FHIR © HL7.org  |  Server Home  |  FHIR Server FHIR Server 3.7.11  |  FHIR Version n/a  User: [n/a]

Resource Measure/FHIR Server from package gov.healthit.ecqi.ecqms#current (203 ms)

Package gov.healthit.ecqi.ecqms
Type Measure
Id Id
FHIR Version R4
Source http://ecqi.healthit.gov/ecqms/https://build.fhir.org/ig/cqframework/ecqm-content-qicore-2024/Measure-AnticoagulationTherapyforAtrialFibrillationFlutterFHIR.html
Url https://madie.cms.gov/Measure/AnticoagulationTherapyforAtrialFibrillationFlutterFHIR
Version 0.3.000
Status draft
Date 2024-12-16T18:17:09+00:00
Name AnticoagulationTherapyforAtrialFibrillationFlutterFHIR
Title Anticoagulation Therapy for Atrial Fibrillation/FlutterFHIR
Experimental False
Description Ischemic stroke patients with atrial fibrillation/flutter who are prescribed or continuing to take anticoagulation therapy at hospital discharge
Purpose UNKNOWN
Copyright Measure specifications are in the Public Domain. LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2023 World Health Organization. All Rights Reserved.

Resources that use this resource

No resources found

Resources that this resource uses

No resources found

Narrative

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

Title: Anticoagulation Therapy for Atrial Fibrillation/FlutterFHIR
Id: AnticoagulationTherapyforAtrialFibrillationFlutterFHIR
Version: 0.3.000
Url: Anticoagulation Therapy for Atrial Fibrillation/FlutterFHIR
short-name identifier:

CMS71FHIR

version-independent identifier:

urn:uuid:bc80e4cf-d267-47bf-ad0d-4d37f8ae2328

version-specific identifier:

urn:uuid:5c16a2fb-1882-49aa-802b-a0b73ed17c05

publisher (CMS) identifier:

71FHIR

Effective Period: 2025-01-01..2025-12-31
Status: draft
Publisher: The Joint Commission
Author: The Joint Commission
Description:

Ischemic stroke patients with atrial fibrillation/flutter who are prescribed or continuing to take anticoagulation therapy at hospital discharge
Purpose:

UNKNOWN
Copyright:

Measure specifications are in the Public Domain.

LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2023 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.
Scoring:

Proportion

Rationale:

Nonvalvular atrial fibrillation (NVAF) is a common arrhythmia and an important risk factor for stroke. It is one of several conditions and lifestyle factors that have been identified as risk factors for stroke. It has been estimated that over 2 million adults in the United States have NVAF. While the median age of patients with atrial fibrillation is 75 years, the incidence increases with advancing age. For example, The Framingham Heart Study noted a dramatic increase in stroke risk associated with atrial fibrillation with advancing age, from 1.5% for those 50 to 59 years of age to 23.5% for those 80 to 89 years of age. Furthermore, a prior stroke or transient ischemic attack (TIA) are among a limited number of predictors of high stroke risk within the population of patients with atrial fibrillation. Therefore, much emphasis has been placed on identifying methods for preventing recurrent ischemic stroke as well as preventing first stroke. Prevention strategies focus on the modifiable risk factors such as hypertension, smoking, and atrial fibrillation. Analysis of five placebo-controlled clinical trials investigating the efficacy of warfarin in the primary prevention of thromboembolic stroke, found the relative risk of thromboembolic stroke was reduced by 68% for atrial fibrillation patients treated with warfarin. The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk-atrial fibrillation patients with TIA or prior stroke.
Clinical recommendation statement:

The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk atrial fibrillation patients with TIA or prior stroke
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 Inpatient Encounters include emergency, urgent, and unplanned admissions. The "Medication, Discharge" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use. The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This 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: CMS71v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).
Population Criteria:
64f0d91d56d636294b157d97
Initial Population: Inpatient hospitalizations (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke, that ends during the measurement period
Denominator: Inpatient hospitalizations for patients with a principal diagnosis of ischemic stroke, and a history of atrial ablation, or current or history of atrial fibrillation/flutter
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
Numerator: Inpatient hospitalizations for patients prescribed or continuing to take anticoagulation therapy at hospital discharge
Denominator Exception: Inpatient hospitalizations for patients with a documented reason for not prescribing anticoagulation therapy at discharge
Supplemental Data Elements:

SDE Ethnicity

SDE Payer

SDE Race

SDE Sex
Supplemental Data Guidance : For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity-Patient's Ethnicity: Hispanic or Latino Not Hispanic or Latino SDE Payer-Patient's Payer: Categories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system SDE Race-Patient's Race: Native Hawaiian or Other Pacific Islander Asian American Indian or Alaska Native Other Race White Black or African American SDE Sex-Patient's Sex: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.
Libraries:
AnticoagulationTherapyforAtrialFibrillationFlutterFHIR
Terminology and Other Dependencies:
  • Library/SupplementalDataElements|3.5.000
  • Library/TJCOverall|8.14.000
  • Library/FHIRHelpers|4.4.000
  • Library/CQMCommon|2.2.000
  • Library/QICoreCommon|2.1.000
  • AdministrativeGender
  • Diagnosis Role
  • ConditionVerificationStatus
  • MedicationRequest Category Codes
  • Non-Elective Inpatient Encounter
  • Ischemic Stroke
  • Atrial Ablation
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.76
  • Atrial Fibrillation/Flutter
  • Anticoagulant 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
    		•
    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(QICorePatient) ethnicity race
    Encounter(QICoreEncounter) type period rank rank.value use condition condition.reference condition.reference.value status status.value hospitalization hospitalization.dischargeDisposition Nonelective Inpatient Encounter Non-Elective Inpatient Encounter
    Encounter(QICoreEncounter) type period rank rank.value use condition condition.reference condition.reference.value status status.value hospitalization hospitalization.dischargeDisposition Nonelective Inpatient Encounter Non-Elective Inpatient Encounter
    Encounter(QICoreEncounter) type status status.value period rank rank.value use condition condition.reference condition.reference.value hospitalization hospitalization.dischargeDisposition Observation Services Observation Services
    Encounter(QICoreEncounter) type status status.value period rank rank.value use condition condition.reference condition.reference.value hospitalization hospitalization.dischargeDisposition Emergency Department Visit Emergency Department Visit
    Encounter(QICoreEncounter) type period rank rank.value use condition condition.reference condition.reference.value status status.value hospitalization hospitalization.dischargeDisposition Nonelective Inpatient Encounter Non-Elective Inpatient Encounter
    Condition(QICoreCondition) code verificationStatus onset History of Atrial Ablation http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.76
    Condition(QICoreCondition) id id.value code
    Condition(QICoreCondition) code verificationStatus onset Atrial Fibrillation or Flutter Atrial Fibrillation/Flutter
    Procedure(QICoreProcedure) code status status.value performed Atrial Ablation Atrial Ablation
    Procedure(QICoreProcedure) code status status.value Comfort Measures Comfort Measures
    Observation(QICoreObservation) code status status.value effective History of Atrial Ablation http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.76
    Medication(QICoreMedication) id
    MedicationRequest(QICoreMedicationRequest) medication.reference status status.value intent intent.value authoredOn authoredOn.value
    MedicationRequest(QICoreMedicationRequest) medication status status.value intent intent.value authoredOn authoredOn.value Anticoagulant Therapy Anticoagulant Therapy
    Coverage(QICoreCoverage) type period Payer Type Payer
    ServiceRequest(QICoreServiceRequest) code status status.value intent intent.value doNotPerform doNotPerform.value Comfort Measures Comfort Measures
    MedicationRequest(QICoreMedicationNotRequested) medication reasonCode intent intent.value authoredOn authoredOn.value Anticoagulant Therapy Anticoagulant Therapy
    Direct Reference Codes:
    display code system
    Male M http://hl7.org/fhir/administrative-gender
    Female F http://hl7.org/fhir/administrative-gender
    Billing billing http://terminology.hl7.org/CodeSystem/diagnosis-role
    Confirmed confirmed http://terminology.hl7.org/CodeSystem/condition-ver-status
    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
    64f0d91d56d636294b157d97 Group scoring: proportion Measure scoring:

    Proportion

    Type:

    Process

    Rate Aggregation: None
    Improvement Notation:

    increase

    Initial Population 
    define "Initial Population":
  TJC."Ischemic Stroke Encounter"
    Denominator 
    define "Denominator":
  "Encounter with a History of Atrial Ablation"
    union "Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Flutter"
    Denominator Exclusion 
    define "Denominator Exclusions":
  ( "Denominator" Encounter
      where Encounter.status = 'finished'
        and ( Encounter.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"
            or Encounter.hospitalization.dischargeDisposition in "Left Against Medical Advice"
            or Encounter.hospitalization.dischargeDisposition in "Patient Expired"
            or Encounter.hospitalization.dischargeDisposition in "Discharged to Home for Hospice Care"
            or Encounter.hospitalization.dischargeDisposition in "Discharged to Health Care Facility for Hospice Care"
        )
  )
    union "Encounter with Comfort Measures during Hospitalization for Patients with Documented Atrial Fibrillation or Flutter"
    Numerator 
    define "Numerator":
  "Denominator" Encounter
    with ["MedicationRequest": "Anticoagulant Therapy"] DischargeAnticoagulant
      such that ( DischargeAnticoagulant.isCommunity ( )
          or DischargeAnticoagulant.isDischarge ( )
      )
        and DischargeAnticoagulant.status in { 'active', 'completed' }
        and DischargeAnticoagulant.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and DischargeAnticoagulant.authoredOn during Encounter.period
    Denominator Exception 
    //BONNIEMAT-1617-Since there is an anticipated resolution for STU 5 for Medication.Discharge which leaves one blockers on coverage, will leave the assertion logic as is and update the test cases for coverage.


define "Denominator Exceptions":
  "Denominator" Encounter
    with "Documented Reason for Not Giving Anticoagulant at Discharge" NoDischargeAnticoagulant
      such that NoDischargeAnticoagulant.authoredOn during Encounter.period
    Library Name Name
    SupplementalDataElements SDE Sex 
    define "SDE Sex":
  case
    when Patient.gender = 'male' then "M"
    when Patient.gender = 'female' then "F"
    else null
  end
    Library Name Name
    AnticoagulationTherapyforAtrialFibrillationFlutterFHIR SDE Sex 
    define "SDE Sex":
  SDE."SDE Sex"
    Library Name Name
    TJCOverall Non Elective Inpatient Encounter with Age 
    define "Non Elective Inpatient Encounter with Age":
  ["Encounter": "Nonelective Inpatient Encounter"] NonElectiveEncounter
        where AgeInYearsAt(date from start of NonElectiveEncounter.period ) >= 18
         and NonElectiveEncounter.period ends during day of "Measurement Period"
    Library Name Name
    TJCOverall Ischemic Stroke Encounter 
    define "Ischemic Stroke Encounter":
  "Non Elective Inpatient Encounter with Age" NonElectiveEncounterWithAge
    where NonElectiveEncounterWithAge.principalDiagnosis().code in "Ischemic Stroke"
    Library Name Name
    AnticoagulationTherapyforAtrialFibrillationFlutterFHIR Encounter with a History of Atrial Ablation 
    define "Encounter with a History of Atrial Ablation":
  ( TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
      where exists ( ["Procedure": "Atrial Ablation"] AtrialAblationProcedure
          where AtrialAblationProcedure.status = 'completed'
            and AtrialAblationProcedure.performed.toInterval ( ) starts before start of IschemicStrokeEncounter.period
      )
  )
    union ( TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
        with ["Condition": "History of Atrial Ablation"] AtrialAblationDiagnosis
          such that AtrialAblationDiagnosis.verificationStatus is not null
            and AtrialAblationDiagnosis.verificationStatus ~ QICoreCommon."confirmed"
            and AtrialAblationDiagnosis.onset.toInterval ( ) starts before start of IschemicStrokeEncounter.period
    )
    union ( TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
        with ["Observation": "History of Atrial Ablation"] AtrialAblationObservation
          such that AtrialAblationObservation.status in { 'final', 'amended', 'corrected' }
            and AtrialAblationObservation.effective.earliest ( ) on or before end of IschemicStrokeEncounter.period
    )
    Library Name Name
    AnticoagulationTherapyforAtrialFibrillationFlutterFHIR Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Flutter 
    define "Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Flutter":
  ( TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
      with ["Condition": "Atrial Fibrillation or Flutter"] AtrialFibrillationFlutter
        such that AtrialFibrillationFlutter.verificationStatus is not null
          and AtrialFibrillationFlutter.verificationStatus ~ QICoreCommon."confirmed"
          and AtrialFibrillationFlutter.onset.toInterval ( ) starts on or before end of IschemicStrokeEncounter.period
  )
    union TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
      where exists ( ( IschemicStrokeEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
          where EncounterDiagnosis.code in "Atrial Fibrillation or Flutter"
      )
    Library Name Name
    AnticoagulationTherapyforAtrialFibrillationFlutterFHIR Denominator 
    define "Denominator":
  "Encounter with a History of Atrial Ablation"
    union "Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Flutter"
    Library Name Name
    AnticoagulationTherapyforAtrialFibrillationFlutterFHIR Numerator 
    define "Numerator":
  "Denominator" Encounter
    with ["MedicationRequest": "Anticoagulant Therapy"] DischargeAnticoagulant
      such that ( DischargeAnticoagulant.isCommunity ( )
          or DischargeAnticoagulant.isDischarge ( )
      )
        and DischargeAnticoagulant.status in { 'active', 'completed' }
        and DischargeAnticoagulant.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and DischargeAnticoagulant.authoredOn during Encounter.period
    Library Name Name
    SupplementalDataElements SDE Payer 
    define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }
    Library Name Name
    AnticoagulationTherapyforAtrialFibrillationFlutterFHIR SDE Payer 
    define "SDE Payer":
  SDE."SDE Payer"
    Library Name Name
    AnticoagulationTherapyforAtrialFibrillationFlutterFHIR Initial Population 
    define "Initial Population":
  TJC."Ischemic Stroke Encounter"
    Library Name Name
    SupplementalDataElements SDE Ethnicity 
    define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }
    Library Name Name
    AnticoagulationTherapyforAtrialFibrillationFlutterFHIR SDE Ethnicity 
    define "SDE Ethnicity":
  SDE."SDE Ethnicity"
    Library Name Name
    TJCOverall 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
    AnticoagulationTherapyforAtrialFibrillationFlutterFHIR Encounter with Comfort Measures during Hospitalization for Patients with Documented Atrial Fibrillation or Flutter 
    define "Encounter with Comfort Measures during Hospitalization for Patients with Documented Atrial Fibrillation or Flutter":
  "Denominator" Encounter
    with TJC."Intervention Comfort Measures" ComfortMeasure
      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during Encounter.hospitalizationWithObservation ( )
    Library Name Name
    AnticoagulationTherapyforAtrialFibrillationFlutterFHIR Denominator Exclusions 
    define "Denominator Exclusions":
  ( "Denominator" Encounter
      where Encounter.status = 'finished'
        and ( Encounter.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"
            or Encounter.hospitalization.dischargeDisposition in "Left Against Medical Advice"
            or Encounter.hospitalization.dischargeDisposition in "Patient Expired"
            or Encounter.hospitalization.dischargeDisposition in "Discharged to Home for Hospice Care"
            or Encounter.hospitalization.dischargeDisposition in "Discharged to Health Care Facility for Hospice Care"
        )
  )
    union "Encounter with Comfort Measures during Hospitalization for Patients with Documented Atrial Fibrillation or Flutter"
    Library Name Name
    SupplementalDataElements SDE Race 
    define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }
    Library Name Name
    AnticoagulationTherapyforAtrialFibrillationFlutterFHIR SDE Race 
    define "SDE Race":
  SDE."SDE Race"
    Library Name Name
    AnticoagulationTherapyforAtrialFibrillationFlutterFHIR Documented Reason for Not Giving Anticoagulant at Discharge 
    define "Documented Reason for Not Giving Anticoagulant at Discharge":
  ["MedicationNotRequested": medication in "Anticoagulant Therapy"] NoAnticoagulant
    where ( NoAnticoagulant.reasonCode in "Medical Reason For Not Providing Treatment"
        or NoAnticoagulant.reasonCode in "Patient Refusal"
    )
      and ( NoAnticoagulant.isCommunity ( )
          or NoAnticoagulant.isDischarge ( )
      )
      and NoAnticoagulant.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
    Library Name Name
    AnticoagulationTherapyforAtrialFibrillationFlutterFHIR Denominator Exceptions 
    //BONNIEMAT-1617-Since there is an anticipated resolution for STU 5 for Medication.Discharge which leaves one blockers on coverage, will leave the assertion logic as is and update the test cases for coverage.


define "Denominator Exceptions":
  "Denominator" Encounter
    with "Documented Reason for Not Giving Anticoagulant at Discharge" NoDischargeAnticoagulant
      such that NoDischargeAnticoagulant.authoredOn during Encounter.period
    Library Name Name
    CQMCommon 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 and D.use ~ "Billing") PD
      return singleton from ([Condition] C where C.id = PD.condition.reference.getId())
	)
    Library Name Name
    QICoreCommon 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
    QICoreCommon earliest 
    /*
@description: Given an interval, return the starting point if the interval has a starting boundary specified,
otherwise, return the ending point
*/
define fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
  (choice.toInterval()) period
    return
      if (period."hasStart"()) then start of period
      else end of period
    Library Name Name
    CQMCommon encounterDiagnosis 
    /*
@description: Returns the Condition resources referenced by the diagnosis element of the Encounter
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
  Encounter.diagnosis D
    return singleton from ([Condition] C where C.id = D.condition.reference.getId())
    Library Name Name
    QICoreCommon isCommunity 
    /*
@description: Returns true if the given MedicationRequest has a category of Community
*/
define fluent function isCommunity(medicationRequest MedicationRequest):
  exists (medicationRequest.category C
    where C ~ Community
  )
    Library Name Name
    FHIRHelpers ToConcept 
    /*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }
    Library Name Name
    QICoreCommon isDischarge 
    /*
@description: Returns true if the given MedicationRequest has a category of Discharge
*/
define fluent function isDischarge(medicationRequest MedicationRequest):
  exists (medicationRequest.category C
    where C ~ Discharge
  )
    Library Name Name
    FHIRHelpers ToString 
    define function ToString(value uri): value.value
    Library Name Name
    FHIRHelpers ToCode 
    /*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }
    Library Name Name
    CQMCommon 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]

    Source

    {
      "resourceType" : "Measure",
      "id" : "AnticoagulationTherapyforAtrialFibrillationFlutterFHIR",
      "meta" : {
        "profile" : [
          "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm",
          "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm",
          "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"
        ]
      },
      "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;\">Anticoagulation Therapy for Atrial Fibrillation/FlutterFHIR</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Id: </b></th>\n                <td style=\"padding-left: 4px;\">AnticoagulationTherapyforAtrialFibrillationFlutterFHIR</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Version: </b></th>\n                <td style=\"padding-left: 4px;\">0.3.000</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-AnticoagulationTherapyforAtrialFibrillationFlutterFHIR.html\">Anticoagulation Therapy for Atrial Fibrillation/FlutterFHIR</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>CMS71FHIR</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:bc80e4cf-d267-47bf-ad0d-4d37f8ae2328</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:5c16a2fb-1882-49aa-802b-a0b73ed17c05</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>71FHIR</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;\">2025-01-01..2025-12-31</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;\">The Joint Commission</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 with atrial fibrillation/flutter who are prescribed or continuing to take anticoagulation therapy at hospital discharge</p>\n</div></td>\n            </tr>\n        \n\n        \n\n        \n\n        \n\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 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2023 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            <tr>\n                <th scope=\"row\"><b>Scoring: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    \n                        \n                            <p style=\"margin-bottom: 5px;\">\n                                <span>Proportion </span>\n                            </p>\n                        \n                    \n                    \n                </td>\n            </tr>\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>Nonvalvular atrial fibrillation (NVAF) is a common arrhythmia and an important risk factor for stroke. It is one of several conditions and lifestyle factors that have been identified as risk factors for stroke. It has been estimated that over 2 million adults in the United States have NVAF. While the median age of patients with atrial fibrillation is 75 years, the incidence increases with advancing age. For example, The Framingham Heart Study noted a dramatic increase in stroke risk associated with atrial fibrillation with advancing age, from 1.5% for those 50 to 59 years of age to 23.5% for those 80 to 89 years of age. Furthermore, a prior stroke or transient ischemic attack (TIA) are among a limited number of predictors of high stroke risk within the population of patients with atrial fibrillation. Therefore, much emphasis has been placed on identifying methods for preventing recurrent ischemic stroke as well as preventing first stroke. Prevention strategies focus on the modifiable risk factors such as hypertension, smoking, and atrial fibrillation. Analysis of five placebo-controlled clinical trials investigating the efficacy of warfarin in the primary prevention of thromboembolic stroke, found the relative risk of thromboembolic stroke was reduced by 68% for atrial fibrillation patients treated with warfarin. The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk-atrial fibrillation patients with TIA or prior stroke.</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>The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk atrial fibrillation patients with TIA or prior stroke</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 Inpatient Encounters include emergency, urgent, and unplanned admissions.\n\nThe &quot;Medication, Discharge&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. This FHIR-based measure has been derived from the QDM-based measure: CMS71v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/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>64f0d91d56d636294b157d97</b></th>\n                                    </tr>\n                                \n                                \n                                    <tr>\n                                        <td>Initial Population:</td>\n\n                                        \n                                            \n                                                <td>Inpatient hospitalizations (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke, that ends during the measurement period</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, and a history of atrial ablation, or current or history of atrial fibrillation/flutter</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>Numerator:</td>\n\n                                        \n                                            \n                                                <td>Inpatient hospitalizations for patients prescribed or continuing to take anticoagulation therapy at hospital discharge</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 anticoagulation therapy at discharge</td>\n                                            \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;\"> For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity-Patient's Ethnicity:\nHispanic or Latino\nNot Hispanic or Latino \n SDE Payer-Patient's Payer:\nCategories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system \n SDE Race-Patient's Race:\nNative Hawaiian or Other Pacific Islander\nAsian\nAmerican Indian or Alaska Native\nOther Race\nWhite\nBlack or African American \n SDE Sex-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-AnticoagulationTherapyforAtrialFibrillationFlutterFHIR.html\">AnticoagulationTherapyforAtrialFibrillationFlutterFHIR</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><code>Library/SupplementalDataElements|3.5.000</code></li>\n                        \n                            <li><code>Library/TJCOverall|8.14.000</code></li>\n                        \n                            <li><code>Library/FHIRHelpers|4.4.000</code></li>\n                        \n                            <li><code>Library/CQMCommon|2.2.000</code></li>\n                        \n                            <li><code>Library/QICoreCommon|2.1.000</code></li>\n                        \n                            <li><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">AdministrativeGender</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-diagnosis-role.html\">Diagnosis Role</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-ver-status.html\">ConditionVerificationStatus</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/5.5.0/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/2.16.840.1.113883.3.117.1.7.1.247/expansion\">Ischemic Stroke</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.203/expansion\">Atrial Ablation</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.76/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.76</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.202/expansion\">Atrial Fibrillation/Flutter</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.200/expansion\">Anticoagulant 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                    </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/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n                                    <td>\n                                        \n                                            ethnicity\n                                        \n                                            race\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/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                            rank\n                                        \n                                            rank.value\n                                        \n                                            use\n                                        \n                                            condition\n                                        \n                                            condition.reference\n                                        \n                                            condition.reference.value\n                                        \n                                            status\n                                        \n                                            status.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/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                            rank\n                                        \n                                            rank.value\n                                        \n                                            use\n                                        \n                                            condition\n                                        \n                                            condition.reference\n                                        \n                                            condition.reference.value\n                                        \n                                            status\n                                        \n                                            status.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/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</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                                            use\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/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</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                                            use\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>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                            rank\n                                        \n                                            rank.value\n                                        \n                                            use\n                                        \n                                            condition\n                                        \n                                            condition.reference\n                                        \n                                            condition.reference.value\n                                        \n                                            status\n                                        \n                                            status.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>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            verificationStatus\n                                        \n                                            onset\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 History of Atrial Ablation\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.76/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.76</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            id\n                                        \n                                            id.value\n                                        \n                                            code\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            verificationStatus\n                                        \n                                            onset\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Atrial Fibrillation or Flutter\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.202/expansion\">Atrial Fibrillation/Flutter</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Procedure(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html\">QICoreProcedure</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            performed\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Atrial Ablation\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.203/expansion\">Atrial Ablation</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Procedure(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-procedure.html\">QICoreProcedure</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>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            effective\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 History of Atrial Ablation\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1110.76/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.76</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Medication(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medication.html\">QICoreMedication</a>)</td>\n                                    <td>\n                                        \n                                            id\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/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n                                    <td>\n                                        \n                                            medication.reference\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            intent\n                                        \n                                            intent.value\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.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/STU4.1.1/StructureDefinition-qicore-medicationrequest.html\">QICoreMedicationRequest</a>)</td>\n                                    <td>\n                                        \n                                            medication\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            intent\n                                        \n                                            intent.value\n                                        \n                                            authoredOn\n                                        \n                                            authoredOn.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Anticoagulant Therapy\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.200/expansion\">Anticoagulant Therapy</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Coverage(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html\">QICoreCoverage</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/STU4.1.1/StructureDefinition-qicore-servicerequest.html\">QICoreServiceRequest</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>MedicationRequest(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-mednotrequested.html\">QICoreMedicationNotRequested</a>)</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                                                 Anticoagulant Therapy\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.200/expansion\">Anticoagulant 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>Male</td>\n                                        <td>M</td>\n                                        <td><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">http://hl7.org/fhir/administrative-gender</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Female</td>\n                                        <td>F</td>\n                                        <td><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">http://hl7.org/fhir/administrative-gender</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Billing</td>\n                                        <td>billing</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-diagnosis-role.html\">http://terminology.hl7.org/CodeSystem/diagnosis-role</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Confirmed</td>\n                                        <td>confirmed</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-ver-status.html\">http://terminology.hl7.org/CodeSystem/condition-ver-status</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Community</td>\n                                        <td>community</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/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://terminology.hl7.org/5.5.0/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> 64f0d91d56d636294b157d97 </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                                        <b>Measure scoring:</b>\n                                        \n                                            <p style=\"margin-bottom: 5px;\">\n                                                <span>Proportion</span>\n                                            </p>\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                                    <tr>\n                                        <th scope=\"row\"><b>Rate Aggregation: </b></th>\n                                        <td colspan=\"3\" style=\"padding-left: 4px;\">None</td>\n                                    </tr>\n                                    \n\n                                    \n                                        <tr>\n                                            <th scope=\"row\"><b>Improvement Notation: </b></th>\n                                            <td style=\"padding-left: 4px;\">\n                                            \n                                                \n                                                    \n                                                        <p style=\"margin-bottom: 5px;\">\n                                                            <span>increase </span>\n                                                        </p>\n                                                    \n                                                \n                                                \n                                            \n                                            </td>\n                                        </tr>\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;Ischemic Stroke Encounter&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  &quot;Encounter with a History of Atrial Ablation&quot;\n    union &quot;Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Flutter&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  ( &quot;Denominator&quot; Encounter\n      where Encounter.status = 'finished'\n        and ( Encounter.hospitalization.dischargeDisposition in &quot;Discharge To Acute Care Facility&quot;\n            or Encounter.hospitalization.dischargeDisposition in &quot;Left Against Medical Advice&quot;\n            or Encounter.hospitalization.dischargeDisposition in &quot;Patient Expired&quot;\n            or Encounter.hospitalization.dischargeDisposition in &quot;Discharged to Home for Hospice Care&quot;\n            or Encounter.hospitalization.dischargeDisposition in &quot;Discharged to Health Care Facility for Hospice Care&quot;\n        )\n  )\n    union &quot;Encounter with Comfort Measures during Hospitalization for Patients with Documented Atrial Fibrillation or Flutter&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  &quot;Denominator&quot; Encounter\n    with [&quot;MedicationRequest&quot;: &quot;Anticoagulant Therapy&quot;] DischargeAnticoagulant\n      such that ( DischargeAnticoagulant.isCommunity ( )\n          or DischargeAnticoagulant.isDischarge ( )\n      )\n        and DischargeAnticoagulant.status in { 'active', 'completed' }\n        and DischargeAnticoagulant.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n        and DischargeAnticoagulant.authoredOn during Encounter.period</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\">//BONNIEMAT-1617-Since there is an anticipated resolution for STU 5 for Medication.Discharge which leaves one blockers on coverage, will leave the assertion logic as is and update the test cases for coverage.\n\n\ndefine &quot;Denominator Exceptions&quot;:\n  &quot;Denominator&quot; Encounter\n    with &quot;Documented Reason for Not Giving Anticoagulant at Discharge&quot; NoDischargeAnticoagulant\n      such that NoDischargeAnticoagulant.authoredOn during Encounter.period</code></pre>\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>SupplementalDataElements</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 &quot;M&quot;\n    when Patient.gender = 'female' then &quot;F&quot;\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>AnticoagulationTherapyforAtrialFibrillationFlutterFHIR</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>TJCOverall</td>\n                            \n                            \n                                <td>Non Elective Inpatient Encounter with Age</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 with Age&quot;:\n  [&quot;Encounter&quot;: &quot;Nonelective Inpatient Encounter&quot;] NonElectiveEncounter\n        where AgeInYearsAt(date from start of NonElectiveEncounter.period ) &gt;= 18\n         and 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>TJCOverall</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;Non Elective Inpatient Encounter with Age&quot; NonElectiveEncounterWithAge\n    where NonElectiveEncounterWithAge.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>AnticoagulationTherapyforAtrialFibrillationFlutterFHIR</td>\n                            \n                            \n                                <td>Encounter with a History of Atrial Ablation</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 a History of Atrial Ablation&quot;:\n  ( TJC.&quot;Ischemic Stroke Encounter&quot; IschemicStrokeEncounter\n      where exists ( [&quot;Procedure&quot;: &quot;Atrial Ablation&quot;] AtrialAblationProcedure\n          where AtrialAblationProcedure.status = 'completed'\n            and AtrialAblationProcedure.performed.toInterval ( ) starts before start of IschemicStrokeEncounter.period\n      )\n  )\n    union ( TJC.&quot;Ischemic Stroke Encounter&quot; IschemicStrokeEncounter\n        with [&quot;Condition&quot;: &quot;History of Atrial Ablation&quot;] AtrialAblationDiagnosis\n          such that AtrialAblationDiagnosis.verificationStatus is not null\n            and AtrialAblationDiagnosis.verificationStatus ~ QICoreCommon.&quot;confirmed&quot;\n            and AtrialAblationDiagnosis.onset.toInterval ( ) starts before start of IschemicStrokeEncounter.period\n    )\n    union ( TJC.&quot;Ischemic Stroke Encounter&quot; IschemicStrokeEncounter\n        with [&quot;Observation&quot;: &quot;History of Atrial Ablation&quot;] AtrialAblationObservation\n          such that AtrialAblationObservation.status in { 'final', 'amended', 'corrected' }\n            and AtrialAblationObservation.effective.earliest ( ) on or before end of IschemicStrokeEncounter.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>AnticoagulationTherapyforAtrialFibrillationFlutterFHIR</td>\n                            \n                            \n                                <td>Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Flutter</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 Prior or Present Diagnosis of Atrial Fibrillation or Flutter&quot;:\n  ( TJC.&quot;Ischemic Stroke Encounter&quot; IschemicStrokeEncounter\n      with [&quot;Condition&quot;: &quot;Atrial Fibrillation or Flutter&quot;] AtrialFibrillationFlutter\n        such that AtrialFibrillationFlutter.verificationStatus is not null\n          and AtrialFibrillationFlutter.verificationStatus ~ QICoreCommon.&quot;confirmed&quot;\n          and AtrialFibrillationFlutter.onset.toInterval ( ) starts on or before end of IschemicStrokeEncounter.period\n  )\n    union TJC.&quot;Ischemic Stroke Encounter&quot; IschemicStrokeEncounter\n      where exists ( ( IschemicStrokeEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n          where EncounterDiagnosis.code in &quot;Atrial Fibrillation or Flutter&quot;\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>AnticoagulationTherapyforAtrialFibrillationFlutterFHIR</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  &quot;Encounter with a History of Atrial Ablation&quot;\n    union &quot;Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Flutter&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>AnticoagulationTherapyforAtrialFibrillationFlutterFHIR</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  &quot;Denominator&quot; Encounter\n    with [&quot;MedicationRequest&quot;: &quot;Anticoagulant Therapy&quot;] DischargeAnticoagulant\n      such that ( DischargeAnticoagulant.isCommunity ( )\n          or DischargeAnticoagulant.isDischarge ( )\n      )\n        and DischargeAnticoagulant.status in { 'active', 'completed' }\n        and DischargeAnticoagulant.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n        and DischargeAnticoagulant.authoredOn during Encounter.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>SupplementalDataElements</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>AnticoagulationTherapyforAtrialFibrillationFlutterFHIR</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>AnticoagulationTherapyforAtrialFibrillationFlutterFHIR</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;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>SupplementalDataElements</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>AnticoagulationTherapyforAtrialFibrillationFlutterFHIR</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>TJCOverall</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>AnticoagulationTherapyforAtrialFibrillationFlutterFHIR</td>\n                            \n                            \n                                <td>Encounter with Comfort Measures during Hospitalization for Patients with Documented Atrial Fibrillation or Flutter</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 Atrial Fibrillation or Flutter&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>AnticoagulationTherapyforAtrialFibrillationFlutterFHIR</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  ( &quot;Denominator&quot; Encounter\n      where Encounter.status = 'finished'\n        and ( Encounter.hospitalization.dischargeDisposition in &quot;Discharge To Acute Care Facility&quot;\n            or Encounter.hospitalization.dischargeDisposition in &quot;Left Against Medical Advice&quot;\n            or Encounter.hospitalization.dischargeDisposition in &quot;Patient Expired&quot;\n            or Encounter.hospitalization.dischargeDisposition in &quot;Discharged to Home for Hospice Care&quot;\n            or Encounter.hospitalization.dischargeDisposition in &quot;Discharged to Health Care Facility for Hospice Care&quot;\n        )\n  )\n    union &quot;Encounter with Comfort Measures during Hospitalization for Patients with Documented Atrial Fibrillation or Flutter&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>SupplementalDataElements</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>AnticoagulationTherapyforAtrialFibrillationFlutterFHIR</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>AnticoagulationTherapyforAtrialFibrillationFlutterFHIR</td>\n                            \n                            \n                                <td>Documented Reason for Not Giving Anticoagulant 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;Documented Reason for Not Giving Anticoagulant at Discharge&quot;:\n  [&quot;MedicationNotRequested&quot;: medication in &quot;Anticoagulant Therapy&quot;] NoAnticoagulant\n    where ( NoAnticoagulant.reasonCode in &quot;Medical Reason For Not Providing Treatment&quot;\n        or NoAnticoagulant.reasonCode in &quot;Patient Refusal&quot;\n    )\n      and ( NoAnticoagulant.isCommunity ( )\n          or NoAnticoagulant.isDischarge ( )\n      )\n      and NoAnticoagulant.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>AnticoagulationTherapyforAtrialFibrillationFlutterFHIR</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\">//BONNIEMAT-1617-Since there is an anticipated resolution for STU 5 for Medication.Discharge which leaves one blockers on coverage, will leave the assertion logic as is and update the test cases for coverage.\n\n\ndefine &quot;Denominator Exceptions&quot;:\n  &quot;Denominator&quot; Encounter\n    with &quot;Documented Reason for Not Giving Anticoagulant at Discharge&quot; NoDischargeAnticoagulant\n      such that NoDischargeAnticoagulant.authoredOn during Encounter.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>CQMCommon</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 and D.use ~ &quot;Billing&quot;) 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>QICoreCommon</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>QICoreCommon</td>\n                            \n                            \n                                <td>earliest</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Given an interval, return the starting point if the interval has a starting boundary specified,\notherwise, return the ending point\n*/\ndefine fluent function earliest(choice Choice&lt;DateTime, Quantity, Interval&lt;DateTime&gt;, Interval&lt;Quantity&gt;&gt; ):\n  (choice.toInterval()) period\n    return\n      if (period.&quot;hasStart&quot;()) then start of period\n      else end of 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>CQMCommon</td>\n                            \n                            \n                                <td>encounterDiagnosis</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 resources referenced by the diagnosis element of the Encounter\n*/\ndefine fluent function encounterDiagnosis(Encounter Encounter ):\n  Encounter.diagnosis D\n    return singleton from ([Condition] C where C.id = D.condition.reference.getId())</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>QICoreCommon</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 MedicationRequest):\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>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\">/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }</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>QICoreCommon</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 MedicationRequest):\n  exists (medicationRequest.category C\n    where C ~ Discharge\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>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\">/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }</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>CQMCommon</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                    </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://hl7.org/fhir/administrative-gender",
                "code" : "M",
                "display" : "Male"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://hl7.org/fhir/administrative-gender",
                "code" : "F",
                "display" : "Female"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/diagnosis-role",
                "code" : "billing",
                "display" : "Billing"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
                "code" : "confirmed",
                "display" : "Confirmed"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/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" : "SupplementalDataElements"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Sex"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Sex\":\n  case\n    when Patient.gender = 'male' then \"M\"\n    when Patient.gender = 'female' then \"F\"\n    else null\n  end"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 0
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "AnticoagulationTherapyforAtrialFibrillationFlutterFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Sex"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 1
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "TJCOverall"
                },
                {
                  "url" : "name",
                  "valueString" : "Non Elective Inpatient Encounter with Age"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Non Elective Inpatient Encounter with Age\":\n  [\"Encounter\": \"Nonelective Inpatient Encounter\"] NonElectiveEncounter\n        where AgeInYearsAt(date from start of NonElectiveEncounter.period ) >= 18\n         and NonElectiveEncounter.period ends during day of \"Measurement Period\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 2
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "TJCOverall"
                },
                {
                  "url" : "name",
                  "valueString" : "Ischemic Stroke Encounter"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Ischemic Stroke Encounter\":\n  \"Non Elective Inpatient Encounter with Age\" NonElectiveEncounterWithAge\n    where NonElectiveEncounterWithAge.principalDiagnosis().code in \"Ischemic Stroke\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 3
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "AnticoagulationTherapyforAtrialFibrillationFlutterFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Encounter with a History of Atrial Ablation"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Encounter with a History of Atrial Ablation\":\n  ( TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n      where exists ( [\"Procedure\": \"Atrial Ablation\"] AtrialAblationProcedure\n          where AtrialAblationProcedure.status = 'completed'\n            and AtrialAblationProcedure.performed.toInterval ( ) starts before start of IschemicStrokeEncounter.period\n      )\n  )\n    union ( TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n        with [\"Condition\": \"History of Atrial Ablation\"] AtrialAblationDiagnosis\n          such that AtrialAblationDiagnosis.verificationStatus is not null\n            and AtrialAblationDiagnosis.verificationStatus ~ QICoreCommon.\"confirmed\"\n            and AtrialAblationDiagnosis.onset.toInterval ( ) starts before start of IschemicStrokeEncounter.period\n    )\n    union ( TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n        with [\"Observation\": \"History of Atrial Ablation\"] AtrialAblationObservation\n          such that AtrialAblationObservation.status in { 'final', 'amended', 'corrected' }\n            and AtrialAblationObservation.effective.earliest ( ) on or before end of IschemicStrokeEncounter.period\n    )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 4
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "AnticoagulationTherapyforAtrialFibrillationFlutterFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Flutter"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Flutter\":\n  ( TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n      with [\"Condition\": \"Atrial Fibrillation or Flutter\"] AtrialFibrillationFlutter\n        such that AtrialFibrillationFlutter.verificationStatus is not null\n          and AtrialFibrillationFlutter.verificationStatus ~ QICoreCommon.\"confirmed\"\n          and AtrialFibrillationFlutter.onset.toInterval ( ) starts on or before end of IschemicStrokeEncounter.period\n  )\n    union TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n      where exists ( ( IschemicStrokeEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n          where EncounterDiagnosis.code in \"Atrial Fibrillation or Flutter\"\n      )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 5
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "AnticoagulationTherapyforAtrialFibrillationFlutterFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Denominator\":\n  \"Encounter with a History of Atrial Ablation\"\n    union \"Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Flutter\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 6
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "AnticoagulationTherapyforAtrialFibrillationFlutterFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Numerator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Numerator\":\n  \"Denominator\" Encounter\n    with [\"MedicationRequest\": \"Anticoagulant Therapy\"] DischargeAnticoagulant\n      such that ( DischargeAnticoagulant.isCommunity ( )\n          or DischargeAnticoagulant.isDischarge ( )\n      )\n        and DischargeAnticoagulant.status in { 'active', 'completed' }\n        and DischargeAnticoagulant.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n        and DischargeAnticoagulant.authoredOn during Encounter.period"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 7
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "SupplementalDataElements"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Payer"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Payer\":\n  [Coverage: type in \"Payer Type\"] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 8
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "AnticoagulationTherapyforAtrialFibrillationFlutterFHIR"
                },
                {
                  "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" : "AnticoagulationTherapyforAtrialFibrillationFlutterFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Initial Population"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Initial Population\":\n  TJC.\"Ischemic Stroke Encounter\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 10
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "SupplementalDataElements"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Ethnicity"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Ethnicity\":\n  Patient.ethnicity E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 11
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "AnticoagulationTherapyforAtrialFibrillationFlutterFHIR"
                },
                {
                  "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" : "TJCOverall"
                },
                {
                  "url" : "name",
                  "valueString" : "Intervention Comfort Measures"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Intervention Comfort Measures\":\n  ( [\"ServiceRequest\": code in \"Comfort Measures\"] SR\n    where SR.status in { 'active', 'completed', 'on-hold' }\n      and SR.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n      and SR.doNotPerform is not true\n  )  \n  union ( [\"Procedure\": \"Comfort Measures\"] InterventionPerformed\n        where InterventionPerformed.status in { 'completed', 'in-progress' }\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 13
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "AnticoagulationTherapyforAtrialFibrillationFlutterFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Encounter with Comfort Measures during Hospitalization for Patients with Documented Atrial Fibrillation or Flutter"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Encounter with Comfort Measures during Hospitalization for Patients with Documented Atrial Fibrillation or Flutter\":\n  \"Denominator\" Encounter\n    with TJC.\"Intervention Comfort Measures\" ComfortMeasure\n      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during Encounter.hospitalizationWithObservation ( )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 14
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "AnticoagulationTherapyforAtrialFibrillationFlutterFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator Exclusions"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Denominator Exclusions\":\n  ( \"Denominator\" Encounter\n      where Encounter.status = 'finished'\n        and ( Encounter.hospitalization.dischargeDisposition in \"Discharge To Acute Care Facility\"\n            or Encounter.hospitalization.dischargeDisposition in \"Left Against Medical Advice\"\n            or Encounter.hospitalization.dischargeDisposition in \"Patient Expired\"\n            or Encounter.hospitalization.dischargeDisposition in \"Discharged to Home for Hospice Care\"\n            or Encounter.hospitalization.dischargeDisposition in \"Discharged to Health Care Facility for Hospice Care\"\n        )\n  )\n    union \"Encounter with Comfort Measures during Hospitalization for Patients with Documented Atrial Fibrillation or Flutter\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 15
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "SupplementalDataElements"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Race"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Race\":\n  Patient.race R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 16
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "AnticoagulationTherapyforAtrialFibrillationFlutterFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Race"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Race\":\n  SDE.\"SDE Race\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 17
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "AnticoagulationTherapyforAtrialFibrillationFlutterFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Documented Reason for Not Giving Anticoagulant at Discharge"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Documented Reason for Not Giving Anticoagulant at Discharge\":\n  [\"MedicationNotRequested\": medication in \"Anticoagulant Therapy\"] NoAnticoagulant\n    where ( NoAnticoagulant.reasonCode in \"Medical Reason For Not Providing Treatment\"\n        or NoAnticoagulant.reasonCode in \"Patient Refusal\"\n    )\n      and ( NoAnticoagulant.isCommunity ( )\n          or NoAnticoagulant.isDischarge ( )\n      )\n      and NoAnticoagulant.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 18
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "AnticoagulationTherapyforAtrialFibrillationFlutterFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator Exceptions"
                },
                {
                  "url" : "statement",
                  "valueString" : "//BONNIEMAT-1617-Since there is an anticipated resolution for STU 5 for Medication.Discharge which leaves one blockers on coverage, will leave the assertion logic as is and update the test cases for coverage.\n\n\ndefine \"Denominator Exceptions\":\n  \"Denominator\" Encounter\n    with \"Documented Reason for Not Giving Anticoagulant at Discharge\" NoDischargeAnticoagulant\n      such that NoDischargeAnticoagulant.authoredOn during Encounter.period"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 19
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CQMCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "principalDiagnosis"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns the 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 and D.use ~ \"Billing\") PD\n      return singleton from ([Condition] C where C.id = PD.condition.reference.getId())\n\t)"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 20
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommon"
                },
                {
                  "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" : 21
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "earliest"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Given an interval, return the starting point if the interval has a starting boundary specified,\notherwise, return the ending point\n*/\ndefine fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):\n  (choice.toInterval()) period\n    return\n      if (period.\"hasStart\"()) then start of period\n      else end of period"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 22
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CQMCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "encounterDiagnosis"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns the Condition resources referenced by the diagnosis element of the Encounter\n*/\ndefine fluent function encounterDiagnosis(Encounter Encounter ):\n  Encounter.diagnosis D\n    return singleton from ([Condition] C where C.id = D.condition.reference.getId())"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 23
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "isCommunity"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns true if the given MedicationRequest has a category of Community\n*/\ndefine fluent function isCommunity(medicationRequest MedicationRequest):\n  exists (medicationRequest.category C\n    where C ~ Community\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 24
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToConcept"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 25
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "isDischarge"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns true if the given MedicationRequest has a category of Discharge\n*/\ndefine fluent function isDischarge(medicationRequest MedicationRequest):\n  exists (medicationRequest.category C\n    where C ~ Discharge\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 26
                }
              ],
              "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" : 27
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToCode"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 28
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "CQMCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "hospitalizationWithObservation"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter\n*/\ndefine fluent function hospitalizationWithObservation(TheEncounter Encounter ):\n  TheEncounter Visit\n  \t\tlet ObsVisit: Last([Encounter: \"Observation Services\"] LastObs\n  \t\t\t\twhere LastObs.status = 'finished'\n            and LastObs.period ends 1 hour or less on or before start of Visit.period\n  \t\t\t\tsort by end of period\n  \t\t\t),\n  \t\t\tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n  \t\t\tEDVisit: Last([Encounter: \"Emergency Department Visit\"] LastED\n  \t\t\t\twhere LastED.status = 'finished'\n            and LastED.period ends 1 hour or less on or before VisitStart\n  \t\t\t\tsort by end of period\n  \t\t\t)\n  \t\treturn Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 29
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            }
          ],
          "name" : "EffectiveDataRequirements",
          "status" : "active",
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/library-type",
                "code" : "module-definition"
              }
            ]
          },
          "relatedArtifact" : [
            {
              "type" : "depends-on",
              "display" : "Library SDE",
              "resource" : "Library/SupplementalDataElements|3.5.000"
            },
            {
              "type" : "depends-on",
              "display" : "Library TJC",
              "resource" : "Library/TJCOverall|8.14.000"
            },
            {
              "type" : "depends-on",
              "display" : "Library FHIRHelpers",
              "resource" : "Library/FHIRHelpers|4.4.000"
            },
            {
              "type" : "depends-on",
              "display" : "Library CQMCommon",
              "resource" : "Library/CQMCommon|2.2.000"
            },
            {
              "type" : "depends-on",
              "display" : "Library QICoreCommon",
              "resource" : "Library/QICoreCommon|2.1.000"
            },
            {
              "type" : "depends-on",
              "display" : "Code system AdministrativeGender",
              "resource" : "http://hl7.org/fhir/administrative-gender"
            },
            {
              "type" : "depends-on",
              "display" : "Code system DiagnosisRole",
              "resource" : "http://terminology.hl7.org/CodeSystem/diagnosis-role"
            },
            {
              "type" : "depends-on",
              "display" : "Code system ConditionVerificationStatusCodes",
              "resource" : "http://terminology.hl7.org/CodeSystem/condition-ver-status"
            },
            {
              "type" : "depends-on",
              "display" : "Code system MedicationRequestCategory",
              "resource" : "http://terminology.hl7.org/CodeSystem/medicationrequest-category"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Nonelective Inpatient Encounter",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Ischemic Stroke",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Atrial Ablation",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.203"
            },
            {
              "type" : "depends-on",
              "display" : "Value set History of Atrial Ablation",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.76"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Atrial Fibrillation or Flutter",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.202"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Anticoagulant Therapy",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.200"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Payer Type",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Discharge To Acute Care Facility",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Left Against Medical Advice",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.308"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Patient Expired",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Discharged to Home for Hospice Care",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.209"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Discharged to Health Care Facility for Hospice Care",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.207"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Comfort Measures",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Observation Services",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Emergency Department Visit",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Medical Reason For Not Providing Treatment",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Patient Refusal",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93"
            }
          ],
          "parameter" : [
            {
              "name" : "Measurement Period",
              "use" : "in",
              "min" : 0,
              "max" : "1",
              "type" : "Period"
            },
            {
              "name" : "SDE Sex",
              "use" : "out",
              "min" : 0,
              "max" : "1",
              "type" : "Coding"
            },
            {
              "name" : "Numerator",
              "use" : "out",
              "min" : 0,
              "max" : "*",
              "type" : "Resource"
            },
            {
              "name" : "Denominator",
              "use" : "out",
              "min" : 0,
              "max" : "*",
              "type" : "Resource"
            },
            {
              "name" : "SDE Payer",
              "use" : "out",
              "min" : 0,
              "max" : "*",
              "type" : "Resource"
            },
            {
              "name" : "Initial Population",
              "use" : "out",
              "min" : 0,
              "max" : "*",
              "type" : "Resource"
            },
            {
              "name" : "SDE Ethnicity",
              "use" : "out",
              "min" : 0,
              "max" : "1",
              "type" : "Resource"
            },
            {
              "name" : "Denominator Exclusions",
              "use" : "out",
              "min" : 0,
              "max" : "*",
              "type" : "Resource"
            },
            {
              "name" : "SDE Race",
              "use" : "out",
              "min" : 0,
              "max" : "1",
              "type" : "Resource"
            },
            {
              "name" : "Denominator Exceptions",
              "use" : "out",
              "min" : 0,
              "max" : "*",
              "type" : "Resource"
            }
          ],
          "dataRequirement" : [
            {
              "type" : "Patient",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
              ],
              "mustSupport" : [
                "ethnicity",
                "race"
              ]
            },
            {
              "id" : "230",
              "type" : "Encounter",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "period",
                "rank",
                "rank.value",
                "use",
                "condition",
                "condition.reference",
                "condition.reference.value",
                "status",
                "status.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"
                }
              ],
              "dateFilter" : [
                {
                  "path" : "period",
                  "valuePeriod" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
                        "valueExpression" : {
                          "language" : "text/cql-identifier",
                          "expression" : "Measurement Period"
                        }
                      }
                    ]
                  }
                }
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "period",
                "rank",
                "rank.value",
                "use",
                "condition",
                "condition.reference",
                "condition.reference.value",
                "status",
                "status.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"
                }
              ],
              "dateFilter" : [
                {
                  "path" : "period",
                  "valuePeriod" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
                        "valueExpression" : {
                          "language" : "text/cql-identifier",
                          "expression" : "Measurement Period"
                        }
                      }
                    ]
                  }
                }
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "status",
                "status.value",
                "period",
                "rank",
                "rank.value",
                "use",
                "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"
                },
                {
                  "path" : "status.value",
                  "code" : [
                    {
                      "code" : "finished"
                    }
                  ]
                }
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "status",
                "status.value",
                "period",
                "rank",
                "rank.value",
                "use",
                "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"
                },
                {
                  "path" : "status.value",
                  "code" : [
                    {
                      "code" : "finished"
                    }
                  ]
                }
              ],
              "dateFilter" : [
                {
                  "path" : "period",
                  "valuePeriod" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/uv/crmi-analysisException",
                        "valueString" : "Error attempting to determine filter value: toFhirValue not implemented for Subtract"
                      }
                    ]
                  }
                }
              ]
            },
            {
              "type" : "Encounter",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
              ],
              "mustSupport" : [
                "type",
                "period",
                "rank",
                "rank.value",
                "use",
                "condition",
                "condition.reference",
                "condition.reference.value",
                "status",
                "status.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"
                }
              ],
              "dateFilter" : [
                {
                  "path" : "period",
                  "valuePeriod" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
                        "valueExpression" : {
                          "language" : "text/cql-identifier",
                          "expression" : "Measurement Period"
                        }
                      }
                    ]
                  }
                }
              ]
            },
            {
              "type" : "Condition",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"
              ],
              "mustSupport" : [
                "code",
                "verificationStatus",
                "onset"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.76"
                },
                {
                  "path" : "verificationStatus"
                }
              ]
            },
            {
              "type" : "Condition",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"
              ],
              "mustSupport" : [
                "id",
                "id.value",
                "code"
              ]
            },
            {
              "type" : "Condition",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"
              ],
              "mustSupport" : [
                "code",
                "verificationStatus",
                "onset"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.202"
                },
                {
                  "path" : "verificationStatus"
                }
              ]
            },
            {
              "type" : "Procedure",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
              ],
              "mustSupport" : [
                "code",
                "status",
                "status.value",
                "performed"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.203"
                },
                {
                  "path" : "status.value",
                  "code" : [
                    {
                      "code" : "completed"
                    }
                  ]
                }
              ]
            },
            {
              "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" : "Observation",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"
              ],
              "mustSupport" : [
                "code",
                "status",
                "status.value",
                "effective"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.76"
                }
              ]
            },
            {
              "extension" : [
                {
                  "extension" : [
                    {
                      "url" : "targetId",
                      "valueString" : "565"
                    },
                    {
                      "url" : "targetProperty",
                      "valueString" : "medication"
                    }
                  ],
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-relatedRequirement"
                }
              ],
              "type" : "Medication",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication"
              ],
              "mustSupport" : [
                "id"
              ]
            },
            {
              "id" : "565",
              "type" : "MedicationRequest",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
              ],
              "mustSupport" : [
                "medication.reference",
                "status",
                "status.value",
                "intent",
                "intent.value",
                "authoredOn",
                "authoredOn.value"
              ]
            },
            {
              "type" : "MedicationRequest",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
              ],
              "mustSupport" : [
                "medication",
                "status",
                "status.value",
                "intent",
                "intent.value",
                "authoredOn",
                "authoredOn.value"
              ],
              "codeFilter" : [
                {
                  "path" : "medication",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.200"
                }
              ]
            },
            {
              "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" : "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/2.16.840.1.113883.3.117.1.7.1.200"
                }
              ]
            }
          ]
        }
      ],
      "extension" : [
        {
          "id" : "supplementalDataGuidance",
          "extension" : [
            {
              "url" : "guidance",
              "valueString" : "For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity-Patient's Ethnicity:\nHispanic or Latino\nNot Hispanic or Latino \n SDE Payer-Patient's Payer:\nCategories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system \n SDE Race-Patient's Race:\nNative Hawaiian or Other Pacific Islander\nAsian\nAmerican Indian or Alaska Native\nOther Race\nWhite\nBlack or African American \n SDE Sex-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" : "https://madie.cms.gov/Measure/AnticoagulationTherapyforAtrialFibrillationFlutterFHIR",
      "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" : "CMS71FHIR"
        },
        {
          "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:bc80e4cf-d267-47bf-ad0d-4d37f8ae2328"
        },
        {
          "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:5c16a2fb-1882-49aa-802b-a0b73ed17c05"
        },
        {
          "use" : "official",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
                "code" : "publisher"
              }
            ]
          },
          "system" : "https://madie.cms.gov/measure/cmsId",
          "value" : "71FHIR",
          "assigner" : {
            "display" : "CMS"
          }
        }
      ],
      "version" : "0.3.000",
      "name" : "AnticoagulationTherapyforAtrialFibrillationFlutterFHIR",
      "title" : "Anticoagulation Therapy for Atrial Fibrillation/FlutterFHIR",
      "status" : "draft",
      "experimental" : false,
      "date" : "2024-12-16T18:17:09+00:00",
      "publisher" : "The Joint Commission",
      "contact" : [
        {
          "telecom" : [
            {
              "system" : "url",
              "value" : "https://www.jointcommission.org/"
            }
          ]
        }
      ],
      "description" : "Ischemic stroke patients with atrial fibrillation/flutter who are prescribed or continuing to take anticoagulation therapy at hospital discharge",
      "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 Inpatient Encounters include emergency, urgent, and unplanned admissions.\n\nThe \"Medication, Discharge\" 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. This FHIR-based measure has been derived from the QDM-based measure: CMS71v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).",
      "copyright" : "Measure specifications are in the Public Domain.\n\nLOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2023 World Health Organization. All Rights Reserved.",
      "effectivePeriod" : {
        "start" : "2025-01-01",
        "end" : "2025-12-31"
      },
      "author" : [
        {
          "name" : "The Joint Commission",
          "telecom" : [
            {
              "system" : "url",
              "value" : "https://www.jointcommission.org/"
            }
          ]
        }
      ],
      "library" : [
        "https://madie.cms.gov/Library/AnticoagulationTherapyforAtrialFibrillationFlutterFHIR"
      ],
      "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.",
      "scoring" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
            "code" : "proportion",
            "display" : "Proportion"
          }
        ]
      },
      "rationale" : "Nonvalvular atrial fibrillation (NVAF) is a common arrhythmia and an important risk factor for stroke. It is one of several conditions and lifestyle factors that have been identified as risk factors for stroke. It has been estimated that over 2 million adults in the United States have NVAF. While the median age of patients with atrial fibrillation is 75 years, the incidence increases with advancing age. For example, The Framingham Heart Study noted a dramatic increase in stroke risk associated with atrial fibrillation with advancing age, from 1.5% for those 50 to 59 years of age to 23.5% for those 80 to 89 years of age. Furthermore, a prior stroke or transient ischemic attack (TIA) are among a limited number of predictors of high stroke risk within the population of patients with atrial fibrillation. Therefore, much emphasis has been placed on identifying methods for preventing recurrent ischemic stroke as well as preventing first stroke. Prevention strategies focus on the modifiable risk factors such as hypertension, smoking, and atrial fibrillation. Analysis of five placebo-controlled clinical trials investigating the efficacy of warfarin in the primary prevention of thromboembolic stroke, found the relative risk of thromboembolic stroke was reduced by 68% for atrial fibrillation patients treated with warfarin. The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk-atrial fibrillation patients with TIA or prior stroke.",
      "clinicalRecommendationStatement" : "The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk atrial fibrillation patients with TIA or prior stroke",
      "group" : [
        {
          "id" : "64f0d91d56d636294b157d97",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
                    "code" : "proportion",
                    "display" : "Proportion"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
              "valueCode" : "Encounter"
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-type",
                    "code" : "process",
                    "display" : "Process"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
              "valueCode" : "None"
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                    "code" : "decrease",
                    "display" : "increase"
                  }
                ]
              }
            }
          ],
          "description" : "Ischemic stroke patients with atrial fibrillation/flutter who are prescribed or continuing to take anticoagulation therapy at hospital discharge",
          "population" : [
            {
              "id" : "692C6F6B-4153-496F-8582-0839A0816567",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "initial-population",
                    "display" : "Initial Population"
                  }
                ]
              },
              "description" : "Inpatient hospitalizations (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke, that ends during the measurement period",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Initial Population"
              }
            },
            {
              "id" : "3116F1E4-8334-4CA0-9BEF-16CFEEDCB2A9",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "denominator",
                    "display" : "Denominator"
                  }
                ]
              },
              "description" : "Inpatient hospitalizations for patients with a principal diagnosis of ischemic stroke, and a history of atrial ablation, or current or history of atrial fibrillation/flutter",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Denominator"
              }
            },
            {
              "id" : "AA76FF0E-0EF9-40E6-9913-90FA63D50298",
              "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" : "3D2BED97-5ADC-4210-8A3E-91B13652E7D0",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "numerator",
                    "display" : "Numerator"
                  }
                ]
              },
              "description" : "Inpatient hospitalizations for patients prescribed or continuing to take anticoagulation therapy at hospital discharge",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Numerator"
              }
            },
            {
              "id" : "4511743B-B054-4A08-800B-C4624450C38C",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "denominator-exception",
                    "display" : "Denominator Exception"
                  }
                ]
              },
              "description" : "Inpatient hospitalizations for patients with a documented reason for not prescribing anticoagulation therapy at discharge",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Denominator Exceptions"
              }
            }
          ]
        }
      ],
      "supplementalData" : [
        {
          "id" : "sde-ethnicity",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "SDE Ethnicity",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "SDE Ethnicity"
          }
        },
        {
          "id" : "sde-payer",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "SDE Payer",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "SDE Payer"
          }
        },
        {
          "id" : "sde-race",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "SDE Race",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "SDE Race"
          }
        },
        {
          "id" : "sde-sex",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "SDE Sex",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "SDE Sex"
          }
        }
      ]
    }

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