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Package example.fhir.uv.mycontentig
Type Measure
Id Id
FHIR Version R4
Source http://somewhere.org/fhir/uv/mycontentig/https://build.fhir.org/ig/cqframework/sample-content-ig/Measure-DischargedonAntithromboticTherapyFHIRExample.html
Url http://somewhere.org/fhir/uv/mycontentig/Measure/DischargedonAntithromboticTherapyFHIRExample
Version 0.4.4
Status draft
Date 2024-05-06T01:40:05+00:00
Name DischargedonAntithromboticTherapyFHIRExample
Title Discharged on Antithrombotic Therapy FHIR Example
Experimental False
Realm uv
Authority hl7
Description Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge
Purpose UNKNOWN
Copyright Measure specifications are in the Public Domain LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2021 World Health Organization. All Rights Reserved.

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Narrative

Note: links and images are rebased to the (stated) source

Title: Discharged on Antithrombotic Therapy FHIR Example
Id: DischargedonAntithromboticTherapyFHIRExample
Version: 0.4.4
Url: Discharged on Antithrombotic Therapy FHIR Example
short-name identifier:

CMS104FHIR

version-independent identifier:

urn:uuid:4f57e4a2-097b-45f8-9c85-91b35ea92dc1

version-specific identifier:

urn:uuid:e0b5379f-4b9c-4177-a530-d744fa95d080

publisher (CMS) identifier:

104FHIR

Effective Period: 2024-01-01..2024-12-31
Status: draft
Publisher: HL7 International - [Some] Work Group
Author: The Joint Commission
Description:

Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge
Use Context:
code value
program
Jurisdiction: 001
Purpose:

UNKNOWN
Copyright:

Measure specifications are in the Public Domain

LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2021 World Health Organization. All Rights Reserved.
Disclaimer:

These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.
Rationale:

The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist.

or patients with a stroke due to a cardioembolic source (e.g. atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. In recent years, novel oral anticoagulant agents (NOACs) have been developed and approved by the U.S. Food and Drug Administration (FDA) for stroke prevention, and may be considered as an alternative to warfarin for select patients. Anticoagulation therapy is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke. Anticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or transient ischemic attack (TIA).
Clinical recommendation statement:

Clinical trial results suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist
Guidance (Usage): The "Nonelective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions. The "MedicationRequest" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use. The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This eCQM 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: CMS104v12. Please refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html).
Population Criteria:
64403d17d4d7050edabb0562
Initial Population: Inpatient hospitalizations for patients age 18 and older, discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less than or equal to 120 days that ends during the measurement period
Denominator: Inpatient hospitalizations for patients with a principal diagnosis of Ischemic stroke
Denominator Exclusion: - Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations. - Inpatient hospitalizations for patients discharged to another hospital - Inpatient hospitalizations for patients who left against medical advice - Inpatient hospitalizations for patients who expired - Inpatient hospitalizations for patients discharged to home for hospice care - Inpatient hospitalizations for patients discharged to a health care facility for hospice care - Inpatient hospitalizations for patients with comfort measures documented
Denominator Exception: - Inpatient hospitalizations for patients with a documented reason for not prescribing antithrombotic therapy at discharge. - Inpatient hospitalizations for patients who receive Prasugrel as an antithrombotic therapy at discharge.
Numerator: Inpatient hospitalizations for patients prescribed or continuing to take antithrombotic therapy at hospital discharge
Numerator Exclusion: None
Supplemental Data Elements:

SDE Ethnicity

SDE Payer

SDE Race

SDE Sex
Supplemental Data Guidance : Patient's Ethnicity: Hispanic or Latino Not Hispanic or Latino Patient's Payer: Categories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system Patient's Race: Native Hawaiian or Other Pacific Islander Asian American Indian or Alaska Native Other Race White Black or African American Patient's Sex: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.
Libraries:
Discharged on Antithrombotic Therapy FHIR Example
Terminology and Other Dependencies:
  • Supplemental Data Elements Example
  • TJC Overall Example
  • http://hl7.org/fhir/Library/FHIRHelpers|4.0.1
  • CQM Common Example
  • QICore Common Example
  • MedicationRequest Category Codes
  • Non-Elective Inpatient Encounter
  • Hemorrhagic Stroke
  • Ischemic Stroke
  • Antithrombotic Therapy
  • Payer
  • Discharge To Acute Care Facility
  • Left Against Medical Advice
  • Patient Expired
  • Discharged to Home for Hospice Care
  • Discharged to Health Care Facility for Hospice Care
  • Comfort Measures
  • Observation Services
  • Emergency Department Visit
  • Medical Reason
  • Patient Refusal
  • Pharmacological Contraindications For Antithrombotic Therapy
    		•
    Parameters:
    name use min max type
    Measurement Period In 0 1 Period
    SDE Sex Out 0 1 Coding
    Numerator Out 0 * Resource
    Denominator Out 0 * Resource
    SDE Payer Out 0 * Resource
    Initial Population Out 0 * Resource
    SDE Ethnicity Out 0 1 Resource
    Denominator Exclusions Out 0 * Resource
    SDE Race Out 0 1 Resource
    Denominator Exceptions Out 0 * Resource
    DataRequirements:
    Resource Type Resource Elements Valueset Name Valueset
    Patient(QICore Patient) url extension
    Encounter(QICore Encounter) type period rank rank.value condition condition.reference condition.reference.value hospitalization hospitalization.dischargeDisposition Nonelective Inpatient Encounter Non-Elective Inpatient Encounter
    Encounter(QICore Encounter) type status status.value period rank rank.value condition condition.reference condition.reference.value hospitalization hospitalization.dischargeDisposition Observation Services Observation Services
    Encounter(QICore Encounter) type status status.value period rank rank.value condition condition.reference condition.reference.value hospitalization hospitalization.dischargeDisposition Emergency Department Visit Emergency Department Visit
    Condition(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition) id id.value
    MedicationRequest(QICore MedicationRequest) medication authoredOn authoredOn.value status status.value intent intent.value doNotPerform doNotPerform.value Antithrombotic Therapy for Ischemic Stroke Antithrombotic Therapy
    MedicationRequest(QICore MedicationRequest) medication authoredOn authoredOn.value status status.value intent intent.value doNotPerform doNotPerform.value Pharmacological Contraindications For Antithrombotic Therapy Pharmacological Contraindications For Antithrombotic Therapy
    MedicationRequest(QICore MedicationRequest) medication.reference authoredOn authoredOn.value status status.value intent intent.value doNotPerform doNotPerform.value
    Medication(QICore Medication) id
    Coverage(QICore Coverage) type period Payer Type Payer
    ServiceRequest(QICore ServiceRequest) code status status.value intent intent.value doNotPerform doNotPerform.value Comfort Measures Comfort Measures
    Procedure(QICore Procedure) code status status.value Comfort Measures Comfort Measures
    MedicationRequest(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotrequested) medication reasonCode intent intent.value authoredOn authoredOn.value Antithrombotic Therapy for Ischemic Stroke Antithrombotic Therapy
    MedicationRequest(http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotrequested) medication reasonCode intent intent.value authoredOn authoredOn.value Antithrombotic Therapy for Ischemic Stroke Antithrombotic Therapy
    Direct Reference Codes:
    display code system
    Community community http://terminology.hl7.org/CodeSystem/medicationrequest-category
    Discharge discharge http://terminology.hl7.org/CodeSystem/medicationrequest-category
    Logic Definitions:
    Group Scoring Population Criteria Expression
    64403d17d4d7050edabb0562 Group scoring: proportion
    Type:

    Process

    Initial Population 
    define "Initial Population":
  TJC."Encounter with Principal Diagnosis and Age"
    Denominator 
    define "Denominator":
  TJC."Ischemic Stroke Encounter"
    Denominator Exclusion 
    define "Denominator Exclusions":
  TJC."Ischemic Stroke Encounters with Discharge Disposition"
    union "Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke"
    Denominator Exception 
    define "Denominator Exceptions":
  "Encounter with Documented Reason for No Antithrombotic At Discharge"
    union "Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge"
    Numerator 
    define "Numerator":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with ["MedicationRequest": "Antithrombotic Therapy for Ischemic Stroke"] DischargeAntithrombotic
      such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period
    Numerator Exclusion None
    Library Name Name
    SupplementalDataElementsExample SDE Sex 
    define "SDE Sex":
  case
      when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }
      when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }
      else null
    end
    Library Name Name
    DischargedonAntithromboticTherapyFHIRExample SDE Sex 
    define "SDE Sex":
  SDE."SDE Sex"
    Library Name Name
    TJCOverallExample Non Elective Inpatient Encounter 
    define "Non Elective Inpatient Encounter":
  ["Encounter": "Nonelective Inpatient Encounter"] NonElectiveEncounter
        where NonElectiveEncounter.period ends during day of "Measurement Period"
    Library Name Name
    TJCOverallExample All Stroke Encounter 
    define "All Stroke Encounter":
  "Non Elective Inpatient Encounter" NonElectiveEncounter
  let ConditionCode: NonElectiveEncounter.principalDiagnosis().code
    where ( ConditionCode in "Hemorrhagic Stroke"
       or   ConditionCode in "Ischemic Stroke" )
    Library Name Name
    TJCOverallExample Encounter with Principal Diagnosis and Age 
    define "Encounter with Principal Diagnosis and Age":
  "All Stroke Encounter" AllStrokeEncounter
    where AgeInYearsAt(date from start of AllStrokeEncounter.period ) >= 18
    Library Name Name
    TJCOverallExample Ischemic Stroke Encounter 
    define "Ischemic Stroke Encounter":
  "Encounter with Principal Diagnosis and Age" EncounterWithAge
    where EncounterWithAge.principalDiagnosis().code in "Ischemic Stroke"
    Library Name Name
    DischargedonAntithromboticTherapyFHIRExample Numerator 
    define "Numerator":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with ["MedicationRequest": "Antithrombotic Therapy for Ischemic Stroke"] DischargeAntithrombotic
      such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period
    Library Name Name
    DischargedonAntithromboticTherapyFHIRExample Denominator 
    define "Denominator":
  TJC."Ischemic Stroke Encounter"
    Library Name Name
    SupplementalDataElementsExample SDE Payer 
    define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }
    Library Name Name
    DischargedonAntithromboticTherapyFHIRExample SDE Payer 
    define "SDE Payer":
  SDE."SDE Payer"
    Library Name Name
    DischargedonAntithromboticTherapyFHIRExample Initial Population 
    define "Initial Population":
  TJC."Encounter with Principal Diagnosis and Age"
    Library Name Name
    SupplementalDataElementsExample SDE Ethnicity 
    define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }
    Library Name Name
    DischargedonAntithromboticTherapyFHIRExample SDE Ethnicity 
    define "SDE Ethnicity":
  SDE."SDE Ethnicity"
    Library Name Name
    TJCOverallExample Ischemic Stroke Encounters with Discharge Disposition 
    define "Ischemic Stroke Encounters with Discharge Disposition":
  "Ischemic Stroke Encounter" IschemicStrokeEncounter
  let DischDisp: IschemicStrokeEncounter.hospitalization.dischargeDisposition
  	where  DischDisp in "Discharge To Acute Care Facility"
		or DischDisp in "Left Against Medical Advice"
		or DischDisp in "Patient Expired"
		or DischDisp in "Discharged to Home for Hospice Care"
		or DischDisp in "Discharged to Health Care Facility for Hospice Care"
    Library Name Name
    TJCOverallExample Intervention Comfort Measures 
    define "Intervention Comfort Measures":
  ( ["ServiceRequest": code in "Comfort Measures"] SR
    where SR.status in { 'active', 'completed', 'on-hold' }
      and SR.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
      and SR.doNotPerform is not true
  )  
  union ( ["Procedure": "Comfort Measures"] InterventionPerformed
        where InterventionPerformed.status in { 'completed', 'in-progress' }
  )
    Library Name Name
    DischargedonAntithromboticTherapyFHIRExample Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke 
    define "Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke":
  "Denominator" Encounter
    with TJC."Intervention Comfort Measures" ComfortMeasure
      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during Encounter.hospitalizationWithObservation ( )
    Library Name Name
    DischargedonAntithromboticTherapyFHIRExample Denominator Exclusions 
    define "Denominator Exclusions":
  TJC."Ischemic Stroke Encounters with Discharge Disposition"
    union "Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke"
    Library Name Name
    SupplementalDataElementsExample SDE Race 
    define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }
    Library Name Name
    DischargedonAntithromboticTherapyFHIRExample SDE Race 
    define "SDE Race":
  SDE."SDE Race"
    Library Name Name
    DischargedonAntithromboticTherapyFHIRExample Reason for Not Giving Antithrombotic at Discharge 
    define "Reason for Not Giving Antithrombotic at Discharge":
  ["MedicationNotRequested": "Antithrombotic Therapy for Ischemic Stroke"] NoAntithromboticDischarge
    where ( NoAntithromboticDischarge.reasonCode in "Medical Reason For Not Providing Treatment"
        or NoAntithromboticDischarge.reasonCode in "Patient Refusal"
    )
      and ( NoAntithromboticDischarge.isCommunity ( )
          or NoAntithromboticDischarge.isDischarge ( )
      )
      and NoAntithromboticDischarge.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
    Library Name Name
    DischargedonAntithromboticTherapyFHIRExample Encounter with Documented Reason for No Antithrombotic At Discharge 
    define "Encounter with Documented Reason for No Antithrombotic At Discharge":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with "Reason for Not Giving Antithrombotic at Discharge" NoDischargeAntithrombotic
      such that NoDischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period
    Library Name Name
    DischargedonAntithromboticTherapyFHIRExample Pharmacological Contraindications for Antithrombotic Therapy at Discharge 
    define "Pharmacological Contraindications for Antithrombotic Therapy at Discharge":
  ["MedicationRequest": "Pharmacological Contraindications For Antithrombotic Therapy"] Pharmacological
    where ( Pharmacological.isCommunity ( )
        or Pharmacological.isDischarge ( )
    )
      and Pharmacological.status in { 'active', 'completed' }
      and Pharmacological.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
      and Pharmacological.doNotPerform is not true
    Library Name Name
    DischargedonAntithromboticTherapyFHIRExample Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge 
    define "Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with "Pharmacological Contraindications for Antithrombotic Therapy at Discharge" DischargePharmacological
      such that DischargePharmacological.authoredOn during IschemicStrokeEncounter.period
    Library Name Name
    DischargedonAntithromboticTherapyFHIRExample Denominator Exceptions 
    define "Denominator Exceptions":
  "Encounter with Documented Reason for No Antithrombotic At Discharge"
    union "Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge"
    Library Name Name
    CQMCommonExample principalDiagnosis 
    /*
@description: Returns the condition that is specified as the principal diagnosis for the encounter
*/
define fluent function principalDiagnosis(Encounter Encounter ):
	singleton from ((Encounter.diagnosis D where D.rank = 1) PD
      return singleton from ([Condition] C where C.id = PD.condition.reference.getId())
	)
    Library Name Name
    QICoreCommonExample getId 
    /*
@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).
@comment: This function can be used to determine the logical id of a given resource. It can be used in
a single-server environment to trace references. However, this function does not attempt to resolve
or distinguish the base of the given url, and so cannot be used safely in multi-server environments.
*/
define fluent function getId(uri String):
  Last(Split(uri, '/'))
    Library Name Name
    FHIRHelpers ToString 
    define function ToString(value uri): value.value
    Library Name Name
    FHIRHelpers ToCode 
    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
        }
    Library Name Name
    CQMCommonExample hospitalizationWithObservation 
    /*
@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]
    Library Name Name
    FHIRHelpers ToConcept 
    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
        }
    Library Name Name
    QICoreCommonExample isCommunity 
    /*
@description: Returns true if the given MedicationRequest has a category of Community
*/
define fluent function isCommunity(medicationRequest MedicationNotRequested):
  exists (medicationRequest.category C
    where C ~ Community
  )
    Library Name Name
    QICoreCommonExample isDischarge 
    /*
@description: Returns true if the given MedicationRequest has a category of Discharge
*/
define fluent function isDischarge(medicationRequest MedicationNotRequested):
  exists (medicationRequest.category C
    where C ~ Discharge
  )

    Source

    {
      "resourceType" : "Measure",
      "id" : "DischargedonAntithromboticTherapyFHIRExample",
      "meta" : {
        "profile" : [
          "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"
        ]
      },
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n    <table class=\"grid dict\">\n        \n            <tr>\n                <th scope=\"row\"><b>Title: </b></th>\n                <td style=\"padding-left: 4px;\">Discharged on Antithrombotic Therapy FHIR Example</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Id: </b></th>\n                <td style=\"padding-left: 4px;\">DischargedonAntithromboticTherapyFHIRExample</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Version: </b></th>\n                <td style=\"padding-left: 4px;\">0.4.4</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Url: </b></th>\n                <td style=\"padding-left: 4px;\"><a href=\"Measure-DischargedonAntithromboticTherapyFHIRExample.html\">Discharged on Antithrombotic Therapy FHIR Example</a></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                short-name identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>CMS104FHIR</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                version-independent identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>urn:uuid:4f57e4a2-097b-45f8-9c85-91b35ea92dc1</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                version-specific identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>urn:uuid:e0b5379f-4b9c-4177-a530-d744fa95d080</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                publisher (CMS) identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>104FHIR</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Effective Period: </b></th>\n                <td style=\"padding-left: 4px;\">2024-01-01..2024-12-31</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Status: </b></th>\n                <td style=\"padding-left: 4px;\">draft</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Publisher: </b></th>\n                <td style=\"padding-left: 4px;\">HL7 International - [Some] Work Group</td>\n            </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Author: </b></th>\n            <td style=\"padding-left: 4px;\">The Joint Commission</td>\n        </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Description: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge</p>\n</div></td>\n            </tr>\n        \n\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Use Context: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    <table class=\"grid-dict\">\n                        <tr>\n                            <th><b>code</b></th>\n                            <th><b>value</b></th>\n                        </tr>\n                        \n                            <tr>\n                                <td>program</td>\n                                <td/>\n                            </tr>\n                        \n                    </table>\n                </td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Jurisdiction: </b></th>\n                <td style=\"padding-left: 4px;\">001</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Purpose: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>UNKNOWN</p>\n</div></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Copyright: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>Measure specifications are in the Public Domain</p>\n<p>LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2021 World Health Organization. All Rights Reserved.</p>\n</div></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Disclaimer: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.</p>\n</div></td>\n            </tr>\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Rationale: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist.</p>\n<p>or patients with a stroke due to a cardioembolic source (e.g. atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. In recent years, novel oral anticoagulant agents (NOACs) have been developed and approved by the U.S. Food and Drug Administration (FDA) for stroke prevention, and may be considered as an alternative to warfarin for select patients. Anticoagulation therapy is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke.\nAnticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or transient ischemic attack (TIA).</p>\n</div></td>\n        </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Clinical recommendation statement: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>Clinical trial results suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist</p>\n</div></td>\n        </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Guidance (Usage): </b></th>\n                <td style=\"padding-left: 4px;\">The &quot;Nonelective Inpatient Encounter&quot; value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the &quot;Inpatient encounter&quot; value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions.\n\nThe &quot;MedicationRequest&quot; datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use.\n\nThe denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.\n\nThis eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS104v12.\n \nPlease refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html).</td>\n            </tr>\n        \n\n        \n            \n                <tr>\n                    <th scope=\"row\"><b>Population Criteria: </b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                            <table class=\"grid-dict\">\n                                \n                                    <tr>\n                                        <th><b>64403d17d4d7050edabb0562</b></th>\n                                    </tr>\n                                \n                                \n                                    <tr>\n                                        <td>Initial Population:</td>\n\n                                        \n                                            \n                                                <td>Inpatient hospitalizations for patients age 18 and older, discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less than or equal to 120 days that ends during the measurement period</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator:</td>\n\n                                        \n                                            \n                                                <td>Inpatient hospitalizations for patients with a principal diagnosis of Ischemic stroke</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator Exclusion:</td>\n\n                                        \n                                            \n                                                <td>- Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations.\n- Inpatient hospitalizations for patients discharged to another hospital\n- Inpatient hospitalizations for patients who left against medical advice\n- Inpatient hospitalizations for patients who expired\n- Inpatient hospitalizations for patients discharged to home for hospice care\n- Inpatient hospitalizations for patients discharged to a health care facility for hospice care\n- Inpatient hospitalizations for patients with comfort measures documented</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator Exception:</td>\n\n                                        \n                                            \n                                                <td>- Inpatient hospitalizations for patients with a documented reason for not prescribing antithrombotic therapy at discharge.\n- Inpatient hospitalizations for patients who receive Prasugrel as an antithrombotic therapy at discharge.</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Numerator:</td>\n\n                                        \n                                            \n                                                <td>Inpatient hospitalizations for patients prescribed or continuing to take antithrombotic therapy at hospital discharge</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Numerator Exclusion:</td>\n\n                                        \n                                            <td>None</td>\n                                        \n\n                                    </tr>\n                                \n                                \n                            </table>\n                        \n                    </td>\n                </tr>\n            \n        \n\n        \n            <tr>\n                <th scope=\"row\"><b> Supplemental Data Elements: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    \n                        \n                            \n                                <p>SDE Ethnicity</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>SDE Payer</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>SDE Race</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>SDE Sex</p>\n                            \n                        \n                    \n                </td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\">\n                    <b> Supplemental Data Guidance\n                        : </b></th>\n                <td style=\"padding-left: 4px;\"> Patient's Ethnicity:\nHispanic or Latino\nNot Hispanic or Latino\n Patient's Payer:\nCategories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system\n Patient's Race:\nNative Hawaiian or Other Pacific Islander\nAsian\nAmerican Indian or Alaska Native\nOther Race\nWhite\nBlack or African American\n Patient's Sex:\nGender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.\n </td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Libraries: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    <table class=\"grid-dict\">\n                        \n                            <tr>\n                                <td><a href=\"Library-DischargedonAntithromboticTherapyFHIRExample.html\">Discharged on Antithrombotic Therapy FHIR Example</a></td>\n                            </tr>\n                        \n                    </table>\n                </td>\n            </tr>\n        \n\n        \n\n        \n            \n                <tr>\n                    <th scope=\"row\"><b>Terminology and Other Dependencies: </b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                            <li><a href=\"Library-SupplementalDataElementsExample.html\">Supplemental Data Elements Example</a></li>\n                        \n                            <li><a href=\"Library-TJCOverallExample.html\">TJC Overall Example</a></li>\n                        \n                            <li><code>http://hl7.org/fhir/Library/FHIRHelpers|4.0.1</code></li>\n                        \n                            <li><a href=\"Library-CQMCommonExample.html\">CQM Common Example</a></li>\n                        \n                            <li><a href=\"Library-QICoreCommonExample.html\">QICore Common Example</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-medicationrequest-category.html\">MedicationRequest Category Codes</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.424/expansion\">Non-Elective Inpatient Encounter</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.212/expansion\">Hemorrhagic Stroke</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.247/expansion\">Ischemic Stroke</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.62/expansion\">Antithrombotic Therapy</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.87/expansion\">Discharge To Acute Care Facility</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.308/expansion\">Left Against Medical Advice</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.309/expansion\">Patient Expired</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.209/expansion\">Discharged to Home for Hospice Care</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.207/expansion\">Discharged to Health Care Facility for Hospice Care</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/1.3.6.1.4.1.33895.1.3.0.45/expansion\">Comfort Measures</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion\">Observation Services</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion\">Emergency Department Visit</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.473/expansion\">Medical Reason</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.93/expansion\">Patient Refusal</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.52/expansion\">Pharmacological Contraindications For Antithrombotic Therapy</a></li>\n                        \n                    </td>\n                </tr>\n                <tr>\n                    <th scope=\"row\"><b>Parameters:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>name</b></th>\n                                <th><b>use</b></th>\n                                <th><b>min</b></th>\n                                <th><b>max</b></th>\n                                <th><b>type</b></th>\n                            </tr>\n                            \n                                <tr>\n                                    <td>Measurement Period</td>\n                                    <td>In</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Period</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Sex</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Coding</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Numerator</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Denominator</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Payer</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Initial Population</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Ethnicity</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Denominator Exclusions</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Race</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Denominator Exceptions</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                        </table>\n                    </td>\n                </tr>\n\n                <tr>\n                    <th scope=\"row\"><b>DataRequirements:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>Resource Type</b></th>\n                                <th><b>Resource Elements</b></th>\n                                <th><b>Valueset Name</b></th>\n                                <th><b>Valueset</b></th>\n                            </tr>\n                            \n                                <tr>\n                                    <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-patient.html\">QICore Patient</a>)</td>\n                                    <td>\n                                        \n                                            url\n                                        \n                                            extension\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-encounter.html\">QICore Encounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                            rank\n                                        \n                                            rank.value\n                                        \n                                            condition\n                                        \n                                            condition.reference\n                                        \n                                            condition.reference.value\n                                        \n                                            hospitalization\n                                        \n                                            hospitalization.dischargeDisposition\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Nonelective Inpatient Encounter\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.424/expansion\">Non-Elective Inpatient Encounter</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-encounter.html\">QICore Encounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            period\n                                        \n                                            rank\n                                        \n                                            rank.value\n                                        \n                                            condition\n                                        \n                                            condition.reference\n                                        \n                                            condition.reference.value\n                                        \n                                            hospitalization\n                                        \n                                            hospitalization.dischargeDisposition\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Observation Services\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.143/expansion\">Observation Services</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-encounter.html\">QICore Encounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            period\n                                        \n                                            rank\n                                        \n                                            rank.value\n                                        \n                                            condition\n                                        \n                                            condition.reference\n                                        \n                                            condition.reference.value\n                                        \n                                            hospitalization\n                                        \n                                            hospitalization.dischargeDisposition\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Emergency Department Visit\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion\">Emergency Department Visit</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<code>http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition</code>)</td>\n                                    <td>\n                                        \n                                            id\n                                        \n                                            id.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-medicationrequest.html\">QICore MedicationRequest</a>)</td>\n                                    <td>\n                                        \n                                            medication\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            intent\n                                        \n                                            intent.value\n                                        \n                                            doNotPerform\n                                        \n                                            doNotPerform.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Antithrombotic Therapy for Ischemic Stroke\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.62/expansion\">Antithrombotic Therapy</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-medicationrequest.html\">QICore MedicationRequest</a>)</td>\n                                    <td>\n                                        \n                                            medication\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            intent\n                                        \n                                            intent.value\n                                        \n                                            doNotPerform\n                                        \n                                            doNotPerform.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Pharmacological Contraindications For Antithrombotic Therapy\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.52/expansion\">Pharmacological Contraindications For Antithrombotic Therapy</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-medicationrequest.html\">QICore MedicationRequest</a>)</td>\n                                    <td>\n                                        \n                                            medication.reference\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            intent\n                                        \n                                            intent.value\n                                        \n                                            doNotPerform\n                                        \n                                            doNotPerform.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-medication.html\">QICore Medication</a>)</td>\n                                    <td>\n                                        \n                                            id\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Coverage(<a href=\"http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-coverage.html\">QICore Coverage</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Payer Type\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>ServiceRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-servicerequest.html\">QICore ServiceRequest</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            intent\n                                        \n                                            intent.value\n                                        \n                                            doNotPerform\n                                        \n                                            doNotPerform.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Comfort Measures\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/1.3.6.1.4.1.33895.1.3.0.45/expansion\">Comfort Measures</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Procedure(<a href=\"http://hl7.org/fhir/us/qicore/STU5/StructureDefinition-qicore-procedure.html\">QICore Procedure</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Comfort Measures\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/1.3.6.1.4.1.33895.1.3.0.45/expansion\">Comfort Measures</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>MedicationRequest(<code>http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotrequested</code>)</td>\n                                    <td>\n                                        \n                                            medication\n                                        \n                                            reasonCode\n                                        \n                                            intent\n                                        \n                                            intent.value\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Antithrombotic Therapy for Ischemic Stroke\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.62/expansion\">Antithrombotic Therapy</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>MedicationRequest(<code>http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotrequested</code>)</td>\n                                    <td>\n                                        \n                                            medication\n                                        \n                                            reasonCode\n                                        \n                                            intent\n                                        \n                                            intent.value\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Antithrombotic Therapy for Ischemic Stroke\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.62/expansion\">Antithrombotic Therapy</a></td>\n                                </tr>\n                            \n                        </table>\n                    </td>\n                </tr>\n\n                \n                    <tr>\n                        <th scope=\"row\"><b>Direct Reference Codes:</b></th>\n                        <td style=\"padding-left: 4px;\">\n                            <table class=\"grid-dict\">\n                                <tr>\n                                    <th><b>display</b></th>\n                                    <th><b>code</b></th>\n                                    <th><b>system</b></th>\n                                </tr>\n                                \n                                    <tr>\n                                        <td>Community</td>\n                                        <td>community</td>\n                                        <td><a href=\"http://hl7.org/fhir/R4/codesystem-medicationrequest-category.html\">http://terminology.hl7.org/CodeSystem/medicationrequest-category</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Discharge</td>\n                                        <td>discharge</td>\n                                        <td><a href=\"http://hl7.org/fhir/R4/codesystem-medicationrequest-category.html\">http://terminology.hl7.org/CodeSystem/medicationrequest-category</a></td>\n                                    </tr>\n                                \n                            </table>\n                        </td>\n                    </tr>\n                \n\n                \n                <tr>\n                    <th scope=\"row\"><b>Logic Definitions:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>Group</b></th>\n                                <th><b>Scoring</b></th>\n                                <th><b>Population Criteria</b></th>\n                                <th><b>Expression</b></th>\n                            </tr>\n                            <tr>\n                                \n                                <td> 64403d17d4d7050edabb0562 </td>\n                                <td colspan=\"3\" style=\"padding-left: 4px;\">\n                                    \n                                        <b>Group scoring:</b>\n                                        \n                                            <span>  proportion </span>\n                                        \n                                    \n\n                                    \n\n                                    \n\n                                    \n\n                                    \n                                        <tr>\n                                        \n                                            <th scope=\"row\"><b>Type: </b></th>\n                                            <td style=\"padding-left: 4px;\">\n                                                \n                                                    \n                                                        <p style=\"margin-bottom: 5px;\">\n                                                            <span>Process </span>\n                                                        </p>\n                                                    \n                                                \n                                                \n                                            </td>\n                                        \n                                        </tr>\n                                    \n\n                                    \n\n                                    \n\n                                    \n\n                                    \n\n                                </td>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Initial Population</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  TJC.&quot;Encounter with Principal Diagnosis and Age&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Denominator&quot;:\n  TJC.&quot;Ischemic Stroke Encounter&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator Exclusion</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Denominator Exclusions&quot;:\n  TJC.&quot;Ischemic Stroke Encounters with Discharge Disposition&quot;\n    union &quot;Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator Exception</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Denominator Exceptions&quot;:\n  &quot;Encounter with Documented Reason for No Antithrombotic At Discharge&quot;\n    union &quot;Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Numerator</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Numerator&quot;:\n  TJC.&quot;Ischemic Stroke Encounter&quot; IschemicStrokeEncounter\n    with [&quot;MedicationRequest&quot;: &quot;Antithrombotic Therapy for Ischemic Stroke&quot;] DischargeAntithrombotic\n      such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Numerator Exclusion</td>\n                                    <td>\n                                        \n                                            None\n                                        \n                                    </td>\n                                </tr>\n                                \n                                \n                            \n                            </tr>\n                        </table>\n                \n\n                <table class=\"grid-dict\">\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElementsExample</td>\n                            \n                            \n                                <td>SDE Sex</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Sex&quot;:\n  case\n      when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }\n      when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }\n      else null\n    end</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIRExample</td>\n                            \n                            \n                                <td>SDE Sex</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Sex&quot;:\n  SDE.&quot;SDE Sex&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>TJCOverallExample</td>\n                            \n                            \n                                <td>Non Elective Inpatient Encounter</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Non Elective Inpatient Encounter&quot;:\n  [&quot;Encounter&quot;: &quot;Nonelective Inpatient Encounter&quot;] NonElectiveEncounter\n        where NonElectiveEncounter.period ends during day of &quot;Measurement Period&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>TJCOverallExample</td>\n                            \n                            \n                                <td>All Stroke Encounter</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;All Stroke Encounter&quot;:\n  &quot;Non Elective Inpatient Encounter&quot; NonElectiveEncounter\n  let ConditionCode: NonElectiveEncounter.principalDiagnosis().code\n    where ( ConditionCode in &quot;Hemorrhagic Stroke&quot;\n       or   ConditionCode in &quot;Ischemic Stroke&quot; )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>TJCOverallExample</td>\n                            \n                            \n                                <td>Encounter with Principal Diagnosis and Age</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Encounter with Principal Diagnosis and Age&quot;:\n  &quot;All Stroke Encounter&quot; AllStrokeEncounter\n    where AgeInYearsAt(date from start of AllStrokeEncounter.period ) &gt;= 18</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>TJCOverallExample</td>\n                            \n                            \n                                <td>Ischemic Stroke Encounter</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Ischemic Stroke Encounter&quot;:\n  &quot;Encounter with Principal Diagnosis and Age&quot; EncounterWithAge\n    where EncounterWithAge.principalDiagnosis().code in &quot;Ischemic Stroke&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIRExample</td>\n                            \n                            \n                                <td>Numerator</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Numerator&quot;:\n  TJC.&quot;Ischemic Stroke Encounter&quot; IschemicStrokeEncounter\n    with [&quot;MedicationRequest&quot;: &quot;Antithrombotic Therapy for Ischemic Stroke&quot;] DischargeAntithrombotic\n      such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIRExample</td>\n                            \n                            \n                                <td>Denominator</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator&quot;:\n  TJC.&quot;Ischemic Stroke Encounter&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElementsExample</td>\n                            \n                            \n                                <td>SDE Payer</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Payer&quot;:\n  [Coverage: type in &quot;Payer Type&quot;] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIRExample</td>\n                            \n                            \n                                <td>SDE Payer</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Payer&quot;:\n  SDE.&quot;SDE Payer&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIRExample</td>\n                            \n                            \n                                <td>Initial Population</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  TJC.&quot;Encounter with Principal Diagnosis and Age&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElementsExample</td>\n                            \n                            \n                                <td>SDE Ethnicity</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Ethnicity&quot;:\n  Patient.ethnicity E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIRExample</td>\n                            \n                            \n                                <td>SDE Ethnicity</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Ethnicity&quot;:\n  SDE.&quot;SDE Ethnicity&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>TJCOverallExample</td>\n                            \n                            \n                                <td>Ischemic Stroke Encounters with Discharge Disposition</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Ischemic Stroke Encounters with Discharge Disposition&quot;:\n  &quot;Ischemic Stroke Encounter&quot; IschemicStrokeEncounter\n  let DischDisp: IschemicStrokeEncounter.hospitalization.dischargeDisposition\n  \twhere  DischDisp in &quot;Discharge To Acute Care Facility&quot;\n\t\tor DischDisp in &quot;Left Against Medical Advice&quot;\n\t\tor DischDisp in &quot;Patient Expired&quot;\n\t\tor DischDisp in &quot;Discharged to Home for Hospice Care&quot;\n\t\tor DischDisp in &quot;Discharged to Health Care Facility for Hospice Care&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>TJCOverallExample</td>\n                            \n                            \n                                <td>Intervention Comfort Measures</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Intervention Comfort Measures&quot;:\n  ( [&quot;ServiceRequest&quot;: code in &quot;Comfort Measures&quot;] SR\n    where SR.status in { 'active', 'completed', 'on-hold' }\n      and SR.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n      and SR.doNotPerform is not true\n  )  \n  union ( [&quot;Procedure&quot;: &quot;Comfort Measures&quot;] InterventionPerformed\n        where InterventionPerformed.status in { 'completed', 'in-progress' }\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIRExample</td>\n                            \n                            \n                                <td>Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke&quot;:\n  &quot;Denominator&quot; Encounter\n    with TJC.&quot;Intervention Comfort Measures&quot; ComfortMeasure\n      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during Encounter.hospitalizationWithObservation ( )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIRExample</td>\n                            \n                            \n                                <td>Denominator Exclusions</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator Exclusions&quot;:\n  TJC.&quot;Ischemic Stroke Encounters with Discharge Disposition&quot;\n    union &quot;Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElementsExample</td>\n                            \n                            \n                                <td>SDE Race</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Race&quot;:\n  Patient.race R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIRExample</td>\n                            \n                            \n                                <td>SDE Race</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Race&quot;:\n  SDE.&quot;SDE Race&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIRExample</td>\n                            \n                            \n                                <td>Reason for Not Giving Antithrombotic at Discharge</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Reason for Not Giving Antithrombotic at Discharge&quot;:\n  [&quot;MedicationNotRequested&quot;: &quot;Antithrombotic Therapy for Ischemic Stroke&quot;] NoAntithromboticDischarge\n    where ( NoAntithromboticDischarge.reasonCode in &quot;Medical Reason For Not Providing Treatment&quot;\n        or NoAntithromboticDischarge.reasonCode in &quot;Patient Refusal&quot;\n    )\n      and ( NoAntithromboticDischarge.isCommunity ( )\n          or NoAntithromboticDischarge.isDischarge ( )\n      )\n      and NoAntithromboticDischarge.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIRExample</td>\n                            \n                            \n                                <td>Encounter with Documented Reason for No Antithrombotic At Discharge</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Encounter with Documented Reason for No Antithrombotic At Discharge&quot;:\n  TJC.&quot;Ischemic Stroke Encounter&quot; IschemicStrokeEncounter\n    with &quot;Reason for Not Giving Antithrombotic at Discharge&quot; NoDischargeAntithrombotic\n      such that NoDischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIRExample</td>\n                            \n                            \n                                <td>Pharmacological Contraindications for Antithrombotic Therapy at Discharge</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Pharmacological Contraindications for Antithrombotic Therapy at Discharge&quot;:\n  [&quot;MedicationRequest&quot;: &quot;Pharmacological Contraindications For Antithrombotic Therapy&quot;] Pharmacological\n    where ( Pharmacological.isCommunity ( )\n        or Pharmacological.isDischarge ( )\n    )\n      and Pharmacological.status in { 'active', 'completed' }\n      and Pharmacological.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n      and Pharmacological.doNotPerform is not true</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIRExample</td>\n                            \n                            \n                                <td>Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge&quot;:\n  TJC.&quot;Ischemic Stroke Encounter&quot; IschemicStrokeEncounter\n    with &quot;Pharmacological Contraindications for Antithrombotic Therapy at Discharge&quot; DischargePharmacological\n      such that DischargePharmacological.authoredOn during IschemicStrokeEncounter.period</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>DischargedonAntithromboticTherapyFHIRExample</td>\n                            \n                            \n                                <td>Denominator Exceptions</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator Exceptions&quot;:\n  &quot;Encounter with Documented Reason for No Antithrombotic At Discharge&quot;\n    union &quot;Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CQMCommonExample</td>\n                            \n                            \n                                <td>principalDiagnosis</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns the condition that is specified as the principal diagnosis for the encounter\n*/\ndefine fluent function principalDiagnosis(Encounter Encounter ):\n\tsingleton from ((Encounter.diagnosis D where D.rank = 1) PD\n      return singleton from ([Condition] C where C.id = PD.condition.reference.getId())\n\t)</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>QICoreCommonExample</td>\n                            \n                            \n                                <td>getId</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).\n@comment: This function can be used to determine the logical id of a given resource. It can be used in\na single-server environment to trace references. However, this function does not attempt to resolve\nor distinguish the base of the given url, and so cannot be used safely in multi-server environments.\n*/\ndefine fluent function getId(uri String):\n  Last(Split(uri, '/'))</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>FHIRHelpers</td>\n                            \n                            \n                                <td>ToString</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function ToString(value uri): value.value</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>FHIRHelpers</td>\n                            \n                            \n                                <td>ToCode</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define 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        }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>CQMCommonExample</td>\n                            \n                            \n                                <td>hospitalizationWithObservation</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\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: &quot;Observation Services&quot;] 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: &quot;Emergency Department Visit&quot;] 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]</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>FHIRHelpers</td>\n                            \n                            \n                                <td>ToConcept</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define 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        }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>QICoreCommonExample</td>\n                            \n                            \n                                <td>isCommunity</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns true if the given MedicationRequest has a category of Community\n*/\ndefine fluent function isCommunity(medicationRequest MedicationNotRequested):\n  exists (medicationRequest.category C\n    where C ~ Community\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>QICoreCommonExample</td>\n                            \n                            \n                                <td>isDischarge</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns true if the given MedicationRequest has a category of Discharge\n*/\ndefine fluent function isDischarge(medicationRequest MedicationNotRequested):\n  exists (medicationRequest.category C\n    where C ~ Discharge\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                    </table>\n                </td>\n            </tr>\n            \n        \n    \n\n    </table>\n</div>"
      },
      "contained" : [
        {
          "resourceType" : "Library",
          "id" : "effective-data-requirements",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                "code" : "community",
                "display" : "Community"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
                "code" : "discharge",
                "display" : "Discharge"
              }
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "SupplementalDataElementsExample"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Sex"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Sex\":\n  case\n      when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }\n      when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }\n      else null\n    end"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 0
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DischargedonAntithromboticTherapyFHIRExample"
                },
                {
                  "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" : "TJCOverallExample"
                },
                {
                  "url" : "name",
                  "valueString" : "Non Elective Inpatient Encounter"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Non Elective Inpatient Encounter\":\n  [\"Encounter\": \"Nonelective Inpatient Encounter\"] NonElectiveEncounter\n        where NonElectiveEncounter.period ends during day of \"Measurement Period\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 2
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "TJCOverallExample"
                },
                {
                  "url" : "name",
                  "valueString" : "All Stroke Encounter"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"All Stroke Encounter\":\n  \"Non Elective Inpatient Encounter\" NonElectiveEncounter\n  let ConditionCode: NonElectiveEncounter.principalDiagnosis().code\n    where ( ConditionCode in \"Hemorrhagic Stroke\"\n       or   ConditionCode in \"Ischemic Stroke\" )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 3
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "TJCOverallExample"
                },
                {
                  "url" : "name",
                  "valueString" : "Encounter with Principal Diagnosis and Age"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Encounter with Principal Diagnosis and Age\":\n  \"All Stroke Encounter\" AllStrokeEncounter\n    where AgeInYearsAt(date from start of AllStrokeEncounter.period ) >= 18"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 4
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "TJCOverallExample"
                },
                {
                  "url" : "name",
                  "valueString" : "Ischemic Stroke Encounter"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Ischemic Stroke Encounter\":\n  \"Encounter with Principal Diagnosis and Age\" EncounterWithAge\n    where EncounterWithAge.principalDiagnosis().code in \"Ischemic Stroke\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 5
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DischargedonAntithromboticTherapyFHIRExample"
                },
                {
                  "url" : "name",
                  "valueString" : "Numerator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Numerator\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with [\"MedicationRequest\": \"Antithrombotic Therapy for Ischemic Stroke\"] DischargeAntithrombotic\n      such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 6
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DischargedonAntithromboticTherapyFHIRExample"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Denominator\":\n  TJC.\"Ischemic Stroke Encounter\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 7
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "SupplementalDataElementsExample"
                },
                {
                  "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" : 8
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DischargedonAntithromboticTherapyFHIRExample"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Payer"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 9
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DischargedonAntithromboticTherapyFHIRExample"
                },
                {
                  "url" : "name",
                  "valueString" : "Initial Population"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Initial Population\":\n  TJC.\"Encounter with Principal Diagnosis and Age\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 10
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "SupplementalDataElementsExample"
                },
                {
                  "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" : 11
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DischargedonAntithromboticTherapyFHIRExample"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Ethnicity"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 12
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "TJCOverallExample"
                },
                {
                  "url" : "name",
                  "valueString" : "Ischemic Stroke Encounters with Discharge Disposition"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Ischemic Stroke Encounters with Discharge Disposition\":\n  \"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n  let DischDisp: IschemicStrokeEncounter.hospitalization.dischargeDisposition\n  \twhere  DischDisp in \"Discharge To Acute Care Facility\"\n\t\tor DischDisp in \"Left Against Medical Advice\"\n\t\tor DischDisp in \"Patient Expired\"\n\t\tor DischDisp in \"Discharged to Home for Hospice Care\"\n\t\tor DischDisp in \"Discharged to Health Care Facility for Hospice Care\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 13
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "TJCOverallExample"
                },
                {
                  "url" : "name",
                  "valueString" : "Intervention Comfort Measures"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Intervention Comfort Measures\":\n  ( [\"ServiceRequest\": code in \"Comfort Measures\"] SR\n    where SR.status in { 'active', 'completed', 'on-hold' }\n      and SR.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n      and SR.doNotPerform is not true\n  )  \n  union ( [\"Procedure\": \"Comfort Measures\"] InterventionPerformed\n        where InterventionPerformed.status in { 'completed', 'in-progress' }\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 14
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DischargedonAntithromboticTherapyFHIRExample"
                },
                {
                  "url" : "name",
                  "valueString" : "Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke\":\n  \"Denominator\" Encounter\n    with TJC.\"Intervention Comfort Measures\" ComfortMeasure\n      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during Encounter.hospitalizationWithObservation ( )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 15
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DischargedonAntithromboticTherapyFHIRExample"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator Exclusions"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Denominator Exclusions\":\n  TJC.\"Ischemic Stroke Encounters with Discharge Disposition\"\n    union \"Encounter with Comfort Measures during Hospitalization for Patients with Documented Ischemic Stroke\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 16
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "SupplementalDataElementsExample"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Race"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Race\":\n  Patient.race R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 17
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DischargedonAntithromboticTherapyFHIRExample"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Race"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Race\":\n  SDE.\"SDE Race\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 18
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DischargedonAntithromboticTherapyFHIRExample"
                },
                {
                  "url" : "name",
                  "valueString" : "Reason for Not Giving Antithrombotic at Discharge"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Reason for Not Giving Antithrombotic at Discharge\":\n  [\"MedicationNotRequested\": \"Antithrombotic Therapy for Ischemic Stroke\"] NoAntithromboticDischarge\n    where ( NoAntithromboticDischarge.reasonCode in \"Medical Reason For Not Providing Treatment\"\n        or NoAntithromboticDischarge.reasonCode in \"Patient Refusal\"\n    )\n      and ( NoAntithromboticDischarge.isCommunity ( )\n          or NoAntithromboticDischarge.isDischarge ( )\n      )\n      and NoAntithromboticDischarge.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 19
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DischargedonAntithromboticTherapyFHIRExample"
                },
                {
                  "url" : "name",
                  "valueString" : "Encounter with Documented Reason for No Antithrombotic At Discharge"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Encounter with Documented Reason for No Antithrombotic At Discharge\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with \"Reason for Not Giving Antithrombotic at Discharge\" NoDischargeAntithrombotic\n      such that NoDischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 20
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DischargedonAntithromboticTherapyFHIRExample"
                },
                {
                  "url" : "name",
                  "valueString" : "Pharmacological Contraindications for Antithrombotic Therapy at Discharge"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Pharmacological Contraindications for Antithrombotic Therapy at Discharge\":\n  [\"MedicationRequest\": \"Pharmacological Contraindications For Antithrombotic Therapy\"] Pharmacological\n    where ( Pharmacological.isCommunity ( )\n        or Pharmacological.isDischarge ( )\n    )\n      and Pharmacological.status in { 'active', 'completed' }\n      and Pharmacological.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n      and Pharmacological.doNotPerform is not true"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 21
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DischargedonAntithromboticTherapyFHIRExample"
                },
                {
                  "url" : "name",
                  "valueString" : "Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with \"Pharmacological Contraindications for Antithrombotic Therapy at Discharge\" DischargePharmacological\n      such that DischargePharmacological.authoredOn during IschemicStrokeEncounter.period"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 22
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "DischargedonAntithromboticTherapyFHIRExample"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator Exceptions"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Denominator Exceptions\":\n  \"Encounter with Documented Reason for No Antithrombotic At Discharge\"\n    union \"Encounter with Pharmacological Contraindications for Antithrombotic Therapy at Discharge\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 23
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CQMCommonExample"
                },
                {
                  "url" : "name",
                  "valueString" : "principalDiagnosis"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns the condition that is specified as the principal diagnosis for the encounter\n*/\ndefine fluent function principalDiagnosis(Encounter Encounter ):\n\tsingleton from ((Encounter.diagnosis D where D.rank = 1) PD\n      return singleton from ([Condition] C where C.id = PD.condition.reference.getId())\n\t)"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 24
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommonExample"
                },
                {
                  "url" : "name",
                  "valueString" : "getId"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).\n@comment: This function can be used to determine the logical id of a given resource. It can be used in\na single-server environment to trace references. However, this function does not attempt to resolve\nor distinguish the base of the given url, and so cannot be used safely in multi-server environments.\n*/\ndefine fluent function getId(uri String):\n  Last(Split(uri, '/'))"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 25
                }
              ],
              "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" : 26
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToCode"
                },
                {
                  "url" : "statement",
                  "valueString" : "define 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" : 27
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CQMCommonExample"
                },
                {
                  "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" : 28
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToConcept"
                },
                {
                  "url" : "statement",
                  "valueString" : "define function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 29
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommonExample"
                },
                {
                  "url" : "name",
                  "valueString" : "isCommunity"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns true if the given MedicationRequest has a category of Community\n*/\ndefine fluent function isCommunity(medicationRequest MedicationNotRequested):\n  exists (medicationRequest.category C\n    where C ~ Community\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 30
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommonExample"
                },
                {
                  "url" : "name",
                  "valueString" : "isDischarge"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns true if the given MedicationRequest has a category of Discharge\n*/\ndefine fluent function isDischarge(medicationRequest MedicationNotRequested):\n  exists (medicationRequest.category C\n    where C ~ Discharge\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 31
                }
              ],
              "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" : "http://somewhere.org/fhir/uv/mycontentig/Library/SupplementalDataElementsExample"
            },
            {
              "type" : "depends-on",
              "display" : "Library TJC",
              "resource" : "http://somewhere.org/fhir/uv/mycontentig/Library/TJCOverallExample"
            },
            {
              "type" : "depends-on",
              "display" : "Library FHIRHelpers",
              "resource" : "http://hl7.org/fhir/Library/FHIRHelpers|4.0.1"
            },
            {
              "type" : "depends-on",
              "display" : "Library CQMCommon",
              "resource" : "http://somewhere.org/fhir/uv/mycontentig/Library/CQMCommonExample"
            },
            {
              "type" : "depends-on",
              "display" : "Library QICoreCommon",
              "resource" : "http://somewhere.org/fhir/uv/mycontentig/Library/QICoreCommonExample"
            },
            {
              "type" : "depends-on",
              "display" : "Code system MedicationRequestCategory",
              "resource" : "http://terminology.hl7.org/CodeSystem/medicationrequest-category"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Nonelective Inpatient Encounter",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Hemorrhagic Stroke",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.212"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Ischemic Stroke",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Antithrombotic Therapy for Ischemic Stroke",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Payer Type",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Discharge To Acute Care Facility",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Left Against Medical Advice",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.308"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Patient Expired",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Discharged to Home for Hospice Care",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.209"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Discharged to Health Care Facility for Hospice Care",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.207"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Comfort Measures",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Observation Services",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Emergency Department Visit",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Medical Reason For Not Providing Treatment",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Patient Refusal",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Pharmacological Contraindications For Antithrombotic Therapy",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52"
            }
          ],
          "parameter" : [
            {
              "name" : "Measurement Period",
              "use" : "in",
              "min" : 0,
              "max" : "1",
              "type" : "Period"
            },
            {
              "name" : "SDE Sex",
              "use" : "out",
              "min" : 0,
              "max" : "1",
              "type" : "Coding"
            },
            {
              "name" : "Numerator",
              "use" : "out",
              "min" : 0,
              "max" : "*",
              "type" : "Resource"
            },
            {
              "name" : "Denominator",
              "use" : "out",
              "min" : 0,
              "max" : "*",
              "type" : "Resource"
            },
            {
              "name" : "SDE Payer",
              "use" : "out",
              "min" : 0,
              "max" : "*",
              "type" : "Resource"
            },
            {
              "name" : "Initial Population",
              "use" : "out",
              "min" : 0,
              "max" : "*",
              "type" : "Resource"
            },
            {
              "name" : "SDE Ethnicity",
              "use" : "out",
              "min" : 0,
              "max" : "1",
              "type" : "Resource"
            },
            {
              "name" : "Denominator Exclusions",
              "use" : "out",
              "min" : 0,
              "max" : "*",
              "type" : "Resource"
            },
            {
              "name" : "SDE Race",
              "use" : "out",
              "min" : 0,
              "max" : "1",
              "type" : "Resource"
            },
            {
              "name" : "Denominator Exceptions",
              "use" : "out",
              "min" : 0,
              "max" : "*",
              "type" : "Resource"
            }
          ],
          "dataRequirement" : [
            {
              "type" : "Patient",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
              ],
              "mustSupport" : [
                "url",
                "extension"
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "period",
                "rank",
                "rank.value",
                "condition",
                "condition.reference",
                "condition.reference.value",
                "hospitalization",
                "hospitalization.dischargeDisposition"
              ],
              "codeFilter" : [
                {
                  "path" : "type",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
                }
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "status",
                "status.value",
                "period",
                "rank",
                "rank.value",
                "condition",
                "condition.reference",
                "condition.reference.value",
                "hospitalization",
                "hospitalization.dischargeDisposition"
              ],
              "codeFilter" : [
                {
                  "path" : "type",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"
                }
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "status",
                "status.value",
                "period",
                "rank",
                "rank.value",
                "condition",
                "condition.reference",
                "condition.reference.value",
                "hospitalization",
                "hospitalization.dischargeDisposition"
              ],
              "codeFilter" : [
                {
                  "path" : "type",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
                }
              ]
            },
            {
              "type" : "Condition",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"
              ],
              "mustSupport" : [
                "id",
                "id.value"
              ]
            },
            {
              "type" : "MedicationRequest",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
              ],
              "mustSupport" : [
                "medication",
                "authoredOn",
                "authoredOn.value",
                "status",
                "status.value",
                "intent",
                "intent.value",
                "doNotPerform",
                "doNotPerform.value"
              ],
              "codeFilter" : [
                {
                  "path" : "medication",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
                }
              ]
            },
            {
              "type" : "MedicationRequest",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
              ],
              "mustSupport" : [
                "medication",
                "authoredOn",
                "authoredOn.value",
                "status",
                "status.value",
                "intent",
                "intent.value",
                "doNotPerform",
                "doNotPerform.value"
              ],
              "codeFilter" : [
                {
                  "path" : "medication",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52"
                }
              ]
            },
            {
              "type" : "MedicationRequest",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
              ],
              "mustSupport" : [
                "medication.reference",
                "authoredOn",
                "authoredOn.value",
                "status",
                "status.value",
                "intent",
                "intent.value",
                "doNotPerform",
                "doNotPerform.value"
              ]
            },
            {
              "type" : "Medication",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"
              ],
              "mustSupport" : [
                "id"
              ]
            },
            {
              "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" : "ServiceRequest",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"
              ],
              "mustSupport" : [
                "code",
                "status",
                "status.value",
                "intent",
                "intent.value",
                "doNotPerform",
                "doNotPerform.value"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"
                }
              ]
            },
            {
              "type" : "Procedure",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
              ],
              "mustSupport" : [
                "code",
                "status",
                "status.value"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"
                }
              ]
            },
            {
              "type" : "MedicationRequest",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotrequested"
              ],
              "mustSupport" : [
                "medication",
                "reasonCode",
                "intent",
                "intent.value",
                "authoredOn",
                "authoredOn.value"
              ],
              "codeFilter" : [
                {
                  "path" : "medication",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
                }
              ]
            },
            {
              "type" : "MedicationRequest",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotrequested"
              ],
              "mustSupport" : [
                "medication",
                "reasonCode",
                "intent",
                "intent.value",
                "authoredOn",
                "authoredOn.value"
              ],
              "codeFilter" : [
                {
                  "path" : "medication",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
                }
              ]
            }
          ]
        }
      ],
      "extension" : [
        {
          "id" : "supplementalDataGuidance",
          "extension" : [
            {
              "url" : "guidance",
              "valueString" : "Patient's Ethnicity:\nHispanic or Latino\nNot Hispanic or Latino\n Patient's Payer:\nCategories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system\n Patient's Race:\nNative Hawaiian or Other Pacific Islander\nAsian\nAmerican Indian or Alaska Native\nOther Race\nWhite\nBlack or African American\n Patient's Sex:\nGender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.\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"
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem",
          "valueReference" : {
            "reference" : "Device/cqf-tooling"
          }
        },
        {
          "id" : "effective-data-requirements",
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
          "valueReference" : {
            "reference" : "#effective-data-requirements"
          }
        }
      ],
      "url" : "http://somewhere.org/fhir/uv/mycontentig/Measure/DischargedonAntithromboticTherapyFHIRExample",
      "identifier" : [
        {
          "use" : "usual",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
                "code" : "short-name"
              }
            ]
          },
          "system" : "https://madie.cms.gov/measure/shortName",
          "value" : "CMS104FHIR"
        },
        {
          "use" : "official",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
                "code" : "version-independent"
              }
            ]
          },
          "system" : "urn:ietf:rfc:3986",
          "value" : "urn:uuid:4f57e4a2-097b-45f8-9c85-91b35ea92dc1"
        },
        {
          "use" : "official",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
                "code" : "version-specific"
              }
            ]
          },
          "system" : "urn:ietf:rfc:3986",
          "value" : "urn:uuid:e0b5379f-4b9c-4177-a530-d744fa95d080"
        },
        {
          "use" : "official",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
                "code" : "publisher"
              }
            ]
          },
          "system" : "https://madie.cms.gov/measure/cmsId",
          "value" : "104FHIR",
          "assigner" : {
            "display" : "CMS"
          }
        }
      ],
      "version" : "0.4.4",
      "name" : "DischargedonAntithromboticTherapyFHIRExample",
      "title" : "Discharged on Antithrombotic Therapy FHIR Example",
      "status" : "draft",
      "experimental" : false,
      "date" : "2024-05-06T01:40:05+00:00",
      "publisher" : "HL7 International - [Some] Work Group",
      "contact" : [
        {
          "telecom" : [
            {
              "system" : "url",
              "value" : "http://hl7.org/Special/committees/[something]"
            }
          ]
        }
      ],
      "description" : "Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge",
      "useContext" : [
        {
          "code" : {
            "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
            "code" : "program"
          },
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/quality-programs",
                "code" : "eh-cah",
                "display" : "EH/CAH"
              }
            ]
          }
        }
      ],
      "jurisdiction" : [
        {
          "coding" : [
            {
              "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
              "code" : "001"
            }
          ]
        }
      ],
      "purpose" : "UNKNOWN",
      "usage" : "The \"Nonelective Inpatient Encounter\" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the \"Inpatient encounter\" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions.\n\nThe \"MedicationRequest\" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use.\n\nThe denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.\n\nThis eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS104v12.\n \nPlease refer to the HL7 QI-Core Implementation Guide (http://hl7.org/fhir/us/qicore/index.html) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (http://hl7.org/fhir/us/qicore/qdm-to-qicore.html).",
      "copyright" : "Measure specifications are in the Public Domain\n\nLOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2021 World Health Organization. All Rights Reserved.",
      "approvalDate" : "2023-08-01",
      "lastReviewDate" : "2023-08-01",
      "effectivePeriod" : {
        "start" : "2024-01-01",
        "end" : "2024-12-31"
      },
      "author" : [
        {
          "name" : "The Joint Commission",
          "telecom" : [
            {
              "system" : "url",
              "value" : "https://www.jointcommission.org/"
            }
          ]
        }
      ],
      "library" : [
        "http://somewhere.org/fhir/uv/mycontentig/Library/DischargedonAntithromboticTherapyFHIRExample"
      ],
      "disclaimer" : "These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.",
      "rationale" : "The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist.\n\nor patients with a stroke due to a cardioembolic source (e.g. atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. In recent years, novel oral anticoagulant agents (NOACs) have been developed and approved by the U.S. Food and Drug Administration (FDA) for stroke prevention, and may be considered as an alternative to warfarin for select patients. Anticoagulation therapy is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke.\nAnticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or transient ischemic attack (TIA).",
      "clinicalRecommendationStatement" : "Clinical trial results suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist",
      "group" : [
        {
          "id" : "64403d17d4d7050edabb0562",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
                    "code" : "proportion",
                    "display" : "Proportion"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
              "valueCode" : "Encounter"
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-type",
                    "code" : "process",
                    "display" : "Process"
                  }
                ]
              }
            }
          ],
          "population" : [
            {
              "id" : "937BAF2A-D36A-4EE5-B2B2-762A0FE04502",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "initial-population",
                    "display" : "Initial Population"
                  }
                ]
              },
              "description" : "Inpatient hospitalizations for patients age 18 and older, discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less than or equal to 120 days that ends during the measurement period",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Initial Population"
              }
            },
            {
              "id" : "302C1DCC-7FE6-41EF-A94E-FDAE24B7BB1B",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "denominator",
                    "display" : "Denominator"
                  }
                ]
              },
              "description" : "Inpatient hospitalizations for patients with a principal diagnosis of Ischemic stroke",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Denominator"
              }
            },
            {
              "id" : "4B649804-9C55-4949-8CE0-01B462CAA74C",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "denominator-exclusion",
                    "display" : "Denominator Exclusion"
                  }
                ]
              },
              "description" : "- Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations.\n- Inpatient hospitalizations for patients discharged to another hospital\n- Inpatient hospitalizations for patients who left against medical advice\n- Inpatient hospitalizations for patients who expired\n- Inpatient hospitalizations for patients discharged to home for hospice care\n- Inpatient hospitalizations for patients discharged to a health care facility for hospice care\n- Inpatient hospitalizations for patients with comfort measures documented",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Denominator Exclusions"
              }
            },
            {
              "id" : "516A3DD0-69B0-49EF-BBD3-12809CDC843E",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "denominator-exception",
                    "display" : "Denominator Exception"
                  }
                ]
              },
              "description" : "- Inpatient hospitalizations for patients with a documented reason for not prescribing antithrombotic therapy at discharge.\n- Inpatient hospitalizations for patients who receive Prasugrel as an antithrombotic therapy at discharge.",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Denominator Exceptions"
              }
            },
            {
              "id" : "99961E3A-EFC4-4858-A3EE-F7F1D5B222FB",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "numerator",
                    "display" : "Numerator"
                  }
                ]
              },
              "description" : "Inpatient hospitalizations for patients prescribed or continuing to take antithrombotic therapy at hospital discharge",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Numerator"
              }
            },
            {
              "id" : "5f33f3ea-6ffb-4897-85dd-872dd7ac55b8",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "numerator-exclusion",
                    "display" : "Numerator Exclusion"
                  }
                ]
              },
              "criteria" : {
                "language" : "text/cql-identifier"
              }
            }
          ]
        }
      ],
      "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"
          }
        }
      ]
    }

    XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.