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FHIR IG Statistics: Measure/CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia

Packagegov.healthit.ecqi.ecqms
Resource TypeMeasure
IdCMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia
FHIR VersionR4
Sourcehttp://ecqi.healthit.gov/ecqms/https://build.fhir.org/ig/cqframework/ecqm-content-qicore-2025/Measure-CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia.html
URLhttps://madie.cms.gov/Measure/CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia
Version1.5.000
Statusactive
Date2025-07-15T13:37:40+00:00
NameCMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia
TitleUrinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic HyperplasiaFHIR
DescriptionPercentage of patients with an office visit within the measurement period and with a new diagnosis of clinically significant Benign Prostatic Hyperplasia who have International Prostate Symptoms Score (IPSS) or American Urological Association (AUA) Symptom Index (SI) documented at time of diagnosis and again 6-12 months later with an improvement of 3 points
CopyrightLimited proprietary coding is contained in the measure specifications for user convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Large Urology Group Practice Association (LUGPA) and Oregon Urology Institute (OUI) disclaim all liability for the use or accuracy of any third-party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2024. American Medical Association. 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.

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Narrative

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Metadata
Title Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic HyperplasiaFHIR
Version 1.5.000
Short Name CMS771FHIR
GUID (Version Independent) urn:uuid:0748d873-8e20-441e-9bbf-c1eefe3ea054
GUID (Version Specific) urn:uuid:84e7d559-3046-43bf-9298-766d8ac2ebaa
CMS Identifier 771FHIR
Effective Period 2026-01-01 through 2026-12-31
Steward (Publisher) Large Urology Group Practice Association (LUGPA)
Developer Large Urology Group Practice Association (LUGPA)
Description

Percentage of patients with an office visit within the measurement period and with a new diagnosis of clinically significant Benign Prostatic Hyperplasia who have International Prostate Symptoms Score (IPSS) or American Urological Association (AUA) Symptom Index (SI) documented at time of diagnosis and again 6-12 months later with an improvement of 3 points
Copyright

Limited proprietary coding is contained in the measure specifications for user convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Large Urology Group Practice Association (LUGPA) and Oregon Urology Institute (OUI) disclaim all liability for the use or accuracy of any third-party codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2024. American Medical Association. 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.
Disclaimer

The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.

THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

Due to technical limitations, registered trademarks are indicated by (R) or [R], and unregistered trademarks are indicated by (TM) or [TM].
Rationale

Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting older males, with a prevalence of 50% by age 60 years and 90% by the ninth decade of life (Medina et al., 1999). The enlarged gland had been proposed to contribute to the overall lower urinary tract symptoms (LUTS) complex (McVary et al., 2014). Although LUTS secondary to BPH is not often a life-threatening condition, the impact of LUTS/BPH on quality of life can be significant (Wei et al., 2005). The American Urological Association Symptom Index (AUA-SI) and the International Prostate Symptom Score (IPSS) were developed to measure outcomes in studies of different treatments for BPH (Wuerstle et al., 2011). The IPSS uses the same questions as the AUA-SI, but also adds a disease-specific quality of life question (OLeary, 2005). The IPSS was adopted in 1993 by the World Health Organization. It is a reproducible, validated index designed to determine disease severity and response to therapy (D’Silva et al., 2014). It includes 3 storage symptom questions (frequency, nocturia, urgency) and four voiding symptoms (feeling of incomplete emptying, intermittency, straining, and a weak stream) as well as a Bother question: If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that? A three-point improvement in the score is considered meaningful (McVary et al., 2014).
Clinical Recommendation Statement

The symptoms of BPH are lower urinary tract symptoms (LUTS). There are other disorders with similar symptoms that need to be excluded. History, physical examination, and testing are required prior to a diagnosis of BPH. IPSS by itself is not a reliable diagnostic tool for LUTS suggestive of BPH but serves as a quantitative measure of LUTS after the diagnosis is established (D’Silva et al., 2014). Medical and surgical interventions for BPH recommend a follow up IPSS evaluation to determine effectiveness of treatment. IPSS should be evaluated at the time of diagnosis and after definitive treatment.
Guidance (Usage) The IPSS is inclusive of the symptom index score and the quality of life score. The AUA-SI is the symptom index score alone and must be added to the QOL score. The AUA-SI with the QOL equals the IPSS. Both of these are the urinary symptom score. The patient must have a urinary symptom score (USS) within 1 month after initial diagnosis. If more than one USS in the initial one month, then the first USS counts. The patient must have a USS again at 6-12 months after the initial diagnosis and if more than one USS in this time frame, then the last USS counts. The result of the test is a numeric value that relates to a continuous numeric scale. Reported either as an integer, a ratio, a real number, or a range. The test result value may optionally contain a relational operator from the set {<=, <, >, >=}. Valid values for a quantitative test are of the form “7”, “-7”, “7.4”, “-7.4”, “7.8912”, “0.125”, “<10”, “<10.15”, “>12000”, 1-10, 1:256. Hospitalization within 30 days of Initial BPH Diagnosis refers to a 30-day period between the end of the hospitalization and the clinical office setting BPH diagnosis. This is due to aggravating factors from hospitalization, such as bed rest, medications, surgery, and altered body functions. Symptoms of BPH include urinary frequency, urinary urgency, difficulty starting urination, weak urine stream, dribbling at the end of urination, incomplete bladder emptying. This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth. This FHIR-based measure has been derived from the QDM-based measure: CMS771v6. 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 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).
Measure Group (Rate) (ID: Group_1)
Basis boolean
Scoring Proportion
Type Outcome
Rate Aggregation None
Improvement Notation Increased score indicates improvement
Initial Population ID: InitialPopulation_1
Description:

Male patients with an initial diagnosis of benign prostatic hyperplasia 6 months prior to the measurement period, and a urinary symptom score assessment within 1 month of initial diagnosis and a follow-up urinary symptom score assessment within 6-12 months, who had a qualifying visit during the measurement period

Logic Definition: Initial Population
Denominator ID: Denominator_1
Description:

Patients in the Initial Population with a urinary symptom score assessment within 1 month of initial diagnosis and a follow-up urinary symptom score assessment within 6-12 months

Logic Definition: Denominator
Denominator Exclusion ID: DenominatorExclusion_1
Description:

Patients with urinary retention that starts within 1 year of initial BPH diagnosis. Patients with an initial BPH diagnosis that starts during, or within 30 days after end of hospitalization. Patients with a diagnosis of morbid obesity, or with a BMI Exam >=40 before the follow up urinary symptom score.

Logic Definition: Denominator Exclusions
Numerator ID: Numerator_1
Description:

Patients with a documented improvement of at least 3 points in their urinary symptom score during the measurement period

Logic Definition: Numerator
Supplemental Data Guidance For every patient evaluated by this measure also identify payer, race, ethnicity and sex
Supplemental Data Guidance none
Supplemental Data Elements
Supplemental Data Element ID: sde-ethnicity
Usage Code: Supplemental Data
Description: SDE Ethnicity
Logic Definition: SDE Ethnicity
Supplemental Data Element ID: sde-payer
Usage Code: Supplemental Data
Description: SDE Payer
Logic Definition: SDE Payer
Supplemental Data Element ID: sde-race
Usage Code: Supplemental Data
Description: SDE Race
Logic Definition: SDE Race
Supplemental Data Element ID: sde-sex
Usage Code: Supplemental Data
Description: SDE Sex
Logic Definition: SDE Sex
Supplemental Data Element ID: sde-ethnicity
Usage Code: Risk Adjustment Factor
Description: SDE Ethnicity
Logic Definition: SDE Ethnicity
Supplemental Data Element ID: sde-payer
Usage Code: Risk Adjustment Factor
Description: SDE Payer
Logic Definition: SDE Payer
Supplemental Data Element ID: sde-race
Usage Code: Risk Adjustment Factor
Description: SDE Race
Logic Definition: SDE Race
Supplemental Data Element ID: sde-sex
Usage Code: Risk Adjustment Factor
Description: SDE Sex
Logic Definition: SDE Sex
Measure Logic
Primary Library CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia
Contents Population Criteria
Logic Definitions
Terminology
Dependencies
Data Requirements
Population Criteria
Measure Group (Rate) (ID: Group_1)
Initial Population 
define "Initial Population":
  ( "Patient is Male" )
    and "Has Qualifying Encounter"
    and "Has Qualifying BPH Diagnosis"
Initial Population 
define "Initial Population":
  ( "Patient is Male" )
    and "Has Qualifying Encounter"
    and "Has Qualifying BPH Diagnosis"
Denominator 
define "Denominator":
  "Initial Population"
    and "Urinary Symptom Score Within 1 Month After Initial BPH Diagnosis" is not null
    and "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis" is not null
Denominator Exclusion 
define "Denominator Exclusions":
  exists ( "Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis" )
    or ( "Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization" is not null )
    or ( "Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment" )
Numerator 
define "Numerator":
  "Urinary Symptom Score Improvement Greater Than or Equal To 3"
Logic Definitions
Logic Definition Library Name: SupplementalDataElements 
define "SDE Sex":
  case
    when Patient.sex = '248153007' then "Male (finding)"
    when Patient.sex = '248152002' then "Female (finding)"
    else null
  end
Logic Definition Library Name: SupplementalDataElements 
define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }
Logic Definition Library Name: SupplementalDataElements 
define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }
Logic Definition Library Name: SupplementalDataElements 
define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }
Logic Definition Library Name: QICoreCommon 
/*
@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
Logic Definition Library Name: QICoreCommon 
/*
@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
  )
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "SDE Sex":
  SDE."SDE Sex"
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Documented IPSS Assessment Result":
  [ObservationScreeningAssessment: "International Prostate Symptom Score [IPSS]"] IPSSAssessment
    where IPSSAssessment.status in { 'final', 'amended', 'corrected' }
      and IPSSAssessment.value is not null
    return {
      effectiveDatetime: IPSSAssessment.effective.earliest ( ),
      valueInteger: IPSSAssessment.value as Integer
    }
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "AUA Symptom Index and Quality of Life Assessment Result":
  [ObservationScreeningAssessment: "American Urological Association Symptom Index [AUASI]"] AUASIAssessment
    let LastQOLOnDate: Last([ObservationScreeningAssessment: "If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that [IPSS]"] QOLAssessment
        where QOLAssessment.effective.earliest() same day as AUASIAssessment.effective.earliest()
          and QOLAssessment.status in { 'final', 'amended', 'corrected' }
          and QOLAssessment.value is not null
        sort by effective.earliest()
    )
    where AUASIAssessment.status in { 'final', 'amended', 'corrected' }
      and AUASIAssessment.value is not null
    return {
      effectiveDatetime: AUASIAssessment.effective.earliest ( ),
      valueInteger: ( AUASIAssessment.value as Integer ) + ( LastQOLOnDate.value as Integer )
    }
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Urinary Symptom Score Assessment":
  "Documented IPSS Assessment Result"
    union "AUA Symptom Index and Quality of Life Assessment Result"
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period":
  First(([ConditionProblemsHealthConcerns: "Benign prostatic hyperplasia with lower urinary tract symptoms"]
      union [ConditionEncounterDiagnosis: "Benign prostatic hyperplasia with lower urinary tract symptoms"]) NewBPHDiagnosis
      where NewBPHDiagnosis.prevalenceInterval() starts during Interval[start of "Measurement Period" - 6 months, start of "Measurement Period"]
        and NewBPHDiagnosis.isConfirmedActiveDiagnosis()
      sort by start of onset.toInterval()
  )
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Urinary Symptom Score Within 1 Month After Initial BPH Diagnosis":
  First("Urinary Symptom Score Assessment" USSAssessment
      with "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period" InitialBPHDiagnosis
        such that USSAssessment.effectiveDatetime 1 month or less on or after day of start of InitialBPHDiagnosis.prevalenceInterval()
      sort by effectiveDatetime
  )
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis":
  Last("Urinary Symptom Score Assessment" USSAssessment
      with "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period" InitialBPHDiagnosis
        such that months between start of InitialBPHDiagnosis.prevalenceInterval() and USSAssessment.effectiveDatetime in Interval[6, 12]
      sort by effectiveDatetime
  )
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Urinary Symptom Score Change":
  from
    "Urinary Symptom Score Within 1 Month After Initial BPH Diagnosis" FirstUSSAssessment,
    "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis" FollowUpUSSAssessment
    let USSChange: ( FirstUSSAssessment.valueInteger ) - ( FollowUpUSSAssessment.valueInteger )
    return USSChange
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Urinary Symptom Score Improvement Greater Than or Equal To 3":
  ( "Urinary Symptom Score Change" USSImprovement
      where USSImprovement >= 3
  ) is not null
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Numerator":
  "Urinary Symptom Score Improvement Greater Than or Equal To 3"
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Patient is Male":
  Patient.gender = 'male'
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Has Qualifying Encounter":
  exists ( [Encounter: "Office Visit"] ValidEncounter
      where ValidEncounter.period during day of "Measurement Period"
        and ValidEncounter.class !~ "virtual"
        and ValidEncounter.status = 'finished'
  )
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Has Qualifying BPH Diagnosis":
  "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period" is not null
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Initial Population":
  ( "Patient is Male" )
    and "Has Qualifying Encounter"
    and "Has Qualifying BPH Diagnosis"
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Denominator":
  "Initial Population"
    and "Urinary Symptom Score Within 1 Month After Initial BPH Diagnosis" is not null
    and "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis" is not null
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "SDE Payer":
  SDE."SDE Payer"
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Initial Population":
  ( "Patient is Male" )
    and "Has Qualifying Encounter"
    and "Has Qualifying BPH Diagnosis"
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "SDE Ethnicity":
  SDE."SDE Ethnicity"
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis":
  ( [ConditionProblemsHealthConcerns: "Urinary Retention"]
    union [ConditionEncounterDiagnosis: "Urinary Retention"] ) UrinaryRetention
    with "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period" InitialBPHDiagnosis
      such that UrinaryRetention.prevalenceInterval ( ) starts 1 year or less on or after day of start of InitialBPHDiagnosis.prevalenceInterval ( )
    where UrinaryRetention.isConfirmedActiveDiagnosis ( )
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization":
  "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period" InitialBPHDiagnosis
    with [Encounter: "Hospital Services for Urology Care"] UrologyHospitalServices
      such that InitialBPHDiagnosis.prevalenceInterval ( ) starts during Interval[start of UrologyHospitalServices.period, end of UrologyHospitalServices.period + 31 days]
        and UrologyHospitalServices.status = 'finished'
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Morbid Obesity Diagnosis On or Before Follow Up USS Assessment":
  ( [ConditionProblemsHealthConcerns: "Morbid Obesity"]
    union [ConditionEncounterDiagnosis: "Morbid Obesity"] ) MorbidObesityDiagnosis
    with "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis" FollowUpUSSAssessment
      such that MorbidObesityDiagnosis.prevalenceInterval ( ) overlaps "Measurement Period"
        and MorbidObesityDiagnosis.prevalenceInterval ( ) starts on or before FollowUpUSSAssessment.effectiveDatetime
    where MorbidObesityDiagnosis.isConfirmedActiveDiagnosis ( )
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
/*
* @code: Body mass index (BMI) [Ratio] - 39156-5
* @profile: http://hl7.org/fhir/StructureDefinition/bmi
*/


define "BMI Exam Result Greater Than or Equal To 40 During Measurement Period and On or Before Follow Up USS Assessment":
  exists ( ["USCoreBMIProfile"] BMIExam
      with "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis" FollowUpUSSAssessment
        such that BMIExam.value >= 40 'kg/m2'
          and BMIExam.status in { 'final', 'amended', 'corrected' }
          and BMIExam.effective.earliest ( ) during day of "Measurement Period"
          and BMIExam.effective.earliest ( ) on or before FollowUpUSSAssessment.effectiveDatetime
      return BMIExam.effective.earliest ( )
  )
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment":
  exists "Morbid Obesity Diagnosis On or Before Follow Up USS Assessment"
    or "BMI Exam Result Greater Than or Equal To 40 During Measurement Period and On or Before Follow Up USS Assessment"
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "Denominator Exclusions":
  exists ( "Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis" )
    or ( "Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization" is not null )
    or ( "Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment" )
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define "SDE Race":
  SDE."SDE Race"
Logic Definition Library Name: CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia 
define fluent function isConfirmedActiveDiagnosis(condition Choice<ConditionProblemsHealthConcerns, ConditionEncounterDiagnosis>):
  condition.isActive ( )
    and condition.verificationStatus ~ QICoreCommon."confirmed"
Logic Definition Library Name: FHIRHelpers 
define function ToString(value uri): value.value
Logic Definition Library Name: FHIRHelpers 
/*
@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]
Logic Definition Library Name: FHIRHelpers 
/*
@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
        }
Terminology
Code System Description: Code system SNOMEDCT
Resource: SNOMED CT (all versions)
Canonical URL: http://snomed.info/sct
Code System Description: Code system LOINC
Resource: Logical Observation Identifiers, Names and Codes (LOINC)
Canonical URL: http://loinc.org
Code System Description: Code system ICD10CM
Resource: International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)
Canonical URL: http://hl7.org/fhir/sid/icd-10-cm
Code System Description: Code system ConditionVerificationStatusCodes
Resource: ConditionVerificationStatus
Canonical URL: http://terminology.hl7.org/CodeSystem/condition-ver-status
Code System Description: Code system ActCode
Resource: ActCode
Canonical URL: http://terminology.hl7.org/CodeSystem/v3-ActCode
Value Set Description: Value set Office Visit
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
Value Set Description: Value set Payer Type
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Value Set Description: Value set Urinary Retention
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.372
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.372
Value Set Description: Value set Hospital Services for Urology Care
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.360
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.360
Value Set Description: Value set Morbid Obesity
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.368
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.368
Direct Reference Code Display: Male (finding)
Code: 248153007
System: http://snomed.info/sct
Direct Reference Code Display: Female (finding)
Code: 248152002
System: http://snomed.info/sct
Direct Reference Code Display: International Prostate Symptom Score [IPSS]
Code: 80976-4
System: http://loinc.org
Direct Reference Code Display: American Urological Association Symptom Index [AUASI]
Code: 80883-2
System: http://loinc.org
Direct Reference Code Display: If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that [IPSS]
Code: 81090-3
System: http://loinc.org
Direct Reference Code Display: Benign prostatic hyperplasia with lower urinary tract symptoms
Code: N40.1
System: http://hl7.org/fhir/sid/icd-10-cm
Direct Reference Code Display: Confirmed
Code: confirmed
System: http://terminology.hl7.org/CodeSystem/condition-ver-status
Direct Reference Code Display: virtual
Code: VR
System: http://terminology.hl7.org/CodeSystem/v3-ActCode
Dependencies
Dependency Description: Library SDE
Resource: Library/SupplementalDataElements|5.1.000
Canonical URL: Library/SupplementalDataElements|5.1.000
Dependency Description: Library FHIRHelpers
Resource: Library/FHIRHelpers|4.4.000
Canonical URL: Library/FHIRHelpers|4.4.000
Dependency Description: Library FHIRHelpers
Resource: Library/FHIRHelpers|4.4.000
Canonical URL: Library/FHIRHelpers|4.4.000
Dependency Description: Library QICoreCommon
Resource: Library/QICoreCommon|4.0.000
Canonical URL: Library/QICoreCommon|4.0.000
Data Requirements
Data Requirement Type: Observation
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment
Must Support Elements: code, effective, status, status.value, value
Code Filter(s):
Path: code
Code(s): LOINC 80883-2: American Urological Association Symptom Index [AUASI]
Data Requirement Type: Observation
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment
Must Support Elements: code, effective, status, status.value, value
Code Filter(s):
Path: code
Code(s): LOINC 81090-3: If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that [IPSS]
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns
Must Support Elements: code
Code Filter(s):
Path: code
Code(s): International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) N40.1: Benign prostatic hyperplasia with lower urinary tract symptoms
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
Must Support Elements: code
Code Filter(s):
Path: code
Code(s): International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) N40.1: Benign prostatic hyperplasia with lower urinary tract symptoms
Data Requirement Type: Observation
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment
Must Support Elements: code, status, status.value, value, effective
Code Filter(s):
Path: code
Code(s): LOINC 80976-4: International Prostate Symptom Score [IPSS]
Data Requirement Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type, period, class, status, status.value
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.372
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.372
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type, period, status, status.value
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.360
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.368
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.368
Data Requirement Type: Observation
Profile(s): http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi
Must Support Elements: value, status, status.value, effective
Data Requirement Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
Must Support Elements: url
Data Requirement Type: Coverage
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage
Must Support Elements: type, period
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Data Requirement Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
Must Support Elements: url, extension
Generated using version 0.4.8 of the sample-content-ig Liquid templates

Source

{
  "resourceType": "Measure",
  "id": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareablemeasure",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cql-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/elm-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "contained": [
    {
      "resourceType": "Library",
      "id": "effective-data-requirements",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "248153007",
            "display": "Male (finding)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "248152002",
            "display": "Female (finding)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "80976-4",
            "display": "International Prostate Symptom Score [IPSS]"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "80883-2",
            "display": "American Urological Association Symptom Index [AUASI]"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "81090-3",
            "display": "If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that [IPSS]"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://hl7.org/fhir/sid/icd-10-cm",
            "code": "N40.1",
            "display": "Benign prostatic hyperplasia with lower urinary tract symptoms"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
            "code": "confirmed",
            "display": "Confirmed"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
            "code": "VR",
            "display": "virtual"
          }
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":\n  case\n    when Patient.sex = '248153007' then \"Male (finding)\"\n    when Patient.sex = '248152002' then \"Female (finding)\"\n    else null\n  end"
            },
            {
              "url": "displaySequence",
              "valueInteger": 0
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "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": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Documented IPSS Assessment Result"
            },
            {
              "url": "statement",
              "valueString": "define \"Documented IPSS Assessment Result\":\n  [ObservationScreeningAssessment: \"International Prostate Symptom Score [IPSS]\"] IPSSAssessment\n    where IPSSAssessment.status in { 'final', 'amended', 'corrected' }\n      and IPSSAssessment.value is not null\n    return {\n      effectiveDatetime: IPSSAssessment.effective.earliest ( ),\n      valueInteger: IPSSAssessment.value as Integer\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "AUA Symptom Index and Quality of Life Assessment Result"
            },
            {
              "url": "statement",
              "valueString": "define \"AUA Symptom Index and Quality of Life Assessment Result\":\n  [ObservationScreeningAssessment: \"American Urological Association Symptom Index [AUASI]\"] AUASIAssessment\n    let LastQOLOnDate: Last([ObservationScreeningAssessment: \"If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that [IPSS]\"] QOLAssessment\n        where QOLAssessment.effective.earliest() same day as AUASIAssessment.effective.earliest()\n          and QOLAssessment.status in { 'final', 'amended', 'corrected' }\n          and QOLAssessment.value is not null\n        sort by effective.earliest()\n    )\n    where AUASIAssessment.status in { 'final', 'amended', 'corrected' }\n      and AUASIAssessment.value is not null\n    return {\n      effectiveDatetime: AUASIAssessment.effective.earliest ( ),\n      valueInteger: ( AUASIAssessment.value as Integer ) + ( LastQOLOnDate.value as Integer )\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Urinary Symptom Score Assessment"
            },
            {
              "url": "statement",
              "valueString": "define \"Urinary Symptom Score Assessment\":\n  \"Documented IPSS Assessment Result\"\n    union \"AUA Symptom Index and Quality of Life Assessment Result\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period\":\n  First(([ConditionProblemsHealthConcerns: \"Benign prostatic hyperplasia with lower urinary tract symptoms\"]\n      union [ConditionEncounterDiagnosis: \"Benign prostatic hyperplasia with lower urinary tract symptoms\"]) NewBPHDiagnosis\n      where NewBPHDiagnosis.prevalenceInterval() starts during Interval[start of \"Measurement Period\" - 6 months, start of \"Measurement Period\"]\n        and NewBPHDiagnosis.isConfirmedActiveDiagnosis()\n      sort by start of onset.toInterval()\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Urinary Symptom Score Within 1 Month After Initial BPH Diagnosis"
            },
            {
              "url": "statement",
              "valueString": "define \"Urinary Symptom Score Within 1 Month After Initial BPH Diagnosis\":\n  First(\"Urinary Symptom Score Assessment\" USSAssessment\n      with \"Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period\" InitialBPHDiagnosis\n        such that USSAssessment.effectiveDatetime 1 month or less on or after day of start of InitialBPHDiagnosis.prevalenceInterval()\n      sort by effectiveDatetime\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis"
            },
            {
              "url": "statement",
              "valueString": "define \"Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis\":\n  Last(\"Urinary Symptom Score Assessment\" USSAssessment\n      with \"Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period\" InitialBPHDiagnosis\n        such that months between start of InitialBPHDiagnosis.prevalenceInterval() and USSAssessment.effectiveDatetime in Interval[6, 12]\n      sort by effectiveDatetime\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Urinary Symptom Score Change"
            },
            {
              "url": "statement",
              "valueString": "define \"Urinary Symptom Score Change\":\n  from\n    \"Urinary Symptom Score Within 1 Month After Initial BPH Diagnosis\" FirstUSSAssessment,\n    \"Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis\" FollowUpUSSAssessment\n    let USSChange: ( FirstUSSAssessment.valueInteger ) - ( FollowUpUSSAssessment.valueInteger )\n    return USSChange"
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Urinary Symptom Score Improvement Greater Than or Equal To 3"
            },
            {
              "url": "statement",
              "valueString": "define \"Urinary Symptom Score Improvement Greater Than or Equal To 3\":\n  ( \"Urinary Symptom Score Change\" USSImprovement\n      where USSImprovement >= 3\n  ) is not null"
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n  \"Urinary Symptom Score Improvement Greater Than or Equal To 3\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Patient is Male"
            },
            {
              "url": "statement",
              "valueString": "define \"Patient is Male\":\n  Patient.gender = 'male'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Has Qualifying Encounter"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Qualifying Encounter\":\n  exists ( [Encounter: \"Office Visit\"] ValidEncounter\n      where ValidEncounter.period during day of \"Measurement Period\"\n        and ValidEncounter.class !~ \"virtual\"\n        and ValidEncounter.status = 'finished'\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Has Qualifying BPH Diagnosis"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Qualifying BPH Diagnosis\":\n  \"Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period\" is not null"
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  ( \"Patient is Male\" )\n    and \"Has Qualifying Encounter\"\n    and \"Has Qualifying BPH Diagnosis\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n  \"Initial Population\"\n    and \"Urinary Symptom Score Within 1 Month After Initial BPH Diagnosis\" is not null\n    and \"Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis\" is not null"
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "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": 16
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  ( \"Patient is Male\" )\n    and \"Has Qualifying Encounter\"\n    and \"Has Qualifying BPH Diagnosis\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 18
            }
          ],
          "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": 19
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 20
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis"
            },
            {
              "url": "statement",
              "valueString": "define \"Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis\":\n  ( [ConditionProblemsHealthConcerns: \"Urinary Retention\"]\n    union [ConditionEncounterDiagnosis: \"Urinary Retention\"] ) UrinaryRetention\n    with \"Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period\" InitialBPHDiagnosis\n      such that UrinaryRetention.prevalenceInterval ( ) starts 1 year or less on or after day of start of InitialBPHDiagnosis.prevalenceInterval ( )\n    where UrinaryRetention.isConfirmedActiveDiagnosis ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 21
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization\":\n  \"Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period\" InitialBPHDiagnosis\n    with [Encounter: \"Hospital Services for Urology Care\"] UrologyHospitalServices\n      such that InitialBPHDiagnosis.prevalenceInterval ( ) starts during Interval[start of UrologyHospitalServices.period, end of UrologyHospitalServices.period + 31 days]\n        and UrologyHospitalServices.status = 'finished'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 22
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Morbid Obesity Diagnosis On or Before Follow Up USS Assessment"
            },
            {
              "url": "statement",
              "valueString": "define \"Morbid Obesity Diagnosis On or Before Follow Up USS Assessment\":\n  ( [ConditionProblemsHealthConcerns: \"Morbid Obesity\"]\n    union [ConditionEncounterDiagnosis: \"Morbid Obesity\"] ) MorbidObesityDiagnosis\n    with \"Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis\" FollowUpUSSAssessment\n      such that MorbidObesityDiagnosis.prevalenceInterval ( ) overlaps \"Measurement Period\"\n        and MorbidObesityDiagnosis.prevalenceInterval ( ) starts on or before FollowUpUSSAssessment.effectiveDatetime\n    where MorbidObesityDiagnosis.isConfirmedActiveDiagnosis ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 23
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "BMI Exam Result Greater Than or Equal To 40 During Measurement Period and On or Before Follow Up USS Assessment"
            },
            {
              "url": "statement",
              "valueString": "/*\n* @code: Body mass index (BMI) [Ratio] - 39156-5\n* @profile: http://hl7.org/fhir/StructureDefinition/bmi\n*/\n\n\ndefine \"BMI Exam Result Greater Than or Equal To 40 During Measurement Period and On or Before Follow Up USS Assessment\":\n  exists ( [\"USCoreBMIProfile\"] BMIExam\n      with \"Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis\" FollowUpUSSAssessment\n        such that BMIExam.value >= 40 'kg/m2'\n          and BMIExam.status in { 'final', 'amended', 'corrected' }\n          and BMIExam.effective.earliest ( ) during day of \"Measurement Period\"\n          and BMIExam.effective.earliest ( ) on or before FollowUpUSSAssessment.effectiveDatetime\n      return BMIExam.effective.earliest ( )\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 24
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment"
            },
            {
              "url": "statement",
              "valueString": "define \"Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment\":\n  exists \"Morbid Obesity Diagnosis On or Before Follow Up USS Assessment\"\n    or \"BMI Exam Result Greater Than or Equal To 40 During Measurement Period and On or Before Follow Up USS Assessment\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 25
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "Denominator Exclusions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exclusions\":\n  exists ( \"Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis\" )\n    or ( \"Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization\" is not null )\n    or ( \"Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 26
            }
          ],
          "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": 27
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 28
            }
          ],
          "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": 29
            }
          ],
          "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": 30
            }
          ],
          "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": 31
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
            },
            {
              "url": "name",
              "valueString": "isConfirmedActiveDiagnosis"
            },
            {
              "url": "statement",
              "valueString": "define fluent function isConfirmedActiveDiagnosis(condition Choice<ConditionProblemsHealthConcerns, ConditionEncounterDiagnosis>):\n  condition.isActive ( )\n    and condition.verificationStatus ~ QICoreCommon.\"confirmed\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 32
            }
          ],
          "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": 33
            }
          ],
          "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": 34
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        }
      ],
      "name": "EffectiveDataRequirements",
      "status": "active",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/library-type",
            "code": "module-definition"
          }
        ]
      },
      "relatedArtifact": [
        {
          "type": "depends-on",
          "display": "Library SDE",
          "resource": "Library/SupplementalDataElements|5.1.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library QICoreCommon",
          "resource": "Library/QICoreCommon|4.0.000"
        },
        {
          "type": "depends-on",
          "display": "Code system SNOMEDCT",
          "resource": "http://snomed.info/sct"
        },
        {
          "type": "depends-on",
          "display": "Code system LOINC",
          "resource": "http://loinc.org"
        },
        {
          "type": "depends-on",
          "display": "Code system ICD10CM",
          "resource": "http://hl7.org/fhir/sid/icd-10-cm"
        },
        {
          "type": "depends-on",
          "display": "Code system ConditionVerificationStatusCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/condition-ver-status"
        },
        {
          "type": "depends-on",
          "display": "Code system ActCode",
          "resource": "http://terminology.hl7.org/CodeSystem/v3-ActCode"
        },
        {
          "type": "depends-on",
          "display": "Value set Office Visit",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
        },
        {
          "type": "depends-on",
          "display": "Value set Payer Type",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
        },
        {
          "type": "depends-on",
          "display": "Value set Urinary Retention",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.372"
        },
        {
          "type": "depends-on",
          "display": "Value set Hospital Services for Urology Care",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.360"
        },
        {
          "type": "depends-on",
          "display": "Value set Morbid Obesity",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.368"
        }
      ],
      "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": "1",
          "type": "boolean"
        },
        {
          "name": "Denominator",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "SDE Payer",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Initial Population",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "SDE Ethnicity",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Resource"
        },
        {
          "name": "Denominator Exclusions",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "SDE Race",
          "use": "out",
          "min": 0,
          "max": "1",
          "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": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "value",
            "effective"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "80976-4",
                  "display": "International Prostate Symptom Score [IPSS]"
                }
              ]
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment"
          ],
          "mustSupport": [
            "code",
            "effective",
            "status",
            "status.value",
            "value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "80883-2",
                  "display": "American Urological Association Symptom Index [AUASI]"
                }
              ]
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment"
          ],
          "mustSupport": [
            "code",
            "effective",
            "status",
            "status.value",
            "value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "81090-3",
                  "display": "If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that [IPSS]"
                }
              ]
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment"
          ],
          "mustSupport": [
            "code",
            "effective",
            "status",
            "status.value",
            "value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "81090-3",
                  "display": "If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that [IPSS]"
                }
              ]
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"
          ],
          "mustSupport": [
            "code"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://hl7.org/fhir/sid/icd-10-cm",
                  "code": "N40.1",
                  "display": "Benign prostatic hyperplasia with lower urinary tract symptoms"
                }
              ]
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"
          ],
          "mustSupport": [
            "code"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://hl7.org/fhir/sid/icd-10-cm",
                  "code": "N40.1",
                  "display": "Benign prostatic hyperplasia with lower urinary tract symptoms"
                }
              ]
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "value",
            "effective"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "80976-4",
                  "display": "International Prostate Symptom Score [IPSS]"
                }
              ]
            }
          ]
        },
        {
          "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",
            "class",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
            }
          ]
        },
        {
          "type": "Coverage",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
            }
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "extension"
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"
          ],
          "mustSupport": [
            "code"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.372"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"
          ],
          "mustSupport": [
            "code"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.372"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.360"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns"
          ],
          "mustSupport": [
            "code"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.368"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis"
          ],
          "mustSupport": [
            "code"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.368"
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi"
          ],
          "mustSupport": [
            "value",
            "status",
            "status.value",
            "effective"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "extension"
          ]
        },
        {
          "type": "Coverage",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
            }
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "extension"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url",
            "extension"
          ]
        }
      ]
    }
  ],
  "extension": [
    {
      "id": "supplementalDataGuidance",
      "extension": [
        {
          "url": "guidance",
          "valueString": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex\n "
        },
        {
          "url": "usage",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                "code": "supplemental-data",
                "display": "Supplemental Data"
              }
            ],
            "text": "Supplemental Data Guidance"
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance"
    },
    {
      "id": "riskAdjustmentVariableGuidance",
      "extension": [
        {
          "url": "guidance",
          "valueString": "none"
        },
        {
          "url": "usage",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                "code": "risk-adjustment-factor",
                "display": "Risk Adjustment Factor"
              }
            ],
            "text": "Risk Adjustment Variable Guidance"
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance"
    },
    {
      "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
      "valueCanonical": "#effective-data-requirements"
    },
    {
      "id": "effective-data-requirements",
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
      "valueReference": {
        "reference": "#effective-data-requirements"
      }
    }
  ],
  "url": "https://madie.cms.gov/Measure/CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia",
  "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": "CMS771FHIR"
    },
    {
      "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:0748d873-8e20-441e-9bbf-c1eefe3ea054"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "version-specific",
            "display": "Version Specific"
          }
        ]
      },
      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:84e7d559-3046-43bf-9298-766d8ac2ebaa"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type",
            "code": "publisher",
            "display": "Publisher"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/cmsId",
      "value": "771FHIR",
      "assigner": {
        "display": "CMS"
      }
    }
  ],
  "version": "1.5.000",
  "name": "CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia",
  "title": "Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic HyperplasiaFHIR",
  "status": "active",
  "experimental": false,
  "date": "2025-07-15T13:37:40+00:00",
  "publisher": "Large Urology Group Practice Association (LUGPA)",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "https://www.lugpa.org/"
        }
      ]
    }
  ],
  "description": "Percentage of patients with an office visit within the measurement period and with a new diagnosis of clinically significant Benign Prostatic Hyperplasia who have International Prostate Symptoms Score (IPSS) or American Urological Association (AUA) Symptom Index (SI) documented at time of diagnosis and again 6-12 months later with an improvement of 3 points",
  "usage": "The IPSS is inclusive of the symptom index score and the quality of life score. The AUA-SI is the symptom index score alone and must be added to the QOL score. The AUA-SI with the QOL equals the IPSS. Both of these are the urinary symptom score.\n\nThe patient must have a urinary symptom score (USS) within 1 month after initial diagnosis. If more than one USS in the initial one month, then the first USS counts. The patient must have a USS again at 6-12 months after the initial diagnosis and if more than one USS in this time frame, then the last USS counts. \n\nThe result of the test is a numeric value that relates to a continuous numeric scale. Reported either as an integer, a ratio, a real number, or a range. The test result value may optionally contain a relational operator from the set {<=, <, >, >=}. Valid values for a quantitative test are of the form “7”, “-7”, “7.4”, “-7.4”, “7.8912”, “0.125”, “<10”, “<10.15”, “>12000”, 1-10, 1:256. \n\nHospitalization within 30 days of Initial BPH Diagnosis refers to a 30-day period between the end of the hospitalization and the clinical office setting BPH diagnosis. This is due to aggravating factors from hospitalization, such as bed rest, medications, surgery, and altered body functions.\n\nSymptoms of BPH include urinary frequency, urinary urgency, difficulty starting urination, weak urine stream, dribbling at the end of urination, incomplete bladder emptying.\n\nThis eCQM is a patient-based measure.\n\nTelehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS771v6.\n \nPlease 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 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).",
  "copyright": "Limited proprietary coding is contained in the measure specifications for user convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Large Urology Group Practice Association (LUGPA) and Oregon Urology Institute (OUI) disclaim all liability for the use or accuracy of any third-party codes contained in the specifications.\n\nCPT(R) contained in the Measure specifications is copyright 2004-2024. American Medical Association. LOINC(R) 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": "Large Urology Group Practice Association (LUGPA)",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.lugpa.org/"
        }
      ]
    }
  ],
  "library": [
    "https://madie.cms.gov/Library/CMS771FHIRUrinarySymptomScoreChangeBenignProstaticHyperplasia"
  ],
  "disclaimer": "The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.\n\nTHE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.\n\nDue to technical limitations, registered trademarks are indicated by (R) or [R], and unregistered trademarks are indicated by (TM) or [TM].",
  "rationale": "Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting older males, with a prevalence of 50% by age 60 years and 90% by the ninth decade of life (Medina et al., 1999). The enlarged gland had been proposed to contribute to the overall lower urinary tract symptoms (LUTS) complex (McVary et al., 2014). Although LUTS secondary to BPH is not often a life-threatening condition, the impact of LUTS/BPH on quality of life can be significant (Wei et al., 2005). The American Urological Association Symptom Index (AUA-SI) and the International Prostate Symptom Score (IPSS) were developed to measure outcomes in studies of different treatments for BPH (Wuerstle et al., 2011). The IPSS uses the same questions as the AUA-SI, but also adds a disease-specific quality of life question (OLeary, 2005). The IPSS was adopted in 1993 by the World Health Organization. It is a reproducible, validated index designed to determine disease severity and response to therapy (D’Silva et al., 2014). It includes 3 storage symptom questions (frequency, nocturia, urgency) and four voiding symptoms (feeling of incomplete emptying, intermittency, straining, and a weak stream) as well as a Bother question: If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that? A three-point improvement in the score is considered meaningful (McVary et al., 2014).",
  "clinicalRecommendationStatement": "The symptoms of BPH are lower urinary tract symptoms (LUTS). There are other disorders with similar symptoms that need to be excluded. History, physical examination, and testing are required prior to a diagnosis of BPH. IPSS by itself is not a reliable diagnostic tool for LUTS suggestive of BPH but serves as a quantitative measure of LUTS after the diagnosis is established (D’Silva et al., 2014). Medical and surgical interventions for BPH recommend a follow up IPSS evaluation to determine effectiveness of treatment. IPSS should be evaluated at the time of diagnosis and after definitive treatment.",
  "definition": [
    "AUA-SI - American Urological Association-Symptom Index\n",
    "IPSS - International Prostate Symptom Score\n",
    "QOL - Quality of Life score\n"
  ],
  "guidance": "The IPSS is inclusive of the symptom index score and the quality of life score. The AUA-SI is the symptom index score alone and must be added to the QOL score. The AUA-SI with the QOL equals the IPSS. Both of these are the urinary symptom score.\n\nThe patient must have a urinary symptom score (USS) within 1 month after initial diagnosis. If more than one USS in the initial one month, then the first USS counts. The patient must have a USS again at 6-12 months after the initial diagnosis and if more than one USS in this time frame, then the last USS counts. \n\nThe result of the test is a numeric value that relates to a continuous numeric scale. Reported either as an integer, a ratio, a real number, or a range. The test result value may optionally contain a relational operator from the set {<=, <, >, >=}. Valid values for a quantitative test are of the form “7”, “-7”, “7.4”, “-7.4”, “7.8912”, “0.125”, “<10”, “<10.15”, “>12000”, 1-10, 1:256. \n\nHospitalization within 30 days of Initial BPH Diagnosis refers to a 30-day period between the end of the hospitalization and the clinical office setting BPH diagnosis. This is due to aggravating factors from hospitalization, such as bed rest, medications, surgery, and altered body functions.\n\nSymptoms of BPH include urinary frequency, urinary urgency, difficulty starting urination, weak urine stream, dribbling at the end of urination, incomplete bladder emptying.\n\nThis eCQM is a patient-based measure.\n\nTelehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS771v6.\n \nPlease 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 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).",
  "group": [
    {
      "id": "Group_1",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
                "code": "proportion",
                "display": "Proportion"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
          "valueCode": "boolean"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-type",
                "code": "outcome",
                "display": "Outcome"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode": "None"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "increase",
                "display": "Increased score indicates improvement"
              }
            ]
          }
        }
      ],
      "population": [
        {
          "id": "InitialPopulation_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Male patients with an initial diagnosis of benign prostatic hyperplasia 6 months prior to the measurement period, and a urinary symptom score assessment within 1 month of initial diagnosis and a follow-up urinary symptom score assessment within 6-12 months, who had a qualifying visit 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": "Patients in the Initial Population with a urinary symptom score assessment within 1 month of initial diagnosis and a follow-up urinary symptom score assessment within 6-12 months",
          "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": "Patients with urinary retention that starts within 1 year of initial BPH diagnosis.\nPatients with an initial BPH diagnosis that starts during, or within 30 days after end of hospitalization.\nPatients with a diagnosis of morbid obesity, or with a BMI Exam >=40 before the follow up urinary symptom score.",
          "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": "Patients with a documented improvement of at least 3 points in their urinary symptom score during the measurement period",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        }
      ]
    }
  ],
  "supplementalData": [
    {
      "id": "sde-ethnicity",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Ethnicity",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Ethnicity"
      }
    },
    {
      "id": "sde-payer",
      "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"
      }
    },
    {
      "id": "sde-ethnicity",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "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": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "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": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "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": "risk-adjustment-factor"
            }
          ]
        }
      ],
      "description": "SDE Sex",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Sex"
      }
    }
  ]
}