FHIR IG Statistics: Measure/CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement

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define "Initial Population":
  "Has Qualifying Encounter"
    and exists ( "Total Hip Arthroplasty Procedure" )
    and AgeInYearsAt(date from start of "Measurement Period") >= 19

define "Initial Population":
  "Has Qualifying Encounter"
    and exists ( "Total Hip Arthroplasty Procedure" )
    and AgeInYearsAt(date from start of "Measurement Period") >= 19

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or "Has Severe Cognitive Impairment"
    or "Has Total Hip Arthroplasty with 1 or More Lower Body Fractures"
    or "Has Partial Hip Arthroplasty Procedure"
    or "Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure"
    or "Has Malignant Neoplasm of Lower and Unspecified Limbs"
    or "Has Mechanical Complication"
    or "Has More Than One Elective Primary Total Hip Arthroplasty Performed"
    or "Death Within 300 Days of the THA Procedure"

define "Numerator":
  ( "Has THA with Initial and Follow Up HOOS Assessments" )
    or ( "Has THA with Initial and Follow Up HOOSJr Assessments" )
    or ( "Has THA with Initial and Follow Up PROMIS10 Assessments" )
    or ( "Has THA with Initial and Follow Up VR12 Oblique Assessments" )
    or ( "Has THA with Initial and Follow Up VR12 Orthogonal Assessments" )

define "Has Hospice Services":
  exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter
      where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
          or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
      )
        and InpatientEncounter.period.toInterval() ends during day of "Measurement Period"
  )
    or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter
        where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period"
    )
    or exists ((([ObservationScreeningAssessment: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment
        where HospiceAssessment.value ~ "Yes (qualifier value)"
          and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"
    )
    or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder
        where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period"
    )
    or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed
        where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"
    )
    or exists ((([ConditionProblemsHealthConcerns: "Hospice Diagnosis"])
        union ([ConditionEncounterDiagnosis: "Hospice Diagnosis"])) HospiceCareDiagnosis
        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
    )

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 "November 1 Two Years Prior to the Measurement Period":
  DateTime((year from start of "Measurement Period" - 2), 11, 1, 0, 0, 0, 0, 0)

define "October 31 Year Prior to the Measurement Period":
  DateTime((year from start of "Measurement Period" - 1), 10, 31, 23, 59, 59, 0, 0)

define "Total Hip Arthroplasty Procedure":
  ( ( [Procedure: "Primary THA Procedure"] ).isProcedurePerformed ( ) ) THAProcedure
    where THAProcedure.performed.toInterval ( ) starts during day of Interval["November 1 Two Years Prior to the Measurement Period", "October 31 Year Prior to the Measurement Period"]

define "Date HOOS Total Assessment Completed":
  from
    ( ( [ObservationScreeningAssessment: "Quality of life score [HOOS]"] ).isAssessmentPerformed ( ) ) HOOSLifeQuality,
    ( ( [ObservationScreeningAssessment: "Sport-recreation score [HOOS]"] ).isAssessmentPerformed ( ) ) HOOSSport,
    ( ( [ObservationScreeningAssessment: "Activities of daily living score [HOOS]"] ).isAssessmentPerformed ( ) ) HOOSActivityScore,
    ( ( [ObservationScreeningAssessment: "Symptoms score [HOOS]"] ).isAssessmentPerformed ( ) ) HOOSSymptoms,
    ( ( [ObservationScreeningAssessment: "Pain score [HOOS]"] ).isAssessmentPerformed ( ) ) HOOSPain
    let HOOSLifeQualityDate: date from start of HOOSLifeQuality.effective.toInterval ( ),
    HOOSSportDate: date from start of HOOSSport.effective.toInterval ( ),
    HOOSActivityScoreDate: date from start of HOOSActivityScore.effective.toInterval ( ),
    HOOSSymptomsDate: date from start of HOOSSymptoms.effective.toInterval ( ),
    HOOSPainDate: date from start of HOOSPain.effective.toInterval ( )
    where HOOSLifeQualityDate same day as HOOSSportDate
      and ( HOOSSport as ObservationScreeningAssessment ).value is not null
      and HOOSLifeQualityDate same day as HOOSActivityScoreDate
      and ( HOOSActivityScore as ObservationScreeningAssessment ).value is not null
      and HOOSLifeQualityDate same day as HOOSSymptomsDate
      and ( HOOSSymptoms as ObservationScreeningAssessment ).value is not null
      and HOOSLifeQualityDate same day as HOOSPainDate
      and ( HOOSPain as ObservationScreeningAssessment ).value is not null
      and ( HOOSLifeQuality as ObservationScreeningAssessment ).value is not null
    return Max({ HOOSLifeQualityDate, HOOSSportDate, HOOSActivityScoreDate, HOOSSymptomsDate, HOOSPainDate })

define "Has THA with Initial and Follow Up HOOS Assessments":
  exists ( ( "Total Hip Arthroplasty Procedure" THAProcedure
      return THAProcedure.performed.toInterval ( ) ) TotalHip
      with "Date HOOS Total Assessment Completed" InitialHipAssessmentHOOS
        such that TotalHip starts 90 days or less on or after day of InitialHipAssessmentHOOS
      with "Date HOOS Total Assessment Completed" FollowUpHipAssessmentHOOS
        such that date from FollowUpHipAssessmentHOOS during day of Interval[date from end of TotalHip + 300 days, date from end of TotalHip + 425 days]
  )

define "Date HOOSJr Total Assessment Completed":
  ( ( ( [ObservationScreeningAssessment: "Total interval score [HOOSJR]"] ).isAssessmentPerformed ( ) ) HOOSJr
    where ( HOOSJr as ObservationScreeningAssessment ).value is not null ) DocumentedHOOSJr
    return date from start of DocumentedHOOSJr.effective.toInterval ( )

define "Has THA with Initial and Follow Up HOOSJr Assessments":
  exists ( ( "Total Hip Arthroplasty Procedure" THAProcedure
      return THAProcedure.performed.toInterval ( ) ) TotalHip
      with "Date HOOSJr Total Assessment Completed" InitialHipAssessment
        such that TotalHip starts 90 days or less on or after day of InitialHipAssessment
      with "Date HOOSJr Total Assessment Completed" FollowUpHipAssessment
        such that date from FollowUpHipAssessment during day of Interval[date from end of TotalHip + 300 days, date from end of TotalHip + 425 days]
  )

define "Date PROMIS10 Total Assessment Completed":
  from
    ( ( [ObservationScreeningAssessment: "PROMIS-10 Global Mental Health (GMH) score T-score"] ).isAssessmentPerformed ( ) ) PROMIS10MentalScore,
    ( ( [ObservationScreeningAssessment: "PROMIS-10 Global Physical Health (GPH) score T-score"] ).isAssessmentPerformed ( ) ) PROMIS10PhysicalScore
    let PROMIS10MentalScoreDate: date from start of PROMIS10MentalScore.effective.toInterval ( ),
    PROMIS10PhysicalScoreDate: date from start of PROMIS10PhysicalScore.effective.toInterval ( )
    where PROMIS10MentalScoreDate same day as PROMIS10PhysicalScoreDate
      and ( PROMIS10PhysicalScore as ObservationScreeningAssessment ).value is not null
      and ( PROMIS10MentalScore as ObservationScreeningAssessment ).value is not null
    return Max({ PROMIS10MentalScoreDate, PROMIS10PhysicalScoreDate })

define "Has THA with Initial and Follow Up PROMIS10 Assessments":
  exists ( ( "Total Hip Arthroplasty Procedure" THAProcedure
      return THAProcedure.performed.toInterval ( ) ) TotalHip
      with "Date PROMIS10 Total Assessment Completed" InitialHipAssessmentPROMIS10
        such that TotalHip starts 90 days or less on or after day of InitialHipAssessmentPROMIS10
      with "Date PROMIS10 Total Assessment Completed" FollowUpHipAssessmentPROMIS10
        such that date from FollowUpHipAssessmentPROMIS10 during day of Interval[date from end of TotalHip + 300 days, date from end of TotalHip + 425 days]
  )

define "Date VR12 Oblique Total Assessment Completed":
  from
    ( ( [ObservationScreeningAssessment: "VR-12 Mental component summary (MCS) score - oblique method T-score"] ).isAssessmentPerformed ( ) ) VR12MentalAssessment,
    ( ( [ObservationScreeningAssessment: "VR-12 Physical component summary (PCS) score - oblique method T-score"] ).isAssessmentPerformed ( ) ) VR12PhysicalAssessment
    let VR12MentalAssessmentDate: date from start of VR12MentalAssessment.effective.toInterval ( ),
    VR12PhysicalAssessmentDate: date from start of VR12PhysicalAssessment.effective.toInterval ( )
    where VR12MentalAssessmentDate same day as VR12PhysicalAssessmentDate
      and ( VR12MentalAssessment as ObservationScreeningAssessment ).value is not null
      and ( VR12PhysicalAssessment as ObservationScreeningAssessment ).value is not null
    return Max({ VR12MentalAssessmentDate, VR12PhysicalAssessmentDate })

define "Has THA with Initial and Follow Up VR12 Oblique Assessments":
  exists ( ( "Total Hip Arthroplasty Procedure" THAProcedure
      return THAProcedure.performed.toInterval ( ) ) TotalHip
      with "Date VR12 Oblique Total Assessment Completed" InitialHipAssessmentOblique
        such that TotalHip starts 90 days or less on or after day of InitialHipAssessmentOblique
      with "Date VR12 Oblique Total Assessment Completed" FollowUpHipAssessmentOblique
        such that date from FollowUpHipAssessmentOblique during day of Interval[date from end of TotalHip + 300 days, date from end of TotalHip + 425 days]
  )

define "Date VR12 Orthogonal Total Assessment Completed":
  from
    ( ( [ObservationScreeningAssessment: "VR-12 Mental component summary (MCS) score - orthogonal method T-score"] ).isAssessmentPerformed ( ) ) VR12MentalAssessment,
    ( ( [ObservationScreeningAssessment: "VR-12 Physical component summary (PCS) score - orthogonal method T-score"] ).isAssessmentPerformed ( ) ) VR12PhysicalAssessment
    let VR12MentalAssessmentDate: date from start of VR12MentalAssessment.effective.toInterval ( ),
    VR12PhysicalAssessmentDate: date from start of VR12PhysicalAssessment.effective.toInterval ( )
    where VR12MentalAssessmentDate same day as VR12PhysicalAssessmentDate
      and ( VR12MentalAssessment as ObservationScreeningAssessment ).value is not null
      and ( VR12PhysicalAssessment as ObservationScreeningAssessment ).value is not null
    return Max({ VR12MentalAssessmentDate, VR12PhysicalAssessmentDate })

define "Has THA with Initial and Follow Up VR12 Orthogonal Assessments":
  exists ( ( "Total Hip Arthroplasty Procedure" THAProcedure
      return THAProcedure.performed.toInterval ( ) ) TotalHip
      with "Date VR12 Orthogonal Total Assessment Completed" InitialHipAssessmentOrthogonal
        such that TotalHip starts 90 days or less on or after day of InitialHipAssessmentOrthogonal
      with "Date VR12 Orthogonal Total Assessment Completed" FollowUpHipAssessmentOrthogonal
        such that date from FollowUpHipAssessmentOrthogonal during day of Interval[date from end of TotalHip + 300 days, date from end of TotalHip + 425 days]
  )

define "Numerator":
  ( "Has THA with Initial and Follow Up HOOS Assessments" )
    or ( "Has THA with Initial and Follow Up HOOSJr Assessments" )
    or ( "Has THA with Initial and Follow Up PROMIS10 Assessments" )
    or ( "Has THA with Initial and Follow Up VR12 Oblique Assessments" )
    or ( "Has THA with Initial and Follow Up VR12 Orthogonal Assessments" )

define "August 1 Year Prior to the Measurement Period":
  DateTime((year from start of "Measurement Period" - 1), 8, 1, 0, 0, 0, 0, 0)

define "Has Qualifying Encounter":
  exists ( ( ( [Encounter: type in "Outpatient Consultation"]
        union [Encounter: type in "Office Visit"]
        union ( [Encounter] E
            where exists ( ( E.type ) T
                where T ~ "Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure"
            )
        )
        union [Encounter: type in "Telephone Visits"]
        union [Encounter: type in "Virtual Encounter"]
    ).isEncounterPerformed ( ) ) ValidEncounters
      where ValidEncounters.period.toInterval ( ) during day of Interval["August 1 Year Prior to the Measurement Period", end of "Measurement Period"]
  )

define "Initial Population":
  "Has Qualifying Encounter"
    and exists ( "Total Hip Arthroplasty Procedure" )
    and AgeInYearsAt(date from start of "Measurement Period") >= 19

define "Denominator":
  "Initial Population"

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

define "Initial Population":
  "Has Qualifying Encounter"
    and exists ( "Total Hip Arthroplasty Procedure" )
    and AgeInYearsAt(date from start of "Measurement Period") >= 19

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

define "Has Severe Cognitive Impairment":
  exists ( [ConditionProblemsHealthConcerns: "Severe cognitive impairment (finding)"]
    union [ConditionEncounterDiagnosis: "Severe cognitive impairment (finding)"] ) Dementia
    where Dementia.prevalenceInterval ( ) overlaps day of "Measurement Period"

define "Has Total Hip Arthroplasty with 1 or More Lower Body Fractures":
  exists ( "Total Hip Arthroplasty Procedure" THAProcedure
      with ( [ConditionEncounterDiagnosis: "Lower Body Fractures Excluding Ankle and Foot"]
        union [ConditionProblemsHealthConcerns: "Lower Body Fractures Excluding Ankle and Foot"] ) LowerBodyFracture
        such that LowerBodyFracture.prevalenceInterval ( ) starts 48 hours or less on or before start of THAProcedure.performed.toInterval ( )
  )

define "Has Partial Hip Arthroplasty Procedure":
  exists ( ( ( [Procedure: "Partial Arthroplasty of Hip"] ).isProcedurePerformed ( ) ) PartialTHAProcedure
      with "Total Hip Arthroplasty Procedure" THAProcedure
        such that PartialTHAProcedure.performed.toInterval ( ) during day of THAProcedure.performed.toInterval ( )
  )

define "Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure":
  exists ( "Total Hip Arthroplasty Procedure" THAProcedure
      with ( ( [Procedure: "Removal, Revision and Supplement Procedures of the Lower Body and Spine"] ).isProcedurePerformed ( ) ) RevisionTHAProcedure
        such that RevisionTHAProcedure.performed.toInterval ( ) during day of THAProcedure.performed.toInterval ( )
  )

define "Has Malignant Neoplasm of Lower and Unspecified Limbs":
  exists ( ( [ConditionProblemsHealthConcerns: "Malignant Neoplasms of Lower and Unspecified Limbs"]
      union [ConditionEncounterDiagnosis: "Malignant Neoplasms of Lower and Unspecified Limbs"] ) MalignantNeoplasm
      with "Total Hip Arthroplasty Procedure" THAProcedure
        such that MalignantNeoplasm.prevalenceInterval ( ) overlaps day of THAProcedure.performed.toInterval ( )
  )

define "Has Mechanical Complication":
  exists ( ( [ConditionEncounterDiagnosis: "Mechanical Complications Excluding Upper Body"]
      union [ConditionProblemsHealthConcerns: "Mechanical Complications Excluding Upper Body"] ) MechanicalComplications
      with "Total Hip Arthroplasty Procedure" THAProcedure
        such that MechanicalComplications.prevalenceInterval ( ) overlaps day of THAProcedure.performed.toInterval ( )
  )

define "Has More Than One Elective Primary Total Hip Arthroplasty Performed":
  exists ( "Total Hip Arthroplasty Procedure" THAProcedure
      with ( ( [Procedure: "Primary THA Procedure"] ).isProcedurePerformed ( ) ) ElectiveTHAProcedure
        such that THAProcedure.id !~ ElectiveTHAProcedure.id
          and start of ElectiveTHAProcedure.performed.toInterval ( ) during day of Interval[( start of THAProcedure.performed.toInterval ( ) ) - 1 year, ( start of THAProcedure.performed.toInterval ( ) ) + 1 year]
  )

define "Death Within 300 Days of the THA Procedure":
  exists "Total Hip Arthroplasty Procedure" THAProcedure
    where date from Patient.deceased during day of Interval[date from start of THAProcedure.performed.toInterval ( ), date from start of THAProcedure.performed.toInterval ( ) + 300 days]

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or "Has Severe Cognitive Impairment"
    or "Has Total Hip Arthroplasty with 1 or More Lower Body Fractures"
    or "Has Partial Hip Arthroplasty Procedure"
    or "Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure"
    or "Has Malignant Neoplasm of Lower and Unspecified Limbs"
    or "Has Mechanical Complication"
    or "Has More Than One Elective Primary Total Hip Arthroplasty Performed"
    or "Death Within 300 Days of the THA Procedure"

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

/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
  case
	  when choice is DateTime then
    	Interval[choice as DateTime, choice as DateTime]
		when choice is Interval<DateTime> then
  		choice as Interval<DateTime>
		when choice is Quantity then
		  Interval[Patient.birthDate + (choice as Quantity),
			  Patient.birthDate + (choice as Quantity) + 1 year)
		when choice is Interval<Quantity> then
		  Interval[Patient.birthDate + (choice.low as Quantity),
			  Patient.birthDate + (choice.high as Quantity) + 1 year)
		when choice is Timing then
      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
		else
			null as Interval<DateTime>
	end

define function ToString(value uri): value.value

/*
@description: Converts the given 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: 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]

//Procedure, Performed
define fluent function isProcedurePerformed(Proc List<Procedure>):
  Proc P
    where P.status ~ 'completed'

//This library contains functions used to constrain FHIR resource elements for measures authored by NCQA, based on QICore 6.0.0 resources including IG and authoring patterns. The functions may appear similar to some QICoreCommon functions but differ in that they have constraints that are relevant for measures authored by NCQA.

//Assessment, Performed
define fluent function isAssessmentPerformed(Obs List<ObservationScreeningAssessment>):
  Obs O
    where O.status in { 'final', 'amended', 'corrected' }

//Encounter, Performed
//General usage unless required otherwise by measure intent (e.g., follow-up encounters)
define fluent function isEncounterPerformed(Enc List<Encounter>):
  Enc E
    where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}

//Intervention, Order
define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):
  ServiceRequest S
    where S.status in { 'active', 'completed' }
      and S.intent = 'order'

//Intervention, Performed
define fluent function isInterventionPerformed(Proc List<Procedure>):
  Proc P
    where P.status ~ 'completed'

Source

{
  "resourceType": "Measure",
  "id": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement",
  "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://loinc.org",
            "code": "72093-8",
            "display": "Quality of life score [HOOS]"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "72094-6",
            "display": "Sport-recreation score [HOOS]"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "72095-3",
            "display": "Activities of daily living score [HOOS]"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "72096-1",
            "display": "Symptoms score [HOOS]"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "72097-9",
            "display": "Pain score [HOOS]"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "82323-7",
            "display": "Total interval score [HOOSJR]"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "71969-0",
            "display": "PROMIS-10 Global Mental Health (GMH) score T-score"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "71971-6",
            "display": "PROMIS-10 Global Physical Health (GPH) score T-score"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "72026-8",
            "display": "VR-12 Mental component summary (MCS) score - oblique method T-score"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "72025-0",
            "display": "VR-12 Physical component summary (PCS) score - oblique method T-score"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "72028-4",
            "display": "VR-12 Mental component summary (MCS) score - orthogonal method T-score"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "72027-6",
            "display": "VR-12 Physical component summary (PCS) score - orthogonal method T-score"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://www.ama-assn.org/go/cpt",
            "code": "99024",
            "display": "Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "428361000124107",
            "display": "Discharge to home for hospice care (procedure)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "428371000124100",
            "display": "Discharge to healthcare facility for hospice care (procedure)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "45755-6",
            "display": "Hospice care [Minimum Data Set]"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "373066001",
            "display": "Yes (qualifier value)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "702956004",
            "display": "Severe cognitive impairment (finding)"
          }
        },
        {
          "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": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "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": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "November 1 Two Years Prior to the Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"November 1 Two Years Prior to the Measurement Period\":\n  DateTime((year from start of \"Measurement Period\" - 2), 11, 1, 0, 0, 0, 0, 0)"
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "October 31 Year Prior to the Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"October 31 Year Prior to the Measurement Period\":\n  DateTime((year from start of \"Measurement Period\" - 1), 10, 31, 23, 59, 59, 0, 0)"
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Total Hip Arthroplasty Procedure"
            },
            {
              "url": "statement",
              "valueString": "define \"Total Hip Arthroplasty Procedure\":\n  ( ( [Procedure: \"Primary THA Procedure\"] ).isProcedurePerformed ( ) ) THAProcedure\n    where THAProcedure.performed.toInterval ( ) starts during day of Interval[\"November 1 Two Years Prior to the Measurement Period\", \"October 31 Year Prior to the Measurement Period\"]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Date HOOS Total Assessment Completed"
            },
            {
              "url": "statement",
              "valueString": "define \"Date HOOS Total Assessment Completed\":\n  from\n    ( ( [ObservationScreeningAssessment: \"Quality of life score [HOOS]\"] ).isAssessmentPerformed ( ) ) HOOSLifeQuality,\n    ( ( [ObservationScreeningAssessment: \"Sport-recreation score [HOOS]\"] ).isAssessmentPerformed ( ) ) HOOSSport,\n    ( ( [ObservationScreeningAssessment: \"Activities of daily living score [HOOS]\"] ).isAssessmentPerformed ( ) ) HOOSActivityScore,\n    ( ( [ObservationScreeningAssessment: \"Symptoms score [HOOS]\"] ).isAssessmentPerformed ( ) ) HOOSSymptoms,\n    ( ( [ObservationScreeningAssessment: \"Pain score [HOOS]\"] ).isAssessmentPerformed ( ) ) HOOSPain\n    let HOOSLifeQualityDate: date from start of HOOSLifeQuality.effective.toInterval ( ),\n    HOOSSportDate: date from start of HOOSSport.effective.toInterval ( ),\n    HOOSActivityScoreDate: date from start of HOOSActivityScore.effective.toInterval ( ),\n    HOOSSymptomsDate: date from start of HOOSSymptoms.effective.toInterval ( ),\n    HOOSPainDate: date from start of HOOSPain.effective.toInterval ( )\n    where HOOSLifeQualityDate same day as HOOSSportDate\n      and ( HOOSSport as ObservationScreeningAssessment ).value is not null\n      and HOOSLifeQualityDate same day as HOOSActivityScoreDate\n      and ( HOOSActivityScore as ObservationScreeningAssessment ).value is not null\n      and HOOSLifeQualityDate same day as HOOSSymptomsDate\n      and ( HOOSSymptoms as ObservationScreeningAssessment ).value is not null\n      and HOOSLifeQualityDate same day as HOOSPainDate\n      and ( HOOSPain as ObservationScreeningAssessment ).value is not null\n      and ( HOOSLifeQuality as ObservationScreeningAssessment ).value is not null\n    return Max({ HOOSLifeQualityDate, HOOSSportDate, HOOSActivityScoreDate, HOOSSymptomsDate, HOOSPainDate })"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Has THA with Initial and Follow Up HOOS Assessments"
            },
            {
              "url": "statement",
              "valueString": "define \"Has THA with Initial and Follow Up HOOS Assessments\":\n  exists ( ( \"Total Hip Arthroplasty Procedure\" THAProcedure\n      return THAProcedure.performed.toInterval ( ) ) TotalHip\n      with \"Date HOOS Total Assessment Completed\" InitialHipAssessmentHOOS\n        such that TotalHip starts 90 days or less on or after day of InitialHipAssessmentHOOS\n      with \"Date HOOS Total Assessment Completed\" FollowUpHipAssessmentHOOS\n        such that date from FollowUpHipAssessmentHOOS during day of Interval[date from end of TotalHip + 300 days, date from end of TotalHip + 425 days]\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Date HOOSJr Total Assessment Completed"
            },
            {
              "url": "statement",
              "valueString": "define \"Date HOOSJr Total Assessment Completed\":\n  ( ( ( [ObservationScreeningAssessment: \"Total interval score [HOOSJR]\"] ).isAssessmentPerformed ( ) ) HOOSJr\n    where ( HOOSJr as ObservationScreeningAssessment ).value is not null ) DocumentedHOOSJr\n    return date from start of DocumentedHOOSJr.effective.toInterval ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Has THA with Initial and Follow Up HOOSJr Assessments"
            },
            {
              "url": "statement",
              "valueString": "define \"Has THA with Initial and Follow Up HOOSJr Assessments\":\n  exists ( ( \"Total Hip Arthroplasty Procedure\" THAProcedure\n      return THAProcedure.performed.toInterval ( ) ) TotalHip\n      with \"Date HOOSJr Total Assessment Completed\" InitialHipAssessment\n        such that TotalHip starts 90 days or less on or after day of InitialHipAssessment\n      with \"Date HOOSJr Total Assessment Completed\" FollowUpHipAssessment\n        such that date from FollowUpHipAssessment during day of Interval[date from end of TotalHip + 300 days, date from end of TotalHip + 425 days]\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Date PROMIS10 Total Assessment Completed"
            },
            {
              "url": "statement",
              "valueString": "define \"Date PROMIS10 Total Assessment Completed\":\n  from\n    ( ( [ObservationScreeningAssessment: \"PROMIS-10 Global Mental Health (GMH) score T-score\"] ).isAssessmentPerformed ( ) ) PROMIS10MentalScore,\n    ( ( [ObservationScreeningAssessment: \"PROMIS-10 Global Physical Health (GPH) score T-score\"] ).isAssessmentPerformed ( ) ) PROMIS10PhysicalScore\n    let PROMIS10MentalScoreDate: date from start of PROMIS10MentalScore.effective.toInterval ( ),\n    PROMIS10PhysicalScoreDate: date from start of PROMIS10PhysicalScore.effective.toInterval ( )\n    where PROMIS10MentalScoreDate same day as PROMIS10PhysicalScoreDate\n      and ( PROMIS10PhysicalScore as ObservationScreeningAssessment ).value is not null\n      and ( PROMIS10MentalScore as ObservationScreeningAssessment ).value is not null\n    return Max({ PROMIS10MentalScoreDate, PROMIS10PhysicalScoreDate })"
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Has THA with Initial and Follow Up PROMIS10 Assessments"
            },
            {
              "url": "statement",
              "valueString": "define \"Has THA with Initial and Follow Up PROMIS10 Assessments\":\n  exists ( ( \"Total Hip Arthroplasty Procedure\" THAProcedure\n      return THAProcedure.performed.toInterval ( ) ) TotalHip\n      with \"Date PROMIS10 Total Assessment Completed\" InitialHipAssessmentPROMIS10\n        such that TotalHip starts 90 days or less on or after day of InitialHipAssessmentPROMIS10\n      with \"Date PROMIS10 Total Assessment Completed\" FollowUpHipAssessmentPROMIS10\n        such that date from FollowUpHipAssessmentPROMIS10 during day of Interval[date from end of TotalHip + 300 days, date from end of TotalHip + 425 days]\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Date VR12 Oblique Total Assessment Completed"
            },
            {
              "url": "statement",
              "valueString": "define \"Date VR12 Oblique Total Assessment Completed\":\n  from\n    ( ( [ObservationScreeningAssessment: \"VR-12 Mental component summary (MCS) score - oblique method T-score\"] ).isAssessmentPerformed ( ) ) VR12MentalAssessment,\n    ( ( [ObservationScreeningAssessment: \"VR-12 Physical component summary (PCS) score - oblique method T-score\"] ).isAssessmentPerformed ( ) ) VR12PhysicalAssessment\n    let VR12MentalAssessmentDate: date from start of VR12MentalAssessment.effective.toInterval ( ),\n    VR12PhysicalAssessmentDate: date from start of VR12PhysicalAssessment.effective.toInterval ( )\n    where VR12MentalAssessmentDate same day as VR12PhysicalAssessmentDate\n      and ( VR12MentalAssessment as ObservationScreeningAssessment ).value is not null\n      and ( VR12PhysicalAssessment as ObservationScreeningAssessment ).value is not null\n    return Max({ VR12MentalAssessmentDate, VR12PhysicalAssessmentDate })"
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Has THA with Initial and Follow Up VR12 Oblique Assessments"
            },
            {
              "url": "statement",
              "valueString": "define \"Has THA with Initial and Follow Up VR12 Oblique Assessments\":\n  exists ( ( \"Total Hip Arthroplasty Procedure\" THAProcedure\n      return THAProcedure.performed.toInterval ( ) ) TotalHip\n      with \"Date VR12 Oblique Total Assessment Completed\" InitialHipAssessmentOblique\n        such that TotalHip starts 90 days or less on or after day of InitialHipAssessmentOblique\n      with \"Date VR12 Oblique Total Assessment Completed\" FollowUpHipAssessmentOblique\n        such that date from FollowUpHipAssessmentOblique during day of Interval[date from end of TotalHip + 300 days, date from end of TotalHip + 425 days]\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Date VR12 Orthogonal Total Assessment Completed"
            },
            {
              "url": "statement",
              "valueString": "define \"Date VR12 Orthogonal Total Assessment Completed\":\n  from\n    ( ( [ObservationScreeningAssessment: \"VR-12 Mental component summary (MCS) score - orthogonal method T-score\"] ).isAssessmentPerformed ( ) ) VR12MentalAssessment,\n    ( ( [ObservationScreeningAssessment: \"VR-12 Physical component summary (PCS) score - orthogonal method T-score\"] ).isAssessmentPerformed ( ) ) VR12PhysicalAssessment\n    let VR12MentalAssessmentDate: date from start of VR12MentalAssessment.effective.toInterval ( ),\n    VR12PhysicalAssessmentDate: date from start of VR12PhysicalAssessment.effective.toInterval ( )\n    where VR12MentalAssessmentDate same day as VR12PhysicalAssessmentDate\n      and ( VR12MentalAssessment as ObservationScreeningAssessment ).value is not null\n      and ( VR12PhysicalAssessment as ObservationScreeningAssessment ).value is not null\n    return Max({ VR12MentalAssessmentDate, VR12PhysicalAssessmentDate })"
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Has THA with Initial and Follow Up VR12 Orthogonal Assessments"
            },
            {
              "url": "statement",
              "valueString": "define \"Has THA with Initial and Follow Up VR12 Orthogonal Assessments\":\n  exists ( ( \"Total Hip Arthroplasty Procedure\" THAProcedure\n      return THAProcedure.performed.toInterval ( ) ) TotalHip\n      with \"Date VR12 Orthogonal Total Assessment Completed\" InitialHipAssessmentOrthogonal\n        such that TotalHip starts 90 days or less on or after day of InitialHipAssessmentOrthogonal\n      with \"Date VR12 Orthogonal Total Assessment Completed\" FollowUpHipAssessmentOrthogonal\n        such that date from FollowUpHipAssessmentOrthogonal during day of Interval[date from end of TotalHip + 300 days, date from end of TotalHip + 425 days]\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n  ( \"Has THA with Initial and Follow Up HOOS Assessments\" )\n    or ( \"Has THA with Initial and Follow Up HOOSJr Assessments\" )\n    or ( \"Has THA with Initial and Follow Up PROMIS10 Assessments\" )\n    or ( \"Has THA with Initial and Follow Up VR12 Oblique Assessments\" )\n    or ( \"Has THA with Initial and Follow Up VR12 Orthogonal Assessments\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "August 1 Year Prior to the Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"August 1 Year Prior to the Measurement Period\":\n  DateTime((year from start of \"Measurement Period\" - 1), 8, 1, 0, 0, 0, 0, 0)"
            },
            {
              "url": "displaySequence",
              "valueInteger": 16
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Has Qualifying Encounter"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Qualifying Encounter\":\n  exists ( ( ( [Encounter: type in \"Outpatient Consultation\"]\n        union [Encounter: type in \"Office Visit\"]\n        union ( [Encounter] E\n            where exists ( ( E.type ) T\n                where T ~ \"Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure\"\n            )\n        )\n        union [Encounter: type in \"Telephone Visits\"]\n        union [Encounter: type in \"Virtual Encounter\"]\n    ).isEncounterPerformed ( ) ) ValidEncounters\n      where ValidEncounters.period.toInterval ( ) during day of Interval[\"August 1 Year Prior to the Measurement Period\", end of \"Measurement Period\"]\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  \"Has Qualifying Encounter\"\n    and exists ( \"Total Hip Arthroplasty Procedure\" )\n    and AgeInYearsAt(date from start of \"Measurement Period\") >= 19"
            },
            {
              "url": "displaySequence",
              "valueInteger": 18
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n  \"Initial Population\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 19
            }
          ],
          "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": 20
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "SDE Payer Type"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer Type\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 21
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  \"Has Qualifying Encounter\"\n    and exists ( \"Total Hip Arthroplasty Procedure\" )\n    and AgeInYearsAt(date from start of \"Measurement Period\") >= 19"
            },
            {
              "url": "displaySequence",
              "valueInteger": 22
            }
          ],
          "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": 23
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 24
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "Hospice"
            },
            {
              "url": "name",
              "valueString": "Has Hospice Services"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Hospice Services\":\n  exists ((([Encounter: \"Encounter Inpatient\"]).isEncounterPerformed()) InpatientEncounter\n      where (InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n          or InpatientEncounter.hospitalization.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\"\n      )\n        and InpatientEncounter.period.toInterval() ends during day of \"Measurement Period\"\n  )\n    or exists ((([Encounter: \"Hospice Encounter\"]).isEncounterPerformed()) HospiceEncounter\n        where HospiceEncounter.period.toInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists ((([ObservationScreeningAssessment: \"Hospice care [Minimum Data Set]\"]).isAssessmentPerformed()) HospiceAssessment\n        where HospiceAssessment.value ~ \"Yes (qualifier value)\"\n          and HospiceAssessment.effective.toInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists ((([ServiceRequest: \"Hospice Care Ambulatory\"]).isInterventionOrder()) HospiceOrder\n        where HospiceOrder.authoredOn.toInterval() during day of \"Measurement Period\"\n    )\n    or exists ((([Procedure: \"Hospice Care Ambulatory\"]).isInterventionPerformed()) HospicePerformed\n        where HospicePerformed.performed.toInterval() overlaps day of \"Measurement Period\"\n    )\n    or exists ((([ConditionProblemsHealthConcerns: \"Hospice Diagnosis\"])\n        union ([ConditionEncounterDiagnosis: \"Hospice Diagnosis\"])) HospiceCareDiagnosis\n        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of \"Measurement Period\"\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 25
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Has Severe Cognitive Impairment"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Severe Cognitive Impairment\":\n  exists ( [ConditionProblemsHealthConcerns: \"Severe cognitive impairment (finding)\"]\n    union [ConditionEncounterDiagnosis: \"Severe cognitive impairment (finding)\"] ) Dementia\n    where Dementia.prevalenceInterval ( ) overlaps day of \"Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 26
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Has Total Hip Arthroplasty with 1 or More Lower Body Fractures"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Total Hip Arthroplasty with 1 or More Lower Body Fractures\":\n  exists ( \"Total Hip Arthroplasty Procedure\" THAProcedure\n      with ( [ConditionEncounterDiagnosis: \"Lower Body Fractures Excluding Ankle and Foot\"]\n        union [ConditionProblemsHealthConcerns: \"Lower Body Fractures Excluding Ankle and Foot\"] ) LowerBodyFracture\n        such that LowerBodyFracture.prevalenceInterval ( ) starts 48 hours or less on or before start of THAProcedure.performed.toInterval ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 27
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Has Partial Hip Arthroplasty Procedure"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Partial Hip Arthroplasty Procedure\":\n  exists ( ( ( [Procedure: \"Partial Arthroplasty of Hip\"] ).isProcedurePerformed ( ) ) PartialTHAProcedure\n      with \"Total Hip Arthroplasty Procedure\" THAProcedure\n        such that PartialTHAProcedure.performed.toInterval ( ) during day of THAProcedure.performed.toInterval ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 28
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure\":\n  exists ( \"Total Hip Arthroplasty Procedure\" THAProcedure\n      with ( ( [Procedure: \"Removal, Revision and Supplement Procedures of the Lower Body and Spine\"] ).isProcedurePerformed ( ) ) RevisionTHAProcedure\n        such that RevisionTHAProcedure.performed.toInterval ( ) during day of THAProcedure.performed.toInterval ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 29
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Has Malignant Neoplasm of Lower and Unspecified Limbs"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Malignant Neoplasm of Lower and Unspecified Limbs\":\n  exists ( ( [ConditionProblemsHealthConcerns: \"Malignant Neoplasms of Lower and Unspecified Limbs\"]\n      union [ConditionEncounterDiagnosis: \"Malignant Neoplasms of Lower and Unspecified Limbs\"] ) MalignantNeoplasm\n      with \"Total Hip Arthroplasty Procedure\" THAProcedure\n        such that MalignantNeoplasm.prevalenceInterval ( ) overlaps day of THAProcedure.performed.toInterval ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 30
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Has Mechanical Complication"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Mechanical Complication\":\n  exists ( ( [ConditionEncounterDiagnosis: \"Mechanical Complications Excluding Upper Body\"]\n      union [ConditionProblemsHealthConcerns: \"Mechanical Complications Excluding Upper Body\"] ) MechanicalComplications\n      with \"Total Hip Arthroplasty Procedure\" THAProcedure\n        such that MechanicalComplications.prevalenceInterval ( ) overlaps day of THAProcedure.performed.toInterval ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 31
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Has More Than One Elective Primary Total Hip Arthroplasty Performed"
            },
            {
              "url": "statement",
              "valueString": "define \"Has More Than One Elective Primary Total Hip Arthroplasty Performed\":\n  exists ( \"Total Hip Arthroplasty Procedure\" THAProcedure\n      with ( ( [Procedure: \"Primary THA Procedure\"] ).isProcedurePerformed ( ) ) ElectiveTHAProcedure\n        such that THAProcedure.id !~ ElectiveTHAProcedure.id\n          and start of ElectiveTHAProcedure.performed.toInterval ( ) during day of Interval[( start of THAProcedure.performed.toInterval ( ) ) - 1 year, ( start of THAProcedure.performed.toInterval ( ) ) + 1 year]\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 32
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Death Within 300 Days of the THA Procedure"
            },
            {
              "url": "statement",
              "valueString": "define \"Death Within 300 Days of the THA Procedure\":\n  exists \"Total Hip Arthroplasty Procedure\" THAProcedure\n    where date from Patient.deceased during day of Interval[date from start of THAProcedure.performed.toInterval ( ), date from start of THAProcedure.performed.toInterval ( ) + 300 days]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 33
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "Denominator Exclusions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exclusions\":\n  Hospice.\"Has Hospice Services\"\n    or \"Has Severe Cognitive Impairment\"\n    or \"Has Total Hip Arthroplasty with 1 or More Lower Body Fractures\"\n    or \"Has Partial Hip Arthroplasty Procedure\"\n    or \"Has Revision Hip Arthroplasty Procedure or Implanted Device or Prosthesis Removal Procedure\"\n    or \"Has Malignant Neoplasm of Lower and Unspecified Limbs\"\n    or \"Has Mechanical Complication\"\n    or \"Has More Than One Elective Primary Total Hip Arthroplasty Performed\"\n    or \"Death Within 300 Days of the THA Procedure\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 34
            }
          ],
          "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": 35
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 36
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value uri): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 37
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "Status"
            },
            {
              "url": "name",
              "valueString": "isProcedurePerformed"
            },
            {
              "url": "statement",
              "valueString": "//Procedure, Performed\ndefine fluent function isProcedurePerformed(Proc List<Procedure>):\n  Proc P\n    where P.status ~ 'completed'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 38
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "toInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in QICore, allowing this function to be used across any resource.\nThe input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.\nIf the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,\nand the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.\nIf the input is a DateTime Interval, the result is the input.\nIf the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result\nis a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending\nimmediately before one year later than the date the patient turned the age given as the end of the quantity interval.\nIf the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval\n*/\ndefine fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):\n  case\n\t  when choice is DateTime then\n    \tInterval[choice as DateTime, choice as DateTime]\n\t\twhen choice is Interval<DateTime> then\n  \t\tchoice as Interval<DateTime>\n\t\twhen choice is Quantity then\n\t\t  Interval[Patient.birthDate + (choice as Quantity),\n\t\t\t  Patient.birthDate + (choice as Quantity) + 1 year)\n\t\twhen choice is Interval<Quantity> then\n\t\t  Interval[Patient.birthDate + (choice.low as Quantity),\n\t\t\t  Patient.birthDate + (choice.high as Quantity) + 1 year)\n\t\twhen choice is Timing then\n      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>\n\t\telse\n\t\t\tnull as Interval<DateTime>\n\tend"
            },
            {
              "url": "displaySequence",
              "valueInteger": 39
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "Status"
            },
            {
              "url": "name",
              "valueString": "isAssessmentPerformed"
            },
            {
              "url": "statement",
              "valueString": "//This library contains functions used to constrain FHIR resource elements for measures authored by NCQA, based on QICore 6.0.0 resources including IG and authoring patterns. The functions may appear similar to some QICoreCommon functions but differ in that they have constraints that are relevant for measures authored by NCQA.\n\n//Assessment, Performed\ndefine fluent function isAssessmentPerformed(Obs List<ObservationScreeningAssessment>):\n  Obs O\n    where O.status in { 'final', 'amended', 'corrected' }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 40
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "Status"
            },
            {
              "url": "name",
              "valueString": "isEncounterPerformed"
            },
            {
              "url": "statement",
              "valueString": "//Encounter, Performed\n//General usage unless required otherwise by measure intent (e.g., follow-up encounters)\ndefine fluent function isEncounterPerformed(Enc List<Encounter>):\n  Enc E\n    where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}"
            },
            {
              "url": "displaySequence",
              "valueInteger": 41
            }
          ],
          "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": 42
            }
          ],
          "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": 43
            }
          ],
          "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": 44
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "Status"
            },
            {
              "url": "name",
              "valueString": "isInterventionOrder"
            },
            {
              "url": "statement",
              "valueString": "//Intervention, Order\ndefine fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):\n  ServiceRequest S\n    where S.status in { 'active', 'completed' }\n      and S.intent = 'order'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 45
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "Status"
            },
            {
              "url": "name",
              "valueString": "isInterventionPerformed"
            },
            {
              "url": "statement",
              "valueString": "//Intervention, Performed\ndefine fluent function isInterventionPerformed(Proc List<Procedure>):\n  Proc P\n    where P.status ~ 'completed'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 46
            }
          ],
          "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 Status",
          "resource": "Library/Status|1.13.000"
        },
        {
          "type": "depends-on",
          "display": "Library QICoreCommon",
          "resource": "Library/QICoreCommon|4.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library Hospice",
          "resource": "Library/Hospice|6.15.000"
        },
        {
          "type": "depends-on",
          "display": "Library Status",
          "resource": "Library/Status|1.13.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library QICoreCommon",
          "resource": "Library/QICoreCommon|4.0.000"
        },
        {
          "type": "depends-on",
          "display": "Code system SNOMEDCT",
          "resource": "http://snomed.info/sct"
        },
        {
          "type": "depends-on",
          "display": "Code system LOINC",
          "resource": "http://loinc.org"
        },
        {
          "type": "depends-on",
          "display": "Code system CPT",
          "resource": "http://www.ama-assn.org/go/cpt"
        },
        {
          "type": "depends-on",
          "display": "Code system SNOMEDCT",
          "resource": "http://snomed.info/sct"
        },
        {
          "type": "depends-on",
          "display": "Code system LOINC",
          "resource": "http://loinc.org"
        },
        {
          "type": "depends-on",
          "display": "Code system SNOMEDCT",
          "resource": "http://snomed.info/sct"
        },
        {
          "type": "depends-on",
          "display": "Value set Primary THA Procedure",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1006"
        },
        {
          "type": "depends-on",
          "display": "Value set Outpatient Consultation",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008"
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  ],
  "url": "https://madie.cms.gov/Measure/CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement",
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  "version": "1.1.000",
  "name": "CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement",
  "title": "Functional Status Assessment for Total Hip ReplacementFHIR",
  "status": "active",
  "experimental": false,
  "date": "2025-07-15T13:37:40+00:00",
  "publisher": "Centers for Medicare &amp; Medicaid Services (CMS)",
  "contact": [
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  ],
  "description": "Percentage of patients 19 years of age and older who received an elective primary total hip arthroplasty (THA) and completed a functional status assessment within 90 days prior to the surgery and in the 300 - 425 days after the surgery",
  "usage": "The same FSA instrument must be used for the initial and follow-up assessment.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",
  "copyright": "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) codes, descriptions and other data are copyright 2024. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use.\n\nThe measure specifications contain coding from LOINC(R) (http://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2024 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at http://loinc.org/terms-of-use.\n\nThis material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-20234 International Health Terminology Standards Development Organisation.\n\nICD-10 copyright 2024 World Health Organization. All Rights Reserved.\n\n“HL7” is the registered trademark of Health Level Seven International.",
  "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/CMS56FHIRFunctionalStatusAssessmentforTotalHipReplacement"
  ],
  "disclaimer": "The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE 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": "THAs are common surgical procedures that address hip pain and functional impairment, primarily caused by osteoarthritis. Although THA is an effective procedure for addressing osteoarthritis for many patients, some people, particularly those with more severe preoperative pain and impairment, do not experience the improvements in pain, function, and quality of life expected from the procedure (Beswick et al., 2012; Fortin et al., 1999; Tilbury et al., 2016). In 2010, providers performed 326,100 THAs, with 95 percent of them in patients age 45 and older (Wolford, Palso, & Bercovitz, 2015). Although THAs were introduced as a procedure for older adults, the percentage of patients age 55 to 64 (29 percent) who had a THA in 2010 exceeded the percentage of patients age 75 and older (26 percent) who had a THA (Wolford, Palso, & Bercovitz, 2015). Kurtz et al. (2009) projected that patients younger than 65 would account for 52 percent of THAs by 2030. This growth in hip surgeries for patients younger than 65 is significant because these patients often require more expensive joint arthroplasties that will better withstand the wear caused by physical activity (Bozic et al., 2006).\n\nThis measure evaluates whether patients complete a patient-reported functional status assessment (FSA) before and after a THA. Measuring functional status for patients undergoing THA permits longitudinal assessment - from the patient's perspective - of the impact of surgical intervention on pain, physical function, as well as health-related quality of life (Rothrock et al., 2010).",
  "clinicalRecommendationStatement": "While there is no clinical guideline recommending that clinicians assess patients who are undergoing total hip replacements using patient-reported outcomes of function and pain, several clinical specialty societies support the use of a general health questionnaire and a disease-specific questionnaire for these patients. In particular, they recommend the Veterans RAND 12-item health survey (VR-12) or the Patient-Reported Outcomes Measurement Information System [PROMIS]-10-Global as the general health questionnaire and the Hip Disability and Osteoarthritis Outcome Score [HOOS], Jr. as the disease-specific questionnaire (American Association of Orthopaedic Surgeons, the American Joint Replacement Registry, The Hip Society, The Knee Society, & the American Association of Hip and Knee Surgeons, 2015).\n\nPeer-reviewed and grey literature support additional exclusions for patients undergoing total hip replacements. Staged procedures, concurrent procedures, partial procedures, resurfacing procedures, revision procedures, and removal of implant devices or prosthesis were linked to significant morbidity; complications (such as dislocation, infection, and reinfection); and high failure rates (Ludwick et al., 2021). In addition, mechanical complications, such as instability and dislocation, are also linked to complications and are associated with primary and revision THA/Total Knee Arthroplasty (TKA) (Gkiatas et al., 2021). Malignant neoplasms (such as osteonecrosis of the femoral head) are associated with substantial pain and functional disabilities before THA/TKA (Bernhard et al., 2021).\n\nAdditionally, peer-reviewed and grey literature support various postoperative time frames, including follow-up within 10 to 14 months (Franklin et al., 2021) (Holte et al., 2021).",
  "guidance": "The same FSA instrument must be used for the initial and follow-up assessment.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",
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      "extension": [
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                "display": "Proportion"
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        },
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            "coding": [
              {
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                "code": "process",
                "display": "Process"
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        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode": "None"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
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                "code": "increase",
                "display": "Increased score indicates improvement"
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        {
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          "valueMarkdown": "Higher score indicates better quality"
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      ],
      "population": [
        {
          "id": "InitialPopulation_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
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            ]
          },
          "description": "Patients 19 years of age and older who had a primary THA between November two years prior to the measurement period and October of the year prior to measurement period; and who had an outpatient encounter between August of the year prior to the measurement period and the end of the measurement period",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "Denominator_1",
          "code": {
            "coding": [
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                "code": "denominator",
                "display": "Denominator"
              }
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          "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": "Exclude patients who are in hospice care or any part of the measurement period.\n\nExclude patients with severe cognitive impairment that starts before or in any part of the measurement period.\n\nExclude patients with one or more specific lower body fractures indicating trauma in the 48 hours before or at the start of the total hip arthroplasty.\n\nExclude patients with a partial hip arthroplasty procedure on the day of the total hip arthroplasty.\n\nExclude patients with a revision hip arthroplasty procedure, an implanted device/prosthesis removal procedure or a resurfacing/supplement procedure on the day of the total hip arthroplasty.\n\nExclude patients with a malignant neoplasm of the pelvis, sacrum, coccyx, lower limbs, or bone/bone marrow or a disseminated malignant neoplasm on the day of the total hip arthroplasty.\n\nExclude patients with a mechanical complication on the day of the total hip arthroplasty.\n\nExclude patients with a second total hip arthroplasty procedure 1 year before or after the original total hip arthroplasty procedure.\n\nExclude patients who die on the day of the total hip arthroplasty procedure or in the 300 days after.",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator Exclusions"
          }
        },
        {
          "id": "Numerator_1",
          "code": {
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                "code": "numerator",
                "display": "Numerator"
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            ]
          },
          "description": "Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12], Patient-Reported Outcomes Measurement Information System [PROMIS]-10-Global Health, Hip Disability and Osteoarthritis Outcome Score [HOOS], HOOS Jr.) in the 90 days prior to or on the day of the primary THA procedure, and in the 300 - 425 days after the THA procedure",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        }
      ]
    }
  ],
  "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-type",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Payer Type",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Payer Type"
      }
    },
    {
      "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"
      }
    }
  ]
}