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FHIR IG Statistics: Measure/CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes

Packagegov.healthit.ecqi.ecqms
Resource TypeMeasure
IdCMS142FHIRDRCommunicationWithPhysicianManagingDiabetes
FHIR VersionR4
Sourcehttp://ecqi.healthit.gov/ecqms/https://build.fhir.org/ig/cqframework/ecqm-content-qicore-2025/Measure-CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes.html
URLhttps://madie.cms.gov/Measure/CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes
Version0.2.000
Statusactive
Date2025-07-15T13:37:39+00:00
NameCMS142FHIRDRCommunicationWithPhysicianManagingDiabetes
TitleDiabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes CareFHIR
DescriptionPercentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once during the measurement period.
CopyrightCopyright 2025 American Academy of Ophthalmology. All Rights Reserved.

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Narrative

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Metadata
Title Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes CareFHIR
Version 0.2.000
Short Name CMS142FHIR
GUID (Version Independent) urn:uuid:0f55e61f-dc17-4fe4-a604-7f030260618f
GUID (Version Specific) urn:uuid:da30e93a-b712-418c-a222-4899f7585ee8
CMS Identifier 142FHIR
Effective Period 2026-01-01 through 2026-12-31
Approval Date 2023-09-05
Last Review Date 2023-09-05
Steward (Publisher) American Academy of Ophthalmology
Developer American Academy of Ophthalmology
Developer American Medical Association (AMA)
Description

Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once during the measurement period.
Copyright

Copyright 2025 American Academy of Ophthalmology. 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 Academy of Ophthalmology (Academy). Neither the Academy, its members, the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor PCPI, nor their members shall be responsible for any use of the Measure.

The PCPI’s and AMA’s significant past efforts and contributions to the development and updating of the Measures are acknowledged. The National Committee for Quality Assurance's significant past efforts and contributions to the development and updating of the Measure is acknowledged.

THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

Limited proprietary coding is contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party’s use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measures. Any other use of CPT or other coding by the third party is strictly prohibited. The Academy, the AMA, and former members of the PCPI disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association. LOINC(R) is copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2024 World Health Organization. All Rights Reserved.

Due to technical limitations, registered trademarks are indicated by (R) or [R].
Rationale

Diabetic retinopathy is a prevalent complication of diabetes, estimated to affect 28.5% of diabetic patients in the US (Zhang et al., 2010). Diabetic retinopathy is a key indicator of systemic complications of diabetes (Zhang et al., 2010). Coordination of care between the eye care specialist and the physician managing a patient’s ongoing diabetes care is essential in stemming the progression of vision loss. Communication from the eye care specialist to a primary care physician facilitates the exchange of information about the severity and progression of a patient’s diabetic retinopathy, adherence to recommended ocular care, need for follow-up visits, and treatment plans (Storey et al., 2016). Data from the Diabetes Control and Complications Trial showed that diabetic treatment and maintenance of glucose control delays the onset and slows the progression of diabetic retinopathy (Aiello & DCCT/EDIC Research Group, 2014).
Clinical Recommendation Statement

The ophthalmologist should refer patients with diabetes to a primary care physician or endocrinologist for appropriate management of their systemic condition and should communicate examination results to the physician managing the patient'’s ongoing diabetes care Lim et al., ).

Ophthalmologists should communicate the ophthalmologic findings2025).

A goal is to achieve optimal control of blood glucose, blood pressure, and other risk factors through close communication with the patient’s primary care physician on the status of the DR and the need for optim metabolic control (Lim et al,, 2025).

Establishing a close partnership with between the ophthalmologist and the primary care physician is an important to make sure that the care of the step to ensure optimal patient is optimized (III; Good Quality; Strong Recommendation) (Flaxelcare. Furthermore, it is important to help educate patients with diabetes as well as their primary care physician about the ophthalmologic implications of controlling blood glucose (as monitored by HbA1c) to as near to normal as is safely possible (Lim et al., 2025).
Guidance (Usage) Guidance The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality. The communication of results, including the level of severity of diabetic retinopathy and presence or absence of macular edema to the primary care physician providing ongoing care of a patient's diabetes should be completed soon after the dilated exam is performed. Eligible clinicians reporting on this measure should note that all data for the measurement period is to be submitted by the deadline established by CMS. Therefore, eligible clinicians who see patients towards the end of the measurement period (i.e., December in particular), should communicate the results of the dilated macular exam as soon as possible in order for those patients to be counted in the measure numerator. Communicating the results as soon as possible after the date of the exam will ensure the data are included in the submission to CMS. This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth. 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 Outcome
Rate Aggregation None
Improvement Notation Increased score indicates improvement
Initial Population ID: InitialPopulation_1
Description:

All patients aged 18 years and older with a diagnosis of diabetic retinopathy during the measurement period

Logic Definition: Initial Population
Denominator ID: Denominator_1
Description:

Equals Initial Population who had a dilated macular or fundus exam performed during the measurement period

Logic Definition: Denominator
Numerator ID: Numerator_1
Description:

Patients with documentation, at least once within the measurement period, of the findings of the dilated macular or fundus exam via communication to the physician who manages the patient's diabetic care

Logic Definition: Numerator
Denominator Exception ID: DenominatorException_1
Description:

Documentation of medical reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes. Documentation of patient reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes.

Logic Definition: Denominator Exceptions
Supplemental Data Guidance For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity SDE Payer SDE Race SDE Sex
Supplemental Data Elements
Supplemental Data Element ID: sde-ethnicity
Usage Code: Supplemental Data
Description: SDE Ethnicity
Logic Definition: SDE Ethnicity
Supplemental Data Element ID: sde-payer
Usage Code: Supplemental Data
Description: SDE Payer
Logic Definition: SDE Payer
Supplemental Data Element ID: sde-race
Usage Code: Supplemental Data
Description: SDE Race
Logic Definition: SDE Race
Supplemental Data Element ID: sde-sex
Usage Code: Supplemental Data
Description: SDE Sex
Logic Definition: SDE Sex
Measure Logic
Primary Library CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes
Contents Population Criteria
Logic Definitions
Terminology
Dependencies
Data Requirements
Population Criteria
Measure Group (Rate) (ID: Group_1)
Initial Population 
define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists "Diabetic Retinopathy Encounter"
Initial Population 
define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists "Diabetic Retinopathy Encounter"
Denominator 
define "Denominator":
  "Initial Population"
    and exists "Macular Exam Performed"
Numerator 
define "Numerator":
  exists "Level of Severity of Retinopathy Findings Communicated"
    and ( exists "Macular Edema Absence Communicated"
        or exists "Macular Edema Presence Communicated"
    )
Denominator Exception 
define "Denominator Exceptions":
  exists "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy"
    or exists "Medical or Patient Reason for Not Communicating Absence of Macular Edema"
    or exists "Medical or Patient Reason for Not Communicating Presence of Macular Edema"
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: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
define "SDE Sex":
  SDE."SDE Sex"
Logic Definition Library Name: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
define "Qualifying Encounter During Day of Measurement Period":
  ( ["Encounter": "Office Visit"]
    union ["Encounter": "Ophthalmological Services"]
    union ["Encounter": "Outpatient Consultation"]
    union ["Encounter": "Care Services in Long-Term Residential Facility"]
    union ["Encounter": "Nursing Facility Visit"] ) QualifyingEncounter
    where QualifyingEncounter.period during day of "Measurement Period"
      and QualifyingEncounter.status = 'finished'
      and QualifyingEncounter.class !~ "virtual"
Logic Definition Library Name: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
define "Diabetic Retinopathy Encounter":
  "Qualifying Encounter During Day of Measurement Period" ValidQualifyingEncounter
    with ( ["ConditionProblemsHealthConcerns": "Diabetic Retinopathy"]
      union ["ConditionEncounterDiagnosis": "Diabetic Retinopathy"] ) DiabeticRetinopathy
      such that DiabeticRetinopathy.prevalenceInterval ( ) overlaps day of ValidQualifyingEncounter.period
        and DiabeticRetinopathy.isActive ( )
        and not ( DiabeticRetinopathy.verificationStatus ~ QICoreCommon."unconfirmed"
            or DiabeticRetinopathy.verificationStatus ~ QICoreCommon."refuted"
            or DiabeticRetinopathy.verificationStatus ~ QICoreCommon."entered-in-error"
        )
Logic Definition Library Name: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
define "Level of Severity of Retinopathy Findings Communicated":
  ["Communication": category in "Level of Severity of Retinopathy Findings"] LevelOfSeverityCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that LevelOfSeverityCommunicated.sent after start of EncounterDiabeticRetinopathy.period
        and LevelOfSeverityCommunicated.sent during day of "Measurement Period"
    where LevelOfSeverityCommunicated.status = 'completed'
Logic Definition Library Name: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
define "Macular Edema Absence Communicated":
  ["Communication": category in "Macular edema absent (situation)"] MacularEdemaAbsentCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that MacularEdemaAbsentCommunicated.sent after start of EncounterDiabeticRetinopathy.period
        and MacularEdemaAbsentCommunicated.sent during day of "Measurement Period"
    where MacularEdemaAbsentCommunicated.status = 'completed'
Logic Definition Library Name: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
define "Macular Edema Presence Communicated":
  ["Communication": category in "Macular Edema Findings Present"] MacularEdemaPresentCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that MacularEdemaPresentCommunicated.sent after start of EncounterDiabeticRetinopathy.period
        and MacularEdemaPresentCommunicated.sent during day of "Measurement Period"
    where MacularEdemaPresentCommunicated.status = 'completed'
Logic Definition Library Name: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
define "Numerator":
  exists "Level of Severity of Retinopathy Findings Communicated"
    and ( exists "Macular Edema Absence Communicated"
        or exists "Macular Edema Presence Communicated"
    )
Logic Definition Library Name: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists "Diabetic Retinopathy Encounter"
Logic Definition Library Name: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
define "Macular Exam Performed":
  ["ObservationClinicalResult": "Macular Exam"] MacularExam
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that MacularExam.effective.toInterval ( ) during EncounterDiabeticRetinopathy.period
    where MacularExam.value is not null
      and MacularExam.status in { 'final', 'amended', 'corrected', 'preliminary' }
Logic Definition Library Name: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
define "Denominator":
  "Initial Population"
    and exists "Macular Exam Performed"
Logic Definition Library Name: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
define "SDE Payer":
  SDE."SDE Payer"
Logic Definition Library Name: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists "Diabetic Retinopathy Encounter"
Logic Definition Library Name: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
define "SDE Ethnicity":
  SDE."SDE Ethnicity"
Logic Definition Library Name: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
define "SDE Race":
  SDE."SDE Race"
Logic Definition Library Name: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
define "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy":
  [CommunicationNotDone: category in "Level of Severity of Retinopathy Findings"] LevelOfSeverityNotCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that LevelOfSeverityNotCommunicated.sent during EncounterDiabeticRetinopathy.period
    where ( LevelOfSeverityNotCommunicated.statusReason in "Medical Reason"
        or LevelOfSeverityNotCommunicated.statusReason in "Patient Reason"
    )
Logic Definition Library Name: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
/* Note: 
below definition workaround for 
https://oncprojectracking.healthit.gov/support/browse/CQLIT-371. Using value set workaround has been applied for now
but when QI Core STU 5 gets in the tool, it may be reverted back to a DRC */


define "Medical or Patient Reason for Not Communicating Absence of Macular Edema":
  [CommunicationNotDone: category in "Macular edema absent (situation)"] MacularEdemaAbsentNotCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that MacularEdemaAbsentNotCommunicated.sent during EncounterDiabeticRetinopathy.period
    where ( MacularEdemaAbsentNotCommunicated.statusReason in "Medical Reason"
        or MacularEdemaAbsentNotCommunicated.statusReason in "Patient Reason"
    )
Logic Definition Library Name: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
define "Medical or Patient Reason for Not Communicating Presence of Macular Edema":
  [CommunicationNotDone: category in "Macular Edema Findings Present"] MacularEdemaPresentNotCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that MacularEdemaPresentNotCommunicated.sent during EncounterDiabeticRetinopathy.period
    where ( MacularEdemaPresentNotCommunicated.statusReason in "Medical Reason"
        or MacularEdemaPresentNotCommunicated.statusReason in "Patient Reason"
    )
Logic Definition Library Name: CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes 
define "Denominator Exceptions":
  exists "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy"
    or exists "Medical or Patient Reason for Not Communicating Absence of Macular Edema"
    or exists "Medical or Patient Reason for Not Communicating Presence of Macular Edema"
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
        }
Terminology
Code System Description: Code system SNOMEDCT
Resource: SNOMED CT (all versions)
Canonical URL: http://snomed.info/sct
Code System Description: Code system ActCode
Resource: ActCode
Canonical URL: http://terminology.hl7.org/CodeSystem/v3-ActCode
Code System Description: Code system ConditionVerificationStatusCodes
Resource: ConditionVerificationStatus
Canonical URL: http://terminology.hl7.org/CodeSystem/condition-ver-status
Value Set Description: Value set Level of Severity of Retinopathy Findings
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1283
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1283
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 Ophthalmological Services
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1285
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1285
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 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 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 Diabetic Retinopathy
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.327
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.327
Value Set Description: Value set Macular edema absent (situation)
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.2.1391
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.2.1391
Value Set Description: Value set Macular Edema Findings Present
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1320
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1320
Value Set Description: Value set Macular Exam
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1251
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1251
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 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
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: virtual
Code: VR
System: http://terminology.hl7.org/CodeSystem/v3-ActCode
Direct Reference Code Display: Unconfirmed
Code: unconfirmed
System: http://terminology.hl7.org/CodeSystem/condition-ver-status
Direct Reference Code Display: Refuted
Code: refuted
System: http://terminology.hl7.org/CodeSystem/condition-ver-status
Direct Reference Code Display: Entered in Error
Code: entered-in-error
System: http://terminology.hl7.org/CodeSystem/condition-ver-status
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 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: 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/2.16.840.1.113883.3.526.3.1285
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/2.16.840.1.113883.3.464.1003.101.12.1014
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/2.16.840.1.113883.3.464.1003.101.12.1012
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/2.16.840.1.113883.3.526.3.327
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/2.16.840.1.113883.3.526.3.327
Data Requirement Type: Communication
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communication
Must Support Elements: category, sent, sent.value, status, status.value
Code Filter(s):
Path: category
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1283
Data Requirement Type: Communication
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communication
Must Support Elements: category, sent, sent.value, status, status.value
Code Filter(s):
Path: category
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.2.1391
Data Requirement Type: Communication
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communication
Must Support Elements: category, sent, sent.value, status, status.value
Code Filter(s):
Path: category
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1320
Data Requirement Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
Data Requirement Type: Observation
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-clinical-result
Must Support Elements: code, effective, value, status, status.value
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1251
Data Requirement Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
Must Support Elements: url
Data Requirement Type: Communication
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communicationnotdone
Must Support Elements: category, sent, sent.value, statusReason
Code Filter(s):
Path: category
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1283
Data Requirement Type: Communication
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communicationnotdone
Must Support Elements: category, sent, sent.value, statusReason
Code Filter(s):
Path: category
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.2.1391
Data Requirement Type: Communication
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communicationnotdone
Must Support Elements: category, sent, sent.value, statusReason
Code Filter(s):
Path: category
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1320
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": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareablemeasure",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cql-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/elm-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "contained": [
    {
      "resourceType": "Library",
      "id": "effective-data-requirements",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "248153007",
            "display": "Male (finding)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "248152002",
            "display": "Female (finding)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
            "code": "VR",
            "display": "virtual"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
            "code": "unconfirmed",
            "display": "Unconfirmed"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
            "code": "refuted",
            "display": "Refuted"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
            "code": "entered-in-error",
            "display": "Entered in Error"
          }
        },
        {
          "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": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "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": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "url": "name",
              "valueString": "Qualifying Encounter During Day of Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"Qualifying Encounter During Day of Measurement Period\":\n  ( [\"Encounter\": \"Office Visit\"]\n    union [\"Encounter\": \"Ophthalmological Services\"]\n    union [\"Encounter\": \"Outpatient Consultation\"]\n    union [\"Encounter\": \"Care Services in Long-Term Residential Facility\"]\n    union [\"Encounter\": \"Nursing Facility Visit\"] ) QualifyingEncounter\n    where QualifyingEncounter.period during day of \"Measurement Period\"\n      and QualifyingEncounter.status = 'finished'\n      and QualifyingEncounter.class !~ \"virtual\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "url": "name",
              "valueString": "Diabetic Retinopathy Encounter"
            },
            {
              "url": "statement",
              "valueString": "define \"Diabetic Retinopathy Encounter\":\n  \"Qualifying Encounter During Day of Measurement Period\" ValidQualifyingEncounter\n    with ( [\"ConditionProblemsHealthConcerns\": \"Diabetic Retinopathy\"]\n      union [\"ConditionEncounterDiagnosis\": \"Diabetic Retinopathy\"] ) DiabeticRetinopathy\n      such that DiabeticRetinopathy.prevalenceInterval ( ) overlaps day of ValidQualifyingEncounter.period\n        and DiabeticRetinopathy.isActive ( )\n        and not ( DiabeticRetinopathy.verificationStatus ~ QICoreCommon.\"unconfirmed\"\n            or DiabeticRetinopathy.verificationStatus ~ QICoreCommon.\"refuted\"\n            or DiabeticRetinopathy.verificationStatus ~ QICoreCommon.\"entered-in-error\"\n        )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "url": "name",
              "valueString": "Level of Severity of Retinopathy Findings Communicated"
            },
            {
              "url": "statement",
              "valueString": "define \"Level of Severity of Retinopathy Findings Communicated\":\n  [\"Communication\": category in \"Level of Severity of Retinopathy Findings\"] LevelOfSeverityCommunicated\n    with \"Diabetic Retinopathy Encounter\" EncounterDiabeticRetinopathy\n      such that LevelOfSeverityCommunicated.sent after start of EncounterDiabeticRetinopathy.period\n        and LevelOfSeverityCommunicated.sent during day of \"Measurement Period\"\n    where LevelOfSeverityCommunicated.status = 'completed'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "url": "name",
              "valueString": "Macular Edema Absence Communicated"
            },
            {
              "url": "statement",
              "valueString": "define \"Macular Edema Absence Communicated\":\n  [\"Communication\": category in \"Macular edema absent (situation)\"] MacularEdemaAbsentCommunicated\n    with \"Diabetic Retinopathy Encounter\" EncounterDiabeticRetinopathy\n      such that MacularEdemaAbsentCommunicated.sent after start of EncounterDiabeticRetinopathy.period\n        and MacularEdemaAbsentCommunicated.sent during day of \"Measurement Period\"\n    where MacularEdemaAbsentCommunicated.status = 'completed'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "url": "name",
              "valueString": "Macular Edema Presence Communicated"
            },
            {
              "url": "statement",
              "valueString": "define \"Macular Edema Presence Communicated\":\n  [\"Communication\": category in \"Macular Edema Findings Present\"] MacularEdemaPresentCommunicated\n    with \"Diabetic Retinopathy Encounter\" EncounterDiabeticRetinopathy\n      such that MacularEdemaPresentCommunicated.sent after start of EncounterDiabeticRetinopathy.period\n        and MacularEdemaPresentCommunicated.sent during day of \"Measurement Period\"\n    where MacularEdemaPresentCommunicated.status = 'completed'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n  exists \"Level of Severity of Retinopathy Findings Communicated\"\n    and ( exists \"Macular Edema Absence Communicated\"\n        or exists \"Macular Edema Presence Communicated\"\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  AgeInYearsAt(date from start of \"Measurement Period\") >= 18\n    and exists \"Diabetic Retinopathy Encounter\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "url": "name",
              "valueString": "Macular Exam Performed"
            },
            {
              "url": "statement",
              "valueString": "define \"Macular Exam Performed\":\n  [\"ObservationClinicalResult\": \"Macular Exam\"] MacularExam\n    with \"Diabetic Retinopathy Encounter\" EncounterDiabeticRetinopathy\n      such that MacularExam.effective.toInterval ( ) during EncounterDiabeticRetinopathy.period\n    where MacularExam.value is not null\n      and MacularExam.status in { 'final', 'amended', 'corrected', 'preliminary' }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n  \"Initial Population\"\n    and exists \"Macular Exam Performed\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "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": 11
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  AgeInYearsAt(date from start of \"Measurement Period\") >= 18\n    and exists \"Diabetic Retinopathy Encounter\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "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": 14
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "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": 16
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "url": "name",
              "valueString": "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy"
            },
            {
              "url": "statement",
              "valueString": "define \"Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy\":\n  [CommunicationNotDone: category in \"Level of Severity of Retinopathy Findings\"] LevelOfSeverityNotCommunicated\n    with \"Diabetic Retinopathy Encounter\" EncounterDiabeticRetinopathy\n      such that LevelOfSeverityNotCommunicated.sent during EncounterDiabeticRetinopathy.period\n    where ( LevelOfSeverityNotCommunicated.statusReason in \"Medical Reason\"\n        or LevelOfSeverityNotCommunicated.statusReason in \"Patient Reason\"\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 18
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "url": "name",
              "valueString": "Medical or Patient Reason for Not Communicating Absence of Macular Edema"
            },
            {
              "url": "statement",
              "valueString": "/* Note: \nbelow definition workaround for \nhttps://oncprojectracking.healthit.gov/support/browse/CQLIT-371. Using value set workaround has been applied for now\nbut when QI Core STU 5 gets in the tool, it may be reverted back to a DRC */\n\n\ndefine \"Medical or Patient Reason for Not Communicating Absence of Macular Edema\":\n  [CommunicationNotDone: category in \"Macular edema absent (situation)\"] MacularEdemaAbsentNotCommunicated\n    with \"Diabetic Retinopathy Encounter\" EncounterDiabeticRetinopathy\n      such that MacularEdemaAbsentNotCommunicated.sent during EncounterDiabeticRetinopathy.period\n    where ( MacularEdemaAbsentNotCommunicated.statusReason in \"Medical Reason\"\n        or MacularEdemaAbsentNotCommunicated.statusReason in \"Patient Reason\"\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 19
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "url": "name",
              "valueString": "Medical or Patient Reason for Not Communicating Presence of Macular Edema"
            },
            {
              "url": "statement",
              "valueString": "define \"Medical or Patient Reason for Not Communicating Presence of Macular Edema\":\n  [CommunicationNotDone: category in \"Macular Edema Findings Present\"] MacularEdemaPresentNotCommunicated\n    with \"Diabetic Retinopathy Encounter\" EncounterDiabeticRetinopathy\n      such that MacularEdemaPresentNotCommunicated.sent during EncounterDiabeticRetinopathy.period\n    where ( MacularEdemaPresentNotCommunicated.statusReason in \"Medical Reason\"\n        or MacularEdemaPresentNotCommunicated.statusReason in \"Patient Reason\"\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 20
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
            },
            {
              "url": "name",
              "valueString": "Denominator Exceptions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exceptions\":\n  exists \"Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy\"\n    or exists \"Medical or Patient Reason for Not Communicating Absence of Macular Edema\"\n    or exists \"Medical or Patient Reason for Not Communicating Presence of Macular Edema\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 21
            }
          ],
          "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": 22
            }
          ],
          "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": 23
            }
          ],
          "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": 24
            }
          ],
          "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 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 ActCode",
          "resource": "http://terminology.hl7.org/CodeSystem/v3-ActCode"
        },
        {
          "type": "depends-on",
          "display": "Code system ConditionVerificationStatusCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/condition-ver-status"
        },
        {
          "type": "depends-on",
          "display": "Value set Level of Severity of Retinopathy Findings",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1283"
        },
        {
          "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 Ophthalmological Services",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1285"
        },
        {
          "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 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 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 Diabetic Retinopathy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.327"
        },
        {
          "type": "depends-on",
          "display": "Value set Macular edema absent (situation)",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.2.1391"
        },
        {
          "type": "depends-on",
          "display": "Value set Macular Edema Findings Present",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1320"
        },
        {
          "type": "depends-on",
          "display": "Value set Macular Exam",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1251"
        },
        {
          "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 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"
        }
      ],
      "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": "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/2.16.840.1.113883.3.464.1003.101.12.1001"
            }
          ]
        },
        {
          "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/2.16.840.1.113883.3.526.3.1285"
            }
          ]
        },
        {
          "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": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
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          ],
          "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/2.16.840.1.113883.3.464.1003.101.12.1012"
            }
          ]
        },
        {
          "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/2.16.840.1.113883.3.526.3.327"
            }
          ]
        },
        {
          "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/2.16.840.1.113883.3.526.3.327"
            }
          ]
        },
        {
          "type": "Communication",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communication"
          ],
          "mustSupport": [
            "category",
            "sent",
            "sent.value",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "category",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1283"
            }
          ]
        },
        {
          "type": "Communication",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communication"
          ],
          "mustSupport": [
            "category",
            "sent",
            "sent.value",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "category",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.2.1391"
            }
          ]
        },
        {
          "type": "Communication",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communication"
          ],
          "mustSupport": [
            "category",
            "sent",
            "sent.value",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "category",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1320"
            }
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-clinical-result"
          ],
          "mustSupport": [
            "code",
            "effective",
            "value",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1251"
            }
          ]
        },
        {
          "type": "Coverage",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
            }
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "extension"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "extension"
          ]
        },
        {
          "type": "Communication",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communicationnotdone"
          ],
          "mustSupport": [
            "category",
            "sent",
            "sent.value",
            "statusReason"
          ],
          "codeFilter": [
            {
              "path": "category",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1283"
            }
          ]
        },
        {
          "type": "Communication",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communicationnotdone"
          ],
          "mustSupport": [
            "category",
            "sent",
            "sent.value",
            "statusReason"
          ],
          "codeFilter": [
            {
              "path": "category",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.2.1391"
            }
          ]
        },
        {
          "type": "Communication",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-communicationnotdone"
          ],
          "mustSupport": [
            "category",
            "sent",
            "sent.value",
            "statusReason"
          ],
          "codeFilter": [
            {
              "path": "category",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1320"
            }
          ]
        },
        {
          "type": "Coverage",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
            }
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "extension"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "extension"
          ]
        }
      ]
    }
  ],
  "extension": [
    {
      "id": "supplementalDataGuidance",
      "extension": [
        {
          "url": "guidance",
          "valueString": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity \n SDE Payer \n SDE Race \n SDE Sex \n "
        },
        {
          "url": "usage",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                "code": "supplemental-data",
                "display": "Supplemental Data"
              }
            ],
            "text": "Supplemental Data Guidance"
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance"
    },
    {
      "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
      "valueCanonical": "#effective-data-requirements"
    },
    {
      "id": "effective-data-requirements",
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
      "valueReference": {
        "reference": "#effective-data-requirements"
      }
    }
  ],
  "url": "https://madie.cms.gov/Measure/CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes",
  "identifier": [
    {
      "use": "usual",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "short-name",
            "display": "Short Name"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/shortName",
      "value": "CMS142FHIR"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "version-independent",
            "display": "Version Independent"
          }
        ]
      },
      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:0f55e61f-dc17-4fe4-a604-7f030260618f"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "version-specific",
            "display": "Version Specific"
          }
        ]
      },
      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:da30e93a-b712-418c-a222-4899f7585ee8"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "publisher",
            "display": "Publisher"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/cmsId",
      "value": "142FHIR",
      "assigner": {
        "display": "CMS"
      }
    }
  ],
  "version": "0.2.000",
  "name": "CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes",
  "title": "Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes CareFHIR",
  "status": "active",
  "experimental": false,
  "date": "2025-07-15T13:37:39+00:00",
  "publisher": "American Academy of Ophthalmology",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "www.aao.org"
        }
      ]
    }
  ],
  "description": "Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once during the measurement period.",
  "usage": "Guidance\tThe measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality.\n\nThe communication of results, including the level of severity of diabetic retinopathy and presence or absence of macular edema to the primary care physician providing ongoing care of a patient's diabetes should be completed soon after the dilated exam is performed. Eligible clinicians reporting on this measure should note that all data for the measurement period is to be submitted by the deadline established by CMS. Therefore, eligible clinicians who see patients towards the end of the measurement period (i.e., December in particular), should communicate the results of the dilated macular exam as soon as possible in order for those patients to be counted in the measure numerator. Communicating the results as soon as possible after the date of the exam will ensure the data are included in the submission to CMS.\n\nThis eCQM is a patient-based measure.\n\nTelehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.\n\nThis version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",
  "copyright": "Copyright 2025 American Academy of Ophthalmology. All Rights Reserved.",
  "approvalDate": "2023-09-05",
  "lastReviewDate": "2023-09-05",
  "effectivePeriod": {
    "start": "2026-01-01",
    "end": "2026-12-31"
  },
  "author": [
    {
      "name": "American Academy of Ophthalmology",
      "telecom": [
        {
          "system": "url",
          "value": "www.aao.org"
        }
      ]
    },
    {
      "name": "American Medical Association (AMA)",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.ama-assn.org/"
        }
      ]
    }
  ],
  "library": [
    "https://madie.cms.gov/Library/CMS142FHIRDRCommunicationWithPhysicianManagingDiabetes"
  ],
  "disclaimer": "The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. \n\nThe Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. \n\nCommercial uses of the Measure require a license agreement between the user and the American Academy of Ophthalmology (Academy). Neither the Academy, its members, the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor PCPI, nor their members shall be responsible for any use of the Measure.\n\nThe PCPI’s and AMA’s significant past efforts and contributions to the development and updating of the Measures are acknowledged. The National Committee for Quality Assurance's significant past efforts and contributions to the development and updating of the Measure is acknowledged. \n\nTHE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.\n\nLimited proprietary coding is contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party’s use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measures. Any other use of CPT or other coding by the third party is strictly prohibited. The Academy, the AMA, and former members of the PCPI disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications. \n\nCPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association. LOINC(R) is copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2024 World Health Organization. All Rights Reserved.\n\nDue to technical limitations, registered trademarks are indicated by (R) or [R].",
  "rationale": "Diabetic retinopathy is a prevalent complication of diabetes, estimated to affect 28.5% of diabetic patients in the US (Zhang et al., 2010). Diabetic retinopathy is a key indicator of systemic complications of diabetes (Zhang et al., 2010). Coordination of care between the eye care specialist and the physician managing a patient’s ongoing diabetes care is essential in stemming the progression of vision loss. Communication from the eye care specialist to a primary care physician facilitates the exchange of information about the severity and progression of a patient’s diabetic retinopathy, adherence to recommended ocular care, need for follow-up visits, and treatment plans (Storey et al., 2016). Data from the Diabetes Control and Complications Trial showed that diabetic treatment and maintenance of glucose control delays the onset and slows the progression of diabetic retinopathy (Aiello & DCCT/EDIC Research Group, 2014).",
  "clinicalRecommendationStatement": "The ophthalmologist should refer patients with diabetes to a primary care physician or endocrinologist for appropriate management of their systemic condition and should communicate examination results to the physician managing the patient'’s ongoing diabetes care Lim et al., ).\n\nOphthalmologists should communicate the ophthalmologic findings2025).\n\nA goal is to achieve optimal control of blood glucose, blood pressure, and other risk factors through close communication with the patient’s primary care physician on the status of the DR and the need for optim metabolic control (Lim et al,, 2025).\n\nEstablishing a close partnership with between the ophthalmologist and the primary care physician is an important to make sure that the care of the step to ensure optimal patient is optimized (III; Good Quality; Strong Recommendation) (Flaxelcare. Furthermore, it is important to help educate patients with diabetes as well as their primary care physician about the ophthalmologic implications of controlling blood glucose (as monitored by HbA1c) to as near to normal as is safely possible (Lim et al., 2025).",
  "definition": [
    "Communication - May include documentation in the medical record indicating that the findings of the dilated macular or fundus exam were communicated (e.g., verbally, by letter) with the clinician managing the patient's diabetic care OR a copy of a letter in the medical record to the clinician managing the patient's diabetic care outlining the findings of the dilated macular or fundus exam.\n",
    "Findings - Includes level of severity of retinopathy (e.g., mild nonproliferative, moderate nonproliferative, severe nonproliferative, very severe nonproliferative, proliferative) AND the presence or absence of macular edema.\n"
  ],
  "guidance": "Guidance\tThe measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality.\n\nThe communication of results, including the level of severity of diabetic retinopathy and presence or absence of macular edema to the primary care physician providing ongoing care of a patient's diabetes should be completed soon after the dilated exam is performed. Eligible clinicians reporting on this measure should note that all data for the measurement period is to be submitted by the deadline established by CMS. Therefore, eligible clinicians who see patients towards the end of the measurement period (i.e., December in particular), should communicate the results of the dilated macular exam as soon as possible in order for those patients to be counted in the measure numerator. Communicating the results as soon as possible after the date of the exam will ensure the data are included in the submission to CMS.\n\nThis eCQM is a patient-based measure.\n\nTelehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.\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": "outcome",
                "display": "Outcome"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode": "None"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "increase",
                "display": "Increased score indicates improvement"
              }
            ]
          }
        },
        {
          "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 a diagnosis of diabetic retinopathy during the measurement period",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "Denominator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator",
                "display": "Denominator"
              }
            ]
          },
          "description": "Equals Initial Population who had a dilated macular or fundus exam performed during the measurement period",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator"
          }
        },
        {
          "id": "Numerator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator",
                "display": "Numerator"
              }
            ]
          },
          "description": "Patients with documentation, at least once within the measurement period, of the findings of the dilated macular or fundus exam via communication to the physician who manages the patient's diabetic care",
          "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 communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes.\n\nDocumentation of patient reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes.",
          "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"
      }
    }
  ]
}