FHIR IG Statistics: Measure/CMS190VTEProphylaxisICUFHIR

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Narrative

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

define "Initial Population":
  VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions"

define "Denominator":
  "Encounter With ICU Location"

define "Denominator Exclusions":
  "Encounter With ICU Location And Encounter Less Than 2 Days"
    union "Encounter With First ICU Stay With Principal Procedure Of Selected Surgery"
    union "Encounter With Intervention Comfort Measures From Day Of Start Of Hospitalization To Day After First ICU Stay"
    union "Encounter With Intervention Comfort Measures On Day Of Or Day After Procedure"

define "Numerator":
  "Encounter With VTE Prophylaxis Received On Day Of Or Day After First ICU Stay Or Procedure"
    union ( "Encounter With Medication Oral Factor Xa Inhibitor Administered On Day Of Or Day After First ICU Stay Or Procedure"
        intersect ( "Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Prior Diagnosis Of VTE"
            union "Encounter With Prior Or Present Procedure Of Hip Or Knee Replacement Surgery"
        )
    )
    union "Encounter With Low Risk For VTE Or Anticoagulant Administered"
    union "Encounter With No VTE Prophylaxis Due To Medical Reason"
    union "Encounter With No VTE Prophylaxis Due To Patient Refusal"

define "Denominator Exceptions":
  "Encounter With First ICU Location Stay Less Than 1 day"

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

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

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

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

define 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 fluent function CalendarDayOfOrDayAfter(StartValue DateTime):
  Interval [date from (StartValue), date from (StartValue) + 1 day]

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

define "Encounter With ICU Location":
  VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter
    where exists ( QualifyingEncounter.location Location
        where Location.location.getLocation ( ).type in "Intensive Care Unit"
          and Location.period during QualifyingEncounter.period
    )

define "Pharmacological Or Mechanical VTE Prophylaxis Received":
  ( ["MedicationAdministration": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"] VTEMedication
      where VTEMedication.status = 'completed'
        and VTEMedication.dosage.route in "Subcutaneous route"
  )
    union ( ["MedicationAdministration": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"] LMWH
        where LMWH.status = 'completed'
    )
    union ( ["MedicationAdministration": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"] FactorXa
        where FactorXa.status = 'completed'
    )
    union ( ["MedicationAdministration": medication in "Warfarin"] WarfarinAdm
        where WarfarinAdm.status = 'completed'
    )
    union ( ["MedicationAdministration": medication in "Rivaroxaban for VTE Prophylaxis"] Rivaroxaban
        where Rivaroxaban.status = 'completed'
    )
    union ( ( ["Procedure": "Application of Intermittent Pneumatic Compression Devices"]
        union ["Procedure": "Application of Venous Foot Pumps"]
        union ["Procedure": "Application of Graduated Compression Stockings"] ) DeviceApplied
        where DeviceApplied.status = 'completed'
    )

define "Encounter With VTE Prophylaxis Received On Day Of Or Day After First ICU Stay Or Procedure":
  ( "Encounter With ICU Location" QualifyingEncounterICU
      with "Pharmacological Or Mechanical VTE Prophylaxis Received" VTEProphylaxis
        such that start of Coalesce(VTEProphylaxis.effective.toInterval(), VTEProphylaxis.performed.toInterval()) during day of QualifyingEncounterICU.startOfFirstICU ( ).CalendarDayOfOrDayAfter ( )
  )
    union ( from
        "Encounter With ICU Location" QualifyingEncounterICU,
        ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
        "Pharmacological Or Mechanical VTE Prophylaxis Received" VTEProphylaxis
        where AnesthesiaProcedure.status = 'completed'
          and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of QualifyingEncounterICU.startOfFirstICU ( )
          and start of Coalesce(VTEProphylaxis.effective.toInterval(), VTEProphylaxis.performed.toInterval()) during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )
        return QualifyingEncounterICU
    )

define "Encounter With Medication Oral Factor Xa Inhibitor Administered On Day Of Or Day After First ICU Stay Or Procedure":
  ( "Encounter With ICU Location" QualifyingEncounterICU
      with ["MedicationAdministration": medication in "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication
        such that FactorXaMedication.status = 'completed'
          and FactorXaMedication.effective.toInterval ( ) starts during day of QualifyingEncounterICU.startOfFirstICU ( ).CalendarDayOfOrDayAfter ( )
  )
    union ( from
        "Encounter With ICU Location" QualifyingEncounterICU,
        ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
        ["MedicationAdministration": medication in "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication
        where FactorXaMedication.status = 'completed'
          and AnesthesiaProcedure.status = 'completed'
          and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of QualifyingEncounterICU.startOfFirstICU ( )
          and FactorXaMedication.effective.toInterval ( ) starts during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )
        return QualifyingEncounterICU
    )

define "Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Prior Diagnosis Of VTE":
  ( "Encounter With ICU Location" QualifyingEncounterICU
      with ["ConditionProblemsHealthConcerns": "Atrial Fibrillation or Flutter"] AtrialFibrillation
        such that  // CQMCOmmon new function isVerified() will be used to replace the following verificationStatus logic
        AtrialFibrillation.verificationStatus is not null implies ( AtrialFibrillation.verificationStatus !~ QICoreCommon."refuted"
            and AtrialFibrillation.verificationStatus !~ QICoreCommon."entered-in-error"
        )
          and AtrialFibrillation.onset.toInterval ( ) starts on or before end of QualifyingEncounterICU.period
  )
    union ( "Encounter With ICU Location" QualifyingEncounterICU
        where QualifyingEncounterICU.hasEncDiagnosisOf ( "Atrial Fibrillation or Flutter" )
    )
    union ( "Encounter With ICU Location" QualifyingEncounterICU
        with ["ConditionProblemsHealthConcerns": "Venous Thromboembolism"] VTEDiagnosis
          such that ( VTEDiagnosis.clinicalStatus ~ QICoreCommon."inactive"
              or VTEDiagnosis.clinicalStatus ~ QICoreCommon."remission"
              or VTEDiagnosis.clinicalStatus ~ QICoreCommon."resolved"
          ) // CQMCOmmon new function isVerified() will be used to replace the following verificationStatus logic
            
            and VTEDiagnosis.verificationStatus is not null implies ( VTEDiagnosis.verificationStatus !~ QICoreCommon."refuted"
              and VTEDiagnosis.verificationStatus !~ QICoreCommon."entered-in-error"
          )
            and VTEDiagnosis.onset.toInterval ( ) before start of QualifyingEncounterICU.period
    )

define "Encounter With Prior Or Present Procedure Of Hip Or Knee Replacement Surgery":
  "Encounter With ICU Location" QualifyingEncounterICU
    with ( ["Procedure": "Hip Replacement Surgery"]
      union ["Procedure": "Knee Replacement Surgery"] ) HipKneeProcedure
      such that HipKneeProcedure.status = 'completed'
        and HipKneeProcedure.performed.toInterval ( ) starts on or before end of QualifyingEncounterICU.period

define "Low Risk Indicator For VTE":
  ( ["SimpleObservation": "Risk for venous thromboembolism"] VTERiskAssessment
      where VTERiskAssessment.value as Concept in "Low Risk"
        and VTERiskAssessment.status in { 'final', 'amended', 'corrected' }
      return {
        id: VTERiskAssessment.id,
        LowRiskDatetime: VTERiskAssessment.effective.earliest ( )
      }
  )
    union ( ["LaboratoryResultObservation": "INR"] INRLabTest
        where INRLabTest.value as Quantity > 3.0
          and INRLabTest.status in { 'final', 'amended', 'corrected' }
        return {
          id: INRLabTest.id,
          LowRiskDatetime: INRLabTest.issued
        }
    )
    union ( ( ( ["MedicationAdministration": medication in "Unfractionated Heparin"] UnfractionatedHeparin
          where UnfractionatedHeparin.dosage.route in "Intravenous route"
      )
        union ["MedicationAdministration": medication in "Direct Thrombin Inhibitor"]
        union ["MedicationAdministration": medication in "Glycoprotein IIb IIIa Inhibitors"] ) AnticoagulantMedication
        where AnticoagulantMedication.status = 'completed'
        return {
          id: AnticoagulantMedication.id,
          LowRiskDatetime: start of AnticoagulantMedication.effective.toInterval ( )
        }
    )

define "Low Risk For VTE Or Anticoagulant Administered From Day Of Start Of Hospitalization To Day After First ICU Stay":
  "Encounter With ICU Location" QualifyingEncounterICU
    with "Low Risk Indicator For VTE" LowRiskForVTE
      such that LowRiskForVTE.LowRiskDatetime during day of QualifyingEncounterICU.fromDayOfStartOfHospitalizationToDayAfterFirstICU ( )

define "Low Risk For VTE Or Anticoagulant Administered On Day Of Or Day After Procedure":
  from
    "Encounter With ICU Location" QualifyingEncounterICU,
    ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
    "Low Risk Indicator For VTE" LowRiskForVTE
    where AnesthesiaProcedure.status = 'completed'
      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of QualifyingEncounterICU.startOfFirstICU ( )
      and LowRiskForVTE.LowRiskDatetime during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )
    return QualifyingEncounterICU

define "Encounter With Low Risk For VTE Or Anticoagulant Administered":
  "Low Risk For VTE Or Anticoagulant Administered From Day Of Start Of Hospitalization To Day After First ICU Stay"
    union "Low Risk For VTE Or Anticoagulant Administered On Day Of Or Day After Procedure"

define "No VTE Prophylaxis Medication Administered Or Ordered":
  ( ( [MedicationAdministrationNotDone: "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
      union [MedicationAdministrationNotDone: "Low Molecular Weight Heparin for VTE Prophylaxis"]
      union [MedicationAdministrationNotDone: "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
      union [MedicationAdministrationNotDone: "Warfarin"]
      union [MedicationAdministrationNotDone: "Rivaroxaban for VTE Prophylaxis"] ) NoMedicationAdm
      return {
        id: NoMedicationAdm.id,
        medicationStatusReason: NoMedicationAdm.statusReason,
        authoredOn: NoMedicationAdm.recorded
      }
  )
    union ( ( ["MedicationNotRequested": "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
        union ["MedicationNotRequested": "Low Molecular Weight Heparin for VTE Prophylaxis"]
        union ["MedicationNotRequested": "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
        union ["MedicationNotRequested": "Warfarin"]
        union ["MedicationNotRequested": "Rivaroxaban for VTE Prophylaxis"] ) NoMedicationOrder
        where NoMedicationOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        return {
          id: NoMedicationOrder.id,
          medicationStatusReason: NoMedicationOrder.reasonCode,
          authoredOn: NoMedicationOrder.authoredOn
        }
    )
    union ( from
        ( ["MedicationRequest": "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
          union ["MedicationRequest": "Low Molecular Weight Heparin for VTE Prophylaxis"]
          union ["MedicationRequest": "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
          union ["MedicationRequest": "Warfarin"]
          union ["MedicationRequest": "Rivaroxaban for VTE Prophylaxis"] ) MedicationOrderReject,
        [TaskRejected] T
        where T.focus.references ( MedicationOrderReject )
          and T.code ~ QICoreCommon."Fulfill"
          and MedicationOrderReject.status = 'active'
        return {
          id: MedicationOrderReject.id,
          medicationStatusReason: { T.statusReason },
          authoredOn: MedicationOrderReject.authoredOn
        }
    )

define "No VTE Prophylaxis Medication Due To Medical Reason From Day Of Start Of Hospitalization To Day After First ICU Stay":
  "Encounter With ICU Location" QualifyingEncounterICU
    with "No VTE Prophylaxis Medication Administered Or Ordered" NoVTEMedication
      such that NoVTEMedication.medicationStatusReason in "Medical Reason For Not Providing Treatment"
        and NoVTEMedication.authoredOn during day of QualifyingEncounterICU.fromDayOfStartOfHospitalizationToDayAfterFirstICU ( )

define "No Mechanical VTE Prophylaxis Performed Or Ordered":
  ( ( [ServiceNotRequested: "Venous foot pumps"]
      union [ServiceNotRequested: "Intermittent pneumatic compression devices"]
      union [ServiceNotRequested: "Graduated compression stockings"] ) DeviceNotOrder
      where DeviceNotOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
      return {
        id: DeviceNotOrder.id,
        requestStatusReason: DeviceNotOrder.reasonRefused,
        authoredOn: DeviceNotOrder.authoredOn
      }
  )
    union ( from
        ( [ServiceRequest: "Venous foot pumps"]
          union [ServiceRequest: "Intermittent pneumatic compression devices"]
          union [ServiceRequest: "Graduated compression stockings"] ) DeviceOrderReject,
        [TaskRejected] T
        where DeviceOrderReject.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
          and DeviceOrderReject.status = 'active'
          and T.focus.references ( DeviceOrderReject )
          and T.code ~ QICoreCommon."Fulfill"
        return {
          id: DeviceOrderReject.id,
          requestStatusReason: T.statusReason,
          authoredOn: DeviceOrderReject.authoredOn
        }
    )
    union ( ( [ProcedureNotDone: "Application of Intermittent Pneumatic Compression Devices"]
        union [ProcedureNotDone: "Application of Venous Foot Pumps"]
        union [ProcedureNotDone: "Application of Graduated Compression Stockings"] ) DeviceNotApplied
        let DeviceNotDoneTiming: DeviceNotApplied.recorded
        return {
          id: DeviceNotApplied.id,
          requestStatusReason: DeviceNotApplied.statusReason,
          authoredOn: DeviceNotDoneTiming
        }
    )

define "No Mechanical VTE Prophylaxis Due To Medical Reason From Day Of Start Of Hospitalization To Day After First ICU Stay":
  "Encounter With ICU Location" QualifyingEncounterICU
    with "No Mechanical VTE Prophylaxis Performed Or Ordered" NoVTEDevice
      such that NoVTEDevice.requestStatusReason in "Medical Reason For Not Providing Treatment"
        and NoVTEDevice.authoredOn during day of QualifyingEncounterICU.fromDayOfStartOfHospitalizationToDayAfterFirstICU ( )

define "No VTE Prophylaxis Medication Due To Medical Reason On Day Of Or Day After Procedure":
  from
    "Encounter With ICU Location" QualifyingEncounterICU,
    ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
    "No VTE Prophylaxis Medication Administered Or Ordered" NoVTEMedication
    where NoVTEMedication.medicationStatusReason in "Medical Reason For Not Providing Treatment"
      and AnesthesiaProcedure.status = 'completed'
      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of QualifyingEncounterICU.startOfFirstICU ( )
      and NoVTEMedication.authoredOn during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )
    return QualifyingEncounterICU

define "No Mechanical VTE Prophylaxis Due To Medical Reason On Day Of Or Day After Procedure":
  from
    "Encounter With ICU Location" QualifyingEncounterICU,
    ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
    "No Mechanical VTE Prophylaxis Performed Or Ordered" NoVTEDevice
    where NoVTEDevice.requestStatusReason in "Medical Reason For Not Providing Treatment"
      and AnesthesiaProcedure.status = 'completed'
      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of QualifyingEncounterICU.startOfFirstICU ( )
      and NoVTEDevice.authoredOn during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )
    return QualifyingEncounterICU

define "Encounter With No VTE Prophylaxis Due To Medical Reason":
  ( "No VTE Prophylaxis Medication Due To Medical Reason From Day Of Start Of Hospitalization To Day After First ICU Stay"
      intersect "No Mechanical VTE Prophylaxis Due To Medical Reason From Day Of Start Of Hospitalization To Day After First ICU Stay"
  )
    union ( "No VTE Prophylaxis Medication Due To Medical Reason On Day Of Or Day After Procedure"
        intersect "No Mechanical VTE Prophylaxis Due To Medical Reason On Day Of Or Day After Procedure"
    )

define "No Mechanical or Pharmacological VTE Prophylaxis Due To Patient Refusal":
  ( "No VTE Prophylaxis Medication Administered Or Ordered" NoVTEMedication
      where NoVTEMedication.medicationStatusReason in "Patient Refusal"
  )
    union ( "No Mechanical VTE Prophylaxis Performed Or Ordered" NoVTEDevice
        where NoVTEDevice.requestStatusReason in "Patient Refusal"
    )

define "No VTE Prophylaxis Due To Patient Refusal From Day Of Start Of Hospitalization To Day After First ICU Stay":
  "Encounter With ICU Location" QualifyingEncounterICU
    with "No Mechanical or Pharmacological VTE Prophylaxis Due To Patient Refusal" PatientRefusal
      such that PatientRefusal.authoredOn during day of QualifyingEncounterICU.fromDayOfStartOfHospitalizationToDayAfterFirstICU ( )

define "No VTE Prophylaxis Due To Patient Refusal On Day Of Or Day After Procedure":
  from
    "Encounter With ICU Location" QualifyingEncounterICU,
    ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
    "No Mechanical or Pharmacological VTE Prophylaxis Due To Patient Refusal" PatientRefusal
    where AnesthesiaProcedure.status = 'completed'
      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of QualifyingEncounterICU.startOfFirstICU ( )
      and PatientRefusal.authoredOn during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )
    return QualifyingEncounterICU

define "Encounter With No VTE Prophylaxis Due To Patient Refusal":
  "No VTE Prophylaxis Due To Patient Refusal From Day Of Start Of Hospitalization To Day After First ICU Stay"
    union "No VTE Prophylaxis Due To Patient Refusal On Day Of Or Day After Procedure"

define "Numerator":
  "Encounter With VTE Prophylaxis Received On Day Of Or Day After First ICU Stay Or Procedure"
    union ( "Encounter With Medication Oral Factor Xa Inhibitor Administered On Day Of Or Day After First ICU Stay Or Procedure"
        intersect ( "Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Prior Diagnosis Of VTE"
            union "Encounter With Prior Or Present Procedure Of Hip Or Knee Replacement Surgery"
        )
    )
    union "Encounter With Low Risk For VTE Or Anticoagulant Administered"
    union "Encounter With No VTE Prophylaxis Due To Medical Reason"
    union "Encounter With No VTE Prophylaxis Due To Patient Refusal"

define "Denominator":
  "Encounter With ICU Location"

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

define "Initial Population":
  VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions"

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

define "Encounter With ICU Location And Encounter Less Than 2 Days":
  "Encounter With ICU Location" QualifyingEncounterICU
    where QualifyingEncounterICU.period.lengthInDays ( ) < 2

define "Encounter With First ICU Stay With Principal Procedure Of Selected Surgery":
  "Encounter With ICU Location" QualifyingEncounterICU
    where QualifyingEncounterICU.hasPrincipalProcedureOf ( "General Surgery" )
      or QualifyingEncounterICU.hasPrincipalProcedureOf ( "Gynecological Surgery" )
      or QualifyingEncounterICU.hasPrincipalProcedureOf ( "Hip Fracture Surgery" )
      or QualifyingEncounterICU.hasPrincipalProcedureOf ( "Hip Replacement Surgery" )
      or QualifyingEncounterICU.hasPrincipalProcedureOf ( "Intracranial Neurosurgery" )
      or QualifyingEncounterICU.hasPrincipalProcedureOf ( "Knee Replacement Surgery" )
      or QualifyingEncounterICU.hasPrincipalProcedureOf ( "Urological Surgery" )

define "Intervention Comfort Measures":
  ( ["ServiceRequest": "Comfort Measures"] InterventionRequest
      where InterventionRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and InterventionRequest.status in { 'active', 'on-hold', 'completed' }
  )
    union ( ["Procedure": "Comfort Measures"] InterventionPerformed
        where InterventionPerformed.status in { 'completed', 'in-progress' }
    )

define "Encounter With Intervention Comfort Measures From Day Of Start Of Hospitalization To Day After First ICU Stay":
  "Encounter With ICU Location" QualifyingEncounterICU
    with "Intervention Comfort Measures" ComfortMeasure
      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during day of QualifyingEncounterICU.fromDayOfStartOfHospitalizationToDayAfterFirstICU ( )

define "Encounter With Intervention Comfort Measures On Day Of Or Day After Procedure":
  from
    "Encounter With ICU Location" QualifyingEncounterICU,
    ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
    "Intervention Comfort Measures" ComfortMeasure
    where AnesthesiaProcedure.status = 'completed'
      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of QualifyingEncounterICU.startOfFirstICU ( )
      and Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )
    return QualifyingEncounterICU

define "Denominator Exclusions":
  "Encounter With ICU Location And Encounter Less Than 2 Days"
    union "Encounter With First ICU Stay With Principal Procedure Of Selected Surgery"
    union "Encounter With Intervention Comfort Measures From Day Of Start Of Hospitalization To Day After First ICU Stay"
    union "Encounter With Intervention Comfort Measures On Day Of Or Day After Procedure"

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

define "Encounter With First ICU Location Stay Less Than 1 day":
  "Encounter With ICU Location" QualifyingEncounterICU
    where QualifyingEncounterICU.firstInpatientIntensiveCareUnit ( ).period.lengthInDays ( ) < 1

define "Denominator Exceptions":
  "Encounter With First ICU Location Stay Less Than 1 day"

define fluent function "startOfFirstICU"(Encounter Encounter):
  start of Encounter.firstInpatientIntensiveCareUnit ( ).period

define fluent function "fromDayOfStartOfHospitalizationToDayAfterFirstICU"(Encounter Encounter):
  Interval[date from ( start of Encounter.hospitalizationWithObservation ( ) ), date from ( Encounter.startOfFirstICU ( ) ) + 1 day]

define "Admission Without VTE Or Obstetrical Conditions":
  CQMCommon."Inpatient Encounter" InpatientEncounter
  where not (InpatientEncounter.hasEncDiagnosisOf("Obstetrical or Pregnancy Related Conditions")
             or InpatientEncounter.hasEncDiagnosisOf("Venous Thromboembolism")
             or InpatientEncounter.hasEncDiagnosisOf("Obstetrics VTE")
            )

define "Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions":
 "Admission Without VTE Or Obstetrical Conditions" EncounterWithoutConditions
     where AgeInYearsAt(date from start of EncounterWithoutConditions.period) >= 18

define fluent function hasEncDiagnosisOf(TheEncounter Encounter, DiagnosisValueSet ValueSet):
   TheEncounter E
     return (E.encounterDiagnosis()).code in DiagnosisValueSet
       or E.reasonCode in DiagnosisValueSet

define fluent function hasPrincipalProcedureOf(TheEncounter Encounter, DiagnosisValueSet ValueSet):
   TheEncounter E
   let
        PPx: E.principalProcedure(),
        CPx: singleton from ([Procedure] P where PPx.procedure.references(P.id))
     return PPx.procedure in DiagnosisValueSet
       or CPx.code in DiagnosisValueSet

define "Inpatient Encounter":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.status = 'finished'
      and EncounterInpatient.period ends during day of "Measurement Period"

/*  
@description: Returns the Condition resources referenced by the diagnosis element of the Encounter  
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
  Encounter.reasonReference D
    return singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where D.references(C.id))

/*
@description: Returns the Location resource specified by the given reference.
*/
define fluent function getLocation(reference Reference):
  singleton from (
    [Location] L where reference.references(L)
  )

/*
@description: First Inpatient Intensive Care Unit returns the first intensive care unit for the given encounter, without considering any immediately prior emergency department visit.
*/
define fluent function firstInpatientIntensiveCareUnit(Encounter Encounter ):
  First((Encounter.location)HospitalLocation
  			where GetLocation(HospitalLocation.location).type in "Intensive Care Unit"
  				and HospitalLocation.period during Encounter.period
  			sort by start of period
  	)

/*
@description: Returns the Location resource specified by the given reference
@deprecated: This function is deprecated. Use the fluent function `getLocation()` instead.
*/
define function "GetLocation"(reference Reference):
  singleton from (
    [Location] L where reference.references(L)
  )

/*
@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter
*/
define fluent function hospitalizationWithObservation(TheEncounter Encounter ):
  TheEncounter Visit
  		let ObsVisit: Last([Encounter: "Observation Services"] LastObs
  				where LastObs.status = 'finished'
            and LastObs.period ends 1 hour or less on or before start of Visit.period
  				sort by end of period
  			),
  			VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
  			EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
  				where LastED.status = 'finished'
            and LastED.period ends 1 hour or less on or before VisitStart
  				sort by end of period
  			)
  		return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]

/*
@description: Calculates the difference in calendar days between the start and end of the given interval.
*/
define fluent function lengthInDays(Value Interval<DateTime> ):
  difference in days between start of Value and end of Value

/*
@description: Returns the claim procedure elements for the given encounter
*/
define fluent function principalProcedure(encounter Encounter):  	  
  	 encounter E
  	 let 
        claim: [Claim] C where C.status = 'active' and C.use = 'claim' and exists (C.item I where I.encounter.references(E)),
        claimItem: claim.item I where I.encounter.references(E),
        princProcedure: singleton from (claim.procedure P where P.sequence in claimItem.procedureSequence and P.type.includesCode("Primary procedure"))
    return princProcedure

/*
@description: Returns true if the given reference is to the given resourceId
@comment: Returns true if the `resourceId` parameter exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference Reference, resourceId String):
  resourceId = Last(Split(reference.reference, '/'))

/*
@description: Returns true if the given reference is to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference Reference, resource Resource):
  resource.id = Last(Split(reference.reference, '/'))

/*
@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

/*
@description: Given an interval, return the starting point if the interval has a starting boundary specified,
otherwise, return the ending point
*/
define fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
  (choice.toInterval()) period
    return
      if (period."hasStart"()) then start of period
      else end of period

/*
@description: Given an interval, return true if the interval has a starting boundary specified
(i.e. the start of the interval is not null and not the minimum DateTime value)
*/
define fluent function hasStart(period Interval<DateTime> ):
  not ( start of period is null
      or start of period = minimum DateTime
  )

/*
@description: Returns true if any of the given references are to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(references List<Reference>, resource Resource):
  exists (references R where R.references(resource))

/*
@description: Returns true if the given code is in the given codeList
@comment: Returns true if the `code` is equivalent to any of the codes in the given `codeList`, false otherwise.
*/
define fluent function includesCode(codeList List<Concept>, code Code):
  exists (codeList C where C ~ code)

Source

{
  "resourceType": "Measure",
  "id": "CMS190VTEProphylaxisICUFHIR",
  "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-ver-status",
            "code": "refuted",
            "display": "Refuted"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
            "code": "entered-in-error",
            "display": "Entered in Error"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "inactive",
            "display": "Inactive"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "remission",
            "display": "Remission"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "resolved",
            "display": "Resolved"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "72136-5",
            "display": "Risk for venous thromboembolism"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://hl7.org/fhir/CodeSystem/task-code",
            "code": "fulfill",
            "display": "Fulfill"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/ex-procedure-type",
            "code": "primary",
            "display": "Primary procedure"
          }
        },
        {
          "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/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 1
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "Inpatient Encounter"
            },
            {
              "url": "statement",
              "valueString": "define \"Inpatient Encounter\":\n  [Encounter: \"Encounter Inpatient\"] EncounterInpatient\n    where EncounterInpatient.status = 'finished'\n      and EncounterInpatient.period ends during day of \"Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "VTE"
            },
            {
              "url": "name",
              "valueString": "Admission Without VTE Or Obstetrical Conditions"
            },
            {
              "url": "statement",
              "valueString": "define \"Admission Without VTE Or Obstetrical Conditions\":\n  CQMCommon.\"Inpatient Encounter\" InpatientEncounter\n  where not (InpatientEncounter.hasEncDiagnosisOf(\"Obstetrical or Pregnancy Related Conditions\")\n             or InpatientEncounter.hasEncDiagnosisOf(\"Venous Thromboembolism\")\n             or InpatientEncounter.hasEncDiagnosisOf(\"Obstetrics VTE\")\n            )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "VTE"
            },
            {
              "url": "name",
              "valueString": "Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions\":\n \"Admission Without VTE Or Obstetrical Conditions\" EncounterWithoutConditions\n     where AgeInYearsAt(date from start of EncounterWithoutConditions.period) >= 18"
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Encounter With ICU Location"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With ICU Location\":\n  VTE.\"Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions\" QualifyingEncounter\n    where exists ( QualifyingEncounter.location Location\n        where Location.location.getLocation ( ).type in \"Intensive Care Unit\"\n          and Location.period during QualifyingEncounter.period\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Pharmacological Or Mechanical VTE Prophylaxis Received"
            },
            {
              "url": "statement",
              "valueString": "define \"Pharmacological Or Mechanical VTE Prophylaxis Received\":\n  ( [\"MedicationAdministration\": medication in \"Low Dose Unfractionated Heparin for VTE Prophylaxis\"] VTEMedication\n      where VTEMedication.status = 'completed'\n        and VTEMedication.dosage.route in \"Subcutaneous route\"\n  )\n    union ( [\"MedicationAdministration\": medication in \"Low Molecular Weight Heparin for VTE Prophylaxis\"] LMWH\n        where LMWH.status = 'completed'\n    )\n    union ( [\"MedicationAdministration\": medication in \"Injectable Factor Xa Inhibitor for VTE Prophylaxis\"] FactorXa\n        where FactorXa.status = 'completed'\n    )\n    union ( [\"MedicationAdministration\": medication in \"Warfarin\"] WarfarinAdm\n        where WarfarinAdm.status = 'completed'\n    )\n    union ( [\"MedicationAdministration\": medication in \"Rivaroxaban for VTE Prophylaxis\"] Rivaroxaban\n        where Rivaroxaban.status = 'completed'\n    )\n    union ( ( [\"Procedure\": \"Application of Intermittent Pneumatic Compression Devices\"]\n        union [\"Procedure\": \"Application of Venous Foot Pumps\"]\n        union [\"Procedure\": \"Application of Graduated Compression Stockings\"] ) DeviceApplied\n        where DeviceApplied.status = 'completed'\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Encounter With VTE Prophylaxis Received On Day Of Or Day After First ICU Stay Or Procedure"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With VTE Prophylaxis Received On Day Of Or Day After First ICU Stay Or Procedure\":\n  ( \"Encounter With ICU Location\" QualifyingEncounterICU\n      with \"Pharmacological Or Mechanical VTE Prophylaxis Received\" VTEProphylaxis\n        such that start of Coalesce(VTEProphylaxis.effective.toInterval(), VTEProphylaxis.performed.toInterval()) during day of QualifyingEncounterICU.startOfFirstICU ( ).CalendarDayOfOrDayAfter ( )\n  )\n    union ( from\n        \"Encounter With ICU Location\" QualifyingEncounterICU,\n        [\"Procedure\": \"General or Neuraxial Anesthesia\"] AnesthesiaProcedure,\n        \"Pharmacological Or Mechanical VTE Prophylaxis Received\" VTEProphylaxis\n        where AnesthesiaProcedure.status = 'completed'\n          and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of QualifyingEncounterICU.startOfFirstICU ( )\n          and start of Coalesce(VTEProphylaxis.effective.toInterval(), VTEProphylaxis.performed.toInterval()) during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )\n        return QualifyingEncounterICU\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Encounter With Medication Oral Factor Xa Inhibitor Administered On Day Of Or Day After First ICU Stay Or Procedure"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Medication Oral Factor Xa Inhibitor Administered On Day Of Or Day After First ICU Stay Or Procedure\":\n  ( \"Encounter With ICU Location\" QualifyingEncounterICU\n      with [\"MedicationAdministration\": medication in \"Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment\"] FactorXaMedication\n        such that FactorXaMedication.status = 'completed'\n          and FactorXaMedication.effective.toInterval ( ) starts during day of QualifyingEncounterICU.startOfFirstICU ( ).CalendarDayOfOrDayAfter ( )\n  )\n    union ( from\n        \"Encounter With ICU Location\" QualifyingEncounterICU,\n        [\"Procedure\": \"General or Neuraxial Anesthesia\"] AnesthesiaProcedure,\n        [\"MedicationAdministration\": medication in \"Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment\"] FactorXaMedication\n        where FactorXaMedication.status = 'completed'\n          and AnesthesiaProcedure.status = 'completed'\n          and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of QualifyingEncounterICU.startOfFirstICU ( )\n          and FactorXaMedication.effective.toInterval ( ) starts during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )\n        return QualifyingEncounterICU\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Prior Diagnosis Of VTE"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Prior Diagnosis Of VTE\":\n  ( \"Encounter With ICU Location\" QualifyingEncounterICU\n      with [\"ConditionProblemsHealthConcerns\": \"Atrial Fibrillation or Flutter\"] AtrialFibrillation\n        such that  // CQMCOmmon new function isVerified() will be used to replace the following verificationStatus logic\n        AtrialFibrillation.verificationStatus is not null implies ( AtrialFibrillation.verificationStatus !~ QICoreCommon.\"refuted\"\n            and AtrialFibrillation.verificationStatus !~ QICoreCommon.\"entered-in-error\"\n        )\n          and AtrialFibrillation.onset.toInterval ( ) starts on or before end of QualifyingEncounterICU.period\n  )\n    union ( \"Encounter With ICU Location\" QualifyingEncounterICU\n        where QualifyingEncounterICU.hasEncDiagnosisOf ( \"Atrial Fibrillation or Flutter\" )\n    )\n    union ( \"Encounter With ICU Location\" QualifyingEncounterICU\n        with [\"ConditionProblemsHealthConcerns\": \"Venous Thromboembolism\"] VTEDiagnosis\n          such that ( VTEDiagnosis.clinicalStatus ~ QICoreCommon.\"inactive\"\n              or VTEDiagnosis.clinicalStatus ~ QICoreCommon.\"remission\"\n              or VTEDiagnosis.clinicalStatus ~ QICoreCommon.\"resolved\"\n          ) // CQMCOmmon new function isVerified() will be used to replace the following verificationStatus logic\n            \n            and VTEDiagnosis.verificationStatus is not null implies ( VTEDiagnosis.verificationStatus !~ QICoreCommon.\"refuted\"\n              and VTEDiagnosis.verificationStatus !~ QICoreCommon.\"entered-in-error\"\n          )\n            and VTEDiagnosis.onset.toInterval ( ) before start of QualifyingEncounterICU.period\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Encounter With Prior Or Present Procedure Of Hip Or Knee Replacement Surgery"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Prior Or Present Procedure Of Hip Or Knee Replacement Surgery\":\n  \"Encounter With ICU Location\" QualifyingEncounterICU\n    with ( [\"Procedure\": \"Hip Replacement Surgery\"]\n      union [\"Procedure\": \"Knee Replacement Surgery\"] ) HipKneeProcedure\n      such that HipKneeProcedure.status = 'completed'\n        and HipKneeProcedure.performed.toInterval ( ) starts on or before end of QualifyingEncounterICU.period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Low Risk Indicator For VTE"
            },
            {
              "url": "statement",
              "valueString": "define \"Low Risk Indicator For VTE\":\n  ( [\"SimpleObservation\": \"Risk for venous thromboembolism\"] VTERiskAssessment\n      where VTERiskAssessment.value as Concept in \"Low Risk\"\n        and VTERiskAssessment.status in { 'final', 'amended', 'corrected' }\n      return {\n        id: VTERiskAssessment.id,\n        LowRiskDatetime: VTERiskAssessment.effective.earliest ( )\n      }\n  )\n    union ( [\"LaboratoryResultObservation\": \"INR\"] INRLabTest\n        where INRLabTest.value as Quantity > 3.0\n          and INRLabTest.status in { 'final', 'amended', 'corrected' }\n        return {\n          id: INRLabTest.id,\n          LowRiskDatetime: INRLabTest.issued\n        }\n    )\n    union ( ( ( [\"MedicationAdministration\": medication in \"Unfractionated Heparin\"] UnfractionatedHeparin\n          where UnfractionatedHeparin.dosage.route in \"Intravenous route\"\n      )\n        union [\"MedicationAdministration\": medication in \"Direct Thrombin Inhibitor\"]\n        union [\"MedicationAdministration\": medication in \"Glycoprotein IIb IIIa Inhibitors\"] ) AnticoagulantMedication\n        where AnticoagulantMedication.status = 'completed'\n        return {\n          id: AnticoagulantMedication.id,\n          LowRiskDatetime: start of AnticoagulantMedication.effective.toInterval ( )\n        }\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Low Risk For VTE Or Anticoagulant Administered From Day Of Start Of Hospitalization To Day After First ICU Stay"
            },
            {
              "url": "statement",
              "valueString": "define \"Low Risk For VTE Or Anticoagulant Administered From Day Of Start Of Hospitalization To Day After First ICU Stay\":\n  \"Encounter With ICU Location\" QualifyingEncounterICU\n    with \"Low Risk Indicator For VTE\" LowRiskForVTE\n      such that LowRiskForVTE.LowRiskDatetime during day of QualifyingEncounterICU.fromDayOfStartOfHospitalizationToDayAfterFirstICU ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Low Risk For VTE Or Anticoagulant Administered On Day Of Or Day After Procedure"
            },
            {
              "url": "statement",
              "valueString": "define \"Low Risk For VTE Or Anticoagulant Administered On Day Of Or Day After Procedure\":\n  from\n    \"Encounter With ICU Location\" QualifyingEncounterICU,\n    [\"Procedure\": \"General or Neuraxial Anesthesia\"] AnesthesiaProcedure,\n    \"Low Risk Indicator For VTE\" LowRiskForVTE\n    where AnesthesiaProcedure.status = 'completed'\n      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of QualifyingEncounterICU.startOfFirstICU ( )\n      and LowRiskForVTE.LowRiskDatetime during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )\n    return QualifyingEncounterICU"
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Encounter With Low Risk For VTE Or Anticoagulant Administered"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Low Risk For VTE Or Anticoagulant Administered\":\n  \"Low Risk For VTE Or Anticoagulant Administered From Day Of Start Of Hospitalization To Day After First ICU Stay\"\n    union \"Low Risk For VTE Or Anticoagulant Administered On Day Of Or Day After Procedure\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "No VTE Prophylaxis Medication Administered Or Ordered"
            },
            {
              "url": "statement",
              "valueString": "define \"No VTE Prophylaxis Medication Administered Or Ordered\":\n  ( ( [MedicationAdministrationNotDone: \"Low Dose Unfractionated Heparin for VTE Prophylaxis\"]\n      union [MedicationAdministrationNotDone: \"Low Molecular Weight Heparin for VTE Prophylaxis\"]\n      union [MedicationAdministrationNotDone: \"Injectable Factor Xa Inhibitor for VTE Prophylaxis\"]\n      union [MedicationAdministrationNotDone: \"Warfarin\"]\n      union [MedicationAdministrationNotDone: \"Rivaroxaban for VTE Prophylaxis\"] ) NoMedicationAdm\n      return {\n        id: NoMedicationAdm.id,\n        medicationStatusReason: NoMedicationAdm.statusReason,\n        authoredOn: NoMedicationAdm.recorded\n      }\n  )\n    union ( ( [\"MedicationNotRequested\": \"Low Dose Unfractionated Heparin for VTE Prophylaxis\"]\n        union [\"MedicationNotRequested\": \"Low Molecular Weight Heparin for VTE Prophylaxis\"]\n        union [\"MedicationNotRequested\": \"Injectable Factor Xa Inhibitor for VTE Prophylaxis\"]\n        union [\"MedicationNotRequested\": \"Warfarin\"]\n        union [\"MedicationNotRequested\": \"Rivaroxaban for VTE Prophylaxis\"] ) NoMedicationOrder\n        where NoMedicationOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n        return {\n          id: NoMedicationOrder.id,\n          medicationStatusReason: NoMedicationOrder.reasonCode,\n          authoredOn: NoMedicationOrder.authoredOn\n        }\n    )\n    union ( from\n        ( [\"MedicationRequest\": \"Low Dose Unfractionated Heparin for VTE Prophylaxis\"]\n          union [\"MedicationRequest\": \"Low Molecular Weight Heparin for VTE Prophylaxis\"]\n          union [\"MedicationRequest\": \"Injectable Factor Xa Inhibitor for VTE Prophylaxis\"]\n          union [\"MedicationRequest\": \"Warfarin\"]\n          union [\"MedicationRequest\": \"Rivaroxaban for VTE Prophylaxis\"] ) MedicationOrderReject,\n        [TaskRejected] T\n        where T.focus.references ( MedicationOrderReject )\n          and T.code ~ QICoreCommon.\"Fulfill\"\n          and MedicationOrderReject.status = 'active'\n        return {\n          id: MedicationOrderReject.id,\n          medicationStatusReason: { T.statusReason },\n          authoredOn: MedicationOrderReject.authoredOn\n        }\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "No VTE Prophylaxis Medication Due To Medical Reason From Day Of Start Of Hospitalization To Day After First ICU Stay"
            },
            {
              "url": "statement",
              "valueString": "define \"No VTE Prophylaxis Medication Due To Medical Reason From Day Of Start Of Hospitalization To Day After First ICU Stay\":\n  \"Encounter With ICU Location\" QualifyingEncounterICU\n    with \"No VTE Prophylaxis Medication Administered Or Ordered\" NoVTEMedication\n      such that NoVTEMedication.medicationStatusReason in \"Medical Reason For Not Providing Treatment\"\n        and NoVTEMedication.authoredOn during day of QualifyingEncounterICU.fromDayOfStartOfHospitalizationToDayAfterFirstICU ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 16
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "No Mechanical VTE Prophylaxis Performed Or Ordered"
            },
            {
              "url": "statement",
              "valueString": "define \"No Mechanical VTE Prophylaxis Performed Or Ordered\":\n  ( ( [ServiceNotRequested: \"Venous foot pumps\"]\n      union [ServiceNotRequested: \"Intermittent pneumatic compression devices\"]\n      union [ServiceNotRequested: \"Graduated compression stockings\"] ) DeviceNotOrder\n      where DeviceNotOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n      return {\n        id: DeviceNotOrder.id,\n        requestStatusReason: DeviceNotOrder.reasonRefused,\n        authoredOn: DeviceNotOrder.authoredOn\n      }\n  )\n    union ( from\n        ( [ServiceRequest: \"Venous foot pumps\"]\n          union [ServiceRequest: \"Intermittent pneumatic compression devices\"]\n          union [ServiceRequest: \"Graduated compression stockings\"] ) DeviceOrderReject,\n        [TaskRejected] T\n        where DeviceOrderReject.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n          and DeviceOrderReject.status = 'active'\n          and T.focus.references ( DeviceOrderReject )\n          and T.code ~ QICoreCommon.\"Fulfill\"\n        return {\n          id: DeviceOrderReject.id,\n          requestStatusReason: T.statusReason,\n          authoredOn: DeviceOrderReject.authoredOn\n        }\n    )\n    union ( ( [ProcedureNotDone: \"Application of Intermittent Pneumatic Compression Devices\"]\n        union [ProcedureNotDone: \"Application of Venous Foot Pumps\"]\n        union [ProcedureNotDone: \"Application of Graduated Compression Stockings\"] ) DeviceNotApplied\n        let DeviceNotDoneTiming: DeviceNotApplied.recorded\n        return {\n          id: DeviceNotApplied.id,\n          requestStatusReason: DeviceNotApplied.statusReason,\n          authoredOn: DeviceNotDoneTiming\n        }\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "No Mechanical VTE Prophylaxis Due To Medical Reason From Day Of Start Of Hospitalization To Day After First ICU Stay"
            },
            {
              "url": "statement",
              "valueString": "define \"No Mechanical VTE Prophylaxis Due To Medical Reason From Day Of Start Of Hospitalization To Day After First ICU Stay\":\n  \"Encounter With ICU Location\" QualifyingEncounterICU\n    with \"No Mechanical VTE Prophylaxis Performed Or Ordered\" NoVTEDevice\n      such that NoVTEDevice.requestStatusReason in \"Medical Reason For Not Providing Treatment\"\n        and NoVTEDevice.authoredOn during day of QualifyingEncounterICU.fromDayOfStartOfHospitalizationToDayAfterFirstICU ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 18
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "No VTE Prophylaxis Medication Due To Medical Reason On Day Of Or Day After Procedure"
            },
            {
              "url": "statement",
              "valueString": "define \"No VTE Prophylaxis Medication Due To Medical Reason On Day Of Or Day After Procedure\":\n  from\n    \"Encounter With ICU Location\" QualifyingEncounterICU,\n    [\"Procedure\": \"General or Neuraxial Anesthesia\"] AnesthesiaProcedure,\n    \"No VTE Prophylaxis Medication Administered Or Ordered\" NoVTEMedication\n    where NoVTEMedication.medicationStatusReason in \"Medical Reason For Not Providing Treatment\"\n      and AnesthesiaProcedure.status = 'completed'\n      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of QualifyingEncounterICU.startOfFirstICU ( )\n      and NoVTEMedication.authoredOn during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )\n    return QualifyingEncounterICU"
            },
            {
              "url": "displaySequence",
              "valueInteger": 19
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "No Mechanical VTE Prophylaxis Due To Medical Reason On Day Of Or Day After Procedure"
            },
            {
              "url": "statement",
              "valueString": "define \"No Mechanical VTE Prophylaxis Due To Medical Reason On Day Of Or Day After Procedure\":\n  from\n    \"Encounter With ICU Location\" QualifyingEncounterICU,\n    [\"Procedure\": \"General or Neuraxial Anesthesia\"] AnesthesiaProcedure,\n    \"No Mechanical VTE Prophylaxis Performed Or Ordered\" NoVTEDevice\n    where NoVTEDevice.requestStatusReason in \"Medical Reason For Not Providing Treatment\"\n      and AnesthesiaProcedure.status = 'completed'\n      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of QualifyingEncounterICU.startOfFirstICU ( )\n      and NoVTEDevice.authoredOn during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )\n    return QualifyingEncounterICU"
            },
            {
              "url": "displaySequence",
              "valueInteger": 20
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Encounter With No VTE Prophylaxis Due To Medical Reason"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With No VTE Prophylaxis Due To Medical Reason\":\n  ( \"No VTE Prophylaxis Medication Due To Medical Reason From Day Of Start Of Hospitalization To Day After First ICU Stay\"\n      intersect \"No Mechanical VTE Prophylaxis Due To Medical Reason From Day Of Start Of Hospitalization To Day After First ICU Stay\"\n  )\n    union ( \"No VTE Prophylaxis Medication Due To Medical Reason On Day Of Or Day After Procedure\"\n        intersect \"No Mechanical VTE Prophylaxis Due To Medical Reason On Day Of Or Day After Procedure\"\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 21
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "No Mechanical or Pharmacological VTE Prophylaxis Due To Patient Refusal"
            },
            {
              "url": "statement",
              "valueString": "define \"No Mechanical or Pharmacological VTE Prophylaxis Due To Patient Refusal\":\n  ( \"No VTE Prophylaxis Medication Administered Or Ordered\" NoVTEMedication\n      where NoVTEMedication.medicationStatusReason in \"Patient Refusal\"\n  )\n    union ( \"No Mechanical VTE Prophylaxis Performed Or Ordered\" NoVTEDevice\n        where NoVTEDevice.requestStatusReason in \"Patient Refusal\"\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 22
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "No VTE Prophylaxis Due To Patient Refusal From Day Of Start Of Hospitalization To Day After First ICU Stay"
            },
            {
              "url": "statement",
              "valueString": "define \"No VTE Prophylaxis Due To Patient Refusal From Day Of Start Of Hospitalization To Day After First ICU Stay\":\n  \"Encounter With ICU Location\" QualifyingEncounterICU\n    with \"No Mechanical or Pharmacological VTE Prophylaxis Due To Patient Refusal\" PatientRefusal\n      such that PatientRefusal.authoredOn during day of QualifyingEncounterICU.fromDayOfStartOfHospitalizationToDayAfterFirstICU ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 23
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "No VTE Prophylaxis Due To Patient Refusal On Day Of Or Day After Procedure"
            },
            {
              "url": "statement",
              "valueString": "define \"No VTE Prophylaxis Due To Patient Refusal On Day Of Or Day After Procedure\":\n  from\n    \"Encounter With ICU Location\" QualifyingEncounterICU,\n    [\"Procedure\": \"General or Neuraxial Anesthesia\"] AnesthesiaProcedure,\n    \"No Mechanical or Pharmacological VTE Prophylaxis Due To Patient Refusal\" PatientRefusal\n    where AnesthesiaProcedure.status = 'completed'\n      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of QualifyingEncounterICU.startOfFirstICU ( )\n      and PatientRefusal.authoredOn during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )\n    return QualifyingEncounterICU"
            },
            {
              "url": "displaySequence",
              "valueInteger": 24
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Encounter With No VTE Prophylaxis Due To Patient Refusal"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With No VTE Prophylaxis Due To Patient Refusal\":\n  \"No VTE Prophylaxis Due To Patient Refusal From Day Of Start Of Hospitalization To Day After First ICU Stay\"\n    union \"No VTE Prophylaxis Due To Patient Refusal On Day Of Or Day After Procedure\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 25
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n  \"Encounter With VTE Prophylaxis Received On Day Of Or Day After First ICU Stay Or Procedure\"\n    union ( \"Encounter With Medication Oral Factor Xa Inhibitor Administered On Day Of Or Day After First ICU Stay Or Procedure\"\n        intersect ( \"Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Prior Diagnosis Of VTE\"\n            union \"Encounter With Prior Or Present Procedure Of Hip Or Knee Replacement Surgery\"\n        )\n    )\n    union \"Encounter With Low Risk For VTE Or Anticoagulant Administered\"\n    union \"Encounter With No VTE Prophylaxis Due To Medical Reason\"\n    union \"Encounter With No VTE Prophylaxis Due To Patient Refusal\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 26
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n  \"Encounter With ICU Location\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 27
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-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/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 29
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  VTE.\"Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 30
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-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": 31
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 32
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Encounter With ICU Location And Encounter Less Than 2 Days"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With ICU Location And Encounter Less Than 2 Days\":\n  \"Encounter With ICU Location\" QualifyingEncounterICU\n    where QualifyingEncounterICU.period.lengthInDays ( ) < 2"
            },
            {
              "url": "displaySequence",
              "valueInteger": 33
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Encounter With First ICU Stay With Principal Procedure Of Selected Surgery"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With First ICU Stay With Principal Procedure Of Selected Surgery\":\n  \"Encounter With ICU Location\" QualifyingEncounterICU\n    where QualifyingEncounterICU.hasPrincipalProcedureOf ( \"General Surgery\" )\n      or QualifyingEncounterICU.hasPrincipalProcedureOf ( \"Gynecological Surgery\" )\n      or QualifyingEncounterICU.hasPrincipalProcedureOf ( \"Hip Fracture Surgery\" )\n      or QualifyingEncounterICU.hasPrincipalProcedureOf ( \"Hip Replacement Surgery\" )\n      or QualifyingEncounterICU.hasPrincipalProcedureOf ( \"Intracranial Neurosurgery\" )\n      or QualifyingEncounterICU.hasPrincipalProcedureOf ( \"Knee Replacement Surgery\" )\n      or QualifyingEncounterICU.hasPrincipalProcedureOf ( \"Urological Surgery\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 34
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Intervention Comfort Measures"
            },
            {
              "url": "statement",
              "valueString": "define \"Intervention Comfort Measures\":\n  ( [\"ServiceRequest\": \"Comfort Measures\"] InterventionRequest\n      where InterventionRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n        and InterventionRequest.status in { 'active', 'on-hold', 'completed' }\n  )\n    union ( [\"Procedure\": \"Comfort Measures\"] InterventionPerformed\n        where InterventionPerformed.status in { 'completed', 'in-progress' }\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 35
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Encounter With Intervention Comfort Measures From Day Of Start Of Hospitalization To Day After First ICU Stay"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Intervention Comfort Measures From Day Of Start Of Hospitalization To Day After First ICU Stay\":\n  \"Encounter With ICU Location\" QualifyingEncounterICU\n    with \"Intervention Comfort Measures\" ComfortMeasure\n      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during day of QualifyingEncounterICU.fromDayOfStartOfHospitalizationToDayAfterFirstICU ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 36
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Encounter With Intervention Comfort Measures On Day Of Or Day After Procedure"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Intervention Comfort Measures On Day Of Or Day After Procedure\":\n  from\n    \"Encounter With ICU Location\" QualifyingEncounterICU,\n    [\"Procedure\": \"General or Neuraxial Anesthesia\"] AnesthesiaProcedure,\n    \"Intervention Comfort Measures\" ComfortMeasure\n    where AnesthesiaProcedure.status = 'completed'\n      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of QualifyingEncounterICU.startOfFirstICU ( )\n      and Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )\n    return QualifyingEncounterICU"
            },
            {
              "url": "displaySequence",
              "valueInteger": 37
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Denominator Exclusions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exclusions\":\n  \"Encounter With ICU Location And Encounter Less Than 2 Days\"\n    union \"Encounter With First ICU Stay With Principal Procedure Of Selected Surgery\"\n    union \"Encounter With Intervention Comfort Measures From Day Of Start Of Hospitalization To Day After First ICU Stay\"\n    union \"Encounter With Intervention Comfort Measures On Day Of Or Day After Procedure\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 38
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-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": 39
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 40
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Encounter With First ICU Location Stay Less Than 1 day"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With First ICU Location Stay Less Than 1 day\":\n  \"Encounter With ICU Location\" QualifyingEncounterICU\n    where QualifyingEncounterICU.firstInpatientIntensiveCareUnit ( ).period.lengthInDays ( ) < 1"
            },
            {
              "url": "displaySequence",
              "valueInteger": 41
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "Denominator Exceptions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exceptions\":\n  \"Encounter With First ICU Location Stay Less Than 1 day\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 42
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value uri): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 43
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-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": 44
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "VTE"
            },
            {
              "url": "name",
              "valueString": "hasEncDiagnosisOf"
            },
            {
              "url": "statement",
              "valueString": "define fluent function hasEncDiagnosisOf(TheEncounter Encounter, DiagnosisValueSet ValueSet):\n   TheEncounter E\n     return (E.encounterDiagnosis()).code in DiagnosisValueSet\n       or E.reasonCode in DiagnosisValueSet"
            },
            {
              "url": "displaySequence",
              "valueInteger": 45
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "encounterDiagnosis"
            },
            {
              "url": "statement",
              "valueString": "/*  \n@description: Returns the Condition resources referenced by the diagnosis element of the Encounter  \n*/\ndefine fluent function encounterDiagnosis(Encounter Encounter ):\n  Encounter.reasonReference D\n    return singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where D.references(C.id))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 46
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "references"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given reference is to the given resourceId\n@comment: Returns true if the `resourceId` parameter exactly equals the tail of the given reference.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(reference Reference, resourceId String):\n  resourceId = Last(Split(reference.reference, '/'))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 47
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-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": 48
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-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": 49
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "getLocation"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns the Location resource specified by the given reference.\n*/\ndefine fluent function getLocation(reference Reference):\n  singleton from (\n    [Location] L where reference.references(L)\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 50
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "references"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given reference is to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(reference Reference, resource Resource):\n  resource.id = Last(Split(reference.reference, '/'))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 51
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-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": 52
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "TJCOverall"
            },
            {
              "url": "name",
              "valueString": "CalendarDayOfOrDayAfter"
            },
            {
              "url": "statement",
              "valueString": "define fluent function CalendarDayOfOrDayAfter(StartValue DateTime):\n  Interval [date from (StartValue), date from (StartValue) + 1 day]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 53
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "startOfFirstICU"
            },
            {
              "url": "statement",
              "valueString": "define fluent function \"startOfFirstICU\"(Encounter Encounter):\n  start of Encounter.firstInpatientIntensiveCareUnit ( ).period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 54
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "firstInpatientIntensiveCareUnit"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: First Inpatient Intensive Care Unit returns the first intensive care unit for the given encounter, without considering any immediately prior emergency department visit.\n*/\ndefine fluent function firstInpatientIntensiveCareUnit(Encounter Encounter ):\n  First((Encounter.location)HospitalLocation\n  \t\t\twhere GetLocation(HospitalLocation.location).type in \"Intensive Care Unit\"\n  \t\t\t\tand HospitalLocation.period during Encounter.period\n  \t\t\tsort by start of period\n  \t)"
            },
            {
              "url": "displaySequence",
              "valueInteger": 55
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "GetLocation"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns the Location resource specified by the given reference\n@deprecated: This function is deprecated. Use the fluent function `getLocation()` instead.\n*/\ndefine function \"GetLocation\"(reference Reference):\n  singleton from (\n    [Location] L where reference.references(L)\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 56
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "earliest"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Given an interval, return the starting point if the interval has a starting boundary specified,\notherwise, return the ending point\n*/\ndefine fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):\n  (choice.toInterval()) period\n    return\n      if (period.\"hasStart\"()) then start of period\n      else end of period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 57
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "hasStart"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Given an interval, return true if the interval has a starting boundary specified\n(i.e. the start of the interval is not null and not the minimum DateTime value)\n*/\ndefine fluent function hasStart(period Interval<DateTime> ):\n  not ( start of period is null\n      or start of period = minimum DateTime\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 58
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS190VTEProphylaxisICUFHIR"
            },
            {
              "url": "name",
              "valueString": "fromDayOfStartOfHospitalizationToDayAfterFirstICU"
            },
            {
              "url": "statement",
              "valueString": "define fluent function \"fromDayOfStartOfHospitalizationToDayAfterFirstICU\"(Encounter Encounter):\n  Interval[date from ( start of Encounter.hospitalizationWithObservation ( ) ), date from ( Encounter.startOfFirstICU ( ) ) + 1 day]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 59
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "hospitalizationWithObservation"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter\n*/\ndefine fluent function hospitalizationWithObservation(TheEncounter Encounter ):\n  TheEncounter Visit\n  \t\tlet ObsVisit: Last([Encounter: \"Observation Services\"] LastObs\n  \t\t\t\twhere LastObs.status = 'finished'\n            and LastObs.period ends 1 hour or less on or before start of Visit.period\n  \t\t\t\tsort by end of period\n  \t\t\t),\n  \t\t\tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n  \t\t\tEDVisit: Last([Encounter: \"Emergency Department Visit\"] LastED\n  \t\t\t\twhere LastED.status = 'finished'\n            and LastED.period ends 1 hour or less on or before VisitStart\n  \t\t\t\tsort by end of period\n  \t\t\t)\n  \t\treturn Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 60
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "lengthInDays"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Calculates the difference in calendar days between the start and end of the given interval.\n*/\ndefine fluent function lengthInDays(Value Interval<DateTime> ):\n  difference in days between start of Value and end of Value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 61
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "VTE"
            },
            {
              "url": "name",
              "valueString": "hasPrincipalProcedureOf"
            },
            {
              "url": "statement",
              "valueString": "define fluent function hasPrincipalProcedureOf(TheEncounter Encounter, DiagnosisValueSet ValueSet):\n   TheEncounter E\n   let\n        PPx: E.principalProcedure(),\n        CPx: singleton from ([Procedure] P where PPx.procedure.references(P.id))\n     return PPx.procedure in DiagnosisValueSet\n       or CPx.code in DiagnosisValueSet"
            },
            {
              "url": "displaySequence",
              "valueInteger": 62
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "principalProcedure"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns the claim procedure elements for the given encounter\n*/\ndefine fluent function principalProcedure(encounter Encounter):  \t  \n  \t encounter E\n  \t let \n        claim: [Claim] C where C.status = 'active' and C.use = 'claim' and exists (C.item I where I.encounter.references(E)),\n        claimItem: claim.item I where I.encounter.references(E),\n        princProcedure: singleton from (claim.procedure P where P.sequence in claimItem.procedureSequence and P.type.includesCode(\"Primary procedure\"))\n    return princProcedure"
            },
            {
              "url": "displaySequence",
              "valueInteger": 63
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "references"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if any of the given references are to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(references List<Reference>, resource Resource):\n  exists (references R where R.references(resource))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 64
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "includesCode"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given code is in the given codeList\n@comment: Returns true if the `code` is equivalent to any of the codes in the given `codeList`, false otherwise.\n*/\ndefine fluent function includesCode(codeList List<Concept>, code Code):\n  exists (codeList C where C ~ code)"
            },
            {
              "url": "displaySequence",
              "valueInteger": 65
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-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": "https://madie.cms.gov/Library/SupplementalDataElements|5.1.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "https://madie.cms.gov/Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library VTE",
          "resource": "https://madie.cms.gov/Library/VTE|8.18.000"
        },
        {
          "type": "depends-on",
          "display": "Library CQMCommon",
          "resource": "https://madie.cms.gov/Library/CQMCommon|4.1.000"
        },
        {
          "type": "depends-on",
          "display": "Library QICoreCommon",
          "resource": "https://madie.cms.gov/Library/QICoreCommon|4.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library TJC",
          "resource": "https://madie.cms.gov/Library/TJCOverall|8.23.000"
        },
        {
          "type": "depends-on",
          "display": "Code system SNOMEDCT",
          "resource": "http://snomed.info/sct"
        },
        {
          "type": "depends-on",
          "display": "Code system ConditionVerificationStatusCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/condition-ver-status"
        },
        {
          "type": "depends-on",
          "display": "Code system ConditionClinicalStatusCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/condition-clinical"
        },
        {
          "type": "depends-on",
          "display": "Code system LOINC",
          "resource": "http://loinc.org"
        },
        {
          "type": "depends-on",
          "display": "Code system TaskCodeSystem",
          "resource": "http://hl7.org/fhir/CodeSystem/task-code"
        },
        {
          "type": "depends-on",
          "display": "Code system Procedure Type",
          "resource": "http://terminology.hl7.org/CodeSystem/ex-procedure-type"
        },
        {
          "type": "depends-on",
          "display": "Value set Encounter Inpatient",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
        },
        {
          "type": "depends-on",
          "display": "Value set Obstetrical or Pregnancy Related Conditions",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.263"
        },
        {
          "type": "depends-on",
          "display": "Value set Venous Thromboembolism",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.279"
        },
        {
          "type": "depends-on",
          "display": "Value set Obstetrics VTE",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.264"
        },
        {
          "type": "depends-on",
          "display": "Value set Intensive Care Unit",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1029.206"
        },
        {
          "type": "depends-on",
          "display": "Value set Low Dose Unfractionated Heparin for VTE Prophylaxis",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39"
        },
        {
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          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedurenotdone"
          ],
          "mustSupport": [
            "code",
            "extension",
            "id",
            "id.value",
            "statusReason"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.66"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedurenotdone"
          ],
          "mustSupport": [
            "code",
            "extension",
            "id",
            "id.value",
            "statusReason"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.66"
            }
          ]
        },
        {
          "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": "Claim",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim"
          ],
          "mustSupport": [
            "status",
            "status.value",
            "use",
            "use.value",
            "item"
          ]
        }
      ]
    }
  ],
  "extension": [
    {
      "id": "supplementalDataGuidance",
      "extension": [
        {
          "url": "guidance",
          "valueString": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity-Patient's Ethnicity:\nHispanic or Latino\nNot Hispanic or Latino \n SDE Payer-Patient's Payer:\nCategories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system \n SDE Race-Patient's Race:\nNative Hawaiian or Other Pacific Islander\nAsian\nAmerican Indian or Alaska Native\nOther Race\nWhite\nBlack or African American \n SDE Sex-Patient's Sex:\nGender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories. \n "
        },
        {
          "url": "usage",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                "code": "supplemental-data",
                "display": "Supplemental Data"
              }
            ],
            "text": "Supplemental Data Guidance"
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance"
    },
    {
      "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
      "valueReference": {
        "reference": "#effective-data-requirements"
      }
    }
  ],
  "url": "https://madie.cms.gov/Measure/CMS190VTEProphylaxisICUFHIR",
  "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": "CMS190FHIR"
    },
    {
      "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:693f0836-228e-43cc-ac71-53388e5dc010"
    },
    {
      "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:9f89afda-e6c9-4c01-91a0-cff67bcad731"
    },
    {
      "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": "190FHIR",
      "assigner": {
        "display": "CMS"
      }
    }
  ],
  "version": "0.3.001",
  "name": "CMS190VTEProphylaxisICUFHIR",
  "title": "Intensive Care Unit Venous Thromboembolism ProphylaxisFHIR",
  "status": "active",
  "experimental": false,
  "date": "2025-06-23T15:36:04+00:00",
  "publisher": "The Joint Commission",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "https://www.jointcommission.org/"
        }
      ]
    }
  ],
  "description": "This measure assesses the number of patients who received Venous Thromboembolism (VTE) prophylaxis on the day of or the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) or on the day of or the day after surgery end date for surgeries that end the day after ICU admission (or transfer) or have documentation why no VTE prophylaxis was given between the day of arrival and the day after ICU admission (for patients directly admitted as inpatients to the ICU) or on the day of or the day after surgery end date for surgeries that end the day after ICU admission (or transfer)",
  "usage": "The definition of an ICU for the purpose of the measures noted above is that used by the CDC in the NHSN Patient Safety Project (CDC, 2022). An intensive care unit can be defined as a nursing care area that provides intensive observation, diagnosis, and therapeutic procedures for adults and/or children who are critically ill. An ICU excludes nursing areas that provide step-down, intermediate care or telemetry only and specialty care areas.\n\nReasons for no pharmacological and no mechanical VTE prophylaxis must be explicitly documented by the medical doctor, advanced practice registered nurse, physician assistant, or pharmacist and linked with VTE prophylaxis. The only exception is patient refusal may be documented by a nurse. Ambulation alone is not a sufficient reason for not administering VTE prophylaxis. In order for ambulation/patient ambulating to be considered as an acceptable reason, there needs to be explicit documentation, e.g., \"patient out of bed and ambulating in halls - no VTE prophylaxis needed.\"\n\nThis measure does not require the use of a specific risk assessment model or tool (e.g., Caprini, Padua, and IMPROVE) to determine VTE risk. \n\nThe denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. Inpatient hospitalizations for patients with a principal procedure of selected surgeries are excluded from the measure’s denominator. Selected surgeries include general surgery, gynecological surgery, hip fracture surgery, hip/knee replacement surgery, intracranial neurosurgery, and urological surgery.\n\nInpatient hospitalizations for patients administered apixaban or edoxaban, medications included in the “Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment” value set, would be counted in the numerator population only when the patients also have either a prior or present diagnosis of atrial fibrillation, a prior diagnosis of VTE, or a prior or present procedure of hip/knee replacement surgery.\n\nThis dCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS108v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6. (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html)",
  "copyright": "Measure specifications are in the Public Domain.\n\nLOINC(R) 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 copyright 2024 World Health Organization. All Rights Reserved.",
  "effectivePeriod": {
    "start": "2026-01-01",
    "end": "2026-12-31"
  },
  "author": [
    {
      "name": "The Joint Commission",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.jointcommission.org/"
        }
      ]
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
      "citation": "CITATION - Geerts, W. H., Bergqvist, D., Pineo, G. F., et al. (2008). Prevention of venous thromboembolism: The Eighth ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest, 133, 381S-453S.\n"
    },
    {
      "type": "citation",
      "citation": "CITATION - Geerts, W. H., Pineo, G. F., Heit, J. A., et al. (2004). Prevention of venous thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest, 126(3 Suppl.), 338S-400S.\n"
    },
    {
      "type": "citation",
      "citation": "CITATION - Guyatt, G. H., Akl, E. A., Crowther, M., et al. (2012). Antithrombotic therapy and prevention of thrombosis, 9th edition: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2 Suppl.), 7S-47S.\n"
    },
    {
      "type": "citation",
      "citation": "CITATION - Kearon, C., Akl, E. A., Comerota, A. J., et al. (2012, February). Antithrombotic therapy for VTE disease: Antithrombotic therapy and prevention of thrombosis, 9th edition: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2 Suppl.), e419S-e494S.\n"
    },
    {
      "type": "citation",
      "citation": "CITATION - Shojania, K. G., Duncan, B. W., McDonald, D. M., et al. (eds.). (2001). Making health care safer: A critical analysis of patient safety practices. Evidence Report/Technology Assessment No. 43. Rockville, MD: Agency for Healthcare Research and Quality.\n"
    },
    {
      "type": "citation",
      "citation": "CITATION - Anderson, D. R., Morgano, G. P., Bennett, C., Dentali, F., Francis, C. W., Garcia, D. A., . . . Dahm, P. (2019). American Society of Hematology 2019 guidelines for management of venous thromboembolism: Prevention of venous thromboembolism in surgical hospitalized patients. Blood Advances, 3(23), 3898–3944. doi: 10.1182/bloodadvances.2019000975.\n"
    }
  ],
  "library": [
    "https://madie.cms.gov/Library/CMS190VTEProphylaxisICUFHIR"
  ],
  "disclaimer": "These performance measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.",
  "rationale": "Venous Thromboembolism (VTE) is a known complication of hospitalization, frequently extending the length of stay and increasing hospital mortality (Maynard, 2016). Approximately 20% of VTE are associated with a surgical procedure (Henke et al., 2020).\n\nAlmost all hospitalized patients have at least one risk factor for VTE, and approximately 40% have three or more risk factors. Without thromboprophylaxis, the incidence of objectively confirmed, hospital-acquired deep-vein thrombosis (DVT) is approximately 10% to 40% among medical or general surgical patients and 40% to 60% following major orthopedic surgery (Geerts et al., 2008).\n\nCommonly, criteria for admission to the Intensive Care Unit (ICU) itself puts patients at an increased risk for developing VTE and subsequent increased risk of morbidity from pulmonary embolism (PE). Some risk factors are related to the acute illness present that allowed for the admission to the ICU unit, and some risk factors may be acquired during the ICU admission due to subsequent medical treatments, for example limitations of mobility, presence of central venous lines or mechanical ventilation and subsequent pharmacological paralysis. Reports of DVT in the population of ICU patients vary in relation to the acuity of the illness in this population. DVT in ICU patients diagnosed with routine venography or Doppler ultrasound found ranges between 10% to 100%. Five studies prospectively screened patients who were not receiving thromboprophylaxis during their ICU stays. The rates of DVT using Fibrinogen Uptake Test, Doppler Ultrasound or venography ranged from 13 to 31% (Geerts et al., 2008). It is essential for all ICUs to assess each patient upon admission to the ICU unit, a change in level of status, for the need for VTE prophylaxis due to the above increased development of risk factors (Geerts et al., 2004).\n\nAmerican Society of Hematology (ASH) 2018 VTE prophylaxis guidelines strongly recommend pharmacological prophylaxis using unfractionated heparin (UFH), low molecular weight heparin (LMWH) or fondaparinux for acutely and critically ill hospitalized medical patients, unless contraindicated. The use of mechanical prophylaxis is an acceptable alternative for patients with increased risk of bleeding and preferred over no prophylaxis.  ASH 2019 guidelines for surgical patients similarly recommend pharmacological or mechanical prophylaxis over no VTE prophylaxis. (NOTE: Some select surgeries have previously been monitored in the Surgical Care Improvement Project; since performance on these surgeries has achieved very high levels, they are not included in this measure.)",
  "clinicalRecommendationStatement": "Failure to recognize and protect patients at risk for venous thromboembolism (VTE) increases the chances for critically ill hospitalized patients for developing a deep vein thrombosis or dying from a pulmonary embolism. Screening all patients is the only evidence based practice in reducing incidence of disease. All intensive care unit (ICU) patients should be evaluated for primary VTE prophylaxis, and given appropriate prophylaxis when indicated.",
  "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": "Encounter"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-type",
                "code": "process",
                "display": "Process"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode": "None"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "increase",
                "display": "Increased score indicates improvement"
              }
            ]
          }
        }
      ],
      "population": [
        {
          "id": "InitialPopulation_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Inpatient hospitalizations for patients age 18 and older, discharged from hospital inpatient acute care without a diagnosis of venous thromboembolism (VTE) or obstetrics that ends during the measurement period",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "Denominator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator",
                "display": "Denominator"
              }
            ]
          },
          "description": "Inpatient hospitalizations for patients directly admitted or transferred to ICU during the hospitalization",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator"
          }
        },
        {
          "id": "DenominatorExclusion_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator-exclusion",
                "display": "Denominator Exclusion"
              }
            ]
          },
          "description": "- Inpatient hospitalizations for patients who have a hospital length of stay (LOS) less than 2 days\n- Inpatient hospitalizations for patients with a principal procedure of selected surgeries that end the day of or the day after ICU admission or transfer\n- Inpatient hospitalizations for patients with comfort measures documented anytime between the day of arrival and the day after ICU admission or transfer\n- Inpatient hospitalizations for patients with comfort measures documented by the day after surgery end date for surgeries that end the day after ICU admission or transfer",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator Exclusions"
          }
        },
        {
          "id": "Numerator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator",
                "display": "Numerator"
              }
            ]
          },
          "description": "Inpatient hospitalizations for patients who received VTE prophylaxis: \n- the day of or the day after ICU admission (or transfer) \n- the day of or the day after surgery end date (for surgeries that end the day after ICU admission or transfer)\n\nInpatient hospitalizations for patients who have documentation of a reason why no VTE prophylaxis was given:\n- between the day of arrival and the day after ICU admission (for patients directly admitted as inpatients to the ICU)\n- the day of or the day after surgery end date (for surgeries that end the day after ICU admission or transfer)",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        },
        {
          "id": "DenominatorException_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator-exception",
                "display": "Denominator Exception"
              }
            ]
          },
          "description": "Inpatient hospitalizations for patients with ICU LOS less than one day",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator Exceptions"
          }
        }
      ]
    }
  ],
  "supplementalData": [
    {
      "id": "sde-ethnicity",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Ethnicity",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Ethnicity"
      }
    },
    {
      "id": "sde-payer",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Payer",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Payer"
      }
    },
    {
      "id": "sde-race",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Race",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Race"
      }
    },
    {
      "id": "sde-sex",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Sex",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Sex"
      }
    }
  ]
}