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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-IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR.html
Url https://madie.cms.gov/Measure/IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR
Version 1.4.000
Status draft
Date 2024-12-16T18:17:10+00:00
Name IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR
Title Intravesical Bacillus-Calmette-Guerin for Non-Muscle Invasive Bladder CancerFHIR
Experimental False
Description Percentage of patients initially diagnosed with non-muscle invasive bladder cancer and who received intravesical Bacillus-Calmette-Guerin (BCG) within 6 months of bladder cancer staging
Purpose UNKNOWN
Copyright Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Oregon Urology Institute (OUI) and Large Urology Group Practice Association (LUGPA) disclaim all liability for use or accuracy of third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2023. American Medical Association. 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.

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Narrative

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

Title: Intravesical Bacillus-Calmette-Guerin for Non-Muscle Invasive Bladder CancerFHIR
Id: IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR
Version: 1.4.000
Url: Intravesical Bacillus-Calmette-Guerin for Non-Muscle Invasive Bladder CancerFHIR
short-name identifier:

CMS646FHIR

version-independent identifier:

urn:uuid:907ead5a-2f8f-468e-b774-309ea8aa6182

version-specific identifier:

urn:uuid:2247c9d9-9de5-47dd-a2a5-cb05249f6a3e

publisher (CMS) identifier:

646FHIR

Effective Period: 2025-01-01..2025-12-31
Status: draft
Publisher: Oregon Urology
Author: Oregon Urology
Description:

Percentage of patients initially diagnosed with non-muscle invasive bladder cancer and who received intravesical Bacillus-Calmette-Guerin (BCG) within 6 months of bladder cancer staging
Purpose:

UNKNOWN
Copyright:

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

CPT(R) contained in the Measure specifications is copyright 2004-2023. American Medical Association. 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:

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

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

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

Proportion

Rationale:

Bladder cancer is ranked 10th for new cancer cases in 2020 and is the 9th leading cause of cancer death in the United States. There are 81,400 estimated new cases in 2020 and 17,980 estimated deaths in 2020. In 2016, there were an estimated 699,450 people living with bladder cancer in the United States. Early detection (discovery of cancer in situ or localized to the primary site) is found in 85% of the patients, and with these there is a five-year survival rate of 95.8% for In Situ and 69.2% for Localized. Bladder cancer is rarely found in patients under age 20, with the median age of diagnosis being 73 (NIH, 2020). National Comprehensive Cancer Network (NCCN) Guidelines for Bladder Cancer (version 6.2021) defines intravesical BCG as Category 1 Treatment for Ta - high grade, T1 and Tis non-muscle invasive bladder cancer. Most public data reflects prophylactic or adjuvant use of intravesical therapy with the goal of preventing recurrence or delaying progression to a higher grade or stage. BCG has been shown to be effective as prophylaxis to prevent bladder cancer recurrences following TURBT. The NCCN Bladder Cancer Panel Members recommend BCG as the preferred option over Mitomycin C for adjuvant treatment of high-grade lesions (Ta). BCG is also standard therapy for Primary Tis. Most T1 lesions are high risk and are similarly treated with adjuvant intravesical therapy with BCG being a Category 1 recommendation. (NCCN, 2021).
Clinical recommendation statement:

Intravesical BCG should be administered within 6 months of the initial diagnosis of non-muscle invasive bladder cancer. It may be administered 3-4 weeks after resection, but there needs to be pathological tumor confirmation and must be withheld if there is traumatic catheterization, bacteriuria, persistent gross hematuria, persistent severe local symptoms or systemic symptoms. The normal induction course is 6 weekly instillations of intravesical BCG (AUA Non-Muscle Invasive Bladder Cancer and American Urological Association (AUA) Guideline for the Management of Non-muscle Invasive Bladder Cancer: Stages Ta High Risk, T1 and TIS).
Guidance (Usage): Ta bladder cancer must be high grade Ta only and is supported by the 2016 AUA guidelines and 2018 NCCN guidelines. The BCG dose can be full or partial and can be from any lot or manufacturer. This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth This FHIR-based measure has been derived from the QDM-based measure: CMS646v5. 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:
6643b88af4fc785d87117101
Initial Population: All patients initially diagnosed with T1, Tis or high grade Ta non-muscle invasive bladder cancer with bladder cancer staging within 6 months before to 6 months after the start of the measurement period and a qualified encounter in the measurement period
Denominator: Equals Initial Population
Denominator Exclusion: Immunosuppressed patients, includes HIV and immunocompromised state, with a diagnosis prior to Bladder Cancer Staging. Immunosuppressive drug therapy starting on or before Bladder Cancer Staging. Active Tuberculosis diagnosis during the Bladder Cancer Staging. Mixed histology urothelial cell carcinoma including micropapillary, plasmacytoid, sarcomatoid, adenocarcinoma and squamous disease prior to Bladder Cancer Staging. Patients who undergo cystectomy, chemotherapy or radiation within 6 months prior to Bladder Cancer Staging.
Numerator: Intravesical Bacillus-Calmette Guerin (BCG) instillation for initial dose or series: BCG is initiated within 6 months of the bladder cancer staging
Denominator Exception: Unavailability of BCG within 6 months after Bladder Cancer Staging
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
Libraries:
IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR
Terminology and Other Dependencies:
  • Library/SupplementalDataElements|3.5.000
  • Library/QICoreCommon|2.1.000
  • Library/FHIRHelpers|4.4.000
  • AdministrativeGender
  • SNOMED CT (all versions)
  • Condition Clinical Status Codes
  • ConditionVerificationStatus
  • International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)
  • ActCode
  • BCG Bacillus Calmette Guerin for Urology Care
  • Bladder Cancer for Urology Care
  • Office Visit
  • Payer
  • Active Tuberculosis for Urology Care
  • Immunosuppressive Drugs for Urology Care
  • Cystectomy for Urology Care
  • HIV
  • Immunocompromised Conditions
  • Mixed histology urothelial cell carcinoma for Urology Care
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1151.60
    		•
    Parameters:
    name use min max type
    Measurement Period In 0 1 Period
    SDE Sex Out 0 1 Coding
    Numerator Out 0 1 boolean
    Denominator Exception Out 0 1 boolean
    Denominator Out 0 1 boolean
    SDE Payer Out 0 * Resource
    Initial Population Out 0 1 boolean
    SDE Ethnicity Out 0 1 Resource
    Denominator Exclusion Out 0 1 boolean
    SDE Race Out 0 1 Resource
    DataRequirements:
    Resource Type Resource Elements Valueset Name Valueset
    Patient(QICorePatient) ethnicity race
    Condition(QICoreCondition) code Bladder Cancer for Urology Care Bladder Cancer for Urology Care
    Condition(QICoreCondition) code Active Tuberculosis for Urology Care Active Tuberculosis for Urology Care
    Condition(QICoreCondition) code HIV HIV
    Condition(QICoreCondition) code Immunocompromised Conditions Immunocompromised Conditions
    Condition(QICoreCondition) code Mixed histology urothelial cell carcinoma for Urology Care Mixed histology urothelial cell carcinoma for Urology Care
    Procedure(QICoreProcedure) code performed status status.value id id.value
    Procedure(QICoreProcedure) code performed status status.value id id.value Cystectomy for Urology Care Cystectomy for Urology Care
    Procedure(QICoreProcedure) code performed status status.value id id.value
    MedicationAdministration(QICoreMedicationAdministration) medication effective status status.value BCG Bacillus Calmette Guerin for Urology Care BCG Bacillus Calmette Guerin for Urology Care
    Observation(QICoreObservation) value status status.value reference reference.value
    Encounter(QICoreEncounter) type period class status status.value Office Visit Office Visit
    Coverage(QICoreCoverage) type period Payer Type Payer
    Medication(QICoreMedication) id
    Medication(QICoreMedication) id
    MedicationRequest(QICoreMedicationRequest) medication dosageInstruction status status.value intent intent.value Immunosuppressive Drugs for Urology Care Immunosuppressive Drugs for Urology Care
    MedicationRequest(QICoreMedicationRequest) medication.reference dosageInstruction status status.value intent intent.value
    MedicationRequest(QICoreMedicationRequest) medication dosageInstruction status status.value intent intent.value Chemotherapy Agents for Advanced Cancer http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1151.60
    Direct Reference Codes:
    display code system
    Male M http://hl7.org/fhir/administrative-gender
    Female F http://hl7.org/fhir/administrative-gender
    Tumor staging (tumor staging) 254292007 http://snomed.info/sct
    Active active http://terminology.hl7.org/CodeSystem/condition-clinical
    Recurrence recurrence http://terminology.hl7.org/CodeSystem/condition-clinical
    Relapse relapse http://terminology.hl7.org/CodeSystem/condition-clinical
    Confirmed confirmed http://terminology.hl7.org/CodeSystem/condition-ver-status
    American Joint Committee on Cancer cT1 (qualifier value) 1228889001 http://snomed.info/sct
    American Joint Committee on Cancer cTis (qualifier value) 1228884006 http://snomed.info/sct
    American Joint Committee on Cancer cTa (qualifier value) 1228883000 http://snomed.info/sct
    Carcinoma in situ of bladder D09.0 http://hl7.org/fhir/sid/icd-10-cm
    virtual VR http://terminology.hl7.org/CodeSystem/v3-ActCode
    Combined radiotherapy (procedure) 169331000 http://snomed.info/sct
    Logic Definitions:
    Group Scoring Population Criteria Expression
    6643b88af4fc785d87117101 Group scoring: proportion Measure scoring:

    Proportion

    Type:

    Process

    Rate Aggregation: None
    Improvement Notation:

    Increased score indicates improvement

    Initial Population 
    define "Initial Population":
  "Has Most Recent Bladder Cancer Tumor Staging is Ta HG, Tis, T1"
    and "Has Qualifying Encounter"
    Denominator 
    define "Denominator":
  "Initial Population"
    Denominator Exclusion 
    define "Denominator Exclusion":
  exists "Acute Tuberculosis Diagnosis"
    or exists "Immunosuppressive Drugs"
    or exists "Cystectomy Done"
    or "Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging"
    or "Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging"
    Numerator 
    define "Numerator":
  "First BCG Administered" is not null
    Denominator Exception 
    /*
@commentedOut: exists "BCG Not Available Within 6 Months After Bladder Cancer Staging"
@commentedOutReason: Negation issue related to https://github.com/cqframework/cql-execution/issues/296, which is tied to https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1455. Due to this being the only logic in this population added 'false' as a placeholder.
*/


define "Denominator Exception":
    //placeholder
  
  false
    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
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR SDE Sex 
    define "SDE Sex":
  SDE."SDE Sex"
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR Bladder Cancer Diagnosis 
    define "Bladder Cancer Diagnosis":
  [Condition: "Bladder Cancer for Urology Care"] BladderCancer
    where BladderCancer.prevalenceInterval ( ) starts before end of "Measurement Period"
      and BladderCancer.isConfirmedActiveDiagnosis ( )
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR First Bladder Cancer Staging Procedure 
    define "First Bladder Cancer Staging Procedure":
  First([Procedure: "Tumor staging (tumor staging)"] BladderCancerStaging
      with "Bladder Cancer Diagnosis" BladderCancer
        such that BladderCancerStaging.performed.toInterval() starts on or before day of start of BladderCancer.prevalenceInterval()
      where BladderCancerStaging.status = 'completed'
      sort by start of performed.toInterval()
  )
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR First BCG Administered 
    define "First BCG Administered":
  First([MedicationAdministration: "BCG Bacillus Calmette Guerin for Urology Care"] BCG
      with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
        such that BCG.effective.toInterval() starts 6 months or less after start of FirstBladderCancerStaging.performed.toInterval()
          and BCG.effective.toInterval() starts during "Measurement Period"
      where BCG.status in { 'in-progress', 'completed' }
      sort by start of effective.toInterval()
  )
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR Numerator 
    define "Numerator":
  "First BCG Administered" is not null
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR Denominator Exception 
    /*
@commentedOut: exists "BCG Not Available Within 6 Months After Bladder Cancer Staging"
@commentedOutReason: Negation issue related to https://github.com/cqframework/cql-execution/issues/296, which is tied to https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1455. Due to this being the only logic in this population added 'false' as a placeholder.
*/


define "Denominator Exception":
    //placeholder
  
  false
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR July 1 of Year Prior to the Measurement Period 
    define "July 1 of Year Prior to the Measurement Period":
  DateTime((year from start of "Measurement Period" - 1), 7, 1, 0, 0, 0, 0, 0)
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR June 30 of the Measurement Period 
    define "June 30 of the Measurement Period":
  DateTime((year from start of "Measurement Period"), 6, 30, 23, 59, 59, 0, 0)
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period 
    define "First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period":
  "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
    where FirstBladderCancerStaging.performed.toInterval ( ) during day of Interval["July 1 of Year Prior to the Measurement Period", "June 30 of the Measurement Period"]
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR Has Most Recent Bladder Cancer Tumor Staging is Ta HG, Tis, T1 
    /*Ta High Grade only to be included.  Ta low grade is to be excluded from this measure.*/


define "Has Most Recent Bladder Cancer Tumor Staging is Ta HG, Tis, T1":
  exists ( [Observation] StagingObservation
      where StagingObservation.getStagingProcedure ( ) is not null
        and ( StagingObservation.value as Concept ~ "American Joint Committee on Cancer cT1 (qualifier value)"
            or StagingObservation.value as Concept ~ "American Joint Committee on Cancer cTis (qualifier value)"
            or StagingObservation.value as Concept ~ "American Joint Committee on Cancer cTa (qualifier value)"
            or StagingObservation.value as Concept ~ "Carcinoma in situ of bladder"
        )
        and StagingObservation.status in { 'final', 'amended', 'corrected' }
  )
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR Has Qualifying Encounter 
    define "Has Qualifying Encounter":
  exists ( [Encounter: "Office Visit"] ValidEncounter
      where ValidEncounter.period during "Measurement Period"
        and ValidEncounter.class !~ "virtual"
        and ValidEncounter.status = 'finished'
  )
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR Initial Population 
    define "Initial Population":
  "Has Most Recent Bladder Cancer Tumor Staging is Ta HG, Tis, T1"
    and "Has Qualifying Encounter"
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR Denominator 
    define "Denominator":
  "Initial Population"
    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
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR SDE Payer 
    define "SDE Payer":
  SDE."SDE Payer"
    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
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR SDE Ethnicity 
    define "SDE Ethnicity":
  SDE."SDE Ethnicity"
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR Acute Tuberculosis Diagnosis 
    define "Acute Tuberculosis Diagnosis":
  [Condition: "Active Tuberculosis for Urology Care"] ActiveTuberculosis
    with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
      such that ActiveTuberculosis.prevalenceInterval ( ) overlaps after day of FirstBladderCancerStaging.performed.toInterval ( )
    where ActiveTuberculosis.isConfirmedActiveDiagnosis ( )
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR Immunosuppressive Drugs 
    define "Immunosuppressive Drugs":
  [MedicationRequest: "Immunosuppressive Drugs for Urology Care"] ImmunosuppressiveDrugs
    let firstMedicationPeriod: First((collapse(ImmunosuppressiveDrugs.dosageInstruction.timing.repeat.bounds DoseTime
          return DoseTime.toInterval()
      )) DrugPeriods
        sort by start of $this
    ),
        //get the very first event
    
    firstMedicationEvent: First((ImmunosuppressiveDrugs.dosageInstruction.timing dosageTiming
                                      //returns first event for the specific dosageTiming
        
        return First(dosageTiming.event dosageTimingEvents
            sort ascending
        )) firstEvents
        sort ascending
    ),
    medicationPeriod: Coalesce(firstMedicationEvent.toInterval(), firstMedicationPeriod)
    with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
      such that medicationPeriod starts on or before day of start of FirstBladderCancerStaging.performed.toInterval ( )
    where ImmunosuppressiveDrugs.status in { 'active', 'completed' }
      and ImmunosuppressiveDrugs.intent = 'order'
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR Cystectomy Done 
    define "Cystectomy Done":
  [Procedure: "Cystectomy for Urology Care"] Cystectomy
    with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
      such that Cystectomy.performed.toInterval ( ) 6 months or less before start of FirstBladderCancerStaging.performed.toInterval ( )
    where Cystectomy.status = 'completed'
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging 
    define "Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging":
  exists ( ( [Condition: "HIV"]
      union [Condition: "Immunocompromised Conditions"]
      union [Condition: "Mixed histology urothelial cell carcinoma for Urology Care"] ) ExclusionDiagnosis
      with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
        such that ExclusionDiagnosis.prevalenceInterval ( ) starts on or before day of start of FirstBladderCancerStaging.performed.toInterval ( )
      where ExclusionDiagnosis.isConfirmedActiveDiagnosis ( )
  )
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging 
    define "Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging":
  exists ( ( [MedicationRequest: "Chemotherapy Agents for Advanced Cancer"] ExclusionMed
        let firstMedicationPeriod: First((collapse(ExclusionMed.dosageInstruction.timing.repeat.bounds DoseTime
              return DoseTime.toInterval()
          )) DrugPeriods
            sort by start of $this
        )
        with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
          such that firstMedicationPeriod starts 6 months or less before FirstBladderCancerStaging.performed.toInterval ( )
        where ExclusionMed.status in { 'active', 'completed' }
          and ExclusionMed.intent = 'order'
    )
      union ( [Procedure: "Combined radiotherapy (procedure)"] ExclusionProcedure
          with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
            such that ExclusionProcedure.performed.toInterval ( ) starts 6 months or less before FirstBladderCancerStaging.performed.toInterval ( )
          where ExclusionProcedure.status = 'completed'
      )
  )
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR Denominator Exclusion 
    define "Denominator Exclusion":
  exists "Acute Tuberculosis Diagnosis"
    or exists "Immunosuppressive Drugs"
    or exists "Cystectomy Done"
    or "Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging"
    or "Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging"
    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
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR SDE Race 
    define "SDE Race":
  SDE."SDE Race"
    Library Name Name
    QICoreCommon prevalenceInterval 
    /*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting 
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
    (end of condition.abatementInterval()) abatementDate
    return if abatementDate is null then
      Interval[start of condition.onset.toInterval(), abatementDate)
    else
      Interval[start of condition.onset.toInterval(), abatementDate]
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR isConfirmedActiveDiagnosis 
    define fluent function isConfirmedActiveDiagnosis(Condition Condition):
  Condition.isActive ( )
    and Condition.verificationStatus ~ QICoreCommon."confirmed"
    Library Name Name
    QICoreCommon isActive 
    /* Candidates for FHIRCommon */

/*
@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse
*/
define fluent function isActive(condition Condition):
  condition.clinicalStatus ~ "active"
    or condition.clinicalStatus ~ "recurrence"
    or condition.clinicalStatus ~ "relapse"
    Library Name Name
    IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR getStagingProcedure 
    define fluent function getStagingProcedure(StagingObservation Observation):
  StagingObservation.partOf StagingReference
    return "First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period" FirstBladderCancerStagingMP
      where FirstBladderCancerStagingMP.id = StagingReference.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
    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
    QICoreCommon toInterval 
    /*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
  case
	  when choice is DateTime then
    	Interval[choice as DateTime, choice as DateTime]
		when choice is Interval<DateTime> then
  		choice as Interval<DateTime>
		when choice is Quantity then
		  Interval[Patient.birthDate + (choice as Quantity),
			  Patient.birthDate + (choice as Quantity) + 1 year)
		when choice is Interval<Quantity> then
		  Interval[Patient.birthDate + (choice.low as Quantity),
			  Patient.birthDate + (choice.high as Quantity) + 1 year)
		when choice is Timing then
      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
		else
			null as Interval<DateTime>
	end

    Source

    {
      "resourceType" : "Measure",
      "id" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR",
      "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;\">Intravesical Bacillus-Calmette-Guerin for Non-Muscle Invasive Bladder CancerFHIR</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Id: </b></th>\n                <td style=\"padding-left: 4px;\">IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Version: </b></th>\n                <td style=\"padding-left: 4px;\">1.4.000</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-IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR.html\">Intravesical Bacillus-Calmette-Guerin for Non-Muscle Invasive Bladder CancerFHIR</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>CMS646FHIR</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:907ead5a-2f8f-468e-b774-309ea8aa6182</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:2247c9d9-9de5-47dd-a2a5-cb05249f6a3e</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>646FHIR</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;\">Oregon Urology</td>\n            </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Author: </b></th>\n            <td style=\"padding-left: 4px;\">Oregon Urology</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>Percentage of patients initially diagnosed with non-muscle invasive bladder cancer and who received intravesical Bacillus-Calmette-Guerin (BCG) within 6 months of bladder cancer staging</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>Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Oregon Urology Institute (OUI) and Large Urology Group Practice Association (LUGPA) disclaim all liability for use or accuracy of third party codes contained in the specifications.</p>\n<p>CPT(R) contained in the Measure specifications is copyright 2004-2023. American Medical Association. 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>The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.</p>\n<p>THE MEASURES AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.</p>\n<p>Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by TM or [TM].</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>Bladder cancer is ranked 10th for new cancer cases in 2020 and is the 9th leading cause of cancer death in the United States. There are 81,400 estimated new cases in 2020 and 17,980 estimated deaths in 2020. In 2016, there were an estimated 699,450 people living with bladder cancer in the United States. Early detection (discovery of cancer in situ or localized to the primary site) is found in 85% of the patients, and with these there is a five-year survival rate of 95.8% for In Situ and 69.2% for Localized. Bladder cancer is rarely found in patients under age 20, with the median age of diagnosis being 73 (NIH, 2020).\nNational Comprehensive Cancer Network (NCCN) Guidelines for Bladder Cancer (version 6.2021) defines intravesical BCG as Category 1 Treatment for Ta - high grade, T1 and Tis non-muscle invasive bladder cancer. Most public data reflects prophylactic or adjuvant use of intravesical therapy with the goal of preventing recurrence or delaying progression to a higher grade or stage. BCG has been shown to be effective as prophylaxis to prevent bladder cancer recurrences following TURBT. The NCCN Bladder Cancer Panel Members recommend BCG as the preferred option over Mitomycin C for adjuvant treatment of high-grade lesions (Ta). BCG is also standard therapy for Primary Tis. Most T1 lesions are high risk and are similarly treated with adjuvant intravesical therapy with BCG being a Category 1 recommendation. (NCCN, 2021).</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>Intravesical BCG should be administered within 6 months of the initial diagnosis of non-muscle invasive bladder cancer. It may be administered 3-4 weeks after resection, but there needs to be pathological tumor confirmation and must be withheld if there is traumatic catheterization, bacteriuria, persistent gross hematuria, persistent severe local symptoms or systemic symptoms. The normal induction course is 6 weekly instillations of intravesical BCG (AUA Non-Muscle Invasive Bladder Cancer and American Urological Association (AUA) Guideline for the Management of Non-muscle Invasive Bladder Cancer: Stages Ta High Risk, T1 and TIS).</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;\">Ta bladder cancer must be high grade Ta only and is supported by the 2016 AUA guidelines and 2018 NCCN guidelines.\n\nThe BCG dose can be full or partial and can be from any lot or manufacturer.\n\nThis eCQM is a patient-based measure.\n\nTelehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS646v5.\n \nPlease 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>6643b88af4fc785d87117101</b></th>\n                                    </tr>\n                                \n                                \n                                    <tr>\n                                        <td>Initial Population:</td>\n\n                                        \n                                            \n                                                <td>All patients initially diagnosed with T1, Tis or high grade Ta non-muscle invasive bladder cancer with bladder cancer staging within 6 months before to 6 months after the start of the measurement period and a qualified encounter in the measurement period</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator:</td>\n\n                                        \n                                            \n                                                <td>Equals Initial Population</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator Exclusion:</td>\n\n                                        \n                                            \n                                                <td>Immunosuppressed patients, includes HIV and immunocompromised state, with a diagnosis prior to Bladder Cancer Staging.\n\nImmunosuppressive drug therapy starting on or before Bladder Cancer Staging.\n\nActive Tuberculosis diagnosis during the Bladder Cancer Staging.\n\nMixed histology urothelial cell carcinoma including micropapillary, plasmacytoid, sarcomatoid, adenocarcinoma and squamous disease prior to Bladder Cancer Staging.\n\nPatients who undergo cystectomy, chemotherapy or radiation within 6 months prior to Bladder Cancer Staging.</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Numerator:</td>\n\n                                        \n                                            \n                                                <td>Intravesical Bacillus-Calmette Guerin (BCG) instillation for initial dose or series:\nBCG is initiated within 6 months of the bladder cancer staging</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator Exception:</td>\n\n                                        \n                                            \n                                                <td>Unavailability of BCG within 6 months after Bladder Cancer Staging</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 </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-IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR.html\">IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</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/QICoreCommon|2.1.000</code></li>\n                        \n                            <li><code>Library/FHIRHelpers|4.4.000</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://hl7.org/fhir/R4/codesystem-snomedct.html\">SNOMED CT (all versions)</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html\">Condition Clinical Status Codes</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-icd10CM.html\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-ActCode.html\">ActCode</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1151.52/expansion\">BCG Bacillus Calmette Guerin for Urology Care</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1151.45/expansion\">Bladder Cancer for Urology Care</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion\">Office Visit</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/2.16.840.1.113762.1.4.1151.56/expansion\">Active Tuberculosis for Urology Care</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1151.32/expansion\">Immunosuppressive Drugs for Urology Care</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1151.55/expansion\">Cystectomy for Urology Care</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.120.12.1003/expansion\">HIV</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.1940/expansion\">Immunocompromised Conditions</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1151.39/expansion\">Mixed histology urothelial cell carcinoma for Urology Care</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1151.60/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1151.60</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>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Denominator Exception</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Denominator</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</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>1</td>\n                                    <td>boolean</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 Exclusion</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</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                        </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>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                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Bladder Cancer for Urology Care\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1151.45/expansion\">Bladder Cancer for Urology Care</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                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Active Tuberculosis for Urology Care\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1151.56/expansion\">Active Tuberculosis for Urology Care</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                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 HIV\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.120.12.1003/expansion\">HIV</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                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Immunocompromised Conditions\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.1940/expansion\">Immunocompromised Conditions</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                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Mixed histology urothelial cell carcinoma for Urology Care\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1151.39/expansion\">Mixed histology urothelial cell carcinoma for Urology Care</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                                            performed\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            id\n                                        \n                                            id.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <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                                            performed\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            id\n                                        \n                                            id.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Cystectomy for Urology Care\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1151.55/expansion\">Cystectomy for Urology Care</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                                            performed\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            id\n                                        \n                                            id.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>MedicationAdministration(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-medicationadministration.html\">QICoreMedicationAdministration</a>)</td>\n                                    <td>\n                                        \n                                            medication\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 BCG Bacillus Calmette Guerin for Urology Care\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1151.52/expansion\">BCG Bacillus Calmette Guerin for Urology Care</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                                            value\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            reference\n                                        \n                                            reference.value\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                                            class\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Office Visit\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion\">Office Visit</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>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>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\n                                        \n                                            dosageInstruction\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            intent\n                                        \n                                            intent.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Immunosuppressive Drugs for Urology Care\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1151.32/expansion\">Immunosuppressive Drugs for Urology Care</a></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                                            dosageInstruction\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            intent\n                                        \n                                            intent.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                                            dosageInstruction\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            intent\n                                        \n                                            intent.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Chemotherapy Agents for Advanced Cancer\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1151.60/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1151.60</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>Tumor staging (tumor staging)</td>\n                                        <td>254292007</td>\n                                        <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Active</td>\n                                        <td>active</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html\">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Recurrence</td>\n                                        <td>recurrence</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html\">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Relapse</td>\n                                        <td>relapse</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html\">http://terminology.hl7.org/CodeSystem/condition-clinical</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>American Joint Committee on Cancer cT1 (qualifier value)</td>\n                                        <td>1228889001</td>\n                                        <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>American Joint Committee on Cancer cTis (qualifier value)</td>\n                                        <td>1228884006</td>\n                                        <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>American Joint Committee on Cancer cTa (qualifier value)</td>\n                                        <td>1228883000</td>\n                                        <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Carcinoma in situ of bladder</td>\n                                        <td>D09.0</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html\">http://hl7.org/fhir/sid/icd-10-cm</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>virtual</td>\n                                        <td>VR</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-ActCode.html\">http://terminology.hl7.org/CodeSystem/v3-ActCode</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Combined radiotherapy (procedure)</td>\n                                        <td>169331000</td>\n                                        <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</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> 6643b88af4fc785d87117101 </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>Increased score indicates improvement </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  &quot;Has Most Recent Bladder Cancer Tumor Staging is Ta HG, Tis, T1&quot;\n    and &quot;Has Qualifying 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;Initial Population&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 Exclusion&quot;:\n  exists &quot;Acute Tuberculosis Diagnosis&quot;\n    or exists &quot;Immunosuppressive Drugs&quot;\n    or exists &quot;Cystectomy Done&quot;\n    or &quot;Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging&quot;\n    or &quot;Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging&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;First BCG Administered&quot; is not null</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\">/*\n@commentedOut: exists &quot;BCG Not Available Within 6 Months After Bladder Cancer Staging&quot;\n@commentedOutReason: Negation issue related to https://github.com/cqframework/cql-execution/issues/296, which is tied to https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1455. Due to this being the only logic in this population added 'false' as a placeholder.\n*/\n\n\ndefine &quot;Denominator Exception&quot;:\n    //placeholder\n  \n  false</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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n                            \n                            \n                                <td>Bladder Cancer Diagnosis</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Bladder Cancer Diagnosis&quot;:\n  [Condition: &quot;Bladder Cancer for Urology Care&quot;] BladderCancer\n    where BladderCancer.prevalenceInterval ( ) starts before end of &quot;Measurement Period&quot;\n      and BladderCancer.isConfirmedActiveDiagnosis ( )</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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n                            \n                            \n                                <td>First Bladder Cancer Staging Procedure</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;First Bladder Cancer Staging Procedure&quot;:\n  First([Procedure: &quot;Tumor staging (tumor staging)&quot;] BladderCancerStaging\n      with &quot;Bladder Cancer Diagnosis&quot; BladderCancer\n        such that BladderCancerStaging.performed.toInterval() starts on or before day of start of BladderCancer.prevalenceInterval()\n      where BladderCancerStaging.status = 'completed'\n      sort by start of performed.toInterval()\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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n                            \n                            \n                                <td>First BCG Administered</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;First BCG Administered&quot;:\n  First([MedicationAdministration: &quot;BCG Bacillus Calmette Guerin for Urology Care&quot;] BCG\n      with &quot;First Bladder Cancer Staging Procedure&quot; FirstBladderCancerStaging\n        such that BCG.effective.toInterval() starts 6 months or less after start of FirstBladderCancerStaging.performed.toInterval()\n          and BCG.effective.toInterval() starts during &quot;Measurement Period&quot;\n      where BCG.status in { 'in-progress', 'completed' }\n      sort by start of effective.toInterval()\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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</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;First BCG Administered&quot; is not null</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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n                            \n                            \n                                <td>Denominator Exception</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@commentedOut: exists &quot;BCG Not Available Within 6 Months After Bladder Cancer Staging&quot;\n@commentedOutReason: Negation issue related to https://github.com/cqframework/cql-execution/issues/296, which is tied to https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1455. Due to this being the only logic in this population added 'false' as a placeholder.\n*/\n\n\ndefine &quot;Denominator Exception&quot;:\n    //placeholder\n  \n  false</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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n                            \n                            \n                                <td>July 1 of Year Prior to the Measurement Period</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;July 1 of Year Prior to the Measurement Period&quot;:\n  DateTime((year from start of &quot;Measurement Period&quot; - 1), 7, 1, 0, 0, 0, 0, 0)</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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n                            \n                            \n                                <td>June 30 of the Measurement Period</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;June 30 of the Measurement Period&quot;:\n  DateTime((year from start of &quot;Measurement Period&quot;), 6, 30, 23, 59, 59, 0, 0)</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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n                            \n                            \n                                <td>First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period&quot;:\n  &quot;First Bladder Cancer Staging Procedure&quot; FirstBladderCancerStaging\n    where FirstBladderCancerStaging.performed.toInterval ( ) during day of Interval[&quot;July 1 of Year Prior to the Measurement Period&quot;, &quot;June 30 of the 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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n                            \n                            \n                                <td>Has Most Recent Bladder Cancer Tumor Staging is Ta HG, Tis, T1</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*Ta High Grade only to be included.  Ta low grade is to be excluded from this measure.*/\n\n\ndefine &quot;Has Most Recent Bladder Cancer Tumor Staging is Ta HG, Tis, T1&quot;:\n  exists ( [Observation] StagingObservation\n      where StagingObservation.getStagingProcedure ( ) is not null\n        and ( StagingObservation.value as Concept ~ &quot;American Joint Committee on Cancer cT1 (qualifier value)&quot;\n            or StagingObservation.value as Concept ~ &quot;American Joint Committee on Cancer cTis (qualifier value)&quot;\n            or StagingObservation.value as Concept ~ &quot;American Joint Committee on Cancer cTa (qualifier value)&quot;\n            or StagingObservation.value as Concept ~ &quot;Carcinoma in situ of bladder&quot;\n        )\n        and StagingObservation.status in { 'final', 'amended', 'corrected' }\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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n                            \n                            \n                                <td>Has Qualifying Encounter</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Has Qualifying Encounter&quot;:\n  exists ( [Encounter: &quot;Office Visit&quot;] ValidEncounter\n      where ValidEncounter.period during &quot;Measurement Period&quot;\n        and ValidEncounter.class !~ &quot;virtual&quot;\n        and ValidEncounter.status = 'finished'\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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</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  &quot;Has Most Recent Bladder Cancer Tumor Staging is Ta HG, Tis, T1&quot;\n    and &quot;Has Qualifying 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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</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;Initial Population&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 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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</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>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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n                            \n                            \n                                <td>Acute Tuberculosis Diagnosis</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Acute Tuberculosis Diagnosis&quot;:\n  [Condition: &quot;Active Tuberculosis for Urology Care&quot;] ActiveTuberculosis\n    with &quot;First Bladder Cancer Staging Procedure&quot; FirstBladderCancerStaging\n      such that ActiveTuberculosis.prevalenceInterval ( ) overlaps after day of FirstBladderCancerStaging.performed.toInterval ( )\n    where ActiveTuberculosis.isConfirmedActiveDiagnosis ( )</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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n                            \n                            \n                                <td>Immunosuppressive Drugs</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Immunosuppressive Drugs&quot;:\n  [MedicationRequest: &quot;Immunosuppressive Drugs for Urology Care&quot;] ImmunosuppressiveDrugs\n    let firstMedicationPeriod: First((collapse(ImmunosuppressiveDrugs.dosageInstruction.timing.repeat.bounds DoseTime\n          return DoseTime.toInterval()\n      )) DrugPeriods\n        sort by start of $this\n    ),\n        //get the very first event\n    \n    firstMedicationEvent: First((ImmunosuppressiveDrugs.dosageInstruction.timing dosageTiming\n                                      //returns first event for the specific dosageTiming\n        \n        return First(dosageTiming.event dosageTimingEvents\n            sort ascending\n        )) firstEvents\n        sort ascending\n    ),\n    medicationPeriod: Coalesce(firstMedicationEvent.toInterval(), firstMedicationPeriod)\n    with &quot;First Bladder Cancer Staging Procedure&quot; FirstBladderCancerStaging\n      such that medicationPeriod starts on or before day of start of FirstBladderCancerStaging.performed.toInterval ( )\n    where ImmunosuppressiveDrugs.status in { 'active', 'completed' }\n      and ImmunosuppressiveDrugs.intent = '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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n                            \n                            \n                                <td>Cystectomy Done</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Cystectomy Done&quot;:\n  [Procedure: &quot;Cystectomy for Urology Care&quot;] Cystectomy\n    with &quot;First Bladder Cancer Staging Procedure&quot; FirstBladderCancerStaging\n      such that Cystectomy.performed.toInterval ( ) 6 months or less before start of FirstBladderCancerStaging.performed.toInterval ( )\n    where Cystectomy.status = 'completed'</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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n                            \n                            \n                                <td>Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging&quot;:\n  exists ( ( [Condition: &quot;HIV&quot;]\n      union [Condition: &quot;Immunocompromised Conditions&quot;]\n      union [Condition: &quot;Mixed histology urothelial cell carcinoma for Urology Care&quot;] ) ExclusionDiagnosis\n      with &quot;First Bladder Cancer Staging Procedure&quot; FirstBladderCancerStaging\n        such that ExclusionDiagnosis.prevalenceInterval ( ) starts on or before day of start of FirstBladderCancerStaging.performed.toInterval ( )\n      where ExclusionDiagnosis.isConfirmedActiveDiagnosis ( )\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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n                            \n                            \n                                <td>Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging&quot;:\n  exists ( ( [MedicationRequest: &quot;Chemotherapy Agents for Advanced Cancer&quot;] ExclusionMed\n        let firstMedicationPeriod: First((collapse(ExclusionMed.dosageInstruction.timing.repeat.bounds DoseTime\n              return DoseTime.toInterval()\n          )) DrugPeriods\n            sort by start of $this\n        )\n        with &quot;First Bladder Cancer Staging Procedure&quot; FirstBladderCancerStaging\n          such that firstMedicationPeriod starts 6 months or less before FirstBladderCancerStaging.performed.toInterval ( )\n        where ExclusionMed.status in { 'active', 'completed' }\n          and ExclusionMed.intent = 'order'\n    )\n      union ( [Procedure: &quot;Combined radiotherapy (procedure)&quot;] ExclusionProcedure\n          with &quot;First Bladder Cancer Staging Procedure&quot; FirstBladderCancerStaging\n            such that ExclusionProcedure.performed.toInterval ( ) starts 6 months or less before FirstBladderCancerStaging.performed.toInterval ( )\n          where ExclusionProcedure.status = 'completed'\n      )\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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n                            \n                            \n                                <td>Denominator Exclusion</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator Exclusion&quot;:\n  exists &quot;Acute Tuberculosis Diagnosis&quot;\n    or exists &quot;Immunosuppressive Drugs&quot;\n    or exists &quot;Cystectomy Done&quot;\n    or &quot;Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging&quot;\n    or &quot;Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging&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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</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>QICoreCommon</td>\n                            \n                            \n                                <td>prevalenceInterval</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting \ninterval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ &quot;active&quot;\n  or condition.clinicalStatus ~ &quot;recurrence&quot;\n  or condition.clinicalStatus ~ &quot;relapse&quot; then\n  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n    (end of condition.abatementInterval()) abatementDate\n    return if abatementDate is null then\n      Interval[start of condition.onset.toInterval(), abatementDate)\n    else\n      Interval[start of condition.onset.toInterval(), abatementDate]</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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n                            \n                            \n                                <td>isConfirmedActiveDiagnosis</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define fluent function isConfirmedActiveDiagnosis(Condition Condition):\n  Condition.isActive ( )\n    and Condition.verificationStatus ~ QICoreCommon.&quot;confirmed&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>QICoreCommon</td>\n                            \n                            \n                                <td>isActive</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/* Candidates for FHIRCommon */\n\n/*\n@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse\n*/\ndefine fluent function isActive(condition Condition):\n  condition.clinicalStatus ~ &quot;active&quot;\n    or condition.clinicalStatus ~ &quot;recurrence&quot;\n    or condition.clinicalStatus ~ &quot;relapse&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>IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR</td>\n                            \n                            \n                                <td>getStagingProcedure</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define fluent function getStagingProcedure(StagingObservation Observation):\n  StagingObservation.partOf StagingReference\n    return &quot;First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period&quot; FirstBladderCancerStagingMP\n      where FirstBladderCancerStagingMP.id = StagingReference.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>getId</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).\n@comment: This function can be used to determine the logical id of a given resource. It can be used in\na single-server environment to trace references. However, this function does not attempt to resolve\nor distinguish the base of the given url, and so cannot be used safely in multi-server environments.\n*/\ndefine fluent function getId(uri String):\n  Last(Split(uri, '/'))</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>FHIRHelpers</td>\n                            \n                            \n                                <td>ToString</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function ToString(value uri): value.value</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>FHIRHelpers</td>\n                            \n                            \n                                <td>ToCode</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\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>QICoreCommon</td>\n                            \n                            \n                                <td>toInterval</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of DateTime, Quanitty, Interval&lt;DateTime&gt;, or Interval&lt;Quantity&gt; types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in QICore, allowing this function to be used across any resource.\nThe input can be provided as a DateTime, Quantity, Interval&lt;DateTime&gt; or Interval&lt;Quantity&gt;.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.\nIf the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,\nand the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.\nIf the input is a DateTime Interval, the result is the input.\nIf the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result\nis a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending\nimmediately before one year later than the date the patient turned the age given as the end of the quantity interval.\nIf the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval\n*/\ndefine fluent function toInterval(choice Choice&lt;DateTime, Quantity, Interval&lt;DateTime&gt;, Interval&lt;Quantity&gt;, Timing&gt;):\n  case\n\t  when choice is DateTime then\n    \tInterval[choice as DateTime, choice as DateTime]\n\t\twhen choice is Interval&lt;DateTime&gt; then\n  \t\tchoice as Interval&lt;DateTime&gt;\n\t\twhen choice is Quantity then\n\t\t  Interval[Patient.birthDate + (choice as Quantity),\n\t\t\t  Patient.birthDate + (choice as Quantity) + 1 year)\n\t\twhen choice is Interval&lt;Quantity&gt; then\n\t\t  Interval[Patient.birthDate + (choice.low as Quantity),\n\t\t\t  Patient.birthDate + (choice.high as Quantity) + 1 year)\n\t\twhen choice is Timing then\n      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval&lt;DateTime&gt;\n\t\telse\n\t\t\tnull as Interval&lt;DateTime&gt;\n\tend</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://snomed.info/sct",
                "code" : "254292007",
                "display" : "Tumor staging (tumor staging)"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
                "code" : "active",
                "display" : "Active"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
                "code" : "recurrence",
                "display" : "Recurrence"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
                "code" : "relapse",
                "display" : "Relapse"
              }
            },
            {
              "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://snomed.info/sct",
                "code" : "1228889001",
                "display" : "American Joint Committee on Cancer cT1 (qualifier value)"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "1228884006",
                "display" : "American Joint Committee on Cancer cTis (qualifier value)"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "1228883000",
                "display" : "American Joint Committee on Cancer cTa (qualifier value)"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://hl7.org/fhir/sid/icd-10-cm",
                "code" : "D09.0",
                "display" : "Carcinoma in situ of bladder"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                "code" : "VR",
                "display" : "virtual"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "169331000",
                "display" : "Combined radiotherapy (procedure)"
              }
            },
            {
              "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" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "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" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Bladder Cancer Diagnosis"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Bladder Cancer Diagnosis\":\n  [Condition: \"Bladder Cancer for Urology Care\"] BladderCancer\n    where BladderCancer.prevalenceInterval ( ) starts before end of \"Measurement Period\"\n      and BladderCancer.isConfirmedActiveDiagnosis ( )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 2
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "First Bladder Cancer Staging Procedure"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"First Bladder Cancer Staging Procedure\":\n  First([Procedure: \"Tumor staging (tumor staging)\"] BladderCancerStaging\n      with \"Bladder Cancer Diagnosis\" BladderCancer\n        such that BladderCancerStaging.performed.toInterval() starts on or before day of start of BladderCancer.prevalenceInterval()\n      where BladderCancerStaging.status = 'completed'\n      sort by start of performed.toInterval()\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 3
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "First BCG Administered"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"First BCG Administered\":\n  First([MedicationAdministration: \"BCG Bacillus Calmette Guerin for Urology Care\"] BCG\n      with \"First Bladder Cancer Staging Procedure\" FirstBladderCancerStaging\n        such that BCG.effective.toInterval() starts 6 months or less after start of FirstBladderCancerStaging.performed.toInterval()\n          and BCG.effective.toInterval() starts during \"Measurement Period\"\n      where BCG.status in { 'in-progress', 'completed' }\n      sort by start of effective.toInterval()\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 4
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Numerator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Numerator\":\n  \"First BCG Administered\" is not null"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 5
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator Exception"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@commentedOut: exists \"BCG Not Available Within 6 Months After Bladder Cancer Staging\"\n@commentedOutReason: Negation issue related to https://github.com/cqframework/cql-execution/issues/296, which is tied to https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1455. Due to this being the only logic in this population added 'false' as a placeholder.\n*/\n\n\ndefine \"Denominator Exception\":\n    //placeholder\n  \n  false"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 6
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "July 1 of Year Prior to the Measurement Period"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"July 1 of Year Prior to the Measurement Period\":\n  DateTime((year from start of \"Measurement Period\" - 1), 7, 1, 0, 0, 0, 0, 0)"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 7
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "June 30 of the Measurement Period"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"June 30 of the Measurement Period\":\n  DateTime((year from start of \"Measurement Period\"), 6, 30, 23, 59, 59, 0, 0)"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 8
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period\":\n  \"First Bladder Cancer Staging Procedure\" FirstBladderCancerStaging\n    where FirstBladderCancerStaging.performed.toInterval ( ) during day of Interval[\"July 1 of Year Prior to the Measurement Period\", \"June 30 of the Measurement Period\"]"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 9
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has Most Recent Bladder Cancer Tumor Staging is Ta HG, Tis, T1"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*Ta High Grade only to be included.  Ta low grade is to be excluded from this measure.*/\n\n\ndefine \"Has Most Recent Bladder Cancer Tumor Staging is Ta HG, Tis, T1\":\n  exists ( [Observation] StagingObservation\n      where StagingObservation.getStagingProcedure ( ) is not null\n        and ( StagingObservation.value as Concept ~ \"American Joint Committee on Cancer cT1 (qualifier value)\"\n            or StagingObservation.value as Concept ~ \"American Joint Committee on Cancer cTis (qualifier value)\"\n            or StagingObservation.value as Concept ~ \"American Joint Committee on Cancer cTa (qualifier value)\"\n            or StagingObservation.value as Concept ~ \"Carcinoma in situ of bladder\"\n        )\n        and StagingObservation.status in { 'final', 'amended', 'corrected' }\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 10
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has Qualifying Encounter"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Has Qualifying Encounter\":\n  exists ( [Encounter: \"Office Visit\"] ValidEncounter\n      where ValidEncounter.period during \"Measurement Period\"\n        and ValidEncounter.class !~ \"virtual\"\n        and ValidEncounter.status = 'finished'\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 11
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Initial Population"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Initial Population\":\n  \"Has Most Recent Bladder Cancer Tumor Staging is Ta HG, Tis, T1\"\n    and \"Has Qualifying Encounter\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 12
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Denominator\":\n  \"Initial Population\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 13
                }
              ],
              "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" : 14
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Payer"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 15
                }
              ],
              "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" : 16
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Ethnicity"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 17
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Acute Tuberculosis Diagnosis"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Acute Tuberculosis Diagnosis\":\n  [Condition: \"Active Tuberculosis for Urology Care\"] ActiveTuberculosis\n    with \"First Bladder Cancer Staging Procedure\" FirstBladderCancerStaging\n      such that ActiveTuberculosis.prevalenceInterval ( ) overlaps after day of FirstBladderCancerStaging.performed.toInterval ( )\n    where ActiveTuberculosis.isConfirmedActiveDiagnosis ( )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 18
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Immunosuppressive Drugs"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Immunosuppressive Drugs\":\n  [MedicationRequest: \"Immunosuppressive Drugs for Urology Care\"] ImmunosuppressiveDrugs\n    let firstMedicationPeriod: First((collapse(ImmunosuppressiveDrugs.dosageInstruction.timing.repeat.bounds DoseTime\n          return DoseTime.toInterval()\n      )) DrugPeriods\n        sort by start of $this\n    ),\n        //get the very first event\n    \n    firstMedicationEvent: First((ImmunosuppressiveDrugs.dosageInstruction.timing dosageTiming\n                                      //returns first event for the specific dosageTiming\n        \n        return First(dosageTiming.event dosageTimingEvents\n            sort ascending\n        )) firstEvents\n        sort ascending\n    ),\n    medicationPeriod: Coalesce(firstMedicationEvent.toInterval(), firstMedicationPeriod)\n    with \"First Bladder Cancer Staging Procedure\" FirstBladderCancerStaging\n      such that medicationPeriod starts on or before day of start of FirstBladderCancerStaging.performed.toInterval ( )\n    where ImmunosuppressiveDrugs.status in { 'active', 'completed' }\n      and ImmunosuppressiveDrugs.intent = 'order'"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 19
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Cystectomy Done"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Cystectomy Done\":\n  [Procedure: \"Cystectomy for Urology Care\"] Cystectomy\n    with \"First Bladder Cancer Staging Procedure\" FirstBladderCancerStaging\n      such that Cystectomy.performed.toInterval ( ) 6 months or less before start of FirstBladderCancerStaging.performed.toInterval ( )\n    where Cystectomy.status = 'completed'"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 20
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging\":\n  exists ( ( [Condition: \"HIV\"]\n      union [Condition: \"Immunocompromised Conditions\"]\n      union [Condition: \"Mixed histology urothelial cell carcinoma for Urology Care\"] ) ExclusionDiagnosis\n      with \"First Bladder Cancer Staging Procedure\" FirstBladderCancerStaging\n        such that ExclusionDiagnosis.prevalenceInterval ( ) starts on or before day of start of FirstBladderCancerStaging.performed.toInterval ( )\n      where ExclusionDiagnosis.isConfirmedActiveDiagnosis ( )\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 21
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging\":\n  exists ( ( [MedicationRequest: \"Chemotherapy Agents for Advanced Cancer\"] ExclusionMed\n        let firstMedicationPeriod: First((collapse(ExclusionMed.dosageInstruction.timing.repeat.bounds DoseTime\n              return DoseTime.toInterval()\n          )) DrugPeriods\n            sort by start of $this\n        )\n        with \"First Bladder Cancer Staging Procedure\" FirstBladderCancerStaging\n          such that firstMedicationPeriod starts 6 months or less before FirstBladderCancerStaging.performed.toInterval ( )\n        where ExclusionMed.status in { 'active', 'completed' }\n          and ExclusionMed.intent = 'order'\n    )\n      union ( [Procedure: \"Combined radiotherapy (procedure)\"] ExclusionProcedure\n          with \"First Bladder Cancer Staging Procedure\" FirstBladderCancerStaging\n            such that ExclusionProcedure.performed.toInterval ( ) starts 6 months or less before FirstBladderCancerStaging.performed.toInterval ( )\n          where ExclusionProcedure.status = 'completed'\n      )\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 22
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator Exclusion"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Denominator Exclusion\":\n  exists \"Acute Tuberculosis Diagnosis\"\n    or exists \"Immunosuppressive Drugs\"\n    or exists \"Cystectomy Done\"\n    or \"Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging\"\n    or \"Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 23
                }
              ],
              "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" : 24
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Race"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Race\":\n  SDE.\"SDE Race\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 25
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "prevalenceInterval"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting \ninterval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ \"active\"\n  or condition.clinicalStatus ~ \"recurrence\"\n  or condition.clinicalStatus ~ \"relapse\" then\n  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n    (end of condition.abatementInterval()) abatementDate\n    return if abatementDate is null then\n      Interval[start of condition.onset.toInterval(), abatementDate)\n    else\n      Interval[start of condition.onset.toInterval(), abatementDate]"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 26
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "isConfirmedActiveDiagnosis"
                },
                {
                  "url" : "statement",
                  "valueString" : "define fluent function isConfirmedActiveDiagnosis(Condition Condition):\n  Condition.isActive ( )\n    and Condition.verificationStatus ~ QICoreCommon.\"confirmed\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 27
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "isActive"
                },
                {
                  "url" : "statement",
                  "valueString" : "/* Candidates for FHIRCommon */\n\n/*\n@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse\n*/\ndefine fluent function isActive(condition Condition):\n  condition.clinicalStatus ~ \"active\"\n    or condition.clinicalStatus ~ \"recurrence\"\n    or condition.clinicalStatus ~ \"relapse\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 28
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "getStagingProcedure"
                },
                {
                  "url" : "statement",
                  "valueString" : "define fluent function getStagingProcedure(StagingObservation Observation):\n  StagingObservation.partOf StagingReference\n    return \"First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period\" FirstBladderCancerStagingMP\n      where FirstBladderCancerStagingMP.id = StagingReference.reference.getId ( )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 29
                }
              ],
              "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" : 30
                }
              ],
              "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" : 31
                }
              ],
              "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" : 32
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "toInterval"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in QICore, allowing this function to be used across any resource.\nThe input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.\nIf the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,\nand the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.\nIf the input is a DateTime Interval, the result is the input.\nIf the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result\nis a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending\nimmediately before one year later than the date the patient turned the age given as the end of the quantity interval.\nIf the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval\n*/\ndefine fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):\n  case\n\t  when choice is DateTime then\n    \tInterval[choice as DateTime, choice as DateTime]\n\t\twhen choice is Interval<DateTime> then\n  \t\tchoice as Interval<DateTime>\n\t\twhen choice is Quantity then\n\t\t  Interval[Patient.birthDate + (choice as Quantity),\n\t\t\t  Patient.birthDate + (choice as Quantity) + 1 year)\n\t\twhen choice is Interval<Quantity> then\n\t\t  Interval[Patient.birthDate + (choice.low as Quantity),\n\t\t\t  Patient.birthDate + (choice.high as Quantity) + 1 year)\n\t\twhen choice is Timing then\n      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>\n\t\telse\n\t\t\tnull as Interval<DateTime>\n\tend"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 33
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            }
          ],
          "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 QICoreCommon",
              "resource" : "Library/QICoreCommon|2.1.000"
            },
            {
              "type" : "depends-on",
              "display" : "Library FHIRHelpers",
              "resource" : "Library/FHIRHelpers|4.4.000"
            },
            {
              "type" : "depends-on",
              "display" : "Code system AdministrativeGender",
              "resource" : "http://hl7.org/fhir/administrative-gender"
            },
            {
              "type" : "depends-on",
              "display" : "Code system SNOMEDCT",
              "resource" : "http://snomed.info/sct"
            },
            {
              "type" : "depends-on",
              "display" : "Code system ConditionClinicalStatusCodes",
              "resource" : "http://terminology.hl7.org/CodeSystem/condition-clinical"
            },
            {
              "type" : "depends-on",
              "display" : "Code system ConditionVerificationStatusCodes",
              "resource" : "http://terminology.hl7.org/CodeSystem/condition-ver-status"
            },
            {
              "type" : "depends-on",
              "display" : "Code system ICD10CM",
              "resource" : "http://hl7.org/fhir/sid/icd-10-cm"
            },
            {
              "type" : "depends-on",
              "display" : "Code system ActCode",
              "resource" : "http://terminology.hl7.org/CodeSystem/v3-ActCode"
            },
            {
              "type" : "depends-on",
              "display" : "Value set BCG Bacillus Calmette Guerin for Urology Care",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1151.52"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Bladder Cancer for Urology Care",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1151.45"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Office Visit",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Payer Type",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Active Tuberculosis for Urology Care",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1151.56"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Immunosuppressive Drugs for Urology Care",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1151.32"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Cystectomy for Urology Care",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1151.55"
            },
            {
              "type" : "depends-on",
              "display" : "Value set HIV",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.120.12.1003"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Immunocompromised Conditions",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1940"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Mixed histology urothelial cell carcinoma for Urology Care",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1151.39"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Chemotherapy Agents for Advanced Cancer",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1151.60"
            }
          ],
          "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",
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              "valueString" : "For every patient evaluated by this measure also identify payer, race, ethnicity and sex"
            },
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          ],
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          "valueReference" : {
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      ],
      "url" : "https://madie.cms.gov/Measure/IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR",
      "identifier" : [
        {
          "use" : "usual",
          "type" : {
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            ]
          },
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        },
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          "value" : "urn:uuid:907ead5a-2f8f-468e-b774-309ea8aa6182"
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                "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
                "code" : "publisher"
              }
            ]
          },
          "system" : "https://madie.cms.gov/measure/cmsId",
          "value" : "646FHIR",
          "assigner" : {
            "display" : "CMS"
          }
        }
      ],
      "version" : "1.4.000",
      "name" : "IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR",
      "title" : "Intravesical Bacillus-Calmette-Guerin for Non-Muscle Invasive Bladder CancerFHIR",
      "status" : "draft",
      "experimental" : false,
      "date" : "2024-12-16T18:17:10+00:00",
      "publisher" : "Oregon Urology",
      "contact" : [
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          "telecom" : [
            {
              "system" : "url",
              "value" : "www.oregonurology.com"
            }
          ]
        }
      ],
      "description" : "Percentage of patients initially diagnosed with non-muscle invasive bladder cancer and who received intravesical Bacillus-Calmette-Guerin (BCG) within 6 months of bladder cancer staging",
      "purpose" : "UNKNOWN",
      "usage" : "Ta bladder cancer must be high grade Ta only and is supported by the 2016 AUA guidelines and 2018 NCCN guidelines.\n\nThe BCG dose can be full or partial and can be from any lot or manufacturer.\n\nThis eCQM is a patient-based measure.\n\nTelehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS646v5.\n \nPlease 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" : "Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Oregon Urology Institute (OUI) and Large Urology Group Practice Association (LUGPA) disclaim all liability for use or accuracy of third party codes contained in the specifications.\n\nCPT(R) contained in the Measure specifications is copyright 2004-2023. American Medical Association. 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.",
      "effectivePeriod" : {
        "start" : "2025-01-01",
        "end" : "2025-12-31"
      },
      "author" : [
        {
          "name" : "Oregon Urology",
          "telecom" : [
            {
              "system" : "url",
              "value" : "www.oregonurology.com"
            }
          ]
        }
      ],
      "library" : [
        "https://madie.cms.gov/Library/IntravesicalBacillusCalmetteGuerinForBladderCancerFHIR"
      ],
      "disclaimer" : "The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.\n\nTHE MEASURES AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.\n\nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by TM or [TM].",
      "scoring" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
            "code" : "proportion",
            "display" : "Proportion"
          }
        ]
      },
      "rationale" : "Bladder cancer is ranked 10th for new cancer cases in 2020 and is the 9th leading cause of cancer death in the United States. There are 81,400 estimated new cases in 2020 and 17,980 estimated deaths in 2020. In 2016, there were an estimated 699,450 people living with bladder cancer in the United States. Early detection (discovery of cancer in situ or localized to the primary site) is found in 85% of the patients, and with these there is a five-year survival rate of 95.8% for In Situ and 69.2% for Localized. Bladder cancer is rarely found in patients under age 20, with the median age of diagnosis being 73 (NIH, 2020).\nNational Comprehensive Cancer Network (NCCN) Guidelines for Bladder Cancer (version 6.2021) defines intravesical BCG as Category 1 Treatment for Ta - high grade, T1 and Tis non-muscle invasive bladder cancer. Most public data reflects prophylactic or adjuvant use of intravesical therapy with the goal of preventing recurrence or delaying progression to a higher grade or stage. BCG has been shown to be effective as prophylaxis to prevent bladder cancer recurrences following TURBT. The NCCN Bladder Cancer Panel Members recommend BCG as the preferred option over Mitomycin C for adjuvant treatment of high-grade lesions (Ta). BCG is also standard therapy for Primary Tis. Most T1 lesions are high risk and are similarly treated with adjuvant intravesical therapy with BCG being a Category 1 recommendation. (NCCN, 2021).",
      "clinicalRecommendationStatement" : "Intravesical BCG should be administered within 6 months of the initial diagnosis of non-muscle invasive bladder cancer. It may be administered 3-4 weeks after resection, but there needs to be pathological tumor confirmation and must be withheld if there is traumatic catheterization, bacteriuria, persistent gross hematuria, persistent severe local symptoms or systemic symptoms. The normal induction course is 6 weekly instillations of intravesical BCG (AUA Non-Muscle Invasive Bladder Cancer and American Urological Association (AUA) Guideline for the Management of Non-muscle Invasive Bladder Cancer: Stages Ta High Risk, T1 and TIS).",
      "group" : [
        {
          "id" : "6643b88af4fc785d87117101",
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                    "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
                    "code" : "proportion",
                    "display" : "Proportion"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
              "valueCode" : "boolean"
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
              "valueCodeableConcept" : {
                "coding" : [
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                    "system" : "http://terminology.hl7.org/CodeSystem/measure-type",
                    "code" : "process",
                    "display" : "Process"
                  }
                ]
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            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
              "valueCode" : "None"
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                    "code" : "increase",
                    "display" : "Increased score indicates improvement"
                  }
                ]
              }
            }
          ],
          "population" : [
            {
              "id" : "4D2F5722-7FA4-4B23-8D7E-356A44FEE386",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "initial-population",
                    "display" : "Initial Population"
                  }
                ]
              },
              "description" : "All patients initially diagnosed with T1, Tis or high grade Ta non-muscle invasive bladder cancer with bladder cancer staging within 6 months before to 6 months after the start of the measurement period and a qualified encounter in the measurement period",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Initial Population"
              }
            },
            {
              "id" : "6F7048E5-A801-4B49-B7F6-DCDE40AB938D",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "denominator",
                    "display" : "Denominator"
                  }
                ]
              },
              "description" : "Equals Initial Population",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Denominator"
              }
            },
            {
              "id" : "3E04DEA7-8F24-4003-89A6-04E7EE62DAF4",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "denominator-exclusion",
                    "display" : "Denominator Exclusion"
                  }
                ]
              },
              "description" : "Immunosuppressed patients, includes HIV and immunocompromised state, with a diagnosis prior to Bladder Cancer Staging.\n\nImmunosuppressive drug therapy starting on or before Bladder Cancer Staging.\n\nActive Tuberculosis diagnosis during the Bladder Cancer Staging.\n\nMixed histology urothelial cell carcinoma including micropapillary, plasmacytoid, sarcomatoid, adenocarcinoma and squamous disease prior to Bladder Cancer Staging.\n\nPatients who undergo cystectomy, chemotherapy or radiation within 6 months prior to Bladder Cancer Staging.",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Denominator Exclusion"
              }
            },
            {
              "id" : "4C0E0E50-2A4D-4C3D-A9AD-12563E9F392F",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "numerator",
                    "display" : "Numerator"
                  }
                ]
              },
              "description" : "Intravesical Bacillus-Calmette Guerin (BCG) instillation for initial dose or series:\nBCG is initiated within 6 months of the bladder cancer staging",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Numerator"
              }
            },
            {
              "id" : "77076019-B76A-4F91-A254-06B870D7A263",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "denominator-exception",
                    "display" : "Denominator Exception"
                  }
                ]
              },
              "description" : "Unavailability of BCG within 6 months after Bladder Cancer Staging",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Denominator Exception"
              }
            }
          ]
        }
      ],
      "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.