FHIR IG Statistics: Measure/CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD

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Narrative

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define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists ( "Qualifying Encounter During Measurement Period" Encounter1
        with "Qualifying Encounter During Measurement Period" Encounter2
          such that Encounter2.id !~ Encounter1.id
    )
    and exists "Qualifying CAD Encounter"

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists ( "Qualifying Encounter During Measurement Period" Encounter1
        with "Qualifying Encounter During Measurement Period" Encounter2
          such that Encounter2.id !~ Encounter1.id
    )
    and exists "Qualifying CAD Encounter"

define "Denominator 1":
  "Initial Population"
    and exists "Qualifying CAD Encounter and History of Moderate or Severe LVSD"

define "Numerator 1":
  "Has Beta Blocker Therapy for LVSD Ordered"
    or "Is Currently Taking Beta Blocker Therapy for LVSD"

define "Denominator Exceptions 1":
  "Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
    or "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer"

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists ( "Qualifying Encounter During Measurement Period" Encounter1
        with "Qualifying Encounter During Measurement Period" Encounter2
          such that Encounter2.id !~ Encounter1.id
    )
    and exists "Qualifying CAD Encounter"

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists ( "Qualifying Encounter During Measurement Period" Encounter1
        with "Qualifying Encounter During Measurement Period" Encounter2
          such that Encounter2.id !~ Encounter1.id
    )
    and exists "Qualifying CAD Encounter"

define "Denominator 2":
  "Initial Population"
    and exists "Qualifying CAD Encounter and Prior MI"

define "Numerator 2":
  "Has Beta Blocker Therapy Ordered"
    or "Is Currently Taking Beta Blocker Therapy"

define "Denominator Exceptions 2":
  "Has Arrhythmia with Qualifying CAD Encounter and Prior MI"
    or "Has Asthma with Qualifying CAD Encounter and Prior MI"
    or "Has Bradycardia with Qualifying CAD Encounter and Prior MI"
    or "Has Hypotension with Qualifying CAD Encounter and Prior MI"
    or "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI"
    or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI"
    or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI"
    or "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
    or "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI 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
    }

/*
@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 true if the given Condition is confirmed as active
*/
define fluent function isConfirmedActiveDiagnosis(condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>):
    condition.isActive()
        and condition.verificationStatus ~ QICoreCommon."confirmed"

/* 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 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

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 [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }

/*
@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
        }

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

define "Qualifying Encounter During Measurement Period":
  ( [Encounter: "Office Visit"]
    union [Encounter: "Outpatient Consultation"]
    union [Encounter: "Nursing Facility Visit"]
    union [Encounter: "Care Services in Long Term Residential Facility"]
    union [Encounter: "Home Healthcare Services"]
    union [Encounter: "Patient Provider Interaction"] ) ValidEncounter
    where ValidEncounter.period during day of "Measurement Period"
      and ValidEncounter.status = 'finished'

define "Outpatient Encounter During Measurement Period":
  ( [Encounter: "Office Visit"]
    union [Encounter: "Outpatient Consultation"]
    union [Encounter: "Care Services in Long Term Residential Facility"]
    union [Encounter: "Home Healthcare Services"]
    union [Encounter: "Nursing Facility Visit"] ) QualifyingEncounter
    where QualifyingEncounter.period during day of "Measurement Period"
      and QualifyingEncounter.status = 'finished'

define "Coronary Artery Disease Encounter":
  "Outpatient Encounter During Measurement Period" ValidQualifyingEncounter
    with [ConditionProblemsHealthConcerns: "Coronary Artery Disease No MI"] CoronaryArteryDisease
      such that CoronaryArteryDisease.overlapsDayOfEncounter ( ValidQualifyingEncounter )

define "History of Cardiac Surgery Prior to Encounter":
  "Outpatient Encounter During Measurement Period" ValidQualifyingEncounter
    with [Procedure: "Cardiac Surgery"] CardiacSurgeryProcedure
      such that CardiacSurgeryProcedure.performed.toInterval ( ) starts before end of ValidQualifyingEncounter.period
        and CardiacSurgeryProcedure.status = 'completed'

define "Qualifying CAD Encounter":
  "Coronary Artery Disease Encounter"
    union "History of Cardiac Surgery Prior to Encounter"

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists ( "Qualifying Encounter During Measurement Period" Encounter1
        with "Qualifying Encounter During Measurement Period" Encounter2
          such that Encounter2.id !~ Encounter1.id
    )
    and exists "Qualifying CAD Encounter"

define "Qualifying CAD Encounter and Prior MI":
  "Qualifying CAD Encounter" EncounterWithCADProxy
    with [ConditionProblemsHealthConcerns: "Myocardial Infarction"] MyocardialInfarction
      such that MyocardialInfarction.prevalenceInterval ( ) starts 3 years or less before day of start of EncounterWithCADProxy.period
        and not exists AHA."Moderate or Severe LVSD Findings"

define "Denominator 2":
  "Initial Population"
    and exists "Qualifying CAD Encounter and Prior MI"

define "Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  "Qualifying CAD Encounter" EncounterWithCADProxy
    with AHA."Moderate or Severe LVSD Findings" LVSDFindings
      such that Coalesce(LVSDFindings.prevalenceInterval(), LVSDFindings.effective.toInterval()) starts before end of EncounterWithCADProxy.period

define "Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( [ConditionProblemsHealthConcerns: "Arrhythmia"] ArrhythmiaDiagnosis
      where ArrhythmiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

define "Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( [ConditionProblemsHealthConcerns: "Asthma"] AsthmaDiagnosis
      where AsthmaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

define "Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( [ConditionProblemsHealthConcerns: "Bradycardia"] BradycardiaDiagnosis
      where BradycardiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

define "Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( [ConditionProblemsHealthConcerns: "Hypotension"] HypotensionDiagnosis
      where HypotensionDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

/*
* @code: Heart rate - 8867-4
* @profile: http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate
*/


define "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( from
      ["USCoreHeartRateProfile"] HeartRateExam,
      "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
      let PriorHeartRateExam: Last(["USCoreHeartRateProfile"] MostRecentPriorHeartRateExam
          where MostRecentPriorHeartRateExam.effective.toInterval() during CADEncounterModerateOrSevereLVSD.period
            and MostRecentPriorHeartRateExam.effective.toInterval() before HeartRateExam.effective.toInterval()
          sort by start of effective.toInterval()
      )
      where HeartRateExam.effective.toInterval ( ) during CADEncounterModerateOrSevereLVSD.period
        and HeartRateExam.value < 50 '/min'
        and PriorHeartRateExam.value < 50 '/min'
  )

define "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( ( [AllergyIntolerance: "Beta Blocker Therapy Ingredient"]
      union [AllergyIntolerance: "Substance with beta adrenergic receptor antagonist mechanism of action (substance)"] ) BetaBlockerAllergyIntolerance
      where BetaBlockerAllergyIntolerance.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

define "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( ( [ConditionProblemsHealthConcerns: "Allergy to Beta Blocker Therapy"]
      union [ConditionProblemsHealthConcerns: "Intolerance to Beta Blocker Therapy"] ) BetaBlockerAllergyOrIntoleranceDiagnosis
      where BetaBlockerAllergyOrIntoleranceDiagnosis.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

// TODO: https://oncprojectracking.healthit.gov/support/projects/MADIE/issues/MADIE-2124
// Expecting 1 failures per population until this translator issue is incorporated into MADiE



define "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD":
  exists ( [MedicationNotRequested: medication in "Beta Blocker Therapy for LVSD"] NoBetaBlockerForLVSDOrdered
      with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" LVSDVisit
        such that NoBetaBlockerForLVSDOrdered.authoredOn during day of LVSDVisit.period
      where NoBetaBlockerForLVSDOrdered.status in { 'active', 'completed' }
        and NoBetaBlockerForLVSDOrdered.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and ( NoBetaBlockerForLVSDOrdered.reasonCode in "Medical Reason"
            or NoBetaBlockerForLVSDOrdered.reasonCode in "Patient Reason"
        )
  )

define "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( [ConditionProblemsHealthConcerns: "Atrioventricular Block"] AtrioventricularBlock
      where AtrioventricularBlock.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

define "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( [ConditionProblemsHealthConcerns: "Cardiac Pacer in Situ"] CardiacPacerDiagnosis
      where CardiacPacerDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

define "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( [Procedure: "Cardiac Pacer"] ImplantedCardiacPacer
      with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
        such that ImplantedCardiacPacer.performed.toInterval ( ) starts before end of CADEncounterModerateOrSevereLVSD.period
  )

define "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer":
  "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    and not "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    and not "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and History of Moderate or Severe LVSD"

define "Denominator Exceptions 1":
  "Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
    or "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer"

define "Has Beta Blocker Therapy for LVSD Ordered":
  exists ( [MedicationRequest: medication in "Beta Blocker Therapy for LVSD"] BetaBlockerForLVSDOrdered
      where BetaBlockerForLVSDOrdered.authoredDuringDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

define "Is Currently Taking Beta Blocker Therapy for LVSD":
  exists ( [MedicationRequest: medication in "Beta Blocker Therapy for LVSD"] ActiveBetaBlockerForLVSD
      with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
        such that First((collapse(ActiveBetaBlockerForLVSD.dosageInstruction.timing.repeat.bounds DoseTime
              return DoseTime.toInterval()
          )) DrugPeriod
            sort by start of $this
        ) overlaps after day of CADEncounterModerateOrSevereLVSD.period
      where ActiveBetaBlockerForLVSD.status in { 'active', 'completed' }
        and ActiveBetaBlockerForLVSD.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
  )

define "Numerator 1":
  "Has Beta Blocker Therapy for LVSD Ordered"
    or "Is Currently Taking Beta Blocker Therapy for LVSD"

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

define "Has Beta Blocker Therapy Ordered":
  exists ( [MedicationRequest: medication in "Beta Blocker Therapy"] BetaBlockerOrdered
      where BetaBlockerOrdered.authoredDuringDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

define "Is Currently Taking Beta Blocker Therapy":
  exists ( [MedicationRequest: medication in "Beta Blocker Therapy"] ActiveBetaBlocker
      with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
        such that First((collapse(ActiveBetaBlocker.dosageInstruction.timing.repeat.bounds DoseTime
              return DoseTime.toInterval()
          )) DrugPeriod
            sort by start of $this
        ) overlaps after day of CADEncounterMI.period
      where ActiveBetaBlocker.status in { 'active', 'completed' }
        and ActiveBetaBlocker.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
  )

define "Numerator 2":
  "Has Beta Blocker Therapy Ordered"
    or "Is Currently Taking Beta Blocker Therapy"

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists ( "Qualifying Encounter During Measurement Period" Encounter1
        with "Qualifying Encounter During Measurement Period" Encounter2
          such that Encounter2.id !~ Encounter1.id
    )
    and exists "Qualifying CAD Encounter"

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

define "Has Arrhythmia with Qualifying CAD Encounter and Prior MI":
  exists ( [ConditionProblemsHealthConcerns: "Arrhythmia"] ArrhythmiaDiagnosis
      where ArrhythmiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

define "Has Asthma with Qualifying CAD Encounter and Prior MI":
  exists ( [ConditionProblemsHealthConcerns: "Asthma"] AsthmaDiagnosis
      where AsthmaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

define "Has Bradycardia with Qualifying CAD Encounter and Prior MI":
  exists ( [ConditionProblemsHealthConcerns: "Bradycardia"] BradycardiaDiagnosis
      where BradycardiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

define "Has Hypotension with Qualifying CAD Encounter and Prior MI":
  exists ( [ConditionProblemsHealthConcerns: "Hypotension"] HypotensionDiagnosis
      where HypotensionDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

/*
* @code: Heart rate - 8867-4
* @profile: http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate 
*/


define "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI":
  exists ( from
      ["USCoreHeartRateProfile"] HeartRateExam,
      "Qualifying CAD Encounter and Prior MI" CADEncounterMI
      let PriorHeartRateExam: Last(["USCoreHeartRateProfile"] MostRecentPriorHeartRateExam
          where MostRecentPriorHeartRateExam.effective.toInterval() during CADEncounterMI.period
            and MostRecentPriorHeartRateExam.status in { 'final', 'amended', 'corrected' }
            and MostRecentPriorHeartRateExam.effective.toInterval() before HeartRateExam.effective.toInterval()
          sort by start of effective.toInterval()
      )
      where HeartRateExam.effective.toInterval ( ) during CADEncounterMI.period
        and HeartRateExam.status in { 'final', 'amended', 'corrected' }
        and HeartRateExam.value < 50 '/min'
        and PriorHeartRateExam.value < 50 '/min'
  )

define "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI":
  exists ( ( [AllergyIntolerance: "Beta Blocker Therapy Ingredient"]
      union [AllergyIntolerance: "Substance with beta adrenergic receptor antagonist mechanism of action (substance)"] ) BetaBlockerAllergyIntolerance
      where BetaBlockerAllergyIntolerance.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

define "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI":
  exists ( ( [ConditionProblemsHealthConcerns: "Allergy to Beta Blocker Therapy"]
      union [ConditionProblemsHealthConcerns: "Intolerance to Beta Blocker Therapy"] ) BetaBlockerAllergyOrIntoleranceDiagnosis
      where BetaBlockerAllergyOrIntoleranceDiagnosis.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

// TODO: https://oncprojectracking.healthit.gov/support/projects/MADIE/issues/MADIE-2124
// Expecting 1 failures per population until this translator issue is incorporated into MADiE



define "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy":
  exists ( [MedicationNotRequested: medication in "Beta Blocker Therapy for LVSD"] NoBetaBlockerForLVSDOrdered
      with "Qualifying CAD Encounter and Prior MI" PriorMIVisit
        such that NoBetaBlockerForLVSDOrdered.authoredOn during day of PriorMIVisit.period
      where NoBetaBlockerForLVSDOrdered.status in { 'active', 'completed' }
        and NoBetaBlockerForLVSDOrdered.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and ( NoBetaBlockerForLVSDOrdered.reasonCode in "Medical Reason"
            or NoBetaBlockerForLVSDOrdered.reasonCode in "Patient Reason"
        )
  )

define "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI":
  exists ( [ConditionProblemsHealthConcerns: "Atrioventricular Block"] AtrioventricularBlockDiagnosis
      where AtrioventricularBlockDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

define "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and Prior MI":
  exists ( [ConditionProblemsHealthConcerns: "Cardiac Pacer in Situ"] CardiacPacerDiagnosis
      where CardiacPacerDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

define "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI":
  exists ( [Procedure: "Cardiac Pacer"] ImplantedCardiacPacer
      with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
        such that ImplantedCardiacPacer.performed.toInterval ( ) starts before end of CADEncounterMI.period
  )

define "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer":
  "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI"
    and not "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and Prior MI"
    and not "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI"

define "Denominator Exceptions 2":
  "Has Arrhythmia with Qualifying CAD Encounter and Prior MI"
    or "Has Asthma with Qualifying CAD Encounter and Prior MI"
    or "Has Bradycardia with Qualifying CAD Encounter and Prior MI"
    or "Has Hypotension with Qualifying CAD Encounter and Prior MI"
    or "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI"
    or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI"
    or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI"
    or "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
    or "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer"

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

define "Denominator 1":
  "Initial Population"
    and exists "Qualifying CAD Encounter and History of Moderate or Severe LVSD"

define fluent function overlapsDayOfEncounter(Diagnosis ConditionProblemsHealthConcerns, TheEncounter Encounter):
  TheEncounter Visit
    where Diagnosis.isConfirmedActiveDiagnosis ( )
    return Diagnosis.prevalenceInterval ( ) overlaps day of Visit.period

define fluent function overlapsDayOfEncounter(Diagnosis ConditionProblemsHealthConcerns, EncounterList List<Encounter>):
  AnyTrue(EncounterList Visit
      where Diagnosis.isActive()
      return Diagnosis.prevalenceInterval() overlaps day of Visit.period
  )

define fluent function overlapsAfterDayOfEncounter(Event Choice<AllergyIntolerance, ConditionProblemsHealthConcerns>, EncounterList List<Encounter>):
  AnyTrue(EncounterList Visit
      return
      case
        when Event is AllergyIntolerance then Interval[start of Event.onset.toInterval(), Event.lastOccurrence]overlaps after day of Visit.period
          and(Event.clinicalStatus is null
              or Event.clinicalStatus ~ QICoreCommon."allergy-active"
          )
        when Event is ConditionProblemsHealthConcerns then Event.isConfirmedActiveDiagnosis()
          and Event.prevalenceInterval() overlaps after day of Visit.period
          and Event.verificationStatus ~ QICoreCommon."confirmed" 
        else false 
      end
  )

define fluent function authoredDuringDayOfEncounter(Order Choice<MedicationRequest, MedicationNotRequested>, EncounterList List<Encounter>):
  AnyTrue(EncounterList Visit
      return
      case
        when Order is MedicationRequest then Order.authoredOn during day of Visit.period
          and Order.status in { 'active', 'completed' }
          and Order.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
          and Order.doNotPerform is not true
        when Order is MedicationNotRequested then Order.authoredOn during day of Visit.period
          and Order.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' } 
        else false 
      end
  )

Source

{
  "resourceType": "Measure",
  "id": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareablemeasure",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cql-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/elm-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "contained": [
    {
      "resourceType": "Library",
      "id": "effective-data-requirements",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "248153007",
            "display": "Male (finding)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "248152002",
            "display": "Female (finding)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/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": "134401001",
            "display": "Left ventricular systolic dysfunction (disorder)"
          }
        },
        {
          "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"
          }
        },
        {
          "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": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "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": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Qualifying Encounter During Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"Qualifying Encounter During Measurement Period\":\n  ( [Encounter: \"Office Visit\"]\n    union [Encounter: \"Outpatient Consultation\"]\n    union [Encounter: \"Nursing Facility Visit\"]\n    union [Encounter: \"Care Services in Long Term Residential Facility\"]\n    union [Encounter: \"Home Healthcare Services\"]\n    union [Encounter: \"Patient Provider Interaction\"] ) ValidEncounter\n    where ValidEncounter.period during day of \"Measurement Period\"\n      and ValidEncounter.status = 'finished'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Outpatient Encounter During Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"Outpatient Encounter During Measurement Period\":\n  ( [Encounter: \"Office Visit\"]\n    union [Encounter: \"Outpatient Consultation\"]\n    union [Encounter: \"Care Services in Long Term Residential Facility\"]\n    union [Encounter: \"Home Healthcare Services\"]\n    union [Encounter: \"Nursing Facility Visit\"] ) QualifyingEncounter\n    where QualifyingEncounter.period during day of \"Measurement Period\"\n      and QualifyingEncounter.status = 'finished'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Coronary Artery Disease Encounter"
            },
            {
              "url": "statement",
              "valueString": "define \"Coronary Artery Disease Encounter\":\n  \"Outpatient Encounter During Measurement Period\" ValidQualifyingEncounter\n    with [ConditionProblemsHealthConcerns: \"Coronary Artery Disease No MI\"] CoronaryArteryDisease\n      such that CoronaryArteryDisease.overlapsDayOfEncounter ( ValidQualifyingEncounter )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "History of Cardiac Surgery Prior to Encounter"
            },
            {
              "url": "statement",
              "valueString": "define \"History of Cardiac Surgery Prior to Encounter\":\n  \"Outpatient Encounter During Measurement Period\" ValidQualifyingEncounter\n    with [Procedure: \"Cardiac Surgery\"] CardiacSurgeryProcedure\n      such that CardiacSurgeryProcedure.performed.toInterval ( ) starts before end of ValidQualifyingEncounter.period\n        and CardiacSurgeryProcedure.status = 'completed'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Qualifying CAD Encounter"
            },
            {
              "url": "statement",
              "valueString": "define \"Qualifying CAD Encounter\":\n  \"Coronary Artery Disease Encounter\"\n    union \"History of Cardiac Surgery Prior to Encounter\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  AgeInYearsAt(date from start of \"Measurement Period\") >= 18\n    and exists ( \"Qualifying Encounter During Measurement Period\" Encounter1\n        with \"Qualifying Encounter During Measurement Period\" Encounter2\n          such that Encounter2.id !~ Encounter1.id\n    )\n    and exists \"Qualifying CAD Encounter\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "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": 8
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Qualifying CAD Encounter and Prior MI"
            },
            {
              "url": "statement",
              "valueString": "define \"Qualifying CAD Encounter and Prior MI\":\n  \"Qualifying CAD Encounter\" EncounterWithCADProxy\n    with [ConditionProblemsHealthConcerns: \"Myocardial Infarction\"] MyocardialInfarction\n      such that MyocardialInfarction.prevalenceInterval ( ) starts 3 years or less before day of start of EncounterWithCADProxy.period\n        and not exists AHA.\"Moderate or Severe LVSD Findings\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Denominator 2"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator 2\":\n  \"Initial Population\"\n    and exists \"Qualifying CAD Encounter and Prior MI\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Qualifying CAD Encounter and History of Moderate or Severe LVSD"
            },
            {
              "url": "statement",
              "valueString": "define \"Qualifying CAD Encounter and History of Moderate or Severe LVSD\":\n  \"Qualifying CAD Encounter\" EncounterWithCADProxy\n    with AHA.\"Moderate or Severe LVSD Findings\" LVSDFindings\n      such that Coalesce(LVSDFindings.prevalenceInterval(), LVSDFindings.effective.toInterval()) starts before end of EncounterWithCADProxy.period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD\":\n  exists ( [ConditionProblemsHealthConcerns: \"Arrhythmia\"] ArrhythmiaDiagnosis\n      where ArrhythmiaDiagnosis.overlapsDayOfEncounter ( \"Qualifying CAD Encounter and History of Moderate or Severe LVSD\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD\":\n  exists ( [ConditionProblemsHealthConcerns: \"Asthma\"] AsthmaDiagnosis\n      where AsthmaDiagnosis.overlapsDayOfEncounter ( \"Qualifying CAD Encounter and History of Moderate or Severe LVSD\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD\":\n  exists ( [ConditionProblemsHealthConcerns: \"Bradycardia\"] BradycardiaDiagnosis\n      where BradycardiaDiagnosis.overlapsDayOfEncounter ( \"Qualifying CAD Encounter and History of Moderate or Severe LVSD\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD\":\n  exists ( [ConditionProblemsHealthConcerns: \"Hypotension\"] HypotensionDiagnosis\n      where HypotensionDiagnosis.overlapsDayOfEncounter ( \"Qualifying CAD Encounter and History of Moderate or Severe LVSD\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
            },
            {
              "url": "statement",
              "valueString": "/*\n* @code: Heart rate - 8867-4\n* @profile: http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate\n*/\n\n\ndefine \"Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD\":\n  exists ( from\n      [\"USCoreHeartRateProfile\"] HeartRateExam,\n      \"Qualifying CAD Encounter and History of Moderate or Severe LVSD\" CADEncounterModerateOrSevereLVSD\n      let PriorHeartRateExam: Last([\"USCoreHeartRateProfile\"] MostRecentPriorHeartRateExam\n          where MostRecentPriorHeartRateExam.effective.toInterval() during CADEncounterModerateOrSevereLVSD.period\n            and MostRecentPriorHeartRateExam.effective.toInterval() before HeartRateExam.effective.toInterval()\n          sort by start of effective.toInterval()\n      )\n      where HeartRateExam.effective.toInterval ( ) during CADEncounterModerateOrSevereLVSD.period\n        and HeartRateExam.value < 50 '/min'\n        and PriorHeartRateExam.value < 50 '/min'\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 16
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD\":\n  exists ( ( [AllergyIntolerance: \"Beta Blocker Therapy Ingredient\"]\n      union [AllergyIntolerance: \"Substance with beta adrenergic receptor antagonist mechanism of action (substance)\"] ) BetaBlockerAllergyIntolerance\n      where BetaBlockerAllergyIntolerance.overlapsAfterDayOfEncounter ( \"Qualifying CAD Encounter and History of Moderate or Severe LVSD\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD\":\n  exists ( ( [ConditionProblemsHealthConcerns: \"Allergy to Beta Blocker Therapy\"]\n      union [ConditionProblemsHealthConcerns: \"Intolerance to Beta Blocker Therapy\"] ) BetaBlockerAllergyOrIntoleranceDiagnosis\n      where BetaBlockerAllergyOrIntoleranceDiagnosis.overlapsAfterDayOfEncounter ( \"Qualifying CAD Encounter and History of Moderate or Severe LVSD\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 18
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
            },
            {
              "url": "statement",
              "valueString": "// TODO: https://oncprojectracking.healthit.gov/support/projects/MADIE/issues/MADIE-2124\n// Expecting 1 failures per population until this translator issue is incorporated into MADiE\n\n\n\ndefine \"Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD\":\n  exists ( [MedicationNotRequested: medication in \"Beta Blocker Therapy for LVSD\"] NoBetaBlockerForLVSDOrdered\n      with \"Qualifying CAD Encounter and History of Moderate or Severe LVSD\" LVSDVisit\n        such that NoBetaBlockerForLVSDOrdered.authoredOn during day of LVSDVisit.period\n      where NoBetaBlockerForLVSDOrdered.status in { 'active', 'completed' }\n        and NoBetaBlockerForLVSDOrdered.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n        and ( NoBetaBlockerForLVSDOrdered.reasonCode in \"Medical Reason\"\n            or NoBetaBlockerForLVSDOrdered.reasonCode in \"Patient Reason\"\n        )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 19
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD\":\n  exists ( [ConditionProblemsHealthConcerns: \"Atrioventricular Block\"] AtrioventricularBlock\n      where AtrioventricularBlock.overlapsDayOfEncounter ( \"Qualifying CAD Encounter and History of Moderate or Severe LVSD\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 20
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and History of Moderate or Severe LVSD\":\n  exists ( [ConditionProblemsHealthConcerns: \"Cardiac Pacer in Situ\"] CardiacPacerDiagnosis\n      where CardiacPacerDiagnosis.overlapsDayOfEncounter ( \"Qualifying CAD Encounter and History of Moderate or Severe LVSD\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 21
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and History of Moderate or Severe LVSD\":\n  exists ( [Procedure: \"Cardiac Pacer\"] ImplantedCardiacPacer\n      with \"Qualifying CAD Encounter and History of Moderate or Severe LVSD\" CADEncounterModerateOrSevereLVSD\n        such that ImplantedCardiacPacer.performed.toInterval ( ) starts before end of CADEncounterModerateOrSevereLVSD.period\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 22
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer\":\n  \"Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD\"\n    and not \"Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and History of Moderate or Severe LVSD\"\n    and not \"Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and History of Moderate or Severe LVSD\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 23
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Denominator Exceptions 1"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exceptions 1\":\n  \"Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD\"\n    or \"Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD\"\n    or \"Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD\"\n    or \"Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD\"\n    or \"Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD\"\n    or \"Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD\"\n    or \"Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD\"\n    or \"Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD\"\n    or \"Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 24
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "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\"] BetaBlockerForLVSDOrdered\n      where BetaBlockerForLVSDOrdered.authoredDuringDayOfEncounter ( \"Qualifying CAD Encounter and History of Moderate or Severe LVSD\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 25
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "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: medication in \"Beta Blocker Therapy for LVSD\"] ActiveBetaBlockerForLVSD\n      with \"Qualifying CAD Encounter and History of Moderate or Severe LVSD\" CADEncounterModerateOrSevereLVSD\n        such that First((collapse(ActiveBetaBlockerForLVSD.dosageInstruction.timing.repeat.bounds DoseTime\n              return DoseTime.toInterval()\n          )) DrugPeriod\n            sort by start of $this\n        ) overlaps after day of CADEncounterModerateOrSevereLVSD.period\n      where ActiveBetaBlockerForLVSD.status in { 'active', 'completed' }\n        and ActiveBetaBlockerForLVSD.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 26
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Numerator 1"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator 1\":\n  \"Has Beta Blocker Therapy for LVSD Ordered\"\n    or \"Is Currently Taking Beta Blocker Therapy for LVSD\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 27
            }
          ],
          "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": 28
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 29
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Beta Blocker Therapy Ordered"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Beta Blocker Therapy Ordered\":\n  exists ( [MedicationRequest: medication in \"Beta Blocker Therapy\"] BetaBlockerOrdered\n      where BetaBlockerOrdered.authoredDuringDayOfEncounter ( \"Qualifying CAD Encounter and Prior MI\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 30
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Is Currently Taking Beta Blocker Therapy"
            },
            {
              "url": "statement",
              "valueString": "define \"Is Currently Taking Beta Blocker Therapy\":\n  exists ( [MedicationRequest: medication in \"Beta Blocker Therapy\"] ActiveBetaBlocker\n      with \"Qualifying CAD Encounter and Prior MI\" CADEncounterMI\n        such that First((collapse(ActiveBetaBlocker.dosageInstruction.timing.repeat.bounds DoseTime\n              return DoseTime.toInterval()\n          )) DrugPeriod\n            sort by start of $this\n        ) overlaps after day of CADEncounterMI.period\n      where ActiveBetaBlocker.status in { 'active', 'completed' }\n        and ActiveBetaBlocker.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 31
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Numerator 2"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator 2\":\n  \"Has Beta Blocker Therapy Ordered\"\n    or \"Is Currently Taking Beta Blocker Therapy\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 32
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  AgeInYearsAt(date from start of \"Measurement Period\") >= 18\n    and exists ( \"Qualifying Encounter During Measurement Period\" Encounter1\n        with \"Qualifying Encounter During Measurement Period\" Encounter2\n          such that Encounter2.id !~ Encounter1.id\n    )\n    and exists \"Qualifying CAD Encounter\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 33
            }
          ],
          "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": 34
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 35
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Arrhythmia with Qualifying CAD Encounter and Prior MI"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Arrhythmia with Qualifying CAD Encounter and Prior MI\":\n  exists ( [ConditionProblemsHealthConcerns: \"Arrhythmia\"] ArrhythmiaDiagnosis\n      where ArrhythmiaDiagnosis.overlapsDayOfEncounter ( \"Qualifying CAD Encounter and Prior MI\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 36
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Asthma with Qualifying CAD Encounter and Prior MI"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Asthma with Qualifying CAD Encounter and Prior MI\":\n  exists ( [ConditionProblemsHealthConcerns: \"Asthma\"] AsthmaDiagnosis\n      where AsthmaDiagnosis.overlapsDayOfEncounter ( \"Qualifying CAD Encounter and Prior MI\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 37
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Bradycardia with Qualifying CAD Encounter and Prior MI"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Bradycardia with Qualifying CAD Encounter and Prior MI\":\n  exists ( [ConditionProblemsHealthConcerns: \"Bradycardia\"] BradycardiaDiagnosis\n      where BradycardiaDiagnosis.overlapsDayOfEncounter ( \"Qualifying CAD Encounter and Prior MI\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 38
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Hypotension with Qualifying CAD Encounter and Prior MI"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Hypotension with Qualifying CAD Encounter and Prior MI\":\n  exists ( [ConditionProblemsHealthConcerns: \"Hypotension\"] HypotensionDiagnosis\n      where HypotensionDiagnosis.overlapsDayOfEncounter ( \"Qualifying CAD Encounter and Prior MI\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 39
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI"
            },
            {
              "url": "statement",
              "valueString": "/*\n* @code: Heart rate - 8867-4\n* @profile: http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate \n*/\n\n\ndefine \"Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI\":\n  exists ( from\n      [\"USCoreHeartRateProfile\"] HeartRateExam,\n      \"Qualifying CAD Encounter and Prior MI\" CADEncounterMI\n      let PriorHeartRateExam: Last([\"USCoreHeartRateProfile\"] MostRecentPriorHeartRateExam\n          where MostRecentPriorHeartRateExam.effective.toInterval() during CADEncounterMI.period\n            and MostRecentPriorHeartRateExam.status in { 'final', 'amended', 'corrected' }\n            and MostRecentPriorHeartRateExam.effective.toInterval() before HeartRateExam.effective.toInterval()\n          sort by start of effective.toInterval()\n      )\n      where HeartRateExam.effective.toInterval ( ) during CADEncounterMI.period\n        and HeartRateExam.status in { 'final', 'amended', 'corrected' }\n        and HeartRateExam.value < 50 '/min'\n        and PriorHeartRateExam.value < 50 '/min'\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 40
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI\":\n  exists ( ( [AllergyIntolerance: \"Beta Blocker Therapy Ingredient\"]\n      union [AllergyIntolerance: \"Substance with beta adrenergic receptor antagonist mechanism of action (substance)\"] ) BetaBlockerAllergyIntolerance\n      where BetaBlockerAllergyIntolerance.overlapsAfterDayOfEncounter ( \"Qualifying CAD Encounter and Prior MI\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 41
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI\":\n  exists ( ( [ConditionProblemsHealthConcerns: \"Allergy to Beta Blocker Therapy\"]\n      union [ConditionProblemsHealthConcerns: \"Intolerance to Beta Blocker Therapy\"] ) BetaBlockerAllergyOrIntoleranceDiagnosis\n      where BetaBlockerAllergyOrIntoleranceDiagnosis.overlapsAfterDayOfEncounter ( \"Qualifying CAD Encounter and Prior MI\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 42
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
            },
            {
              "url": "statement",
              "valueString": "// TODO: https://oncprojectracking.healthit.gov/support/projects/MADIE/issues/MADIE-2124\n// Expecting 1 failures per population until this translator issue is incorporated into MADiE\n\n\n\ndefine \"Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy\":\n  exists ( [MedicationNotRequested: medication in \"Beta Blocker Therapy for LVSD\"] NoBetaBlockerForLVSDOrdered\n      with \"Qualifying CAD Encounter and Prior MI\" PriorMIVisit\n        such that NoBetaBlockerForLVSDOrdered.authoredOn during day of PriorMIVisit.period\n      where NoBetaBlockerForLVSDOrdered.status in { 'active', 'completed' }\n        and NoBetaBlockerForLVSDOrdered.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n        and ( NoBetaBlockerForLVSDOrdered.reasonCode in \"Medical Reason\"\n            or NoBetaBlockerForLVSDOrdered.reasonCode in \"Patient Reason\"\n        )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 43
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI\":\n  exists ( [ConditionProblemsHealthConcerns: \"Atrioventricular Block\"] AtrioventricularBlockDiagnosis\n      where AtrioventricularBlockDiagnosis.overlapsDayOfEncounter ( \"Qualifying CAD Encounter and Prior MI\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 44
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and Prior MI"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and Prior MI\":\n  exists ( [ConditionProblemsHealthConcerns: \"Cardiac Pacer in Situ\"] CardiacPacerDiagnosis\n      where CardiacPacerDiagnosis.overlapsDayOfEncounter ( \"Qualifying CAD Encounter and Prior MI\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 45
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI\":\n  exists ( [Procedure: \"Cardiac Pacer\"] ImplantedCardiacPacer\n      with \"Qualifying CAD Encounter and Prior MI\" CADEncounterMI\n        such that ImplantedCardiacPacer.performed.toInterval ( ) starts before end of CADEncounterMI.period\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 46
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer\":\n  \"Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI\"\n    and not \"Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and Prior MI\"\n    and not \"Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 47
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Denominator Exceptions 2"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exceptions 2\":\n  \"Has Arrhythmia with Qualifying CAD Encounter and Prior MI\"\n    or \"Has Asthma with Qualifying CAD Encounter and Prior MI\"\n    or \"Has Bradycardia with Qualifying CAD Encounter and Prior MI\"\n    or \"Has Hypotension with Qualifying CAD Encounter and Prior MI\"\n    or \"Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI\"\n    or \"Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI\"\n    or \"Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI\"\n    or \"Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy\"\n    or \"Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 48
            }
          ],
          "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": 49
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 50
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "Denominator 1"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator 1\":\n  \"Initial Population\"\n    and exists \"Qualifying CAD Encounter and History of Moderate or Severe LVSD\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 51
            }
          ],
          "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": 52
            }
          ],
          "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": 53
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "overlapsDayOfEncounter"
            },
            {
              "url": "statement",
              "valueString": "define fluent function overlapsDayOfEncounter(Diagnosis ConditionProblemsHealthConcerns, TheEncounter Encounter):\n  TheEncounter Visit\n    where Diagnosis.isConfirmedActiveDiagnosis ( )\n    return Diagnosis.prevalenceInterval ( ) overlaps day of Visit.period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 54
            }
          ],
          "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": 55
            }
          ],
          "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": 56
            }
          ],
          "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": 57
            }
          ],
          "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": 58
            }
          ],
          "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": 59
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "overlapsDayOfEncounter"
            },
            {
              "url": "statement",
              "valueString": "define fluent function overlapsDayOfEncounter(Diagnosis ConditionProblemsHealthConcerns, EncounterList List<Encounter>):\n  AnyTrue(EncounterList Visit\n      where Diagnosis.isActive()\n      return Diagnosis.prevalenceInterval() overlaps day of Visit.period\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 60
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "overlapsAfterDayOfEncounter"
            },
            {
              "url": "statement",
              "valueString": "define fluent function overlapsAfterDayOfEncounter(Event Choice<AllergyIntolerance, ConditionProblemsHealthConcerns>, EncounterList List<Encounter>):\n  AnyTrue(EncounterList Visit\n      return\n      case\n        when Event is AllergyIntolerance then Interval[start of Event.onset.toInterval(), Event.lastOccurrence]overlaps after day of Visit.period\n          and(Event.clinicalStatus is null\n              or Event.clinicalStatus ~ QICoreCommon.\"allergy-active\"\n          )\n        when Event is ConditionProblemsHealthConcerns then Event.isConfirmedActiveDiagnosis()\n          and Event.prevalenceInterval() overlaps after day of Visit.period\n          and Event.verificationStatus ~ QICoreCommon.\"confirmed\" \n        else false \n      end\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 61
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToConcept"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 62
            }
          ],
          "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": 63
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
            },
            {
              "url": "name",
              "valueString": "authoredDuringDayOfEncounter"
            },
            {
              "url": "statement",
              "valueString": "define fluent function authoredDuringDayOfEncounter(Order Choice<MedicationRequest, MedicationNotRequested>, EncounterList List<Encounter>):\n  AnyTrue(EncounterList Visit\n      return\n      case\n        when Order is MedicationRequest then Order.authoredOn during day of Visit.period\n          and Order.status in { 'active', 'completed' }\n          and Order.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n          and Order.doNotPerform is not true\n        when Order is MedicationNotRequested then Order.authoredOn during day of Visit.period\n          and Order.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' } \n        else false \n      end\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 64
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        }
      ],
      "name": "EffectiveDataRequirements",
      "status": "active",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/library-type",
            "code": "module-definition"
          }
        ]
      },
      "relatedArtifact": [
        {
          "type": "depends-on",
          "display": "Library SDE",
          "resource": "Library/SupplementalDataElements|5.1.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library 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 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 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 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": "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 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 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 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 Coronary Artery Disease No MI",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.369"
        },
        {
          "type": "depends-on",
          "display": "Value set Cardiac Surgery",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.371"
        },
        {
          "type": "depends-on",
          "display": "Value set Myocardial Infarction",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.403"
        },
        {
          "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 Arrhythmia",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.366"
        },
        {
          "type": "depends-on",
          "display": "Value set Asthma",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.362"
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            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "extension"
          ]
        },
        {
          "type": "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/2.16.840.1.113883.3.526.3.366"
            }
          ]
        },
        {
          "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/2.16.840.1.113883.3.526.3.362"
            }
          ]
        },
        {
          "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/2.16.840.1.113883.3.526.3.412"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"
          ],
          "mustSupport": [
            "code"
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          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.370"
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate"
          ],
          "mustSupport": [
            "effective",
            "status",
            "status.value",
            "value"
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate"
          ],
          "mustSupport": [
            "effective",
            "status",
            "status.value"
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate"
          ],
          "mustSupport": [
            "effective",
            "status",
            "status.value",
            "value"
          ]
        },
        {
          "type": "AllergyIntolerance",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance"
          ],
          "mustSupport": [
            "code"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1493"
            }
          ]
        },
        {
          "type": "AllergyIntolerance",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance"
          ],
          "mustSupport": [
            "code"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://snomed.info/sct",
                  "code": "373254001",
                  "display": "Substance with beta adrenergic receptor antagonist mechanism of action (substance)"
                }
              ]
            }
          ]
        },
        {
          "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/2.16.840.1.113883.3.526.3.1177"
            }
          ]
        },
        {
          "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/2.16.840.1.113883.3.526.3.1178"
            }
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationnotrequested"
          ],
          "mustSupport": [
            "medication",
            "authoredOn",
            "authoredOn.value",
            "status",
            "status.value",
            "intent",
            "intent.value",
            "reasonCode"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1184"
            }
          ]
        },
        {
          "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/2.16.840.1.113883.3.526.3.367"
            }
          ]
        },
        {
          "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/2.16.840.1.113883.3.526.3.368"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "performed"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1178.53"
            }
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "extension"
          ]
        },
        {
          "type": "Coverage",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
            }
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "extension"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "extension"
          ]
        }
      ]
    }
  ],
  "extension": [
    {
      "id": "supplementalDataGuidance",
      "extension": [
        {
          "url": "guidance",
          "valueString": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex"
        },
        {
          "url": "usage",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                "code": "supplemental-data",
                "display": "Supplemental Data"
              }
            ],
            "text": "Supplemental Data Guidance"
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance"
    },
    {
      "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
      "valueCanonical": "#effective-data-requirements"
    },
    {
      "id": "effective-data-requirements",
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
      "valueReference": {
        "reference": "#effective-data-requirements"
      }
    }
  ],
  "url": "https://madie.cms.gov/Measure/CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD",
  "identifier": [
    {
      "use": "usual",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "short-name",
            "display": "Short Name"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/shortName",
      "value": "CMS145FHIR"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "version-independent",
            "display": "Version Independent"
          }
        ]
      },
      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:466e5d36-1e01-478b-9dcb-edac33594dd5"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "version-specific",
            "display": "Version Specific"
          }
        ]
      },
      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:43373a2a-c9a8-46b7-8e4c-0fb39d0f3eaf"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "endorser",
            "display": "Endorser"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/cbeId",
      "value": "0070e",
      "assigner": {
        "display": "CMS Consensus Based Entity"
      }
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "publisher",
            "display": "Publisher"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/cmsId",
      "value": "145FHIR",
      "assigner": {
        "display": "CMS"
      }
    }
  ],
  "version": "0.4.000",
  "name": "CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD",
  "title": "Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF less than or equal to 40%)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 coronary artery disease seen within a 12-month period who also have a prior MI or a current or prior left ventricular ejection fraction (LVEF) <=40% who were prescribed beta-blocker therapy",
  "usage": "Guidance\tBeta-blocker therapy:\n\n- For patients with prior MI, beta-blocker therapy includes any agent within the beta-blocker drug class. As of 2015, no recommendations or evidence are cited in current stable ischemic heart disease guidelines for preferential use of specific agents.\n\n- For patients with prior LVEF <=40%, beta-blocker therapy includes the following: 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\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\nIf a patient has had a myocardial infarction (MI) within the past 3 years and a current or prior LVEF <=40% (or moderate or severe LVSD), the patient should only be counted in Population Criteria 1. \n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",
  "copyright": "Copyright 2025 American College of Cardiology and American Heart Association. All Rights Reserved.",
  "effectivePeriod": {
    "start": "2026-01-01",
    "end": "2026-12-31"
  },
  "author": [
    {
      "name": "American Heart Association",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.heart.org/"
        }
      ]
    },
    {
      "name": "American Medical Association (AMA)",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.ama-assn.org/"
        }
      ]
    }
  ],
  "library": [
    "https://madie.cms.gov/Library/CMS145FHIRCADBetaBlockerTherapyPriorMIorLVSD"
  ],
  "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": "For patients with coronary artery disease (CAD), beta-blockers are recommended for 3 years after myocardial infarction or acute coronary syndrome. Beta-blockers, particularly carvedilol, metoprolol succinate, or bisoprolol which have been shown to reduce risk of death, are recommended indefinitely for patients with CAD and LV systolic dysfunction. These agents have proven efficacy in reducing angina onset and improving the ischemic threshold during exercise. In patients who have suffered an MI, beta-blockers significantly reduce deaths and recurrent MIs (Fihn et al., 2012). \n\nNonadherence to cardioprotective medications is prevalent among outpatients with CAD and can be associated with a broad range of adverse outcomes, including all-cause and cardiovascular mortality, cardiovascular hospitalizations, and the need for revascularization procedures (Gibbons et al., 2002).\n\nThis measure is intended to promote beta-blocker usage in select patients with CAD.",
  "clinicalRecommendationStatement": "Beta-blocker therapy should be started and continued for 3 years in all patients with normal LV function after MI or acute coronary syndrome (ACS) (Class I, Level of Evidence: B) (Fihn et al., 2012).\n\nBeta-blocker therapy should be used in all patients with LV systolic dysfunction (EF <= 40%) with heart failure or prior MI, unless contraindicated. (Use should be limited to carvedilol, metoprolol succinate, or bisoprolol, which have been shown to reduce risk of death.) (Class I, Level of Evidence: A) (Fihn et al., 2012).\n\nIn patients with chronic coronary disease (CCD) and LVEF ≤40% with or without previous MI, the use of beta-blocker therapy is recommended to reduce the risk of future Major Adverse Cardiac Events (MACE), including cardiovascular death. (Class 1, Level of Evidence: A) (Virani et al., 2023)",
  "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",
    "Prescribed - Prescribed may include prescription given to the patient for beta-blocker therapy at one or more visits in the measurement period OR patient already taking beta-blocker therapy as documented in current medication list.\n\nPrior Myocardial Infarction (MI) for denominator 2 is limited to those occurring within the past 3 years.\n"
  ],
  "guidance": "Guidance\tBeta-blocker therapy:\n\n- For patients with prior MI, beta-blocker therapy includes any agent within the beta-blocker drug class. As of 2015, no recommendations or evidence are cited in current stable ischemic heart disease guidelines for preferential use of specific agents.\n\n- For patients with prior LVEF <=40%, beta-blocker therapy includes the following: 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\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\nIf a patient has had a myocardial infarction (MI) within the past 3 years and a current or prior LVEF <=40% (or moderate or severe LVSD), the patient should only be counted in Population Criteria 1. \n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",
  "group": [
    {
      "id": "Group_1",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
                "code": "proportion",
                "display": "Proportion"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
          "valueCode": "boolean"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-type",
                "code": "process",
                "display": "Process"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode": "This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes: \n- Population 1: Patients with left ventricular systolic dysfunction (LVEF <=40%)\n- Population 2: Patients with a prior (within the past 3 years) myocardial infarction\n\nFor the purposes of this measure, a single performance rate can be calculated as follows:\nPerformance Rate = (Numerator 1 + Numerator 2)/ [(Denominator 1 - Denominator Exceptions 1) + (Denominator 2 - Denominator Exceptions 2)]"
        },
        {
          "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 coronary artery disease",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "Denominator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator",
                "display": "Denominator"
              }
            ]
          },
          "description": "Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <=40%",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator 1"
          }
        },
        {
          "id": "Numerator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator",
                "display": "Numerator"
              }
            ]
          },
          "description": "Patients who were prescribed beta-blocker therapy",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator 1"
          }
        },
        {
          "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 1"
          }
        }
      ]
    },
    {
      "id": "Group_2",
      "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": "This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes: \n- Population 1: Patients with left ventricular systolic dysfunction (LVEF <=40%)\n- Population 2: Patients with a prior (within the past 3 years) myocardial infarction\n\nFor the purposes of this measure, a single performance rate can be calculated as follows:\nPerformance Rate = (Numerator 1 + Numerator 2)/ [(Denominator 1 - Denominator Exceptions 1) + (Denominator 2 - Denominator Exceptions 2)]"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "increase",
                "display": "Increased score indicates improvement"
              }
            ]
          }
        }
      ],
      "population": [
        {
          "id": "InitialPopulation_2",
          "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 coronary artery disease",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "Denominator_2",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator",
                "display": "Denominator"
              }
            ]
          },
          "description": "Equals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <=40%",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator 2"
          }
        },
        {
          "id": "Numerator_2",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator",
                "display": "Numerator"
              }
            ]
          },
          "description": "Patients who were prescribed beta-blocker therapy",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator 2"
          }
        },
        {
          "id": "DenominatorException_2",
          "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 2"
          }
        }
      ]
    }
  ],
  "supplementalData": [
    {
      "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"
      }
    },
    {
      "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-payer",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Payer",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Payer"
      }
    },
    {
      "id": "sde-ethnicity",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Ethnicity",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Ethnicity"
      }
    }
  ]
}