FHIR IG Statistics: Measure/CMS22FHIRPCSBPScreeningFollowUp

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Narrative

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define "Initial Population":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    where AgeInYearsAt(date from start of "Measurement Period") >= 18

define "Initial Population":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    where AgeInYearsAt(date from start of "Measurement Period") >= 18

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    with [ConditionProblemsHealthConcerns: "Diagnosis of Hypertension"] Hypertension
      such that ( Hypertension.isProblemListItem ( )
          or Hypertension.isHealthConcern ( )
      )
        and Hypertension.prevalenceInterval ( ) starts before or on day of QualifyingEncounter.period

define "Numerator":
  "Encounter with Normal Blood Pressure Reading"
    union ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80 and Interventions" )
    union ( "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80 and Interventions" )
    union ( "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions" )
    union ( "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 and Interventions" )

define "Denominator Exceptions":
  "Encounter with Medical Reason for Not Obtaining or Patient Declined Blood Pressure Measurement"
    union "Encounter with Order for Hypertension Follow Up Declined by Patient"

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

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

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

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

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

define "Qualifying Encounter during Measurement Period":
  [Encounter: "Encounter to Screen for Blood Pressure"] ValidEncounter
    where ValidEncounter.period during day of "Measurement Period"
      and ValidEncounter.status ~ 'finished'
      and ValidEncounter.class !~ "virtual"

define "Encounter with Normal Blood Pressure Reading":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    let EncounterLastBP: Last([USCoreBloodPressureProfile] BloodPressure
        where BloodPressure.effective.toInterval() ends during QualifyingEncounter.period
          and BloodPressure.status in { 'final', 'amended', 'corrected' }
        sort by start of effective.toInterval()
    )
    where ( singleton from ( EncounterLastBP.component C
          where C.code ~ "Systolic blood pressure"
      )
    ).value in Interval[1 'mm[Hg]', 120 'mm[Hg]' )
      and ( singleton from ( EncounterLastBP.component C
            where C.code ~ "Diastolic blood pressure"
        )
      ).value in Interval[1 'mm[Hg]', 80 'mm[Hg]' )

define "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    let EncounterLastBP: Last([USCoreBloodPressureProfile] BloodPressure
        where BloodPressure.effective.toInterval() ends during QualifyingEncounter.period
          and BloodPressure.status in { 'final', 'amended', 'corrected' }
        sort by start of effective.toInterval()
    )
    where ( ( singleton from ( EncounterLastBP.component C
            where C.code ~ "Systolic blood pressure"
        )
      ).value in Interval[120 'mm[Hg]', 129 'mm[Hg]']
        and ( singleton from ( EncounterLastBP.component C
              where C.code ~ "Diastolic blood pressure"
          )
        ).value in Interval[1 'mm[Hg]', 80 'mm[Hg]' )
    )

define "Follow up with Rescreen Within 6 Months":
  [ServiceRequest: "Follow Up Within 6 Months"] FollowUp
    where FollowUp.intent ~ 'order'

define "NonPharmacological Interventions":
  ( [ServiceRequest: "Lifestyle Recommendation"]
    union [ServiceRequest: "Weight Reduction Recommended"]
    union [ServiceRequest: "Dietary Recommendations"]
    union [ServiceRequest: "Recommendation to Increase Physical Activity"]
    union [ServiceRequest: "Referral or Counseling for Alcohol Consumption"] ) NonPharmaInterventions
    where NonPharmaInterventions.intent ~ 'order'

define "Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading":
  [ServiceRequest: "Referral to Primary Care or Alternate Provider"] Referral
    where Referral.reasonCode in "Finding of Elevated Blood Pressure or Hypertension"
      and Referral.intent ~ 'order'

define "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80 and Interventions":
  ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80" ElevatedEncounter
      with "Follow up with Rescreen Within 6 Months" Twoto6MonthRescreen
        such that Twoto6MonthRescreen.authoredOn during day of ElevatedEncounter.period
      with "NonPharmacological Interventions" NonPharmInterventions
        such that NonPharmInterventions.authoredOn during day of ElevatedEncounter.period
  )
    union ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80" ElevatedEncounter
        with "Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading" Referral
          such that Referral.authoredOn during day of ElevatedEncounter.period
    )

define "Encounter with Hypertensive Reading Within Year Prior":
  ( "Qualifying Encounter during Measurement Period" QualifyingEncounter
      let EncounterLastBP: Last([USCoreBloodPressureProfile] BloodPressure
          where BloodPressure.effective.toInterval() ends 1 year or less before or on start of QualifyingEncounter.period
            and BloodPressure.status in { 'final', 'amended', 'corrected' }
          sort by start of effective.toInterval()
      )
      where ( ( singleton from ( EncounterLastBP.component C
              where C.code ~ "Systolic blood pressure"
          )
        ).value > 0 'mm[Hg]'
          and ( singleton from ( EncounterLastBP.component C
                where C.code ~ "Diastolic blood pressure"
            )
          ).value > 0 'mm[Hg]'
          and ( ( singleton from ( EncounterLastBP.component C
                  where C.code ~ "Systolic blood pressure"
              )
            ).value >= 130 'mm[Hg]'
              or ( singleton from ( EncounterLastBP.component C
                    where C.code ~ "Diastolic blood pressure"
                )
              ).value >= 80 'mm[Hg]'
          )
      )
  )

define "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80":
  ( "Qualifying Encounter during Measurement Period" QualifyingEncounter
      let EncounterLastBP: Last([USCoreBloodPressureProfile] BloodPressure
          where BloodPressure.effective.toInterval() ends during day of QualifyingEncounter.period
          sort by start of effective.toInterval()
      )
      where ( ( ( singleton from ( EncounterLastBP.component C
                where C.code ~ "Systolic blood pressure"
            )
          ).value > 0 'mm[Hg]'
            and ( singleton from ( EncounterLastBP.component C
                  where C.code ~ "Diastolic blood pressure"
              )
            ).value > 0 'mm[Hg]'
        )
          and ( ( singleton from ( EncounterLastBP.component C
                  where C.code ~ "Systolic blood pressure"
              )
            ).value >= 130 'mm[Hg]'
              or ( singleton from ( EncounterLastBP.component C
                    where C.code ~ "Diastolic blood pressure"
                )
              ).value >= 80 'mm[Hg]'
          )
      )
  )
    except "Encounter with Hypertensive Reading Within Year Prior"

define "First Hypertensive Reading Interventions or Referral to Alternate Professional":
  ( [ServiceRequest: "Follow Up Within 4 Weeks"] FourWeekRescreen
      with "NonPharmacological Interventions" NonPharmInterventionsHTN
        such that FourWeekRescreen.authoredOn during day of "Measurement Period"
          and NonPharmInterventionsHTN.authoredOn during day of "Measurement Period"
          and FourWeekRescreen.intent ~ 'order'
  )
    union ( "Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading" )

define "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80 and Interventions":
  "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80" FirstHTNEncounter
    with "First Hypertensive Reading Interventions or Referral to Alternate Professional" FirstHTNIntervention
      such that FirstHTNIntervention.authoredOn during day of FirstHTNEncounter.period

define "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89":
  ( "Qualifying Encounter during Measurement Period" QualifyingEncounter
      let EncounterLastBP: Last([USCoreBloodPressureProfile] BloodPressure
          where BloodPressure.effective.toInterval() ends during day of QualifyingEncounter.period
            and BloodPressure.status in { 'final', 'amended', 'corrected' }
          sort by start of effective.toInterval()
      )
      where ( ( ( singleton from ( EncounterLastBP.component C
                where C.code ~ "Systolic blood pressure"
            )
          ).value in Interval[130 'mm[Hg]', 139 'mm[Hg]']
            or ( singleton from ( EncounterLastBP.component C
                  where C.code ~ "Diastolic blood pressure"
              )
            ).value in Interval[80 'mm[Hg]', 89 'mm[Hg]']
        )
          and not ( ( singleton from ( EncounterLastBP.component C
                  where C.code ~ "Systolic blood pressure"
              )
            ).value >= 140 'mm[Hg]'
              or ( singleton from ( EncounterLastBP.component C
                    where C.code ~ "Diastolic blood pressure"
                )
              ).value >= 90 'mm[Hg]'
          )
      )
        and ( exists "Encounter with Hypertensive Reading Within Year Prior" )
  )

define "Laboratory Test or ECG for Hypertension":
  ( [ServiceRequest: "12 lead EKG panel"]
    union [ServiceRequest: "EKG study"]
    union [ServiceRequest: "Laboratory Tests for Hypertension"] ) EKGLab
    where EKGLab.intent ~ 'order'

define "Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions":
  "Follow up with Rescreen Within 6 Months" Rescreen2to6
    with "Laboratory Test or ECG for Hypertension" LabECGIntervention
      such that Rescreen2to6.authoredOn during day of "Measurement Period"
        and LabECGIntervention.authoredOn during day of "Measurement Period"
    with "NonPharmacological Interventions" NonPharmSecondIntervention
      such that NonPharmSecondIntervention.authoredOn during day of "Measurement Period"

define "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions":
  ( "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89" SecondHTNEncounterReading
      with "Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions" EncounterInterventions
        such that EncounterInterventions.authoredOn during day of SecondHTNEncounterReading.period
  )
    union ( "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89" SecondHTNEncounterReading
        with "Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading" ReferralForHTN
          such that ReferralForHTN.authoredOn during day of SecondHTNEncounterReading.period
    )

define "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90":
  ( "Qualifying Encounter during Measurement Period" QualifyingEncounter
      let EncounterLastBP: Last([USCoreBloodPressureProfile] BloodPressure
          where BloodPressure.effective.toInterval() ends during QualifyingEncounter.period
            and BloodPressure.status in { 'final', 'amended', 'corrected' }
          sort by start of effective.toInterval()
      )
      where ( ( singleton from ( EncounterLastBP.component C
              where C.code ~ "Systolic blood pressure"
          )
        ).value > 0 'mm[Hg]'
          and ( singleton from ( EncounterLastBP.component C
                where C.code ~ "Diastolic blood pressure"
            )
          ).value > 0 'mm[Hg]'
          and ( ( singleton from ( EncounterLastBP.component C
                  where C.code ~ "Systolic blood pressure"
              )
            ).value >= 140 'mm[Hg]'
              or ( singleton from ( EncounterLastBP.component C
                    where C.code ~ "Diastolic blood pressure"
                )
              ).value >= 90 'mm[Hg]'
          )
      )
        and ( exists "Encounter with Hypertensive Reading Within Year Prior" )
  )

define "Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions":
  ( [ServiceRequest: "Follow Up Within 4 Weeks"] WeeksRescreen
      with "Laboratory Test or ECG for Hypertension" ECGLabTest
        such that WeeksRescreen.authoredOn during day of "Measurement Period"
          and ECGLabTest.authoredOn during day of "Measurement Period"
          and WeeksRescreen.intent ~ 'order'
          and ECGLabTest.intent ~ 'order'
      with "NonPharmacological Interventions" HTNInterventions
        such that HTNInterventions.authoredOn during day of "Measurement Period"
      with ["MedicationRequest": "Pharmacologic Therapy for Hypertension"] Medications
        such that Medications.authoredOn during day of "Measurement Period"
          and Medications.status ~ 'active'
  )

define "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 and Interventions":
  ( "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90" SecondHTNEncounterReading140Over90
      with "Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions" SecondHTN140Over90Interventions
        such that SecondHTN140Over90Interventions.authoredOn during day of SecondHTNEncounterReading140Over90.period
  )
    union "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90" SecondHTNEncounterReading140Over90
      with "Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading" ReferralToProfessional
        such that ReferralToProfessional.authoredOn during day of SecondHTNEncounterReading140Over90.period

define "Numerator":
  "Encounter with Normal Blood Pressure Reading"
    union ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80 and Interventions" )
    union ( "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80 and Interventions" )
    union ( "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions" )
    union ( "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 and Interventions" )

define "Initial Population":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    where AgeInYearsAt(date from start of "Measurement Period") >= 18

define "Denominator":
  "Initial Population"

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

define "Initial Population":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    where AgeInYearsAt(date from start of "Measurement Period") >= 18

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

define "Denominator Exclusions":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    with [ConditionProblemsHealthConcerns: "Diagnosis of Hypertension"] Hypertension
      such that ( Hypertension.isProblemListItem ( )
          or Hypertension.isHealthConcern ( )
      )
        and Hypertension.prevalenceInterval ( ) starts before or on day of QualifyingEncounter.period

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

define "Encounter with Medical Reason for Not Obtaining or Patient Declined Blood Pressure Measurement":
  "Qualifying Encounter during Measurement Period" QualifyingEncounter
    with ( [ObservationCancelled: code ~ "Blood pressure panel with all children optional"]
      union [ObservationCancelled: code ~ "Systolic blood pressure"]
      union [ObservationCancelled: code ~ "Diastolic blood pressure"] ) NoBPScreen
      such that NoBPScreen.issued during day of QualifyingEncounter.period
        and NoBPScreen.status = 'cancelled'
        and ( NoBPScreen.notDoneReason in "Patient Declined"
            or NoBPScreen.notDoneReason in "Medical Reason"
        )

define "NonPharmacological Intervention Not Ordered":
  ( [ServiceNotRequested: "Lifestyle Recommendation"]
    union [ServiceNotRequested: "Weight Reduction Recommended"]
    union [ServiceNotRequested: "Dietary Recommendations"]
    union [ServiceNotRequested: "Recommendation to Increase Physical Activity"]
    union [ServiceNotRequested: "Referral or Counseling for Alcohol Consumption"] ) NonPharmIntervention
    where NonPharmIntervention.status = 'completed'
      and NonPharmIntervention.reasonRefused in "Patient Declined"

define "Laboratory Test or ECG for Hypertension Not Ordered":
  ( [ServiceNotRequested: code = "12 lead EKG panel"]
    union [ServiceNotRequested: code = "EKG study"]
    union [ServiceNotRequested: "Laboratory Tests for Hypertension"] ) LabECGNotDone
    where exists ( LabECGNotDone.extension E
        where E.url = 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-doNotPerformReason'
          and E.value as Concept in "Patient Declined"
    )

define "Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 Interventions Declined":
  ( ( [ServiceNotRequested: "Referral to Primary Care or Alternate Provider"]
      union [ServiceNotRequested: "Follow Up Within 6 Months"] ) SecondHTNDeclinedReferralAndFollowUp
      where SecondHTNDeclinedReferralAndFollowUp.status = 'completed'
        and SecondHTNDeclinedReferralAndFollowUp.reasonRefused in "Patient Declined"
  )
    union "Laboratory Test or ECG for Hypertension Not Ordered"
    union "NonPharmacological Intervention Not Ordered"

define "Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions Declined":
  ( ( ( [ServiceNotRequested: "Referral to Primary Care or Alternate Provider"]
        union [ServiceNotRequested: "Follow Up Within 4 Weeks"] ) SecondHTN140Over90ReferralFollowUpNotDone
        where SecondHTN140Over90ReferralFollowUpNotDone.status = 'completed'
          and SecondHTN140Over90ReferralFollowUpNotDone.reasonRefused in "Patient Declined"
    )
      union ( [MedicationNotRequested: "Pharmacologic Therapy for Hypertension"] MedicationRequestNotOrdered
          where MedicationRequestNotOrdered.status = 'completed'
      )
      union "Laboratory Test or ECG for Hypertension Not Ordered"
      union "NonPharmacological Intervention Not Ordered"
  )

define "Encounter with Order for Hypertension Follow Up Declined by Patient":
  ( ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80" ElevatedBPEncounter
        with ( [ServiceNotRequested: "Referral to Primary Care or Alternate Provider"]
          union [ServiceNotRequested: "Follow Up Within 6 Months"] ) ElevatedBPDeclinedInterventions
          such that ElevatedBPDeclinedInterventions.authoredOn during day of ElevatedBPEncounter.period
            and ElevatedBPDeclinedInterventions.status = 'completed'
            and ElevatedBPDeclinedInterventions.reasonRefused in "Patient Declined"
    )
      union ( "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80" ElevatedBPEncounter
          with "NonPharmacological Intervention Not Ordered" NotOrdered
            such that NotOrdered.authoredOn during day of ElevatedBPEncounter.period
      )
      union ( "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80" FirstHTNEncounter
          with ( [ServiceNotRequested: "Follow Up Within 4 Weeks"]
            union [ServiceNotRequested: "Referral to Primary Care or Alternate Provider"] ) FirstHTNDeclinedInterventions
            such that FirstHTNDeclinedInterventions.authoredOn during day of FirstHTNEncounter.period
              and FirstHTNDeclinedInterventions.status = 'completed'
              and FirstHTNDeclinedInterventions.reasonRefused in "Patient Declined"
      )
      union ( "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80" FirstHTNEncounter
          with "NonPharmacological Intervention Not Ordered" NoNonPharm
            such that NoNonPharm.authoredOn during day of FirstHTNEncounter.period
      )
      union ( "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89" SecondHTNEncounter
          with "Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 Interventions Declined" SecondHTNDeclinedInterventions
            such that SecondHTNDeclinedInterventions.authoredOn during day of SecondHTNEncounter.period
      )
      union ( "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90" SecondHTN140Over90Encounter
          with "Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions Declined" SecondHTN140Over90DeclinedInterventions
            such that SecondHTN140Over90DeclinedInterventions.authoredOn during day of SecondHTN140Over90Encounter.period
      )
  )

define "Denominator Exceptions":
  "Encounter with Medical Reason for Not Obtaining or Patient Declined Blood Pressure Measurement"
    union "Encounter with Order for Hypertension Follow Up Declined by Patient"

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
        }

/*
@description: Returns true if the given condition is a problem list item.
*/
define fluent function isProblemListItem(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
  exists (condition.category C
    where C ~ "problem-list-item"
  )

/*
@description: Returns true if the given condition is a health concern
*/
define fluent function isHealthConcern(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
  exists (condition.category C
    where C ~ "health-concern"
  )

/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting 
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
    (end of condition.abatementInterval()) abatementDate
    return if abatementDate is null then
      Interval[start of condition.onset.toInterval(), abatementDate)
    else
      Interval[start of condition.onset.toInterval(), abatementDate]

/*
@description: Returns an interval representing the normalized abatement of a given Condition.
@comment: If the abatement element of the Condition is represented as a DateTime, the result
is an interval beginning and ending on that DateTime.
If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The
result is an interval from the date the patient turned that age to immediately before one year later.
If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during
which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately
before one year later than the date the patient turned the ending age of the quantity interval.
*/
define fluent function abatementInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
	if condition.abatement is DateTime then
	  Interval[condition.abatement as DateTime, condition.abatement as DateTime]
	else if condition.abatement is Quantity then
		Interval[Patient.birthDate + (condition.abatement as Quantity),
			Patient.birthDate + (condition.abatement as Quantity) + 1 year)
	else if condition.abatement is Interval<Quantity> then
	  Interval[Patient.birthDate + (condition.abatement.low as Quantity),
		  Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)
	else if condition.abatement is Interval<DateTime> then
	  Interval[condition.abatement.low, condition.abatement.high)
	else null as Interval<DateTime>

Source

{
  "resourceType": "Measure",
  "id": "CMS22FHIRPCSBPScreeningFollowUp",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareablemeasure",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cql-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/elm-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "contained": [
    {
      "resourceType": "Library",
      "id": "effective-data-requirements",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "248153007",
            "display": "Male (finding)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "248152002",
            "display": "Female (finding)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
            "code": "VR",
            "display": "virtual"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "34534-8",
            "display": "EKG 12 channel panel"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "11524-6",
            "display": "EKG study"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-category",
            "code": "problem-list-item",
            "display": "Problem List Item"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://hl7.org/fhir/us/core/CodeSystem/condition-category",
            "code": "health-concern",
            "display": "Health Concern"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "active",
            "display": "Active"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "recurrence",
            "display": "Recurrence"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "relapse",
            "display": "Relapse"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "85354-9",
            "display": "Blood pressure panel with all children optional"
          }
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":\n  case\n    when Patient.sex = '248153007' then \"Male (finding)\"\n    when Patient.sex = '248152002' then \"Female (finding)\"\n    else null\n  end"
            },
            {
              "url": "displaySequence",
              "valueInteger": 0
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 1
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Qualifying Encounter during Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"Qualifying Encounter during Measurement Period\":\n  [Encounter: \"Encounter to Screen for Blood Pressure\"] ValidEncounter\n    where ValidEncounter.period during day of \"Measurement Period\"\n      and ValidEncounter.status ~ 'finished'\n      and ValidEncounter.class !~ \"virtual\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Encounter with Normal Blood Pressure Reading"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Normal Blood Pressure Reading\":\n  \"Qualifying Encounter during Measurement Period\" QualifyingEncounter\n    let EncounterLastBP: Last([USCoreBloodPressureProfile] BloodPressure\n        where BloodPressure.effective.toInterval() ends during QualifyingEncounter.period\n          and BloodPressure.status in { 'final', 'amended', 'corrected' }\n        sort by start of effective.toInterval()\n    )\n    where ( singleton from ( EncounterLastBP.component C\n          where C.code ~ \"Systolic blood pressure\"\n      )\n    ).value in Interval[1 'mm[Hg]', 120 'mm[Hg]' )\n      and ( singleton from ( EncounterLastBP.component C\n            where C.code ~ \"Diastolic blood pressure\"\n        )\n      ).value in Interval[1 'mm[Hg]', 80 'mm[Hg]' )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80\":\n  \"Qualifying Encounter during Measurement Period\" QualifyingEncounter\n    let EncounterLastBP: Last([USCoreBloodPressureProfile] BloodPressure\n        where BloodPressure.effective.toInterval() ends during QualifyingEncounter.period\n          and BloodPressure.status in { 'final', 'amended', 'corrected' }\n        sort by start of effective.toInterval()\n    )\n    where ( ( singleton from ( EncounterLastBP.component C\n            where C.code ~ \"Systolic blood pressure\"\n        )\n      ).value in Interval[120 'mm[Hg]', 129 'mm[Hg]']\n        and ( singleton from ( EncounterLastBP.component C\n              where C.code ~ \"Diastolic blood pressure\"\n          )\n        ).value in Interval[1 'mm[Hg]', 80 'mm[Hg]' )\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Follow up with Rescreen Within 6 Months"
            },
            {
              "url": "statement",
              "valueString": "define \"Follow up with Rescreen Within 6 Months\":\n  [ServiceRequest: \"Follow Up Within 6 Months\"] FollowUp\n    where FollowUp.intent ~ 'order'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "NonPharmacological Interventions"
            },
            {
              "url": "statement",
              "valueString": "define \"NonPharmacological Interventions\":\n  ( [ServiceRequest: \"Lifestyle Recommendation\"]\n    union [ServiceRequest: \"Weight Reduction Recommended\"]\n    union [ServiceRequest: \"Dietary Recommendations\"]\n    union [ServiceRequest: \"Recommendation to Increase Physical Activity\"]\n    union [ServiceRequest: \"Referral or Counseling for Alcohol Consumption\"] ) NonPharmaInterventions\n    where NonPharmaInterventions.intent ~ 'order'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading"
            },
            {
              "url": "statement",
              "valueString": "define \"Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading\":\n  [ServiceRequest: \"Referral to Primary Care or Alternate Provider\"] Referral\n    where Referral.reasonCode in \"Finding of Elevated Blood Pressure or Hypertension\"\n      and Referral.intent ~ 'order'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80 and Interventions"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80 and Interventions\":\n  ( \"Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80\" ElevatedEncounter\n      with \"Follow up with Rescreen Within 6 Months\" Twoto6MonthRescreen\n        such that Twoto6MonthRescreen.authoredOn during day of ElevatedEncounter.period\n      with \"NonPharmacological Interventions\" NonPharmInterventions\n        such that NonPharmInterventions.authoredOn during day of ElevatedEncounter.period\n  )\n    union ( \"Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80\" ElevatedEncounter\n        with \"Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading\" Referral\n          such that Referral.authoredOn during day of ElevatedEncounter.period\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Encounter with Hypertensive Reading Within Year Prior"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Hypertensive Reading Within Year Prior\":\n  ( \"Qualifying Encounter during Measurement Period\" QualifyingEncounter\n      let EncounterLastBP: Last([USCoreBloodPressureProfile] BloodPressure\n          where BloodPressure.effective.toInterval() ends 1 year or less before or on start of QualifyingEncounter.period\n            and BloodPressure.status in { 'final', 'amended', 'corrected' }\n          sort by start of effective.toInterval()\n      )\n      where ( ( singleton from ( EncounterLastBP.component C\n              where C.code ~ \"Systolic blood pressure\"\n          )\n        ).value > 0 'mm[Hg]'\n          and ( singleton from ( EncounterLastBP.component C\n                where C.code ~ \"Diastolic blood pressure\"\n            )\n          ).value > 0 'mm[Hg]'\n          and ( ( singleton from ( EncounterLastBP.component C\n                  where C.code ~ \"Systolic blood pressure\"\n              )\n            ).value >= 130 'mm[Hg]'\n              or ( singleton from ( EncounterLastBP.component C\n                    where C.code ~ \"Diastolic blood pressure\"\n                )\n              ).value >= 80 'mm[Hg]'\n          )\n      )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80\":\n  ( \"Qualifying Encounter during Measurement Period\" QualifyingEncounter\n      let EncounterLastBP: Last([USCoreBloodPressureProfile] BloodPressure\n          where BloodPressure.effective.toInterval() ends during day of QualifyingEncounter.period\n          sort by start of effective.toInterval()\n      )\n      where ( ( ( singleton from ( EncounterLastBP.component C\n                where C.code ~ \"Systolic blood pressure\"\n            )\n          ).value > 0 'mm[Hg]'\n            and ( singleton from ( EncounterLastBP.component C\n                  where C.code ~ \"Diastolic blood pressure\"\n              )\n            ).value > 0 'mm[Hg]'\n        )\n          and ( ( singleton from ( EncounterLastBP.component C\n                  where C.code ~ \"Systolic blood pressure\"\n              )\n            ).value >= 130 'mm[Hg]'\n              or ( singleton from ( EncounterLastBP.component C\n                    where C.code ~ \"Diastolic blood pressure\"\n                )\n              ).value >= 80 'mm[Hg]'\n          )\n      )\n  )\n    except \"Encounter with Hypertensive Reading Within Year Prior\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "First Hypertensive Reading Interventions or Referral to Alternate Professional"
            },
            {
              "url": "statement",
              "valueString": "define \"First Hypertensive Reading Interventions or Referral to Alternate Professional\":\n  ( [ServiceRequest: \"Follow Up Within 4 Weeks\"] FourWeekRescreen\n      with \"NonPharmacological Interventions\" NonPharmInterventionsHTN\n        such that FourWeekRescreen.authoredOn during day of \"Measurement Period\"\n          and NonPharmInterventionsHTN.authoredOn during day of \"Measurement Period\"\n          and FourWeekRescreen.intent ~ 'order'\n  )\n    union ( \"Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80 and Interventions"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80 and Interventions\":\n  \"Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80\" FirstHTNEncounter\n    with \"First Hypertensive Reading Interventions or Referral to Alternate Professional\" FirstHTNIntervention\n      such that FirstHTNIntervention.authoredOn during day of FirstHTNEncounter.period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89\":\n  ( \"Qualifying Encounter during Measurement Period\" QualifyingEncounter\n      let EncounterLastBP: Last([USCoreBloodPressureProfile] BloodPressure\n          where BloodPressure.effective.toInterval() ends during day of QualifyingEncounter.period\n            and BloodPressure.status in { 'final', 'amended', 'corrected' }\n          sort by start of effective.toInterval()\n      )\n      where ( ( ( singleton from ( EncounterLastBP.component C\n                where C.code ~ \"Systolic blood pressure\"\n            )\n          ).value in Interval[130 'mm[Hg]', 139 'mm[Hg]']\n            or ( singleton from ( EncounterLastBP.component C\n                  where C.code ~ \"Diastolic blood pressure\"\n              )\n            ).value in Interval[80 'mm[Hg]', 89 'mm[Hg]']\n        )\n          and not ( ( singleton from ( EncounterLastBP.component C\n                  where C.code ~ \"Systolic blood pressure\"\n              )\n            ).value >= 140 'mm[Hg]'\n              or ( singleton from ( EncounterLastBP.component C\n                    where C.code ~ \"Diastolic blood pressure\"\n                )\n              ).value >= 90 'mm[Hg]'\n          )\n      )\n        and ( exists \"Encounter with Hypertensive Reading Within Year Prior\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Laboratory Test or ECG for Hypertension"
            },
            {
              "url": "statement",
              "valueString": "define \"Laboratory Test or ECG for Hypertension\":\n  ( [ServiceRequest: \"12 lead EKG panel\"]\n    union [ServiceRequest: \"EKG study\"]\n    union [ServiceRequest: \"Laboratory Tests for Hypertension\"] ) EKGLab\n    where EKGLab.intent ~ 'order'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions"
            },
            {
              "url": "statement",
              "valueString": "define \"Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions\":\n  \"Follow up with Rescreen Within 6 Months\" Rescreen2to6\n    with \"Laboratory Test or ECG for Hypertension\" LabECGIntervention\n      such that Rescreen2to6.authoredOn during day of \"Measurement Period\"\n        and LabECGIntervention.authoredOn during day of \"Measurement Period\"\n    with \"NonPharmacological Interventions\" NonPharmSecondIntervention\n      such that NonPharmSecondIntervention.authoredOn during day of \"Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions\":\n  ( \"Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89\" SecondHTNEncounterReading\n      with \"Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions\" EncounterInterventions\n        such that EncounterInterventions.authoredOn during day of SecondHTNEncounterReading.period\n  )\n    union ( \"Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89\" SecondHTNEncounterReading\n        with \"Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading\" ReferralForHTN\n          such that ReferralForHTN.authoredOn during day of SecondHTNEncounterReading.period\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 16
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90\":\n  ( \"Qualifying Encounter during Measurement Period\" QualifyingEncounter\n      let EncounterLastBP: Last([USCoreBloodPressureProfile] BloodPressure\n          where BloodPressure.effective.toInterval() ends during QualifyingEncounter.period\n            and BloodPressure.status in { 'final', 'amended', 'corrected' }\n          sort by start of effective.toInterval()\n      )\n      where ( ( singleton from ( EncounterLastBP.component C\n              where C.code ~ \"Systolic blood pressure\"\n          )\n        ).value > 0 'mm[Hg]'\n          and ( singleton from ( EncounterLastBP.component C\n                where C.code ~ \"Diastolic blood pressure\"\n            )\n          ).value > 0 'mm[Hg]'\n          and ( ( singleton from ( EncounterLastBP.component C\n                  where C.code ~ \"Systolic blood pressure\"\n              )\n            ).value >= 140 'mm[Hg]'\n              or ( singleton from ( EncounterLastBP.component C\n                    where C.code ~ \"Diastolic blood pressure\"\n                )\n              ).value >= 90 'mm[Hg]'\n          )\n      )\n        and ( exists \"Encounter with Hypertensive Reading Within Year Prior\" )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions"
            },
            {
              "url": "statement",
              "valueString": "define \"Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions\":\n  ( [ServiceRequest: \"Follow Up Within 4 Weeks\"] WeeksRescreen\n      with \"Laboratory Test or ECG for Hypertension\" ECGLabTest\n        such that WeeksRescreen.authoredOn during day of \"Measurement Period\"\n          and ECGLabTest.authoredOn during day of \"Measurement Period\"\n          and WeeksRescreen.intent ~ 'order'\n          and ECGLabTest.intent ~ 'order'\n      with \"NonPharmacological Interventions\" HTNInterventions\n        such that HTNInterventions.authoredOn during day of \"Measurement Period\"\n      with [\"MedicationRequest\": \"Pharmacologic Therapy for Hypertension\"] Medications\n        such that Medications.authoredOn during day of \"Measurement Period\"\n          and Medications.status ~ 'active'\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 18
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 and Interventions"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 and Interventions\":\n  ( \"Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90\" SecondHTNEncounterReading140Over90\n      with \"Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions\" SecondHTN140Over90Interventions\n        such that SecondHTN140Over90Interventions.authoredOn during day of SecondHTNEncounterReading140Over90.period\n  )\n    union \"Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90\" SecondHTNEncounterReading140Over90\n      with \"Referral to Alternate or Primary Healthcare Professional for Hypertensive Reading\" ReferralToProfessional\n        such that ReferralToProfessional.authoredOn during day of SecondHTNEncounterReading140Over90.period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 19
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n  \"Encounter with Normal Blood Pressure Reading\"\n    union ( \"Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80 and Interventions\" )\n    union ( \"Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80 and Interventions\" )\n    union ( \"Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 and Interventions\" )\n    union ( \"Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 and Interventions\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 20
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  \"Qualifying Encounter during Measurement Period\" QualifyingEncounter\n    where AgeInYearsAt(date from start of \"Measurement Period\") >= 18"
            },
            {
              "url": "displaySequence",
              "valueInteger": 21
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n  \"Initial Population\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 22
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  [Coverage: type in \"Payer Type\"] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 23
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 24
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  \"Qualifying Encounter during Measurement Period\" QualifyingEncounter\n    where AgeInYearsAt(date from start of \"Measurement Period\") >= 18"
            },
            {
              "url": "displaySequence",
              "valueInteger": 25
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  Patient.ethnicity E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 26
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 27
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Denominator Exclusions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exclusions\":\n  \"Qualifying Encounter during Measurement Period\" QualifyingEncounter\n    with [ConditionProblemsHealthConcerns: \"Diagnosis of Hypertension\"] Hypertension\n      such that ( Hypertension.isProblemListItem ( )\n          or Hypertension.isHealthConcern ( )\n      )\n        and Hypertension.prevalenceInterval ( ) starts before or on day of QualifyingEncounter.period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 28
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  Patient.race R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 29
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 30
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Encounter with Medical Reason for Not Obtaining or Patient Declined Blood Pressure Measurement"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Medical Reason for Not Obtaining or Patient Declined Blood Pressure Measurement\":\n  \"Qualifying Encounter during Measurement Period\" QualifyingEncounter\n    with ( [ObservationCancelled: code ~ \"Blood pressure panel with all children optional\"]\n      union [ObservationCancelled: code ~ \"Systolic blood pressure\"]\n      union [ObservationCancelled: code ~ \"Diastolic blood pressure\"] ) NoBPScreen\n      such that NoBPScreen.issued during day of QualifyingEncounter.period\n        and NoBPScreen.status = 'cancelled'\n        and ( NoBPScreen.notDoneReason in \"Patient Declined\"\n            or NoBPScreen.notDoneReason in \"Medical Reason\"\n        )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 31
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "NonPharmacological Intervention Not Ordered"
            },
            {
              "url": "statement",
              "valueString": "define \"NonPharmacological Intervention Not Ordered\":\n  ( [ServiceNotRequested: \"Lifestyle Recommendation\"]\n    union [ServiceNotRequested: \"Weight Reduction Recommended\"]\n    union [ServiceNotRequested: \"Dietary Recommendations\"]\n    union [ServiceNotRequested: \"Recommendation to Increase Physical Activity\"]\n    union [ServiceNotRequested: \"Referral or Counseling for Alcohol Consumption\"] ) NonPharmIntervention\n    where NonPharmIntervention.status = 'completed'\n      and NonPharmIntervention.reasonRefused in \"Patient Declined\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 32
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Laboratory Test or ECG for Hypertension Not Ordered"
            },
            {
              "url": "statement",
              "valueString": "define \"Laboratory Test or ECG for Hypertension Not Ordered\":\n  ( [ServiceNotRequested: code = \"12 lead EKG panel\"]\n    union [ServiceNotRequested: code = \"EKG study\"]\n    union [ServiceNotRequested: \"Laboratory Tests for Hypertension\"] ) LabECGNotDone\n    where exists ( LabECGNotDone.extension E\n        where E.url = 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-doNotPerformReason'\n          and E.value as Concept in \"Patient Declined\"\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 33
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 Interventions Declined"
            },
            {
              "url": "statement",
              "valueString": "define \"Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 Interventions Declined\":\n  ( ( [ServiceNotRequested: \"Referral to Primary Care or Alternate Provider\"]\n      union [ServiceNotRequested: \"Follow Up Within 6 Months\"] ) SecondHTNDeclinedReferralAndFollowUp\n      where SecondHTNDeclinedReferralAndFollowUp.status = 'completed'\n        and SecondHTNDeclinedReferralAndFollowUp.reasonRefused in \"Patient Declined\"\n  )\n    union \"Laboratory Test or ECG for Hypertension Not Ordered\"\n    union \"NonPharmacological Intervention Not Ordered\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 34
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions Declined"
            },
            {
              "url": "statement",
              "valueString": "define \"Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions Declined\":\n  ( ( ( [ServiceNotRequested: \"Referral to Primary Care or Alternate Provider\"]\n        union [ServiceNotRequested: \"Follow Up Within 4 Weeks\"] ) SecondHTN140Over90ReferralFollowUpNotDone\n        where SecondHTN140Over90ReferralFollowUpNotDone.status = 'completed'\n          and SecondHTN140Over90ReferralFollowUpNotDone.reasonRefused in \"Patient Declined\"\n    )\n      union ( [MedicationNotRequested: \"Pharmacologic Therapy for Hypertension\"] MedicationRequestNotOrdered\n          where MedicationRequestNotOrdered.status = 'completed'\n      )\n      union \"Laboratory Test or ECG for Hypertension Not Ordered\"\n      union \"NonPharmacological Intervention Not Ordered\"\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 35
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Encounter with Order for Hypertension Follow Up Declined by Patient"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Order for Hypertension Follow Up Declined by Patient\":\n  ( ( \"Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80\" ElevatedBPEncounter\n        with ( [ServiceNotRequested: \"Referral to Primary Care or Alternate Provider\"]\n          union [ServiceNotRequested: \"Follow Up Within 6 Months\"] ) ElevatedBPDeclinedInterventions\n          such that ElevatedBPDeclinedInterventions.authoredOn during day of ElevatedBPEncounter.period\n            and ElevatedBPDeclinedInterventions.status = 'completed'\n            and ElevatedBPDeclinedInterventions.reasonRefused in \"Patient Declined\"\n    )\n      union ( \"Encounter with Elevated Blood Pressure Reading SBP 120 to 129 AND DBP less than 80\" ElevatedBPEncounter\n          with \"NonPharmacological Intervention Not Ordered\" NotOrdered\n            such that NotOrdered.authoredOn during day of ElevatedBPEncounter.period\n      )\n      union ( \"Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80\" FirstHTNEncounter\n          with ( [ServiceNotRequested: \"Follow Up Within 4 Weeks\"]\n            union [ServiceNotRequested: \"Referral to Primary Care or Alternate Provider\"] ) FirstHTNDeclinedInterventions\n            such that FirstHTNDeclinedInterventions.authoredOn during day of FirstHTNEncounter.period\n              and FirstHTNDeclinedInterventions.status = 'completed'\n              and FirstHTNDeclinedInterventions.reasonRefused in \"Patient Declined\"\n      )\n      union ( \"Encounter with First Hypertensive Reading SBP Greater than or Equal to 130 OR DBP Greater than or Equal to 80\" FirstHTNEncounter\n          with \"NonPharmacological Intervention Not Ordered\" NoNonPharm\n            such that NoNonPharm.authoredOn during day of FirstHTNEncounter.period\n      )\n      union ( \"Encounter with Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89\" SecondHTNEncounter\n          with \"Second Hypertensive Reading SBP 130 to 139 OR DBP 80 to 89 Interventions Declined\" SecondHTNDeclinedInterventions\n            such that SecondHTNDeclinedInterventions.authoredOn during day of SecondHTNEncounter.period\n      )\n      union ( \"Encounter with Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90\" SecondHTN140Over90Encounter\n          with \"Second Hypertensive Reading SBP Greater than or Equal to 140 OR DBP Greater than or Equal to 90 Interventions Declined\" SecondHTN140Over90DeclinedInterventions\n            such that SecondHTN140Over90DeclinedInterventions.authoredOn during day of SecondHTN140Over90Encounter.period\n      )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 36
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS22FHIRPCSBPScreeningFollowUp"
            },
            {
              "url": "name",
              "valueString": "Denominator Exceptions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exceptions\":\n  \"Encounter with Medical Reason for Not Obtaining or Patient Declined Blood Pressure Measurement\"\n    union \"Encounter with Order for Hypertension Follow Up Declined by Patient\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 37
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value uri): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 38
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)\nvalue to a CQL DateTime Interval\n@comment: If the start value of the given period is unspecified, the starting\nboundary of the resulting interval will be open (meaning the start of the interval\nis unknown, as opposed to interpreted as the beginning of time).\n*/\ndefine function ToInterval(period FHIR.Period):\n    if period is null then\n        null\n    else\n        if period.\"start\" is null then\n            Interval(period.\"start\".value, period.\"end\".value]\n        else\n            Interval[period.\"start\".value, period.\"end\".value]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 39
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToConcept"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 40
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "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": 41
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "isProblemListItem"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given condition is a problem list item.\n*/\ndefine fluent function isProblemListItem(condition Choice<\"ConditionEncounterDiagnosis\", \"ConditionProblemsHealthConcerns\">):\n  exists (condition.category C\n    where C ~ \"problem-list-item\"\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 42
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "isHealthConcern"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given condition is a health concern\n*/\ndefine fluent function isHealthConcern(condition Choice<\"ConditionEncounterDiagnosis\", \"ConditionProblemsHealthConcerns\">):\n  exists (condition.category C\n    where C ~ \"health-concern\"\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 43
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "prevalenceInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting \ninterval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.\n*/\ndefine fluent function prevalenceInterval(condition Choice<\"ConditionEncounterDiagnosis\", \"ConditionProblemsHealthConcerns\">):\nif condition.clinicalStatus ~ \"active\"\n  or condition.clinicalStatus ~ \"recurrence\"\n  or condition.clinicalStatus ~ \"relapse\" then\n  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n    (end of condition.abatementInterval()) abatementDate\n    return if abatementDate is null then\n      Interval[start of condition.onset.toInterval(), abatementDate)\n    else\n      Interval[start of condition.onset.toInterval(), abatementDate]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 44
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "abatementInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns an interval representing the normalized abatement of a given Condition.\n@comment: If the abatement element of the Condition is represented as a DateTime, the result\nis an interval beginning and ending on that DateTime.\nIf the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The\nresult is an interval from the date the patient turned that age to immediately before one year later.\nIf the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during\nwhich the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately\nbefore one year later than the date the patient turned the ending age of the quantity interval.\n*/\ndefine fluent function abatementInterval(condition Choice<\"ConditionEncounterDiagnosis\", \"ConditionProblemsHealthConcerns\">):\n\tif condition.abatement is DateTime then\n\t  Interval[condition.abatement as DateTime, condition.abatement as DateTime]\n\telse if condition.abatement is Quantity then\n\t\tInterval[Patient.birthDate + (condition.abatement as Quantity),\n\t\t\tPatient.birthDate + (condition.abatement as Quantity) + 1 year)\n\telse if condition.abatement is Interval<Quantity> then\n\t  Interval[Patient.birthDate + (condition.abatement.low as Quantity),\n\t\t  Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)\n\telse if condition.abatement is Interval<DateTime> then\n\t  Interval[condition.abatement.low, condition.abatement.high)\n\telse null as Interval<DateTime>"
            },
            {
              "url": "displaySequence",
              "valueInteger": 45
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        }
      ],
      "name": "EffectiveDataRequirements",
      "status": "active",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/library-type",
            "code": "module-definition"
          }
        ]
      },
      "relatedArtifact": [
        {
          "type": "depends-on",
          "display": "Library SDE",
          "resource": "Library/SupplementalDataElements|5.1.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library QICoreCommon",
          "resource": "Library/QICoreCommon|4.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
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      "value": "urn:uuid:1257464d-b1d5-4fda-9246-0c3e4cf0d3ef"
    },
    {
      "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": "22FHIR",
      "assigner": {
        "display": "CMS"
      }
    }
  ],
  "version": "0.3.000",
  "name": "CMS22FHIRPCSBPScreeningFollowUp",
  "title": "Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up DocumentedFHIR",
  "status": "active",
  "experimental": false,
  "date": "2025-07-15T13:37:39+00:00",
  "publisher": "American Institutes for Research (AIR)",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "https://www.air.org"
        }
      ]
    }
  ],
  "description": "Percentage of patient visits for patients aged 18 years and older seen during the measurement period who were screened for high blood pressure AND a recommended follow-up plan is documented, as indicated, if blood pressure is elevated or hypertensive",
  "usage": "This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 18 years and older during the measurement period. This measure should be reported for every visit. The measure requires that blood pressure measurements (i.e., diastolic and systolic) be obtained during each visit in order to determine the blood pressure reading used to evaluate if an intervention is needed. \n\nBoth the systolic and diastolic blood pressure measurements are required for inclusion. If there are multiple blood pressures obtained during a patient visit, only the last, or most recent, pressure measurement will be used to evaluate the measure requirements.\n\nThe intent of this measure is to screen patients for high blood pressure and provide recommended follow-up as indicated. The documented follow-up plan must be related to the current blood pressure reading as indicated, example: \"Patient referred to primary care provider for BP management.\"\n\nTelehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.  \n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS22v12.  \nPlease refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).",
  "copyright": "This electronic clinical quality measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract # 75FCMC18D0027/ Task Order #: 75FCMC24F0144) with the American Institutes for Research (AIR) to develop this electronic measure. AIR is not responsible for any use of the Measure. AIR makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and AIR has no liability to anyone who relies on such measures or specifications.\n\nLimited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. AIR disclaims all liability for use or accuracy of any third-party codes contained in the specifications.\n\nCPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association. LOINC(R) is copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2024 World Health Organization. All Rights Reserved.",
  "approvalDate": "2023-08-30",
  "lastReviewDate": "2023-08-30",
  "effectivePeriod": {
    "start": "2026-01-01",
    "end": "2026-12-31"
  },
  "author": [
    {
      "name": "American Institutes for Research (AIR)",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.air.org"
        }
      ]
    }
  ],
  "library": [
    "https://madie.cms.gov/Library/CMS22FHIRPCSBPScreeningFollowUp"
  ],
  "disclaimer": "These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.\n\nTHE MEASURES AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.\n\nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
  "rationale": "Hypertension is a prevalent condition that affects approximately 66.9 million people in the United States. It is estimated that about 20-40% of the adult population has hypertension; the majority of people over age 65 have a hypertension diagnosis (Appleton et al., 2013 and Luehr et al., 2012). Winter (2013) noted that 1 in 3 American adults have hypertension and the lifetime risk of developing hypertension is 90%. The African American population or non-Hispanic Blacks, the elderly, diabetics and those with chronic kidney disease are at increased risk of stroke, myocardial infarction and renal disease. Non-Hispanic Blacks have the highest prevalence at 38.6% (Winter et al., 2013). Hypertension is a major risk factor for ischemic heart disease, left ventricular hypertrophy, renal failure, stroke and dementia (Luehr et al., 2012). Prevention of hypertension and the treatment of established hypertension are complementary approaches to reducing cardiovascular disease risk in the population, but prevention of hypertension provides the optimal means of reducing risk and avoiding harmful consequences. Periodic blood pressure (BP) screening can identify individuals who develop elevated BP over time. More frequent BP screening may be particularly important for individuals with elevated atherosclerotic cardiovascular disease (ASCVD) risk (Whelton et al., 2018).  \n\nHypertension is the most common reason for adult office visits other than pregnancy. Garrison (2013) stated that in 2007, 42 million ambulatory visits were attributed to hypertension (Garrison & Oberhelman, 2013). It also has the highest utilization of prescription drugs. Numerous resources and treatment options are available, yet only about 40-50% of the hypertensive patients have their blood pressure under control (<140/90) (Appleton et al., 2013 and Luehr et al., 2012). In addition to medication non-compliance, poor outcomes are also attributed to poor adherence to lifestyle changes such as a low-sodium diet, weight loss, increased exercise and limiting alcohol intake. Many adults find it difficult to continue medications and lifestyle changes when they are asymptomatic. Symptoms of elevated blood pressure usually do not occur until secondary problems arise such as with vascular diseases (myocardial infarction, stroke, heart failure and renal insufficiency) (Luehr et al., 2012).\n\nAppropriate follow-up after blood pressure measurement is a pivotal component in preventing the progression of hypertension and the development of heart disease. Detection of marginally or fully elevated blood pressure by a specialty clinician warrants referral to a provider familiar with the management of hypertension and prehypertension. \n\nThe American College of Cardiology/American Heart Association (ACC/AHA) 2017 Guidelines provide updated recommendations for ASCVD risk. For additional information please refer to the 2017 ACC/AHA guidelines: https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/11/09/11/41/2017-guideline-for-high-blood-pressure-in-adults.\n\nLifestyle modifications have demonstrated effectiveness in lowering blood pressure (U.S. Department of Health and Human Services, 2003). The synergistic effect of several lifestyle modifications results in greater benefits than a single modification alone. Baseline diagnostic/laboratory testing establishes if a co-existing underlying condition is the etiology of hypertension and evaluates if end organ damage from hypertension has already occurred. Landmark trials such as the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) have repeatedly proven the efficacy of pharmacologic therapy to control blood pressure and reduce the complications of hypertension. A review of 35 studies found that the pharmacist-led interventions involved medication counseling and patient education. Twenty-nine of the 35 studies showed statistically significant improvement in BP levels of the intervention groups at follow-up (Reeves et al., 2020). Follow-up intervals based on blood pressure control have been established by the 2017 ACC/AHA guideline and the United States Preventive Services Task Force (Whelton et al., 2018; USPSTF, 2021).",
  "clinicalRecommendationStatement": "The U.S. Preventive Services Task Force (USPSTF, 2021) recommends screening for high blood pressure in adults aged 18 years and older. This is a grade A recommendation.",
  "guidance": "This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 18 years and older during the measurement period. This measure should be reported for every visit. The measure requires that blood pressure measurements (i.e., diastolic and systolic) be obtained during each visit in order to determine the blood pressure reading used to evaluate if an intervention is needed. \n\nBoth the systolic and diastolic blood pressure measurements are required for inclusion. If there are multiple blood pressures obtained during a patient visit, only the last, or most recent, pressure measurement will be used to evaluate the measure requirements.\n\nThe intent of this measure is to screen patients for high blood pressure and provide recommended follow-up as indicated. The documented follow-up plan must be related to the current blood pressure reading as indicated, example: \"Patient referred to primary care provider for BP management.\"\n\nTelehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.  \n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS22v12.  \nPlease refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).",
  "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": "decrease",
                "display": "increase"
              }
            ]
          }
        }
      ],
      "description": "Percentage of patient visits for patients aged 18 years and older seen during the measurement period who were screened for high blood pressure AND a recommended follow-up plan is documented, as indicated, if blood pressure is elevated or hypertensive",
      "population": [
        {
          "id": "InitialPopulation_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "All patient visits for patients aged 18 years and older at the beginning of the measurement period",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "Denominator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator",
                "display": "Denominator"
              }
            ]
          },
          "description": "Equals Initial Population",
          "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": "Patient has an active diagnosis of hypertension",
          "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": "Patient visits where patients were screened for high blood pressure AND have a recommended follow-up plan documented, as indicated, if the blood pressure is elevated or hypertensive",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        },
        {
          "id": "DenominatorException_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator-exception",
                "display": "Denominator Exception"
              }
            ]
          },
          "description": "Documentation of medical reason(s) for not screening for high blood pressure (e.g., patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient's health status).\n\nDocumentation of patient reason(s) for not screening for blood pressure measurements or for not ordering an appropriate follow-up intervention if patient BP is elevated or hypertensive (e.g., patient refuses).",
          "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"
      }
    }
  ]
}