therapies that consist of an ACEI plus diuretic, ARB + neprilysin inhibitor (ARNI), ARB plus diuretic, ACEI plus calcium channel blocker, ARB plus calcium channel blocker, or ARB plus calcium channel blocker plus diuretic would also meet performance for this measure.\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": "boolean"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-type",
                "code": "process",
                "display": "Process"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode": "None"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "increase",
                "display": "Increased score indicates improvement"
              }
            ]
          }
        },
        {
          "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 patients aged 18 years and older with two qualifying encounters during the measurement period and a diagnosis of heart failure on or before at least one qualifying encounter",
          "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 with a current or prior LVEF <= 40%",
          "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 a history of heart transplant or with a Left Ventricular Assist Device (LVAD) prior to the end of the outpatient encounter with Moderate or Severe LVSD",
          "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": "Patients who were prescribed or already taking ACE inhibitor or ARB or ARNI therapy during the measurement period",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        },
        {
          "id": "DenominatorException_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator-exception",
                "display": "Denominator Exception"
              }
            ]
          },
          "description": "Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., pregnancy, renal failure due to ACEI, allergy, intolerance, other medical reasons).\n\nDocumentation of patient reason(s) for not prescribing ACE inhibitor or ARB or ARNI therapy (e.g., patient declined, other patient reasons).",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator Exceptions"
          }
        }
      ]
    }
  ],
  "supplementalData": [
    {
      "id": "sde-ethnicity",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Ethnicity",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Ethnicity"
      }
    },
    {
      "id": "sde-payer",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Payer",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Payer"
      }
    },
    {
      "id": "sde-race",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Race",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Race"
      }
    },
    {
      "id": "sde-sex",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Sex",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Sex"
      }
    }
  ]
}