FHIR IG Statistics: Measure/CMS71FHIRSTKAnticoagAFFlutter

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Narrative

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define "Initial Population":
  TJC."Ischemic Stroke Encounter"

define "Denominator":
  "Encounter With A History Of Atrial Ablation"
    union "Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Flutter"

define "Denominator":
  "Encounter With A History Of Atrial Ablation"
    union "Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Flutter"

define "Denominator Exclusions":
  ( "Denominator" Encounter
      where Encounter.status = 'finished'
        and ( Encounter.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"
            or Encounter.hospitalization.dischargeDisposition in "Left Against Medical Advice"
            or Encounter.hospitalization.dischargeDisposition in "Patient Expired"
            or Encounter.hospitalization.dischargeDisposition in "Discharged to Home for Hospice Care"
            or Encounter.hospitalization.dischargeDisposition in "Discharged to Health Care Facility for Hospice Care"
        )
  )
    union "Encounter With Comfort Measures During Hospitalization For Patients With Documented Atrial Fibrillation Or Flutter"

define "Numerator":
  "Denominator" Encounter
    with ["MedicationRequest": medication in "Anticoagulant Therapy"] DischargeAnticoagulant
      such that DischargeAnticoagulant.status in { 'active', 'completed' }
        and DischargeAnticoagulant.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and ( DischargeAnticoagulant.isCommunity ( )
            or DischargeAnticoagulant.isDischarge ( )
        )
        and DischargeAnticoagulant.authoredOn during Encounter.period
        and not exists ( ["TaskRejected"] TaskReject
            where TaskReject.focus.references ( DischargeAnticoagulant )
              and TaskReject.code ~ "fulfill"
        )

define "Denominator Exceptions":
  "Denominator" Encounter
    with "Documented Reason For Not Giving Anticoagulant At Discharge" NoDischargeAnticoagulant
      such that NoDischargeAnticoagulant.authoredOn during Encounter.period

define "Non Elective Inpatient Encounter With Age":
  ["Encounter": "Nonelective Inpatient Encounter"] NonElectiveEncounter
        where AgeInYearsAt(date from start of NonElectiveEncounter.period ) >= 18
         and NonElectiveEncounter.period ends during day of "Measurement Period"

define "Ischemic Stroke Encounter":
  "Non Elective Inpatient Encounter With Age" NonElectiveEncounterWithAge
   where NonElectiveEncounterWithAge.hasPrincipalDiagnosisOf("Ischemic Stroke" )

define "Intervention Comfort Measures":
  ( ["ServiceRequest": code in "Comfort Measures"] SR
    where SR.status in { 'active', 'completed', 'on-hold' }
      and SR.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
      and SR.doNotPerform is not true
  )  
  union ( ["Procedure": "Comfort Measures"] InterventionPerformed
        where InterventionPerformed.status in { 'completed', 'in-progress' }
  )

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 "Encounter With A History Of Atrial Ablation":
  ( TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
      where exists ( ["Procedure": "Atrial Ablation"] AtrialAblationProcedure
          where AtrialAblationProcedure.status = 'completed'
            and AtrialAblationProcedure.performed.toInterval ( ) starts before start of IschemicStrokeEncounter.period
      )
  )
    union ( TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
        with ["ConditionProblemsHealthConcerns": "History of Atrial Ablation"] AtrialAblationDiagnosis
          such that AtrialAblationDiagnosis.verificationStatus is not null implies ( AtrialAblationDiagnosis.verificationStatus !~ QICoreCommon."refuted"
              and AtrialAblationDiagnosis.verificationStatus !~ QICoreCommon."entered-in-error"
          )
            and AtrialAblationDiagnosis.onset.toInterval ( ) starts before start of IschemicStrokeEncounter.period
    )
    union ( TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
        with ["SimpleObservation": "History of Atrial Ablation"] AtrialAblationObservation
          such that AtrialAblationObservation.status in { 'final', 'amended', 'corrected' }
            and AtrialAblationObservation.effective.earliest ( ) on or before end of IschemicStrokeEncounter.period
    )
    union ( TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
        with ["ConditionEncounterDiagnosis": "History of Atrial Ablation"] AtrialAblationEncDiagnosis
          such that AtrialAblationEncDiagnosis.verificationStatus is not null implies ( AtrialAblationEncDiagnosis.verificationStatus !~ QICoreCommon."refuted"
              and AtrialAblationEncDiagnosis.verificationStatus !~ QICoreCommon."entered-in-error"
          )
            and AtrialAblationEncDiagnosis.onset.toInterval ( ) starts before start of IschemicStrokeEncounter.period
    )

define "Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Flutter":
  ( TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
      with ["ConditionProblemsHealthConcerns": "Atrial Fibrillation or Flutter"] AtrialFibrillationFlutter
        such that AtrialFibrillationFlutter.verificationStatus is not null implies ( AtrialFibrillationFlutter.verificationStatus !~ QICoreCommon."refuted"
            and AtrialFibrillationFlutter.verificationStatus !~ QICoreCommon."entered-in-error"
        )
          and AtrialFibrillationFlutter.onset.toInterval ( ) starts on or before end of IschemicStrokeEncounter.period
  )
    union TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
      where exists ( ( IschemicStrokeEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
          where EncounterDiagnosis.code in "Atrial Fibrillation or Flutter"
      )

define "Denominator":
  "Encounter With A History Of Atrial Ablation"
    union "Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Flutter"

define "Numerator":
  "Denominator" Encounter
    with ["MedicationRequest": medication in "Anticoagulant Therapy"] DischargeAnticoagulant
      such that DischargeAnticoagulant.status in { 'active', 'completed' }
        and DischargeAnticoagulant.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and ( DischargeAnticoagulant.isCommunity ( )
            or DischargeAnticoagulant.isDischarge ( )
        )
        and DischargeAnticoagulant.authoredOn during Encounter.period
        and not exists ( ["TaskRejected"] TaskReject
            where TaskReject.focus.references ( DischargeAnticoagulant )
              and TaskReject.code ~ "fulfill"
        )

define "Denominator":
  "Encounter With A History Of Atrial Ablation"
    union "Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Flutter"

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

define "Initial Population":
  TJC."Ischemic Stroke Encounter"

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

define "Encounter With Comfort Measures During Hospitalization For Patients With Documented Atrial Fibrillation Or Flutter":
  "Denominator" Encounter
    with TJC."Intervention Comfort Measures" ComfortMeasure
      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during Encounter.hospitalizationWithObservation ( )

define "Denominator Exclusions":
  ( "Denominator" Encounter
      where Encounter.status = 'finished'
        and ( Encounter.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"
            or Encounter.hospitalization.dischargeDisposition in "Left Against Medical Advice"
            or Encounter.hospitalization.dischargeDisposition in "Patient Expired"
            or Encounter.hospitalization.dischargeDisposition in "Discharged to Home for Hospice Care"
            or Encounter.hospitalization.dischargeDisposition in "Discharged to Health Care Facility for Hospice Care"
        )
  )
    union "Encounter With Comfort Measures During Hospitalization For Patients With Documented Atrial Fibrillation Or Flutter"

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

define "Documented Reason For Not Giving Anticoagulant At Discharge":
  ( ["MedicationNotRequested": medication in "Anticoagulant Therapy"] NoAnticoagulant
      where ( NoAnticoagulant.reasonCode in "Medical Reason For Not Providing Treatment"
          or NoAnticoagulant.reasonCode in "Patient Refusal"
      )
        and ( NoAnticoagulant.isCommunity ( )
            or NoAnticoagulant.isDischarge ( )
        )
        and NoAnticoagulant.status in { 'active', 'completed' }
        and NoAnticoagulant.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
  )
    union ( ["MedicationRequest": "Anticoagulant Therapy"] MedReqAntiCoagulant
        with ["TaskRejected"] TaskReject
          such that TaskReject.focus.references ( MedReqAntiCoagulant )
            and ( TaskReject.statusReason in "Medical Reason For Not Providing Treatment"
                or TaskReject.statusReason in "Patient Refusal"
            )
            and MedReqAntiCoagulant.status in { 'active', 'completed' }
            and TaskReject.code ~ "fulfill"
    )

define "Denominator Exceptions":
  "Denominator" Encounter
    with "Documented Reason For Not Giving Anticoagulant At Discharge" NoDischargeAnticoagulant
      such that NoDischargeAnticoagulant.authoredOn during Encounter.period

define function ToString(value uri): value.value

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

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

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

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

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

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

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

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

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

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

/*
@description: Returns true if the given MedicationRequest has a category of Community
*/
define fluent function isCommunity(medicationRequest Choice<MedicationRequest, MedicationNotRequested>):
  exists (medicationRequest.category C
    where C ~ Community
  )

/*
@description: Returns true if the given MedicationRequest has a category of Discharge
*/
define fluent function isDischarge(medicationRequest Choice<MedicationRequest, MedicationNotRequested>):
  exists (medicationRequest.category C
    where C ~ Discharge
  )

/*
 @description: Returns the condition that is specified as the principal diagnosis for the encounter and has a code in the given valueSet.
 @comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information
 */
 define fluent function hasPrincipalDiagnosisOf(encounter Encounter, valueSet ValueSet):
   (encounter.principalDiagnosis()) PD
     return PD.diagnosis in valueSet
       or PD.diagnosis.getCondition().code in valueSet

/*
@description: Returns the claim diagnosis element that is specified as the principal diagnosis for the encounter
 @comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information
*/
define fluent function principalDiagnosis(encounter Encounter):
singleton from (
     (encounter.claimDiagnosis()) CD
       where CD.type.includesCode("Principal Diagnosis")
   )

/*
@description: Returns the claim diagnosis elements for the given encounter
@comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information
*/
define fluent function claimDiagnosis(encounter Encounter):
  encounter E
    let 
      claim: ([Claim] C where C.status = 'active' and C.use = 'claim' and exists (C.item I where I.encounter.references(E))),
      claimItem: (claim.item I where I.encounter.references(E))
    return claim.diagnosis D where D.sequence in claimItem.diagnosisSequence

/*
@description: Returns the Condition resource for the given reference
*/
define fluent function getCondition(reference Reference):
  singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where reference.references(C.id))

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

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

Source

{
  "resourceType": "Measure",
  "id": "CMS71FHIRSTKAnticoagAFFlutter",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareablemeasure",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cql-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/elm-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "contained": [
    {
      "resourceType": "Library",
      "id": "effective-data-requirements",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "248153007",
            "display": "Male (finding)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "248152002",
            "display": "Female (finding)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
            "code": "principal",
            "display": "Principal Diagnosis"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
            "code": "refuted",
            "display": "Refuted"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
            "code": "entered-in-error",
            "display": "Entered in Error"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
            "code": "community",
            "display": "Community"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
            "code": "discharge",
            "display": "Discharge"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://hl7.org/fhir/CodeSystem/task-code",
            "code": "fulfill"
          }
        },
        {
          "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"
            },
            {
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              "valueInteger": 0
            }
          ],
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        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS71FHIRSTKAnticoagAFFlutter"
            },
            {
              "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": "TJCOverall"
            },
            {
              "url": "name",
              "valueString": "Non Elective Inpatient Encounter With Age"
            },
            {
              "url": "statement",
              "valueString": "define \"Non Elective Inpatient Encounter With Age\":\n  [\"Encounter\": \"Nonelective Inpatient Encounter\"] NonElectiveEncounter\n        where AgeInYearsAt(date from start of NonElectiveEncounter.period ) >= 18\n         and NonElectiveEncounter.period ends during day of \"Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "TJCOverall"
            },
            {
              "url": "name",
              "valueString": "Ischemic Stroke Encounter"
            },
            {
              "url": "statement",
              "valueString": "define \"Ischemic Stroke Encounter\":\n  \"Non Elective Inpatient Encounter With Age\" NonElectiveEncounterWithAge\n   where NonElectiveEncounterWithAge.hasPrincipalDiagnosisOf(\"Ischemic Stroke\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS71FHIRSTKAnticoagAFFlutter"
            },
            {
              "url": "name",
              "valueString": "Encounter With A History Of Atrial Ablation"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With A History Of Atrial Ablation\":\n  ( TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n      where exists ( [\"Procedure\": \"Atrial Ablation\"] AtrialAblationProcedure\n          where AtrialAblationProcedure.status = 'completed'\n            and AtrialAblationProcedure.performed.toInterval ( ) starts before start of IschemicStrokeEncounter.period\n      )\n  )\n    union ( TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n        with [\"ConditionProblemsHealthConcerns\": \"History of Atrial Ablation\"] AtrialAblationDiagnosis\n          such that AtrialAblationDiagnosis.verificationStatus is not null implies ( AtrialAblationDiagnosis.verificationStatus !~ QICoreCommon.\"refuted\"\n              and AtrialAblationDiagnosis.verificationStatus !~ QICoreCommon.\"entered-in-error\"\n          )\n            and AtrialAblationDiagnosis.onset.toInterval ( ) starts before start of IschemicStrokeEncounter.period\n    )\n    union ( TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n        with [\"SimpleObservation\": \"History of Atrial Ablation\"] AtrialAblationObservation\n          such that AtrialAblationObservation.status in { 'final', 'amended', 'corrected' }\n            and AtrialAblationObservation.effective.earliest ( ) on or before end of IschemicStrokeEncounter.period\n    )\n    union ( TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n        with [\"ConditionEncounterDiagnosis\": \"History of Atrial Ablation\"] AtrialAblationEncDiagnosis\n          such that AtrialAblationEncDiagnosis.verificationStatus is not null implies ( AtrialAblationEncDiagnosis.verificationStatus !~ QICoreCommon.\"refuted\"\n              and AtrialAblationEncDiagnosis.verificationStatus !~ QICoreCommon.\"entered-in-error\"\n          )\n            and AtrialAblationEncDiagnosis.onset.toInterval ( ) starts before start of IschemicStrokeEncounter.period\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS71FHIRSTKAnticoagAFFlutter"
            },
            {
              "url": "name",
              "valueString": "Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Flutter"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Flutter\":\n  ( TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n      with [\"ConditionProblemsHealthConcerns\": \"Atrial Fibrillation or Flutter\"] AtrialFibrillationFlutter\n        such that AtrialFibrillationFlutter.verificationStatus is not null implies ( AtrialFibrillationFlutter.verificationStatus !~ QICoreCommon.\"refuted\"\n            and AtrialFibrillationFlutter.verificationStatus !~ QICoreCommon.\"entered-in-error\"\n        )\n          and AtrialFibrillationFlutter.onset.toInterval ( ) starts on or before end of IschemicStrokeEncounter.period\n  )\n    union TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n      where exists ( ( IschemicStrokeEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n          where EncounterDiagnosis.code in \"Atrial Fibrillation or Flutter\"\n      )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS71FHIRSTKAnticoagAFFlutter"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n  \"Encounter With A History Of Atrial Ablation\"\n    union \"Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Flutter\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS71FHIRSTKAnticoagAFFlutter"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n  \"Denominator\" Encounter\n    with [\"MedicationRequest\": medication in \"Anticoagulant Therapy\"] DischargeAnticoagulant\n      such that DischargeAnticoagulant.status in { 'active', 'completed' }\n        and DischargeAnticoagulant.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n        and ( DischargeAnticoagulant.isCommunity ( )\n            or DischargeAnticoagulant.isDischarge ( )\n        )\n        and DischargeAnticoagulant.authoredOn during Encounter.period\n        and not exists ( [\"TaskRejected\"] TaskReject\n            where TaskReject.focus.references ( DischargeAnticoagulant )\n              and TaskReject.code ~ \"fulfill\"\n        )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS71FHIRSTKAnticoagAFFlutter"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n  \"Encounter With A History Of Atrial Ablation\"\n    union \"Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Flutter\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "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": 9
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS71FHIRSTKAnticoagAFFlutter"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS71FHIRSTKAnticoagAFFlutter"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  TJC.\"Ischemic Stroke Encounter\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "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": 12
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS71FHIRSTKAnticoagAFFlutter"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "TJCOverall"
            },
            {
              "url": "name",
              "valueString": "Intervention Comfort Measures"
            },
            {
              "url": "statement",
              "valueString": "define \"Intervention Comfort Measures\":\n  ( [\"ServiceRequest\": code in \"Comfort Measures\"] SR\n    where SR.status in { 'active', 'completed', 'on-hold' }\n      and SR.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n      and SR.doNotPerform is not true\n  )  \n  union ( [\"Procedure\": \"Comfort Measures\"] InterventionPerformed\n        where InterventionPerformed.status in { 'completed', 'in-progress' }\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS71FHIRSTKAnticoagAFFlutter"
            },
            {
              "url": "name",
              "valueString": "Encounter With Comfort Measures During Hospitalization For Patients With Documented Atrial Fibrillation Or Flutter"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Comfort Measures During Hospitalization For Patients With Documented Atrial Fibrillation Or Flutter\":\n  \"Denominator\" Encounter\n    with TJC.\"Intervention Comfort Measures\" ComfortMeasure\n      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during Encounter.hospitalizationWithObservation ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS71FHIRSTKAnticoagAFFlutter"
            },
            {
              "url": "name",
              "valueString": "Denominator Exclusions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exclusions\":\n  ( \"Denominator\" Encounter\n      where Encounter.status = 'finished'\n        and ( Encounter.hospitalization.dischargeDisposition in \"Discharge To Acute Care Facility\"\n            or Encounter.hospitalization.dischargeDisposition in \"Left Against Medical Advice\"\n            or Encounter.hospitalization.dischargeDisposition in \"Patient Expired\"\n            or Encounter.hospitalization.dischargeDisposition in \"Discharged to Home for Hospice Care\"\n            or Encounter.hospitalization.dischargeDisposition in \"Discharged to Health Care Facility for Hospice Care\"\n        )\n  )\n    union \"Encounter With Comfort Measures During Hospitalization For Patients With Documented Atrial Fibrillation Or Flutter\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 16
            }
          ],
          "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": 17
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS71FHIRSTKAnticoagAFFlutter"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 18
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS71FHIRSTKAnticoagAFFlutter"
            },
            {
              "url": "name",
              "valueString": "Documented Reason For Not Giving Anticoagulant At Discharge"
            },
            {
              "url": "statement",
              "valueString": "define \"Documented Reason For Not Giving Anticoagulant At Discharge\":\n  ( [\"MedicationNotRequested\": medication in \"Anticoagulant Therapy\"] NoAnticoagulant\n      where ( NoAnticoagulant.reasonCode in \"Medical Reason For Not Providing Treatment\"\n          or NoAnticoagulant.reasonCode in \"Patient Refusal\"\n      )\n        and ( NoAnticoagulant.isCommunity ( )\n            or NoAnticoagulant.isDischarge ( )\n        )\n        and NoAnticoagulant.status in { 'active', 'completed' }\n        and NoAnticoagulant.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n  )\n    union ( [\"MedicationRequest\": \"Anticoagulant Therapy\"] MedReqAntiCoagulant\n        with [\"TaskRejected\"] TaskReject\n          such that TaskReject.focus.references ( MedReqAntiCoagulant )\n            and ( TaskReject.statusReason in \"Medical Reason For Not Providing Treatment\"\n                or TaskReject.statusReason in \"Patient Refusal\"\n            )\n            and MedReqAntiCoagulant.status in { 'active', 'completed' }\n            and TaskReject.code ~ \"fulfill\"\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 19
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS71FHIRSTKAnticoagAFFlutter"
            },
            {
              "url": "name",
              "valueString": "Denominator Exceptions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exceptions\":\n  \"Denominator\" Encounter\n    with \"Documented Reason For Not Giving Anticoagulant At Discharge\" NoDischargeAnticoagulant\n      such that NoDischargeAnticoagulant.authoredOn during Encounter.period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 20
            }
          ],
          "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": 21
            }
          ],
          "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": 22
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "hasPrincipalDiagnosisOf"
            },
            {
              "url": "statement",
              "valueString": "/*\n @description: Returns the condition that is specified as the principal diagnosis for the encounter and has a code in the given valueSet.\n @comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information\n */\n define fluent function hasPrincipalDiagnosisOf(encounter Encounter, valueSet ValueSet):\n   (encounter.principalDiagnosis()) PD\n     return PD.diagnosis in valueSet\n       or PD.diagnosis.getCondition().code in valueSet"
            },
            {
              "url": "displaySequence",
              "valueInteger": 23
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "principalDiagnosis"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns the claim diagnosis element that is specified as the principal diagnosis for the encounter\n @comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information\n*/\ndefine fluent function principalDiagnosis(encounter Encounter):\nsingleton from (\n     (encounter.claimDiagnosis()) CD\n       where CD.type.includesCode(\"Principal Diagnosis\")\n   )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 24
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "claimDiagnosis"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns the claim diagnosis elements for the given encounter\n@comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information\n*/\ndefine fluent function claimDiagnosis(encounter Encounter):\n  encounter E\n    let \n      claim: ([Claim] C where C.status = 'active' and C.use = 'claim' and exists (C.item I where I.encounter.references(E))),\n      claimItem: (claim.item I where I.encounter.references(E))\n    return claim.diagnosis D where D.sequence in claimItem.diagnosisSequence"
            },
            {
              "url": "displaySequence",
              "valueInteger": 25
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "references"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if any of the given references are to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(references List<Reference>, resource Resource):\n  exists (references R where R.references(resource))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 26
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "references"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given reference is to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(reference Reference, resource Resource):\n  resource.id = Last(Split(reference.reference, '/'))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 27
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "includesCode"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given code is in the given codeList\n@comment: Returns true if the `code` is equivalent to any of the codes in the given `codeList`, false otherwise.\n*/\ndefine fluent function includesCode(codeList List<Concept>, code Code):\n  exists (codeList C where C ~ code)"
            },
            {
              "url": "displaySequence",
              "valueInteger": 28
            }
          ],
          "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": 29
            }
          ],
          "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": 30
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "getCondition"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns the Condition resource for the given reference\n*/\ndefine fluent function getCondition(reference Reference):\n  singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where reference.references(C.id))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 31
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "references"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given reference is to the given resourceId\n@comment: Returns true if the `resourceId` parameter exactly equals the tail of the given reference.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(reference Reference, resourceId String):\n  resourceId = Last(Split(reference.reference, '/'))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 32
            }
          ],
          "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": 33
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "earliest"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Given an interval, return the starting point if the interval has a starting boundary specified,\notherwise, return the ending point\n*/\ndefine fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):\n  (choice.toInterval()) period\n    return\n      if (period.\"hasStart\"()) then start of period\n      else end of period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 34
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "hasStart"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Given an interval, return true if the interval has a starting boundary specified\n(i.e. the start of the interval is not null and not the minimum DateTime value)\n*/\ndefine fluent function hasStart(period Interval<DateTime> ):\n  not ( start of period is null\n      or start of period = minimum DateTime\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 35
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "encounterDiagnosis"
            },
            {
              "url": "statement",
              "valueString": "/*  \n@description: Returns the Condition resources referenced by the diagnosis element of the Encounter  \n*/\ndefine fluent function encounterDiagnosis(Encounter Encounter ):\n  Encounter.reasonReference D\n    return singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where D.references(C.id))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 36
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "isCommunity"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given MedicationRequest has a category of Community\n*/\ndefine fluent function isCommunity(medicationRequest Choice<MedicationRequest, MedicationNotRequested>):\n  exists (medicationRequest.category C\n    where C ~ Community\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 37
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "isDischarge"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given MedicationRequest has a category of Discharge\n*/\ndefine fluent function isDischarge(medicationRequest Choice<MedicationRequest, MedicationNotRequested>):\n  exists (medicationRequest.category C\n    where C ~ Discharge\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 38
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "hospitalizationWithObservation"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter\n*/\ndefine fluent function hospitalizationWithObservation(TheEncounter Encounter ):\n  TheEncounter Visit\n  \t\tlet ObsVisit: Last([Encounter: \"Observation Services\"] LastObs\n  \t\t\t\twhere LastObs.status = 'finished'\n            and LastObs.period ends 1 hour or less on or before start of Visit.period\n  \t\t\t\tsort by end of period\n  \t\t\t),\n  \t\t\tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n  \t\t\tEDVisit: Last([Encounter: \"Emergency Department Visit\"] LastED\n  \t\t\t\twhere LastED.status = 'finished'\n            and LastED.period ends 1 hour or less on or before VisitStart\n  \t\t\t\tsort by end of period\n  \t\t\t)\n  \t\treturn Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 39
            }
          ],
          "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 TJC",
          "resource": "Library/TJCOverall|8.24.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library CQMCommon",
          "resource": "Library/CQMCommon|4.1.000"
        },
        {
          "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 QICoreCommon",
          "resource": "Library/QICoreCommon|4.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library CQMCommon",
          "resource": "Library/CQMCommon|4.1.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Code system SNOMEDCT",
          "resource": "http://snomed.info/sct"
        },
        {
          "type": "depends-on",
          "display": "Code system Diagnosis Type",
          "resource": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"
        },
        {
          "type": "depends-on",
          "display": "Code system ConditionVerificationStatusCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/condition-ver-status"
        },
        {
          "type": "depends-on",
          "display": "Code system MedicationRequestCategory",
          "resource": "http://terminology.hl7.org/CodeSystem/medicationrequest-category"
        },
        {
          "type": "depends-on",
          "display": "Code system TaskCode",
          "resource": "http://hl7.org/fhir/CodeSystem/task-code"
        },
        {
          "type": "depends-on",
          "display": "Value set Nonelective Inpatient Encounter",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
        },
        {
          "type": "depends-on",
          "display": "Value set Ischemic Stroke",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247"
        },
        {
          "type": "depends-on",
          "display": "Value set Atrial Ablation",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.203"
        },
        {
          "type": "depends-on",
          "display": "Value set History of Atrial Ablation",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.76"
        },
        {
          "type": "depends-on",
          "display": "Value set Atrial Fibrillation or Flutter",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.202"
        },
        {
          "type": "depends-on",
          "display": "Value set Anticoagulant Therapy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.200"
        },
        {
          "type": "depends-on",
          "display": "Value set Payer Type",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
        },
        {
          "type": "depends-on",
          "display": "Value set Discharge To Acute Care Facility",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87"
        },
        {
          "type": "depends-on",
          "display": "Value set Left Against Medical Advice",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.308"
        },
        {
          "type": "depends-on",
          "display": "Value set Patient Expired",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309"
        },
        {
          "type": "depends-on",
          "display": "Value set Discharged to Home for Hospice Care",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.209"
        },
        {
          "type": "depends-on",
          "display": "Value set Discharged to Health Care Facility for Hospice Care",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.207"
        },
        {
          "type": "depends-on",
          "display": "Value set Comfort Measures",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"
        },
        {
          "type": "depends-on",
          "display": "Value set Observation Services",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"
        },
        {
          "type": "depends-on",
          "display": "Value set Emergency Department Visit",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
        },
        {
          "type": "depends-on",
          "display": "Value set Medical Reason For Not Providing Treatment",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473"
        },
        {
          "type": "depends-on",
          "display": "Value set Patient Refusal",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93"
        }
      ],
      "parameter": [
        {
          "name": "Measurement Period",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "Period"
        },
        {
          "name": "SDE Sex",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Coding"
        },
        {
          "name": "Numerator",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Denominator",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Payer",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Initial Population",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Ethnicity",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Resource"
        },
        {
          "name": "Denominator Exclusions",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Race",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Resource"
        },
        {
          "name": "Denominator Exceptions",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        }
      ],
      "dataRequirement": [
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "value.value"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "value.value"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
            }
          ]
        },
        {
          "type": "Claim",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim"
          ],
          "mustSupport": [
            "status",
            "status.value",
            "use",
            "use.value",
            "item"
          ]
        },
        {
          "type": "Claim",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim"
          ],
          "mustSupport": [
            "status",
            "status.value",
            "use",
            "use.value",
            "item"
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
            }
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "performed"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.203"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"
          ],
          "mustSupport": [
            "code",
            "verificationStatus",
            "onset"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.76"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-simple-observation"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "effective"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.76"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"
          ],
          "mustSupport": [
            "code",
            "verificationStatus",
            "onset"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.76"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"
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            }
          ]
        },
        {
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            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
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            }
          ]
        },
        {
          "type": "Encounter",
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            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
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        },
        {
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            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
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          "mustSupport": [
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          "codeFilter": [
            {
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            }
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            {
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          "mustSupport": [
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            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
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          "mustSupport": [
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        },
        {
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        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationnotrequested"
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          "mustSupport": [
            "medication",
            "reasonCode",
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            "intent",
            "intent.value"
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          "codeFilter": [
            {
              "path": "medication",
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            }
          ]
        },
        {
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            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
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            {
              "path": "medication",
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            }
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
          ],
          "mustSupport": [
            "medication.reference.value"
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        },
        {
          "type": "Medication",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"
          ],
          "mustSupport": [
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            "code"
          ]
        },
        {
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          "mustSupport": [
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        },
        {
          "type": "Coverage",
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        },
        {
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              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
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        {
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          "profile": [
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        },
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    }
  ],
  "extension": [
    {
      "id": "supplementalDataGuidance",
      "extension": [
        {
          "url": "guidance",
          "valueString": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity-Patient's Ethnicity: Hispanic or Latino Not Hispanic or Latino   SDE Payer-Patient's Payer: Categories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system   SDE Race-Patient's Race: Native Hawaiian or Other Pacific Islander Asian American Indian or Alaska Native Other Race White Black or African American   SDE Sex-Patient's Sex: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.   "
        },
        {
          "url": "usage",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                "code": "supplemental-data",
                "display": "Supplemental Data"
              }
            ],
            "text": "Supplemental Data Guidance"
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance"
    },
    {
      "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
      "valueReference": {
        "reference": "#effective-data-requirements"
      }
    },
    {
      "id": "effective-data-requirements",
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
      "valueReference": {
        "reference": "#effective-data-requirements"
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    }
  ],
  "url": "https://madie.cms.gov/Measure/CMS71FHIRSTKAnticoagAFFlutter",
  "identifier": [
    {
      "use": "usual",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "short-name",
            "display": "Short Name"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/shortName",
      "value": "CMS71FHIR"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "version-independent",
            "display": "Version Independent"
          }
        ]
      },
      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:bc80e4cf-d267-47bf-ad0d-4d37f8ae2328"
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    {
      "use": "official",
      "type": {
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            "code": "version-specific",
            "display": "Version Specific"
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      },
      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:d4be44da-1ac8-47a7-97ec-e81fac7c4e80"
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    {
      "use": "official",
      "type": {
        "coding": [
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            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "publisher",
            "display": "Publisher"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/cmsId",
      "value": "71FHIR",
      "assigner": {
        "display": "CMS"
      }
    }
  ],
  "version": "0.3.002",
  "name": "CMS71FHIRSTKAnticoagAFFlutter",
  "title": "Anticoagulation Therapy for Atrial Fibrillation/FlutterFHIR",
  "status": "active",
  "experimental": false,
  "date": "2025-07-15T13:37:39+00:00",
  "publisher": "The Joint Commission",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "https://www.jointcommission.org/"
        }
      ]
    }
  ],
  "description": "Ischemic stroke patients with atrial fibrillation/flutter who are prescribed or continuing to take anticoagulation therapy at hospital discharge",
  "usage": "The \"Nonelective Inpatient Encounter\" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the \"Inpatient Encounter\" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective Inpatient Encounters include emergency, urgent, and unplanned admissions.  The \"Medication, Discharge\" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use.  The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.  This dQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS71v15. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6. (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).",
  "copyright": "Measure specifications are in the Public Domain.  LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved.",
  "effectivePeriod": {
    "start": "2026-01-01",
    "end": "2026-12-31"
  },
  "author": [
    {
      "name": "The Joint Commission",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.jointcommission.org/"
        }
      ]
    }
  ],
  "relatedArtifact": [
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    {
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    }
  ],
  "library": [
    "https://madie.cms.gov/Library/CMS71FHIRSTKAnticoagAFFlutter"
  ],
  "disclaimer": "These performance measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.",
  "rationale": "Nonvalvular atrial fibrillation (NVAF) is a common arrhythmia and an important risk factor for stroke. It is one of several conditions and lifestyle factors that have been identified as risk factors for stroke. It has been estimated that over 2 million adults in the United States have NVAF (Kornej, 2020). While the median age of patients with atrial fibrillation is 75 years, the incidence increases with advancing age. For example, The Framingham Heart Study noted a dramatic increase in stroke risk associated with atrial fibrillation with advancing age, from 1.5% for those 50 to 59 years of age to 23.5% for those 80 to 89 years of age. Furthermore, a prior stroke or transient ischemic attack (TIA) are among a limited number of predictors of high stroke risk within the population of patients with atrial fibrillation. Therefore, much emphasis has been placed on identifying methods for preventing recurrent ischemic stroke as well as preventing first stroke. Prevention strategies focus on the modifiable risk factors such as hypertension, smoking, and atrial fibrillation. Analysis of five placebo-controlled clinical trials investigating the efficacy of warfarin in the primary prevention of thromboembolic stroke, found the relative risk of thromboembolic stroke was reduced by 68% for atrial fibrillation patients treated with warfarin. The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk-atrial fibrillation patients with TIA or prior stroke.",
  "clinicalRecommendationStatement": "The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk atrial fibrillation patients with TIA or prior stroke",
  "group": [
    {
      "id": "Group_1",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
                "code": "proportion",
                "display": "Proportion"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
          "valueCode": "Encounter"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-type",
                "code": "process",
                "display": "Process"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode": "None"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "increase",
                "display": "Increased score indicates improvement"
              }
            ]
          }
        }
      ],
      "description": "Ischemic stroke patients with atrial fibrillation/flutter who are prescribed or continuing to take anticoagulation therapy at hospital discharge",
      "population": [
        {
          "id": "InitialPopulation_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Inpatient hospitalizations (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke, that ends during the measurement period",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "Denominator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator",
                "display": "Denominator"
              }
            ]
          },
          "description": "Inpatient hospitalizations for patients with a principal diagnosis of ischemic stroke, and a history of atrial ablation, or current or history of atrial fibrillation/flutter",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator"
          }
        },
        {
          "id": "DenominatorExclusion_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator-exclusion",
                "display": "Denominator Exclusion"
              }
            ]
          },
          "description": "- Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations. - Inpatient hospitalizations for patients discharged to another hospital - Inpatient hospitalizations for patients who left against medical advice - Inpatient hospitalizations for patients who expired - Inpatient hospitalizations for patients discharged to home for hospice care - Inpatient hospitalizations for patients discharged to a health care facility for hospice care - Inpatient hospitalizations for patients with comfort measures documented",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator Exclusions"
          }
        },
        {
          "id": "Numerator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator",
                "display": "Numerator"
              }
            ]
          },
          "description": "Inpatient hospitalizations for patients prescribed or continuing to take anticoagulation therapy at hospital discharge",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        },
        {
          "id": "DenominatorException_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator-exception",
                "display": "Denominator Exception"
              }
            ]
          },
          "description": "Inpatient hospitalizations for patients with a documented reason for not prescribing anticoagulation therapy at discharge",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator Exceptions"
          }
        }
      ]
    }
  ],
  "supplementalData": [
    {
      "id": "sde-ethnicity",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Ethnicity",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Ethnicity"
      }
    },
    {
      "id": "sde-payer",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Payer",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Payer"
      }
    },
    {
      "id": "sde-race",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Race",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Race"
      }
    },
    {
      "id": "sde-sex",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Sex",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Sex"
      }
    }
  ]
}