FHIR IG Statistics: Measure/CMS144FHIRHFBetaBlockerTherapyforLVSD

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Narrative

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

define "Initial Population":
  AHA."Is Adults With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period"

define "Initial Population":
  AHA."Is Adults With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period"

define "Denominator":
  "Initial Population"
    and exists AHA."Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD"

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"

define "Numerator":
  "Has Beta Blocker Therapy for LVSD Ordered"
    or "Is Currently Taking Beta Blocker Therapy for LVSD"

/*
@commentedOuf: Temporary removal of "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
@commentedOufReason: Negation issue noted in https://github.com/cqframework/cql-execution/issues/296, which is tied to https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1455
*/


define "Denominator Exceptions":
  "Has Consecutive Heart Rates Less than 50"
    or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
    or "Has Arrhythmia Diagnosis"
    or "Has Hypotension Diagnosis"
    or "Has Asthma Diagnosis"
    or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy"
    or "Has Bradycardia Diagnosis"
    or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient"
    or "Atrioventricular Block without Cardiac Pacer"

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

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

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

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

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

define "Has Beta Blocker Therapy for LVSD Ordered":
  exists ( [MedicationRequest: medication in "Beta Blocker Therapy for LVSD"] BetaBlockerOrdered
      where BetaBlockerOrdered.isOrderedDuringHeartFailureOutpatientEncounter2 ( )
  )

define "Is Currently Taking Beta Blocker Therapy for LVSD":
  exists ( ["MedicationRequest": "Beta Blocker Therapy for LVSD"] ActiveBetaBlocker
      where ActiveBetaBlocker.overlapsAfterHeartFailureOutpatientEncounter ( )
  )

define "Numerator":
  "Has Beta Blocker Therapy for LVSD Ordered"
    or "Is Currently Taking Beta Blocker Therapy for LVSD"

define "Initial Population":
  AHA."Is Adults With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period"

define "Denominator":
  "Initial Population"
    and exists AHA."Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD"

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

define "Initial Population":
  AHA."Is Adults With Two Qualifying Outpatient Encounters and One Heart Failure Outpatient Encounter During the Measurement Period"

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

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"

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

define "Has Consecutive Heart Rates Less than 50":
  exists ( from
      ["USCoreHeartRateProfile"] HeartRate,
      AHA."Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
      let PriorHeartRate: Last(["USCoreHeartRateProfile"] MostRecentPriorHeartRate
          where MostRecentPriorHeartRate.effective.toInterval() during ModerateOrSevereLVSDHFOutpatientEncounter.period
            and MostRecentPriorHeartRate.effective.toInterval() before HeartRate.effective.toInterval()
          sort by start of effective.toInterval()
      )
      where HeartRate.effective.toInterval ( ) during ModerateOrSevereLVSDHFOutpatientEncounter.period
        and HeartRate.status in { 'final', 'amended', 'corrected' }
        and HeartRate.value < 50 '/min'
        and PriorHeartRate.value < 50 '/min'
      return HeartRate
  )

define "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD":
  exists ( ["MedicationNotRequested": medication in "Beta Blocker Therapy for LVSD"] NoBetaBlockerOrdered
      with AHA."Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
        such that NoBetaBlockerOrdered.authoredOn during day of ModerateOrSevereLVSDHFOutpatientEncounter.period
    //   where ( NoBetaBlockerOrdered.reasonCode in "Medical Reason"
    //       or NoBetaBlockerOrdered.reasonCode in "Patient Reason"
    //   )
  
  
  
  )

define "Has Arrhythmia Diagnosis":
  exists ( [ConditionProblemsHealthConcerns: "Arrhythmia"] ArrhythmiaAlias
      where ArrhythmiaAlias.overlapsHeartFailureOutpatientEncounter ( )
        and ArrhythmiaAlias.isConfirmedActiveDiagnosis ( )
  )

define "Has Hypotension Diagnosis":
  exists ( ["ConditionProblemsHealthConcerns": "Hypotension"] HypotensionAlias
      where HypotensionAlias.overlapsHeartFailureOutpatientEncounter ( )
        and HypotensionAlias.isConfirmedActiveDiagnosis ( )
  )

define "Has Asthma Diagnosis":
  exists ( [ConditionProblemsHealthConcerns: "Asthma"] AsthmaAlias
      where AsthmaAlias.overlapsHeartFailureOutpatientEncounter ( )
        and AsthmaAlias.isConfirmedActiveDiagnosis ( )
  )

define "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy":
  exists ( ( ["ConditionProblemsHealthConcerns": "Allergy to Beta Blocker Therapy"]
      union ["ConditionProblemsHealthConcerns": "Intolerance to Beta Blocker Therapy"] ) BetaBlockerAllergyOrIntoleranceDiagnosis
      where BetaBlockerAllergyOrIntoleranceDiagnosis.overlapsAfterHeartFailureOutpatientEncounter ( )
        and BetaBlockerAllergyOrIntoleranceDiagnosis.isConfirmedActiveDiagnosis ( )
  )

define "Has Bradycardia Diagnosis":
  exists ( [ConditionProblemsHealthConcerns: "Bradycardia"] BradycardiaAlias
      where BradycardiaAlias.overlapsHeartFailureOutpatientEncounter ( )
        and BradycardiaAlias.isConfirmedActiveDiagnosis ( )
  )

/*
@commentedOutEarlier: implies logic
@commentedOutReason: implies not available in cql-execution. Reference https://github.com/cqframework/cql-execution/issues/319.

@implies logic has been reinstated back
*/


define "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient":
  exists ( ( [AllergyIntolerance: "Beta Blocker Therapy Ingredient"]
      union [AllergyIntolerance: "Substance with beta adrenergic receptor antagonist mechanism of action (substance)"] ) BetaBlockerAllergyIntolerance
      where BetaBlockerAllergyIntolerance.overlapsAfterHeartFailureOutpatientEncounter ( )
        and ( ( BetaBlockerAllergyIntolerance.clinicalStatus is not null implies BetaBlockerAllergyIntolerance.clinicalStatus !~ QICoreCommon."allergy-inactive" )
            or BetaBlockerAllergyIntolerance.clinicalStatus ~ QICoreCommon."allergy-active"
        )
  )

define "Has Atrioventricular Block Diagnosis":
  exists ( [ConditionProblemsHealthConcerns: "Atrioventricular Block"] AtrioventricularBlock
      where AtrioventricularBlock.overlapsHeartFailureOutpatientEncounter ( )
        and AtrioventricularBlock.isConfirmedActiveDiagnosis ( )
  )

define "Has Diagnosis of Cardiac Pacer in Situ":
  exists ( ["ConditionProblemsHealthConcerns": "Cardiac Pacer in Situ"] CardiacPacerDiagnosis
      where CardiacPacerDiagnosis.overlapsAfterHeartFailureOutpatientEncounter ( )
        and CardiacPacerDiagnosis.isConfirmedActiveDiagnosis ( )
  )

define "Has Cardiac Pacer Device Implanted":
  exists ( [Procedure: "Cardiac Pacer"] ImplantedCardiacPacer
      with AHA."Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD" ModerateOrSevereLVSDHFOutpatientEncounter
        such that ImplantedCardiacPacer.performed.toInterval ( ) starts before end of ModerateOrSevereLVSDHFOutpatientEncounter.period
      where ImplantedCardiacPacer.status = 'completed'
  )

define "Atrioventricular Block without Cardiac Pacer":
  "Has Atrioventricular Block Diagnosis"
    and not "Has Diagnosis of Cardiac Pacer in Situ"
    and not "Has Cardiac Pacer Device Implanted"

/*
@commentedOuf: Temporary removal of "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
@commentedOufReason: Negation issue noted in https://github.com/cqframework/cql-execution/issues/296, which is tied to https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1455
*/


define "Denominator Exceptions":
  "Has Consecutive Heart Rates Less than 50"
    or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
    or "Has Arrhythmia Diagnosis"
    or "Has Hypotension Diagnosis"
    or "Has Asthma Diagnosis"
    or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy"
    or "Has Bradycardia Diagnosis"
    or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient"
    or "Atrioventricular Block without Cardiac Pacer"

// TODO: Need to figure out why this function isn't working when invoked from AHAOverall v3.0.000
 //       This test case fails when using AHAOverall v3.0.000, but passes with the copy below:
 //       https://madie.cms.gov/measures/67e2e174ede72744898ad54f/edit/test-cases/67e2e1cb2dcc81152d60e878 




define fluent function isOrderedDuringHeartFailureOutpatientEncounter2(MedicationRequest MedicationRequest):
  exists ( AHA."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 
  
  
  )

define function ToString(value uri): value.value

/*
@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
value to a CQL DateTime Interval
@comment: If the start value of the given period is unspecified, the starting
boundary of the resulting interval will be open (meaning the start of the interval
is unknown, as opposed to interpreted as the beginning of time).
*/
define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period."start" is null then
            Interval(period."start".value, period."end".value]
        else
            Interval[period."start".value, period."end".value]

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

/*
@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]

/*
@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>

/*
@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

/* 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"

/*
@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()

/*
@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()
  )

/*
@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

/*
@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()

/*
@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"

/*
@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'
          )

/*
@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()
          )

/*
@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'
            )

/*
@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()
          )

/*
@description: Returns true if the given Encounter is finished
*/
define fluent function isFinished(Encounter Encounter):
    Encounter.status = 'finished'

/*
@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 
          )

/*
@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()
          )

/*
@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"

/*
@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()
          )

/*
@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" 
          )

Source

{
  "resourceType": "Measure",
  "id": "CMS144FHIRHFBetaBlockerTherapyforLVSD",
  "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://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": "373254001",
            "display": "Substance with beta adrenergic receptor antagonist 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/allergyintolerance-clinical",
            "code": "inactive",
            "display": "Inactive"
          }
        },
        {
          "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": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "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": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Beta Blocker Therapy for LVSD Ordered"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Beta Blocker Therapy for LVSD Ordered\":\n  exists ( [MedicationRequest: medication in \"Beta Blocker Therapy for LVSD\"] BetaBlockerOrdered\n      where BetaBlockerOrdered.isOrderedDuringHeartFailureOutpatientEncounter2 ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "url": "name",
              "valueString": "Is Currently Taking Beta Blocker Therapy for LVSD"
            },
            {
              "url": "statement",
              "valueString": "define \"Is Currently Taking Beta Blocker Therapy for LVSD\":\n  exists ( [\"MedicationRequest\": \"Beta Blocker Therapy for LVSD\"] ActiveBetaBlocker\n      where ActiveBetaBlocker.overlapsAfterHeartFailureOutpatientEncounter ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n  \"Has Beta Blocker Therapy for LVSD Ordered\"\n    or \"Is Currently Taking Beta Blocker Therapy for LVSD\""
            },
            {
              "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": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "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": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "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": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "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": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "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": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "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": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "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": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "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": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Consecutive Heart Rates Less than 50"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Consecutive Heart Rates Less than 50\":\n  exists ( from\n      [\"USCoreHeartRateProfile\"] HeartRate,\n      AHA.\"Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD\" ModerateOrSevereLVSDHFOutpatientEncounter\n      let PriorHeartRate: Last([\"USCoreHeartRateProfile\"] MostRecentPriorHeartRate\n          where MostRecentPriorHeartRate.effective.toInterval() during ModerateOrSevereLVSDHFOutpatientEncounter.period\n            and MostRecentPriorHeartRate.effective.toInterval() before HeartRate.effective.toInterval()\n          sort by start of effective.toInterval()\n      )\n      where HeartRate.effective.toInterval ( ) during ModerateOrSevereLVSDHFOutpatientEncounter.period\n        and HeartRate.status in { 'final', 'amended', 'corrected' }\n        and HeartRate.value < 50 '/min'\n        and PriorHeartRate.value < 50 '/min'\n      return HeartRate\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 24
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD\":\n  exists ( [\"MedicationNotRequested\": medication in \"Beta Blocker Therapy for LVSD\"] NoBetaBlockerOrdered\n      with AHA.\"Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD\" ModerateOrSevereLVSDHFOutpatientEncounter\n        such that NoBetaBlockerOrdered.authoredOn during day of ModerateOrSevereLVSDHFOutpatientEncounter.period\n    //   where ( NoBetaBlockerOrdered.reasonCode in \"Medical Reason\"\n    //       or NoBetaBlockerOrdered.reasonCode in \"Patient Reason\"\n    //   )\n  \n  \n  \n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 25
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Arrhythmia Diagnosis"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Arrhythmia Diagnosis\":\n  exists ( [ConditionProblemsHealthConcerns: \"Arrhythmia\"] ArrhythmiaAlias\n      where ArrhythmiaAlias.overlapsHeartFailureOutpatientEncounter ( )\n        and ArrhythmiaAlias.isConfirmedActiveDiagnosis ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 26
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Hypotension Diagnosis"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Hypotension Diagnosis\":\n  exists ( [\"ConditionProblemsHealthConcerns\": \"Hypotension\"] HypotensionAlias\n      where HypotensionAlias.overlapsHeartFailureOutpatientEncounter ( )\n        and HypotensionAlias.isConfirmedActiveDiagnosis ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 27
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Asthma Diagnosis"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Asthma Diagnosis\":\n  exists ( [ConditionProblemsHealthConcerns: \"Asthma\"] AsthmaAlias\n      where AsthmaAlias.overlapsHeartFailureOutpatientEncounter ( )\n        and AsthmaAlias.isConfirmedActiveDiagnosis ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 28
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy\":\n  exists ( ( [\"ConditionProblemsHealthConcerns\": \"Allergy to Beta Blocker Therapy\"]\n      union [\"ConditionProblemsHealthConcerns\": \"Intolerance to Beta Blocker Therapy\"] ) BetaBlockerAllergyOrIntoleranceDiagnosis\n      where BetaBlockerAllergyOrIntoleranceDiagnosis.overlapsAfterHeartFailureOutpatientEncounter ( )\n        and BetaBlockerAllergyOrIntoleranceDiagnosis.isConfirmedActiveDiagnosis ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 29
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Bradycardia Diagnosis"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Bradycardia Diagnosis\":\n  exists ( [ConditionProblemsHealthConcerns: \"Bradycardia\"] BradycardiaAlias\n      where BradycardiaAlias.overlapsHeartFailureOutpatientEncounter ( )\n        and BradycardiaAlias.isConfirmedActiveDiagnosis ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 30
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient"
            },
            {
              "url": "statement",
              "valueString": "/*\n@commentedOutEarlier: implies logic\n@commentedOutReason: implies not available in cql-execution. Reference https://github.com/cqframework/cql-execution/issues/319.\n\n@implies logic has been reinstated back\n*/\n\n\ndefine \"Has Allergy or Intolerance to Beta Blocker Therapy Ingredient\":\n  exists ( ( [AllergyIntolerance: \"Beta Blocker Therapy Ingredient\"]\n      union [AllergyIntolerance: \"Substance with beta adrenergic receptor antagonist mechanism of action (substance)\"] ) BetaBlockerAllergyIntolerance\n      where BetaBlockerAllergyIntolerance.overlapsAfterHeartFailureOutpatientEncounter ( )\n        and ( ( BetaBlockerAllergyIntolerance.clinicalStatus is not null implies BetaBlockerAllergyIntolerance.clinicalStatus !~ QICoreCommon.\"allergy-inactive\" )\n            or BetaBlockerAllergyIntolerance.clinicalStatus ~ QICoreCommon.\"allergy-active\"\n        )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 31
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Atrioventricular Block Diagnosis"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Atrioventricular Block Diagnosis\":\n  exists ( [ConditionProblemsHealthConcerns: \"Atrioventricular Block\"] AtrioventricularBlock\n      where AtrioventricularBlock.overlapsHeartFailureOutpatientEncounter ( )\n        and AtrioventricularBlock.isConfirmedActiveDiagnosis ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 32
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Diagnosis of Cardiac Pacer in Situ"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Diagnosis of Cardiac Pacer in Situ\":\n  exists ( [\"ConditionProblemsHealthConcerns\": \"Cardiac Pacer in Situ\"] CardiacPacerDiagnosis\n      where CardiacPacerDiagnosis.overlapsAfterHeartFailureOutpatientEncounter ( )\n        and CardiacPacerDiagnosis.isConfirmedActiveDiagnosis ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 33
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Cardiac Pacer Device Implanted"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Cardiac Pacer Device Implanted\":\n  exists ( [Procedure: \"Cardiac Pacer\"] ImplantedCardiacPacer\n      with AHA.\"Heart Failure Outpatient Encounter with History of Moderate or Severe LVSD\" ModerateOrSevereLVSDHFOutpatientEncounter\n        such that ImplantedCardiacPacer.performed.toInterval ( ) starts before end of ModerateOrSevereLVSDHFOutpatientEncounter.period\n      where ImplantedCardiacPacer.status = 'completed'\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 34
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "url": "name",
              "valueString": "Atrioventricular Block without Cardiac Pacer"
            },
            {
              "url": "statement",
              "valueString": "define \"Atrioventricular Block without Cardiac Pacer\":\n  \"Has Atrioventricular Block Diagnosis\"\n    and not \"Has Diagnosis of Cardiac Pacer in Situ\"\n    and not \"Has Cardiac Pacer Device Implanted\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 35
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "url": "name",
              "valueString": "Denominator Exceptions"
            },
            {
              "url": "statement",
              "valueString": "/*\n@commentedOuf: Temporary removal of \"Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD\"\n@commentedOufReason: Negation issue noted in https://github.com/cqframework/cql-execution/issues/296, which is tied to https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1455\n*/\n\n\ndefine \"Denominator Exceptions\":\n  \"Has Consecutive Heart Rates Less than 50\"\n    or \"Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD\"\n    or \"Has Arrhythmia Diagnosis\"\n    or \"Has Hypotension Diagnosis\"\n    or \"Has Asthma Diagnosis\"\n    or \"Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy\"\n    or \"Has Bradycardia Diagnosis\"\n    or \"Has Allergy or Intolerance to Beta Blocker Therapy Ingredient\"\n    or \"Atrioventricular Block without Cardiac Pacer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 36
            }
          ],
          "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": 37
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS144FHIRHFBetaBlockerTherapyforLVSD"
            },
            {
              "url": "name",
              "valueString": "isOrderedDuringHeartFailureOutpatientEncounter2"
            },
            {
              "url": "statement",
              "valueString": "// TODO: Need to figure out why this function isn't working when invoked from AHAOverall v3.0.000\n //       This test case fails when using AHAOverall v3.0.000, but passes with the copy below:\n //       https://madie.cms.gov/measures/67e2e174ede72744898ad54f/edit/test-cases/67e2e1cb2dcc81152d60e878 \n\n\n\n\ndefine fluent function isOrderedDuringHeartFailureOutpatientEncounter2(MedicationRequest MedicationRequest):\n  exists ( AHA.\"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  \n  \n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 38
            }
          ],
          "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": 39
            }
          ],
          "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": 40
            }
          ],
          "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": 41
            }
          ],
          "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": 42
            }
          ],
          "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": 43
            }
          ],
          "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": 44
            }
          ],
          "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": 45
            }
          ],
          "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": 46
            }
          ],
          "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": 47
            }
          ],
          "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": 48
            }
          ],
          "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": 49
            }
          ],
          "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": 50
            }
          ],
          "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 ConditionVerificationStatusCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/condition-ver-status"
        },
        {
          "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": "Value set Beta Blocker Therapy for LVSD",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1184"
        },
        {
          "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 Arrhythmia",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.366"
        },
        {
          "type": "depends-on",
          "display": "Value set Hypotension",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.370"
        },
        {
          "type": "depends-on",
          "display": "Value set Asthma",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.362"
        },
        {
          "type": "depends-on",
          "display": "Value set Allergy to Beta Blocker Therapy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1177"
        },
        {
          "type": "depends-on",
          "display": "Value set Intolerance to Beta Blocker Therapy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1178"
        },
        {
          "type": "depends-on",
          "display": "Value set Bradycardia",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.412"
        },
        {
          "type": "depends-on",
          "display": "Value set Beta Blocker Therapy Ingredient",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1493"
        },
        {
          "type": "depends-on",
          "display": "Value set Atrioventricular Block",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.367"
        },
        {
          "type": "depends-on",
          "display": "Value set Cardiac Pacer in Situ",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.368"
        },
        {
          "type": "depends-on",
          "display": "Value set Cardiac Pacer",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.53"
        }
      ],
      "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"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"
          ],
          "mustSupport": [
            "code"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://snomed.info/sct",
                  "code": "134401001",
                  "display": "Left ventricular systolic dysfunction (disorder)"
                }
              ]
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"
          ],
          "mustSupport": [
            "code"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
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      "id": "supplementalDataGuidance",
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          "url": "guidance",
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  ],
  "url": "https://madie.cms.gov/Measure/CMS144FHIRHFBetaBlockerTherapyforLVSD",
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      "use": "usual",
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            "code": "endorser",
            "display": "Endorser"
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        ]
      },
      "system": "https://madie.cms.gov/measure/cbeId",
      "value": "0083e",
      "assigner": {
        "display": "CMS Consensus Based Entity"
      }
    },
    {
      "use": "official",
      "type": {
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            "code": "publisher",
            "display": "Publisher"
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      "system": "https://madie.cms.gov/measure/cmsId",
      "value": "144FHIR",
      "assigner": {
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  "version": "1.5.000",
  "name": "CMS144FHIRHFBetaBlockerTherapyforLVSD",
  "title": "Heart Failure (HF): Beta-Blocker 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 beta-blocker therapy during the measurement period",
  "usage": "Guidance\tThis 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\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\nBeta-blocker therapy:\n\n-For patients with prior LVEF <= 40%, beta-blocker therapy should include bisoprolol, carvedilol, or sustained release metoprolol succinate.\n\nThe requirement of two or more visits is to establish that the eligible clinician has an existing relationship with the patient.\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 2024 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/CMS144FHIRHFBetaBlockerTherapyforLVSD"
  ],
  "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.\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. 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 2004-2024 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\nThe American Medical Association’s and the PCPI(R) Foundation’s significant past efforts and contributions to the performance measure are gratefully acknowledged.\n\nDue to technical limitations, registered trademarks are indicated by (R) or [R].",
  "rationale": "Beta blockers improve survival and reduce hospitalization for patients with stable heart failure with reduced ejection fraction (HFrEF). Treatment should be initiated as soon as a patient is diagnosed with reduced LVEF and does not have prohibitively low systemic blood pressure, fluid overload, or recent treatment with an intravenous positive inotropic agent. Beta blockers have also been shown to lessen the symptoms of heart failure, improve the clinical status of patients, and reduce future clinical deterioration. Despite these benefits, use of beta blockers in eligible patients remains suboptimal.",
  "clinicalRecommendationStatement": "In patients with HFrEF, with current or previous symptoms, use of 1 of the 3 beta blockers proven to reduce mortality (e.g., bisoprolol, carvedilol, sustained-release metoprolol succinate) is recommended to reduce mortality and hospitalizations (Class I, Level of Evidence A) (Heidenreich, 2022). \n\nDrugs Commonly Used for Stage C HFrEF (abbreviated to align with focus of measure to include only Beta-blocker therapy)\nDrug                                     Initial Daily Dose(s)        Target Dose(s)                Mean Doses Achieved in Clinical Trials\n                                                                                                                                                \nBeta Blockers\nBisoprolol                          1.25 mg once                     10 mg once                     8.6 mg/d\nCarvedilol                          3.125 mg twice                  25-50 mg twice             37 mg/d\nCarvedilol CR                    10 mg once                        80 mg once                    N/A\nMetoprolol succinate     12.5 to 25 mg once          200 mg once                  159 mg/d\nextended release\n(metoprolol CR/XL)",
  "definition": [
    "LVEF - LVEF <=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"
  ],
  "guidance": "Guidance\tThis 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\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\nBeta-blocker therapy:\n\n-For patients with prior LVEF <= 40%, beta-blocker therapy should include bisoprolol, carvedilol, or sustained release metoprolol succinate.\n\nThe requirement of two or more visits is to establish that the eligible clinician has an existing relationship with the patient.\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 beta-blocker 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 beta-blocker therapy (e.g., arrhythmia, asthma, bradycardia, hypotension, patients with atrioventricular block without cardiac pacer, observation of consecutive heart rates <50, allergy, intolerance, other medical reasons).\n\nDocumentation of patient reason(s) for not prescribing beta-blocker 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"
      }
    }
  ]
}