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FHIR IG Statistics: Measure/CMS819FHIRHHORAE

Packagegov.healthit.ecqi.ecqms
Resource TypeMeasure
IdCMS819FHIRHHORAE
FHIR VersionR4
Sourcehttp://ecqi.healthit.gov/ecqms/https://build.fhir.org/ig/cqframework/ecqm-content-qicore-2025/Measure-CMS819FHIRHHORAE.html
URLhttps://madie.cms.gov/Measure/CMS819FHIRHHORAE
Version0.4.000
Statusactive
Date2025-07-15T13:37:39+00:00
NameCMS819FHIRHHORAE
TitleHospital Harm - Opioid-Related Adverse EventsFHIR
DescriptionThis measure assesses the number of inpatient hospitalizations for patients age 18 and older who have been administered an opioid medication and are subsequently administered an opioid antagonist within 12 hours, an indication of an opioid-related adverse event
CopyrightLimited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Mathematica disclaims all liability for use or accuracy of any third-party codes contained in the specifications. 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 Hospital Harm - Opioid-Related Adverse EventsFHIR
Version 0.4.000
Short Name CMS819FHIR
GUID (Version Independent) urn:uuid:30256069-ee4f-45b8-895a-5452cf8e9e4e
GUID (Version Specific) urn:uuid:761866af-769b-465b-aef0-36f70c94e921
CMS Identifier 819FHIR
CMS Consensus Based Entity Identifier 3501e
Effective Period 2026-01-01 through 2026-12-31
Steward (Publisher) Centers for Medicare & Medicaid Services (CMS)
Developer Mathematica
Description

This measure assesses the number of inpatient hospitalizations for patients age 18 and older who have been administered an opioid medication and are subsequently administered an opioid antagonist within 12 hours, an indication of an opioid-related adverse event
Copyright

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Mathematica disclaims all liability for use or accuracy of any third-party codes contained in the specifications. 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

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

Opioids are often the foundation for sedation and pain relief. Opioid-based analgesia continues to be the most commonly used treatment in postoperative pain management, with more than 95% of surgical patients receiving opioids during their hospitalization (Baker et al., 2020). However, use of opioids can also lead to serious adverse events, including constipation, over sedation, delirium, and respiratory depression (Urman et al., 2021a). Opioid-related adverse events (ORADE) have both patient-level and financial implications. The presence of an ORADE was associated with a 55% longer postoperative length of stay, 29% lower odds of discharge home, and 2.9 times the odds of death (Urman et al., 2021b). For surgical patients, occurrence of opioid-related adverse events was associated with an increase of 1.6 days in length of stay (LOS) and $8225 more in cost for the index hospitalization. Patients who experienced ORADEs while in a hospitalized setting were more likely to have received a higher total dose of opioids during hospitalization (Cone et al., 2023; Shafi et al., 2018). Numerous studies report the additive (risk-adjusted) hospitalization cost burden of surgical patients with ORADEs to be between $4350–$8225, representing a 27–47% increase in (risk-adjusted) admission costs (Khanna et al., 2021). Most opioid-related adverse events are preventable. Each year, adverse drug events (ADE) account for nearly 700,000 emergency department visits and 100,000 hospitalizations (AHRQ, 2019). An estimated one-third of all adverse events that occur in the inpatient setting are adverse drug events (ODPHP, 2020). Additionally, in a closed-claims analysis, 97% of adverse events were judged preventable with better monitoring and response (Lee et al., 2015). Naloxone administration is often used as an indicator of a severe opioid-related adverse event, and implementation of this measure can advance safe use of opioids in hospitals and prevent these serious and potentially lethal adverse drug events.
Clinical Recommendation Statement

Naloxone is an opioid reversal agent typically used for severe opioid-related adverse events. Naloxone administration has been used in a number of studies as an indicator of opioid-related adverse events (Yiu, et al., 2022; Lynn & Galinkin, 2017; Nwulu et al., 2013). From Section 10 of the 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (Lavonas et al., 2015), the following recommendation is listed for use of naloxone: Naloxone is a potent opioid receptor antagonist in the brain, spinal cord, and gastrointestinal system. Naloxone has an excellent safety profile and can rapidly reverse central nervous system (CNS) and respiratory depression in a patient with an opioid-associated resuscitative emergency. The 2020 American Heart Association guidelines update for cardiopulmonary resuscitation continue to recommend naloxone for a patient with suspected opioid overdose who has a definite pulse but no normal breathing or only gasping (i.e., a respiratory arrest), in addition to providing standard Pediatric Basic Life Support (PBLS) or Pediatric Advanced Life Support (PALS), it is reasonable for responders to administer intramuscular or intranasal naloxone. These recommendations are identical for adults (American Heart Association, 2020). In February 2022, the Food and Drug Administration (FDA) approved its abbreviated new drug application for nalmefene hydrochloride injection, 2mg/2mL (1mg/1mL). Nalmefene is an opioid antagonist indicated for the complete or partial reversal of opioid drug effects, including respiratory depression, induced by either natural or synthetic opioids, and in the management of known or suspected opioid overdose (FDA, 2022). In contrast to naloxone, the long half-life of nalmefene is similar to or greater than that of many opioid receptor agonists (Britch & Walsh, 2022), which could decrease the need for repeat drug administration. In May 2023, FDA approved nalmefene hydrochloride nasal spray that delivers 2.7 milligrams (mg) of nalmefene into the nasal cavity (FDA, 2023).
Citation

CITATION - Agency for Healthcare Research and Quality. (2019). Medication Errors and Adverse Drug Events. Rockville: US Department of Health & Human Services. Retrieved from https://psnet.ahrq.gov/primer/medication-errors-and-adverse-drug-events
Citation

CITATION - American Heart Association. (2020). Highlights of the 2020 American Heart Association's Guidelines for CPR and ECC. https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf
Citation

CITATION - American Heart Association and American Society of Anesthesiologists. (2021). Naloxone in CPR/AED Training and Public Access to Defibrillation. Retrieved from https://www.heart.org/-/media/Files/About-Us/Policy-Research/Policy-Positions/CPR-and-AED/Naloxone-Position-Statement.pdf
Citation

CITATION - Baker, J., Brovman, E.Y., Rao, N., Beutler, S.S., Urman, R.D. (2020). Potential Opioid-Related Adverse Drug Events Are Associated With Decreased Revenue in Hip Replacement Surgery in the Older Population. Geriatric Orthopaedic Surgery & Rehabilitation. January 2020. doi:10.1177/2151459320915328
Citation

CITATION - Britch, S.C., Walsh, S.L. (2022). Treatment of opioid overdose: current approaches and recent advances. Psychopharmacology (Berl). 2022;239(7):2063-2081. doi:10.1007/s00213-022-06125-5
Citation

CITATION - Food and Drug Administration. (2022). Nalmefene Hydrochloride Injection 2mg/2mL (1mg/1mL) [Full Prescribing Information]. Stamford, CT: Purdue Pharma L.P., 02/08/2022. https://www.accessdata.fda.gov/spl/data/d4bb0797-a4ed-4ed4-9904-604433eea4ff/d4bb0797-a4ed-4ed4-9904-604433eea4ff.xml
Citation

CITATION - Kessler, E. R., Shah, M., Gruschkus, S. K., & Raju, A. (2013). Cost and quality implications of opioid-based postsurgical pain control using administrative claims data from a large health system: opioid-related adverse events and their impact on clinical and economic outcomes. Pharmacotherapy, 33(4), 383-391. doi: 10.1002/phar.1223
Citation

CITATION - Khanna, A.K., Saager, L., Bergese, S.D., et al. (2021). Opioid-induced respiratory depression increases hospital costs and length of stay in patients recovering on the general care floor. BMC Anesthesiol. 2021;21(1):88. Published 2021 Mar 20. doi:10.1186/s12871-021-01307-8
Citation

CITATION - Lavonas, E. J., Drennan, I. R., Gabrielli, A., Heffner, A. C., Hoyte, C. O., Orkin, A. M., Donnino, M. W. (2015). Part 10: Special Circumstances of Resuscitation. 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, 132(18 suppl 2), S501-S518. doi: 10.1161/cir.0000000000000264
Citation

CITATION - Lee, L. A., Caplan, R. A., Stephens, L. S., Posner, K. L., Terman, G. W., Voepel-Lewis, T., & Domino, K. B. (2015). Postoperative opioid-induced respiratory depression: a closed claims analysis. Anesthesiology, 122(3), 659-665
Citation

CITATION - Lynn, R. R., Galinkin, J. (2017). Naloxone dosage for opioid reversal: Current evidence and clinical implications. Therapeutic Advances in Drug Safety, 9(1), 63-88. doi:10.1177/204209861774416
Citation

CITATION - Makary, M. A., Daniel, M. (2016). Medical error-the third leading cause of death in the US. BMJ, 353, i2139. doi: 10.1136/bmj.i2139
Citation

CITATION - Med Lett Drugs Ther. (2022). Nalmefene Returns for Reversal of Opioid Overdose. Sep 5;64(1658):141-2
Citation

CITATION - Nwulu, U., Nirantharakumar, K., Odesanya, R., McDowell, S. E., Coleman, J. J. (2013). Improvement in the detection of adverse drug events by the use of electronic health and prescription records: an evaluation of two trigger tools. Eur J Clin Pharmacol, 69(2), 255-259. doi: 10.1007/s00228-012-1327-1
Citation

CITATION - Shafi, S., Collinsworth, A.W., Copeland, L.A., et al. (2018). Association of Opioid-Related Adverse Drug Events With Clinical and Cost Outcomes Among Surgical Patients in a Large Integrated Health Care Delivery System. JAMA Surg. 2018;153(8):757-763. doi:10.1001/jamasurg.2018.1039. PMID: 29799927; PMCID: PMC6142954
Citation

CITATION - Urman, R.D., Khanna, A.K., Bergese, S.D., et al. (2021). Postoperative opioid administration characteristics associated with opioid-induced respiratory depression: Results from the PRODIGY trial. J Clin Anesth. 2021;70:110167. doi:10.1016/j.jclinane.110167
Citation

CITATION - Urman, R.D., Seger, D.L., Fiskio, J.M., et al. (2021). The Burden of Opioid-Related Adverse Drug Events on Hospitalized Previously Opioid-Free Surgical Patients. J Patient Saf. 2021;17(2):e76-e83
Guidance (Usage) Qualifying encounters (denominator) include all patients 18 years of age or older with at least one opioid medication administered outside of the operating room. To create the numerator: 1. First, start with those encounters meeting denominator criteria. 2. Next, remove all events where an opioid or opioid antagonist was administered in the operating room. Opioid antagonist administrations in the operating room are excluded because they could be part of the sedation plan as administered by an anesthesiologist. Encounters that include use of opioid antagonists for procedures and recovery outside of the operating room (e.g., bone marrow biopsy and PACU) are included in the numerator, as it would indicate the patient was over-sedated. Note that should a facility not utilize temporary patient locations, alternative times may be used to determine whether a patient is in the operating room during opioid antagonist administration. Since anesthesia end time could represent the time the anesthesiologist signed off, and thus may include the patient’s time in the PACU, this should be avoided. 3. Next, remove all events where the opioid antagonist was administered via an enteral route. Only opioid antagonists given by a non-enteral (i.e., intravenous, intramuscular, subcutaneous, intranasal, inhalation) route are considered. 4. Finally, remove all administrations of opioid antagonist that were given greater than 12 hours following hospital administration of an opioid medication. This dQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS819v4. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).
Measure Group (Rate) (ID: Group_1)
Basis Encounter
Scoring Proportion
Type Outcome
Rate Aggregation None
Improvement Notation decrease
Initial Population ID: InitialPopulation_1
Description:

Inpatient hospitalizations that end during the measurement period for patients age 18 and older and at least one opioid medication administration starts during the hospitalization outside of the operating room

Logic Definition: Initial Population
Denominator ID: Denominator_1
Description:

Equals Initial Population

Logic Definition: Denominator
Numerator ID: Numerator_1
Description:

Inpatient hospitalizations where a non-enteral opioid antagonist administration starts during the hospitalization outside of the operating room and 12 hours or less following an opioid medication administered outside of the operating room. The route of administration of the opioid antagonist must be by intranasal spray, inhalation, intramuscular, subcutaneous, or intravenous injection. Only one numerator event is counted per encounter.

Logic Definition: Numerator
Supplemental Data Guidance For every patient evaluated by this measure also identify payer, race, ethnicity and sex
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
Measure Logic
Primary Library CMS819FHIRHHORAE
Contents Population Criteria
Logic Definitions
Terminology
Dependencies
Data Requirements
Population Criteria
Measure Group (Rate) (ID: Group_1)
Initial Population 
define "Initial Population":
  "Encounter With Opioid Administration Outside Of Operating Room"
Initial Population 
define "Initial Population":
  "Encounter With Opioid Administration Outside Of Operating Room"
Denominator 
define "Denominator":
  "Initial Population"
Denominator 
define "Denominator":
  "Initial Population"
Numerator 
define "Numerator":
  "Encounter With NonOperating Room Opioid And Antagonist Administration"
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: CMS819FHIRHHORAE 
define "SDE Sex":
  SDE."SDE Sex"
Logic Definition Library Name: CMS819FHIRHHORAE 
define "Non Enteral Opioid Antagonist Administration":
  ["MedicationAdministration": "Opioid Antagonist"] AntagonistGiven
    where AntagonistGiven.status = 'completed'
Logic Definition Library Name: CMS819FHIRHHORAE 
define "Opioid Administration":
  ["MedicationAdministration": "Opioids, All"] Opioids
    where Opioids.status = 'completed'
Logic Definition Library Name: CMS819FHIRHHORAE 
define "Qualifying Encounter":
  ["Encounter": "Encounter Inpatient"] InpatientEncounter
    where AgeInYearsAt(date from start of InpatientEncounter.period) >= 18
      and InpatientEncounter.period ends during day of "Measurement Period"
      and InpatientEncounter.status = 'finished'
Logic Definition Library Name: CMS819FHIRHHORAE 
define "Encounter With Opioid Administration Outside Of Operating Room":
  "Qualifying Encounter" InpatientEncounter
    with "Opioid Administration" OpioidGiven
      such that OpioidGiven.effective.toInterval ( ) starts during InpatientEncounter.hospitalizationWithObservation ( )
        and not exists ( InpatientEncounter.location EncounterLocation
            where EncounterLocation.location.getLocation ( ).type in "Operating Room Suite"
              and OpioidGiven.effective.toInterval ( ) starts during EncounterLocation.period
        )
Logic Definition Library Name: CMS819FHIRHHORAE 
define "Initial Population":
  "Encounter With Opioid Administration Outside Of Operating Room"
Logic Definition Library Name: CMS819FHIRHHORAE 
define "Denominator":
  "Initial Population"
Logic Definition Library Name: CMS819FHIRHHORAE 
define "Encounter With NonOperating Room Opioid And Antagonist Administration":
  // Excludes opioid antagonist administered in operating room AND excludes opioids administered in operating room AND opioid is administered before opioid antagonist AND limits opioid antagonist to non-enteral routes//
  
  from
    "Non Enteral Opioid Antagonist Administration" NonEnteralOpioidAntagonistGiven,
    "Opioid Administration" OpioidGiven,
    "Denominator" InpatientHospitalization
    where not exists ( InpatientHospitalization.location EncounterLocation
        where EncounterLocation.location.getLocation ( ).type in "Operating Room Suite"
          and NonEnteralOpioidAntagonistGiven.effective.toInterval ( ) starts during EncounterLocation.period
    )
      and ( NonEnteralOpioidAntagonistGiven.effective.toInterval ( ) starts during InpatientHospitalization.hospitalizationWithObservation ( )
          and OpioidGiven.effective.toInterval ( ) starts during InpatientHospitalization.hospitalizationWithObservation ( )
          and OpioidGiven.effective.toInterval ( ) ends 12 hours or less before start of NonEnteralOpioidAntagonistGiven.effective.toInterval ( )
          and NonEnteralOpioidAntagonistGiven.dosage.route in "Routes of Administration for Opioid Antagonists"
      )
    return InpatientHospitalization
Logic Definition Library Name: CMS819FHIRHHORAE 
define "Numerator":
  "Encounter With NonOperating Room Opioid And Antagonist Administration"
Logic Definition Library Name: CMS819FHIRHHORAE 
define "Denominator":
  "Initial Population"
Logic Definition Library Name: CMS819FHIRHHORAE 
define "SDE Payer":
  SDE."SDE Payer"
Logic Definition Library Name: CMS819FHIRHHORAE 
define "Initial Population":
  "Encounter With Opioid Administration Outside Of Operating Room"
Logic Definition Library Name: CMS819FHIRHHORAE 
define "SDE Ethnicity":
  SDE."SDE Ethnicity"
Logic Definition Library Name: CMS819FHIRHHORAE 
define "SDE Race":
  SDE."SDE Race"
Logic Definition Library Name: CQMCommon 
/*
@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter
*/
define fluent function hospitalizationWithObservation(TheEncounter Encounter ):
  TheEncounter Visit
  		let ObsVisit: Last([Encounter: "Observation Services"] LastObs
  				where LastObs.status = 'finished'
            and LastObs.period ends 1 hour or less on or before start of Visit.period
  				sort by end of period
  			),
  			VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
  			EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
  				where LastED.status = 'finished'
            and LastED.period ends 1 hour or less on or before VisitStart
  				sort by end of period
  			)
  		return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]
Logic Definition Library Name: CQMCommon 
/*
@description: Returns the Location resource specified by the given reference.
*/
define fluent function getLocation(reference Reference):
  singleton from (
    [Location] L where reference.references(L)
  )
Logic Definition Library Name: QICoreCommon 
/*
@description: Returns true if the given reference is to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference Reference, resource Resource):
  resource.id = Last(Split(reference.reference, '/'))
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 [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }
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
Value Set Description: Value set Opioid Antagonist
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.119
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.119
Value Set Description: Value set Opioids, All
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1196.226
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1196.226
Value Set Description: Value set Encounter Inpatient
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Value Set Description: Value set Observation Services
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
Value Set Description: Value set Emergency Department Visit
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292
Value Set Description: Value set Operating Room Suite
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.141
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.141
Value Set Description: Value set Routes of Administration for Opioid Antagonists
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.187
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.187
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
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
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
Dependency Description: Library CQMCommon
Resource: Library/CQMCommon|4.1.000
Canonical URL: Library/CQMCommon|4.1.000
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: MedicationAdministration
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration
Must Support Elements: medication
Code Filter(s):
Path: medication
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.119
Data Requirement Type: MedicationAdministration
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration
Must Support Elements: medication
Code Filter(s):
Path: medication
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1196.226
Data Requirement Type: MedicationAdministration
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration
Must Support Elements: medication.reference.value
Data Requirement Type: Medication
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication
Must Support Elements: id.value, code
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, status, status.value
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type, status, status.value, period
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type, status, status.value, period
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292
Data Requirement Type: Location
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-location
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type, period, status, status.value, location
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
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": "CMS819FHIRHHORAE",
  "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)"
          }
        },
        {
          "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": "CMS819FHIRHHORAE"
            },
            {
              "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": "CMS819FHIRHHORAE"
            },
            {
              "url": "name",
              "valueString": "Non Enteral Opioid Antagonist Administration"
            },
            {
              "url": "statement",
              "valueString": "define \"Non Enteral Opioid Antagonist Administration\":\n  [\"MedicationAdministration\": \"Opioid Antagonist\"] AntagonistGiven\n    where AntagonistGiven.status = 'completed'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS819FHIRHHORAE"
            },
            {
              "url": "name",
              "valueString": "Opioid Administration"
            },
            {
              "url": "statement",
              "valueString": "define \"Opioid Administration\":\n  [\"MedicationAdministration\": \"Opioids, All\"] Opioids\n    where Opioids.status = 'completed'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS819FHIRHHORAE"
            },
            {
              "url": "name",
              "valueString": "Qualifying Encounter"
            },
            {
              "url": "statement",
              "valueString": "define \"Qualifying Encounter\":\n  [\"Encounter\": \"Encounter Inpatient\"] InpatientEncounter\n    where AgeInYearsAt(date from start of InpatientEncounter.period) >= 18\n      and InpatientEncounter.period ends during day of \"Measurement Period\"\n      and InpatientEncounter.status = 'finished'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS819FHIRHHORAE"
            },
            {
              "url": "name",
              "valueString": "Encounter With Opioid Administration Outside Of Operating Room"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Opioid Administration Outside Of Operating Room\":\n  \"Qualifying Encounter\" InpatientEncounter\n    with \"Opioid Administration\" OpioidGiven\n      such that OpioidGiven.effective.toInterval ( ) starts during InpatientEncounter.hospitalizationWithObservation ( )\n        and not exists ( InpatientEncounter.location EncounterLocation\n            where EncounterLocation.location.getLocation ( ).type in \"Operating Room Suite\"\n              and OpioidGiven.effective.toInterval ( ) starts during EncounterLocation.period\n        )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS819FHIRHHORAE"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  \"Encounter With Opioid Administration Outside Of Operating Room\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS819FHIRHHORAE"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n  \"Initial Population\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS819FHIRHHORAE"
            },
            {
              "url": "name",
              "valueString": "Encounter With NonOperating Room Opioid And Antagonist Administration"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With NonOperating Room Opioid And Antagonist Administration\":\n  // Excludes opioid antagonist administered in operating room AND excludes opioids administered in operating room AND opioid is administered before opioid antagonist AND limits opioid antagonist to non-enteral routes//\n  \n  from\n    \"Non Enteral Opioid Antagonist Administration\" NonEnteralOpioidAntagonistGiven,\n    \"Opioid Administration\" OpioidGiven,\n    \"Denominator\" InpatientHospitalization\n    where not exists ( InpatientHospitalization.location EncounterLocation\n        where EncounterLocation.location.getLocation ( ).type in \"Operating Room Suite\"\n          and NonEnteralOpioidAntagonistGiven.effective.toInterval ( ) starts during EncounterLocation.period\n    )\n      and ( NonEnteralOpioidAntagonistGiven.effective.toInterval ( ) starts during InpatientHospitalization.hospitalizationWithObservation ( )\n          and OpioidGiven.effective.toInterval ( ) starts during InpatientHospitalization.hospitalizationWithObservation ( )\n          and OpioidGiven.effective.toInterval ( ) ends 12 hours or less before start of NonEnteralOpioidAntagonistGiven.effective.toInterval ( )\n          and NonEnteralOpioidAntagonistGiven.dosage.route in \"Routes of Administration for Opioid Antagonists\"\n      )\n    return InpatientHospitalization"
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS819FHIRHHORAE"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n  \"Encounter With NonOperating Room Opioid And Antagonist Administration\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS819FHIRHHORAE"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n  \"Initial Population\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "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": 11
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS819FHIRHHORAE"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS819FHIRHHORAE"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  \"Encounter With Opioid Administration Outside Of Operating Room\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "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": 14
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS819FHIRHHORAE"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "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": 16
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS819FHIRHHORAE"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "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": 18
            }
          ],
          "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": 19
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "hospitalizationWithObservation"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter\n*/\ndefine fluent function hospitalizationWithObservation(TheEncounter Encounter ):\n  TheEncounter Visit\n  \t\tlet ObsVisit: Last([Encounter: \"Observation Services\"] LastObs\n  \t\t\t\twhere LastObs.status = 'finished'\n            and LastObs.period ends 1 hour or less on or before start of Visit.period\n  \t\t\t\tsort by end of period\n  \t\t\t),\n  \t\t\tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n  \t\t\tEDVisit: Last([Encounter: \"Emergency Department Visit\"] LastED\n  \t\t\t\twhere LastED.status = 'finished'\n            and LastED.period ends 1 hour or less on or before VisitStart\n  \t\t\t\tsort by end of period\n  \t\t\t)\n  \t\treturn Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 20
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "getLocation"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns the Location resource specified by the given reference.\n*/\ndefine fluent function getLocation(reference Reference):\n  singleton from (\n    [Location] L where reference.references(L)\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 21
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "references"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given reference is to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(reference Reference, resource Resource):\n  resource.id = Last(Split(reference.reference, '/'))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 22
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToConcept"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 23
            }
          ],
          "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": 24
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        }
      ],
      "name": "EffectiveDataRequirements",
      "status": "active",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/library-type",
            "code": "module-definition"
          }
        ]
      },
      "relatedArtifact": [
        {
          "type": "depends-on",
          "display": "Library SDE",
          "resource": "Library/SupplementalDataElements|5.1.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library QICoreCommon",
          "resource": "Library/QICoreCommon|4.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library CQMCommon",
          "resource": "Library/CQMCommon|4.1.000"
        },
        {
          "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": "Value set Opioid Antagonist",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.119"
        },
        {
          "type": "depends-on",
          "display": "Value set Opioids, All",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1196.226"
        },
        {
          "type": "depends-on",
          "display": "Value set Encounter Inpatient",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
        },
        {
          "type": "depends-on",
          "display": "Value set Observation Services",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"
        },
        {
          "type": "depends-on",
          "display": "Value set Emergency Department Visit",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
        },
        {
          "type": "depends-on",
          "display": "Value set Operating Room Suite",
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        },
        {
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        },
        {
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      "extension": [
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          "url": "guidance",
          "valueString": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex"
        },
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  "url": "https://madie.cms.gov/Measure/CMS819FHIRHHORAE",
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      "value": "3501e",
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      "value": "819FHIR",
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  "version": "0.4.000",
  "name": "CMS819FHIRHHORAE",
  "title": "Hospital Harm - Opioid-Related Adverse EventsFHIR",
  "status": "active",
  "experimental": false,
  "date": "2025-07-15T13:37:39+00:00",
  "publisher": "Centers for Medicare & Medicaid Services (CMS)",
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  "description": "This measure assesses the number of inpatient hospitalizations for patients age 18 and older who have been administered an opioid medication and are subsequently administered an opioid antagonist within 12 hours, an indication of an opioid-related adverse event",
  "usage": "Qualifying encounters (denominator) include all patients 18 years of age or older with at least one opioid medication administered outside of the operating room.  To create the numerator:   1. First, start with those encounters meeting denominator criteria.  2. Next, remove all events where an opioid or opioid antagonist was administered in the operating room.   Opioid antagonist administrations in the operating room are excluded because they could be part of the sedation plan as administered by an anesthesiologist. Encounters that include use of opioid antagonists for procedures and recovery outside of the operating room (e.g., bone marrow biopsy and PACU) are included in the numerator, as it would indicate the patient was over-sedated. Note that should a facility not utilize temporary patient locations, alternative times may be used to determine whether a patient is in the operating room during opioid antagonist administration. Since anesthesia end time could represent the time the anesthesiologist signed off, and thus may include the patient’s time in the PACU, this should be avoided.  3. Next, remove all events where the opioid antagonist was administered via an enteral route. Only opioid antagonists given by a non-enteral (i.e., intravenous, intramuscular, subcutaneous, intranasal, inhalation) route are considered.  4. Finally, remove all administrations of opioid antagonist that were given greater than 12 hours following hospital administration of an opioid medication.  This dQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.  This FHIR-based measure has been derived from the QDM-based measure: CMS819v4. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).",
  "copyright": "Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Mathematica disclaims all liability for use or accuracy of any third-party codes contained in the specifications.   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": "Mathematica",
      "telecom": [
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          "value": "https://www.mathematica.org/"
        }
      ]
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
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    },
    {
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      "citation": "CITATION - American Heart Association. (2020). Highlights of the 2020 American Heart Association's Guidelines for CPR and ECC. https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf "
    },
    {
      "type": "citation",
      "citation": "CITATION - American Heart Association and American Society of Anesthesiologists. (2021). Naloxone in CPR/AED Training and Public Access to Defibrillation.  Retrieved from https://www.heart.org/-/media/Files/About-Us/Policy-Research/Policy-Positions/CPR-and-AED/Naloxone-Position-Statement.pdf "
    },
    {
      "type": "citation",
      "citation": "CITATION - Baker, J., Brovman, E.Y., Rao, N., Beutler, S.S., Urman, R.D. (2020). Potential Opioid-Related Adverse Drug Events Are Associated With Decreased Revenue in Hip Replacement Surgery in the Older Population. Geriatric Orthopaedic Surgery & Rehabilitation. January 2020. doi:10.1177/2151459320915328 "
    },
    {
      "type": "citation",
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    {
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    },
    {
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    {
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    {
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    }
  ],
  "library": [
    "https://madie.cms.gov/Library/CMS819FHIRHHORAE"
  ],
  "disclaimer": "This performance measure is not a clinical guideline, does not establish a standard of medical care and has not been tested for all potential applications.  THE MEASURES 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": "Opioids are often the foundation for sedation and pain relief. Opioid-based analgesia continues to be the most commonly used treatment in postoperative pain management, with more than 95% of surgical patients receiving opioids during their hospitalization (Baker et al., 2020). However, use of opioids can also lead to serious adverse events, including constipation, over sedation, delirium, and respiratory depression (Urman et al., 2021a). Opioid-related adverse events (ORADE) have both patient-level and financial implications. The presence of an ORADE was associated with a 55% longer postoperative length of stay, 29% lower odds of discharge home, and 2.9 times the odds of death (Urman et al., 2021b). For surgical patients, occurrence of opioid-related adverse events was associated with an increase of 1.6 days in length of stay (LOS) and $8225 more in cost for the index hospitalization. Patients who experienced ORADEs while in a hospitalized setting were more likely to have received a higher total dose of opioids during hospitalization (Cone et al., 2023; Shafi et al., 2018). Numerous studies report the additive (risk-adjusted) hospitalization cost burden of surgical patients with ORADEs to be between $4350–$8225, representing a 27–47% increase in (risk-adjusted) admission costs (Khanna et al., 2021).  Most opioid-related adverse events are preventable. Each year, adverse drug events (ADE) account for nearly 700,000 emergency department visits and 100,000 hospitalizations (AHRQ, 2019). An estimated one-third of all adverse events that occur in the inpatient setting are adverse drug events (ODPHP, 2020). Additionally, in a closed-claims analysis, 97% of adverse events were judged preventable with better monitoring and response (Lee et al., 2015). Naloxone administration is often used as an indicator of a severe opioid-related adverse event, and implementation of this measure can advance safe use of opioids in hospitals and prevent these serious and potentially lethal adverse drug events.",
  "clinicalRecommendationStatement": "Naloxone is an opioid reversal agent typically used for severe opioid-related adverse events. Naloxone administration has been used in a number of studies as an indicator of opioid-related adverse events (Yiu, et al., 2022; Lynn & Galinkin, 2017; Nwulu et al., 2013).  From Section 10 of the 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (Lavonas et al., 2015), the following recommendation is listed for use of naloxone:  Naloxone is a potent opioid receptor antagonist in the brain, spinal cord, and gastrointestinal system. Naloxone has an excellent safety profile and can rapidly reverse central nervous system (CNS) and respiratory depression in a patient with an opioid-associated resuscitative emergency.  The 2020 American Heart Association guidelines update for cardiopulmonary resuscitation continue to recommend naloxone for a patient with suspected opioid overdose who has a definite pulse but no normal breathing or only gasping (i.e., a respiratory arrest), in addition to providing standard Pediatric Basic Life Support (PBLS) or Pediatric Advanced Life Support (PALS), it is reasonable for responders to administer intramuscular or intranasal naloxone. These recommendations are identical for adults (American Heart Association, 2020).  In February 2022, the Food and Drug Administration (FDA) approved its abbreviated new drug application for nalmefene hydrochloride injection, 2mg/2mL (1mg/1mL). Nalmefene is an opioid antagonist indicated for the complete or partial reversal of opioid drug effects, including respiratory depression, induced by either natural or synthetic opioids, and in the management of known or suspected opioid overdose (FDA, 2022). In contrast to naloxone, the long half-life of nalmefene is similar to or greater than that of many opioid receptor agonists (Britch & Walsh, 2022), which could decrease the need for repeat drug administration. In May 2023, FDA approved nalmefene hydrochloride nasal spray that delivers 2.7 milligrams (mg) of nalmefene into the nasal cavity (FDA, 2023).",
  "group": [
    {
      "id": "Group_1",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
                "code": "proportion",
                "display": "Proportion"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
          "valueCode": "Encounter"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-type",
                "code": "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": "decrease",
                "display": "decrease"
              }
            ]
          }
        }
      ],
      "population": [
        {
          "id": "InitialPopulation_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Inpatient hospitalizations that end during the measurement period for patients age 18 and older and at least one opioid medication administration starts during the hospitalization outside of the operating room",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "Denominator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator",
                "display": "Denominator"
              }
            ]
          },
          "description": "Equals Initial Population",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator"
          }
        },
        {
          "id": "Numerator_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator",
                "display": "Numerator"
              }
            ]
          },
          "description": "Inpatient hospitalizations where a non-enteral opioid antagonist administration starts during the hospitalization outside of the operating room and 12 hours or less following an opioid medication administered outside of the operating room.   The route of administration of the opioid antagonist must be by intranasal spray, inhalation, intramuscular, subcutaneous, or intravenous injection.   Only one numerator event is counted per encounter.",
          "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"
      }
    }
  ]
}